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张 涛, 李 振, 崔 焱, 熊 婉, 王 泽, 何 挺, 刘 家, 许 静, 刘 保, 杨 帆. [Research progress in surgical treatment of avascular necrosis of talus]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:493-497. [PMID: 38632072 PMCID: PMC11024533 DOI: 10.7507/1002-1892.202401007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 04/19/2024]
Abstract
Objective To summarize the surgical treatment methods for avascular necrosis of the talus. Methods The recent domestic and international literature related to avascular necrosis of the talus was extensively conducted. The pathogenesis, surgical treatment methods, and prognosis were summarized. Results The clinical symptoms of avascular necrosis of the talus at early stage are not obvious, and most patients have progressed to Ficat-Arlet stages Ⅲ-Ⅳ and require surgical treatment. Currently, surgical treatments for this disease include core decompression, vascularized bone flap transplantation, arthroplasty, and arthrodesis, etc. Early avascular necrosis of the talus can be treated conservatively, and if treatment fails, core decompression can be considered. Arthrodesis is a remedial surgery for patients with end-stage arthritis and collapse, and in cases of severe bone loss, tibiotalocalcaneal arthrodesis and bone grafting are required. Vascularized bone flap transplantation is effective and plays a role in all stages of avascular necrosis of the talus, but the appropriate donor area for the flap still needs further to be studied. Conclusion The surgical treatment and the system of treatment for different stages of avascular necrosis of the talus still need to be refined.
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Affiliation(s)
- 涛 张
- 大连大学附属中山医院骨科(辽宁大连 116001)Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P. R. China
| | - 振豪 李
- 大连大学附属中山医院骨科(辽宁大连 116001)Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P. R. China
| | - 焱 崔
- 大连大学附属中山医院骨科(辽宁大连 116001)Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P. R. China
| | - 婉琦 熊
- 大连大学附属中山医院骨科(辽宁大连 116001)Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P. R. China
| | - 泽文 王
- 大连大学附属中山医院骨科(辽宁大连 116001)Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P. R. China
| | - 挺 何
- 大连大学附属中山医院骨科(辽宁大连 116001)Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P. R. China
| | - 家河 刘
- 大连大学附属中山医院骨科(辽宁大连 116001)Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P. R. China
| | - 静宜 许
- 大连大学附属中山医院骨科(辽宁大连 116001)Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P. R. China
| | - 保一 刘
- 大连大学附属中山医院骨科(辽宁大连 116001)Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P. R. China
| | - 帆 杨
- 大连大学附属中山医院骨科(辽宁大连 116001)Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P. R. China
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Tsubosaka M, Maruyama M, Lui E, Kushioka J, Toya M, Gao Q, Shen H, Li X, Chow SKH, Zhang N, Yang YP, Goodman SB. Preclinical models for studying corticosteroid-induced osteonecrosis of the femoral head. J Biomed Mater Res B Appl Biomater 2024; 112:e35360. [PMID: 38247252 DOI: 10.1002/jbm.b.35360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 11/02/2023] [Accepted: 11/27/2023] [Indexed: 01/23/2024]
Abstract
Nontraumatic osteonecrosis of the femoral head (ONFH) is a refractory condition that commonly results in femoral head collapse and degenerative arthritis of the hip. In the early stages, surgical procedures for hip preservation, including core decompression (CD), have been developed to prevent progressive collapse of the femoral head. Optimization of bone regeneration and biological augmentation may further enhance the therapeutic efficacy of CD for ONFH. Thus, combining CD with cell-based therapy has recently been proposed. In fact, patients treated with cell-based therapy using autologous bone marrow concentrate demonstrate improved survivorship of the femoral head, compared with conventional CD alone. Preclinical research studies to investigate adjunctive therapies for CD often utilize the rabbit model of corticosteroid-induced ONFH. Mesenchymal stem cells (MSCs) are known to promote osteogenesis and angiogenesis, and decrease inflammation in bone. Local drug delivery systems have the potential to achieve targeted therapeutic effects by precisely controlling the drug release rate. Scaffolds can provide an osteoconductive structural framework to facilitate the repair of osteonecrotic bone tissue. We focused on the combination of both cell-based and scaffold-based therapies for bone tissue regeneration in ONFH. We hypothesized that combining CD and osteoconductive scaffolds would provide mechanical strength and structural cell guidance; and that combining CD and genetically modified (GM) MSCs to express relevant cytokines, chemokines, and growth factors would promote bone tissue repair. We developed GM MSCs that overexpress the anti-inflammatory, pro-reconstructive cytokines platelet-derived growth factor-BB to provide MSCs with additional benefits and investigated the efficacy of combinations of these GM MSCs and scaffolds for treatment of ONFH in skeletally mature male New Zealand white rabbits. In the future, the long-term safety, efficacy, durability, and cost-effectiveness of these and other biological and mechanical treatments must be demonstrated for the patients affected by ONFH.
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Affiliation(s)
- Masanori Tsubosaka
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Masahiro Maruyama
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Elaine Lui
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
- Department of Mechanical Engineering, Stanford University School of Engineering, Stanford, California, USA
| | - Junichi Kushioka
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Masakazu Toya
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Qi Gao
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Huaishuang Shen
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Xueping Li
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Simon Kwoon-Ho Chow
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Ning Zhang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Yunzhi Peter Yang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
- Department of Material Science and Engineering, Stanford University School of Medicine, Stanford, California, USA
- Department of Bioengineering, Stanford University School of Medicine, Stanford, California, USA
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
- Department of Bioengineering, Stanford University School of Medicine, Stanford, California, USA
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Karanjkar SM, Dhage P. "Mulligan Bent Leg Raise" Technique in Avascular Necrosis. Cureus 2023; 15:e50727. [PMID: 38234929 PMCID: PMC10793636 DOI: 10.7759/cureus.50727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/18/2023] [Indexed: 01/19/2024] Open
Abstract
This case report examines the effectiveness of the "Mulligan bent leg raise" (MBLR) method for treating femoral head avascular necrosis (AVN). A professional physiotherapist directed a six-week rehabilitation program for a 37-year-old male patient with AVN that included this innovative physiotherapeutic method. According to radiographic results and standardized evaluations, the patient showed significant improvements in hip range of motion, functional ability, and pain levels. As a viable supplement to conventional rehabilitation techniques, the MBLR method has shown promise in improving joint function and reducing symptoms in individuals with acute compartment syndrome. The present study provides significant contributions to the discipline. It highlights the necessity for more investigation to examine the wider relevance and enduring effectiveness of this methodology in various population affected.
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Affiliation(s)
- Samruddhi M Karanjkar
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Pooja Dhage
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha, IND
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4
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Sai Krishna MLV, Kar S, Kumar R, Singh H, Mittal R, Digge VK. The Role of Conservative Management in the Avascular Necrosis of the Femoral Head: A Review of Systematic Reviews. Indian J Orthop 2023; 57:410-420. [PMID: 36777071 PMCID: PMC9897604 DOI: 10.1007/s43465-023-00818-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/06/2023] [Indexed: 02/05/2023]
Abstract
Introduction/Background Multiple medical and surgical treatments have been described in the early stages of Avascular Necrosis (AVN) of the femoral head which delay the disease progression. Similarly, multiple studies, trials, reviews, and systematic reviews exist for the various treatments described and their outcomes but with no consensus over which is superior. So in this study, we reviewed the systematic reviews of all the conservative therapies for AVN of the femoral head systematically to identify a single or a combination of non-surgical treatment choices in the initial stages of the disease. Methodology A thorough literature search has been carried out in January 2022 through the use of Pubmed, EMBASE, and Cochrane electronic databases using PRISMA guidelines. The Mesh words and Keywords used were "femoral head AVN", "Conservative management", and "Systematic Reviews". The inclusion criteria used during the screening were, any systematic reviews which included patients with AVN either idiopathic or secondary, who are managed with conservative therapies like bisphosphonates, Hyper Baric Oxygen Therapy (HBOT), Shock wave therapies like Extracorporeal Shock Wave Therapy (ESWT), or electrical therapy like Pulsed Electro Magnetic Field (PEMF). The quality of the included systematic reviews was assessed using AMSTAR-2 criteria. Results The initial search yielded 364 studies which on screening based on our inclusion criteria finally resulted in seven systematic reviews to be included in the present study. There were two systematic reviews for Hyper Baric Oxygen Therapy (HBOT), two for Extracorporeal Shock Wave Therapy (ESWT), one for electrical stimulation modalities like Pulsed Electro Magnetic Field (PEMF), and two for bisphosphonates. The follow-up of the patients in the included systematic reviews varied from 6 weeks to 10 years. The total number of patients varied from 77 to over 1000 across the systematic reviews. Almost all of the studies included a control group that either received the intended treatment with adjuncts or did not receive any treatment at all. Because of the heterogeneous nature of included articles in the systematic reviews, meta-analysis was performed in only three of the included systematic reviews. Conclusion Of all the modalities of treatment described, bisphosphonates are easily available and cost-effective and do not require any hospital resources/machinery for delivering the treatment. So they can be used as an initial line of treatment for patients with early stages of AVN (Ficat and Arlet 1-3) and based on the hospital availability of resources could be supplemented with any of the biophysical modalities (ESWT/PEMF/HBOT) for maximum efficacy to delay the disease progression. Level of Clinical Evidence Systematic review. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-023-00818-5.
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Affiliation(s)
- M. L. V. Sai Krishna
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Room No 3096, 3rd Floor, Teaching Block, New Delhi, India
| | - Santanu Kar
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Room No 3096, 3rd Floor, Teaching Block, New Delhi, India
| | - Raj Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Room No 3096, 3rd Floor, Teaching Block, New Delhi, India
| | - Hargovind Singh
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Room No 3096, 3rd Floor, Teaching Block, New Delhi, India
| | - Ravi Mittal
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Room No 3096, 3rd Floor, Teaching Block, New Delhi, India
| | - Vijay Kumar Digge
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Room No 3096, 3rd Floor, Teaching Block, New Delhi, India
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The Possible Role of Electrical Stimulation in Osteoporosis: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59010121. [PMID: 36676745 PMCID: PMC9861581 DOI: 10.3390/medicina59010121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
Osteoporosis is mainly a geriatric disease with a high incidence, and the resulting spinal fractures and hip fractures cause great harm to patients. Anti-osteoporosis drugs are the main treatment for osteoporosis currently, but these drugs have potential clinical limitations and side effects, so the development of new therapies is of great significance to patients with osteoporosis. Electrical stimulation therapy mainly includes pulsed electromagnetic fields (PEMF), direct current (DC), and capacitive coupling (CC). Meanwhile, electrical stimulation therapy is clinically convenient without side effects. In recent years, many researchers have explored the use of electrical stimulation therapy for osteoporosis. Based on this, the role of electrical stimulation therapy in osteoporosis was summarized. In the future, electrical stimulation might become a new treatment for osteoporosis.
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Karimi M, Moharrami A, Vahedian Aedakani M, Mirghaderi SP, Ghadimi E, Mortazavi SJ. Predictors of Core Decompression Success in Patients with Femoral Head Avascular Necrosis. THE ARCHIVES OF BONE AND JOINT SURGERY 2023; 11:517-523. [PMID: 37674700 PMCID: PMC10479819 DOI: 10.22038/abjs.2022.61327.3011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 09/02/2022] [Indexed: 09/08/2023]
Abstract
Background Avascular necrosis of the femoral head typically occurs in the young population. Core decompression in the precollapse stage provides pain relief and preservation of the femoral head. The results of core decompression vary considerably despite the early diagnosis. Clinicians concur that primary treatment should focus on preserving the natural surface of the joint. This study investigated the predictive risk factors of failure in femoral head decompression. Methods We retrospectively reviewed 135 patients and 207 hips (77 male (127 hips) and 58 female (80 hips)) who underwent core decompression (mean age: 34.7 years [age range: 21-71]) from April 2010 to December 2017. All patients were followed by a mean of 57 months. All hips were in the precollapse stage (Ficat I, II). Results A total of 207 hips were treated with core decompression surgery, and the overall success rate was 58%. The higher grade of Kerboul, Ficat, ARCO classifications, multifocal avascular necrosis of the femoral head, smoking, opium, and corticosteroids were significantly associated with a higher failure rate after core decompression in univariate analysis. In multivariate logistic regression analysis, the Kerboul and Ficat classifications, alcohol consumption, and multifocal avascular necrosis of the femoral head were significantly correlated with core decompression failure. The most common predictive factors in core decompression failure were Ficat II, Kerboul stage 3, multifocal avascular necrosis of the femoral head, and alcohol consumption. Conclusion In conclusion, we had an overall 58 % success rate in core decompression of femoral head avascular necrosis. Based on the results of this study, imaging evaluation and imaging-based classifications are the most valuable predictor factors for the success of core decompression. Consistent with previous reports, corticosteroid was not a significant predictor of core decompression failure.
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Affiliation(s)
- Mehdi Karimi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Moharrami
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Ehsan Ghadimi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sm Javad Mortazavi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Miyahara HDS, Ranzoni LV, Ejnisman L, Vicente JRN, Croci AT, Gurgel HMDC. Osteonecrose da cabeça femoral: Artigo de atualização. Rev Bras Ortop 2022; 57:351-359. [PMID: 35785123 PMCID: PMC9246540 DOI: 10.1055/s-0041-1736308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/18/2021] [Indexed: 11/19/2022] Open
Abstract
Among the pathologies that affect the hip joint, osteonecrosis of the femoral head (ONFH) is probably the most intriguing and challenging. It consists of a multifactorial disease with a highly-variable spectrum in its clinical presentation. It has a devastating effect, due to disabling painful conditions, both for usual activities and sports. Given the huge range of risk factors, such as prolonged use of corticosteroids (especially in cases of rheumatologic diseases), trauma sequelae, sickle cell anemia, HIV, alcoholism, smoking, blood dyscrasias, and several other diseases that compromise the blood supply to the femoral head, ONFH has a varied clinical presentation and prognosis, which makes it difficult to determine a specific treatment, especially in cases in which chondral involvement has not yet occurred and the hip joint is still preserved. These are the main factors found in the literature that determine the classifications of this pathology. The range of treatments includes several options for cases in which an attempt is made to save the joint: conservative treatment, traditional decompression and/or combined with some type of adjuvant treatment (homologous grafting, synthetic grafting, vascularized grafts, tantalum screws, and bone marrow aspirate injection), and, for cases in which there is already a subchondral fracture and/or collapse of the femoral head and/or a reduction in the joint space, femoral osteotomies or total hip arthroplasty are commonly performed.
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Affiliation(s)
- Helder de Souza Miyahara
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
| | - Lucas Verissimo Ranzoni
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
| | - Leandro Ejnisman
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
| | - José Ricardo Negreiros Vicente
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
| | - Alberto Tesconi Croci
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
| | - Henrique Melo de Campos Gurgel
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
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8
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Liu N, Zheng C, Wang Q, Huang Z. Treatment of non-traumatic avascular necrosis of the femoral head (Review). Exp Ther Med 2022; 23:321. [PMID: 35386618 PMCID: PMC8972838 DOI: 10.3892/etm.2022.11250] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/26/2022] [Indexed: 11/06/2022] Open
Abstract
Non-traumatic osteonecrosis of the femoral head is the main cause of disability in young individuals and incurs major health care expenditure. The lifestyle changes in recent years, especially increased use of hormones and alcohol consumption, has greatly increased the incidence of femoral head necrosis. The underlying causes and risk factors of osteonecrosis of the femoral head are increasingly being elucidated, which has led to the development of novel surgical and non-surgical treatment options. Although the main goal of any treatment method is prevention and delaying the progression of disease, there is no common consensus on the most suitable method of treatment. The present review discussed the latest developments in the etiology and treatment methods for femoral head necrosis.
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Affiliation(s)
- Ning Liu
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | | | - Qinglong Wang
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Zhipeng Huang
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, Shaanxi 710000, P.R. China
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Sconza C, Coletta F, Magarelli N, D'Agostino MC, Egan CG, Di Matteo B, Respizzi S, Mazziotti G. Multimodal conservative treatment of migrating bone marrow edema associated with early osteonecrosis of the hip. SAGE Open Med Case Rep 2022; 10:2050313X211067617. [PMID: 35186294 PMCID: PMC8855375 DOI: 10.1177/2050313x211067617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022] Open
Abstract
Bone marrow edema syndrome is a severely disabling painful condition without a defined treatment and related to pathogenetic mechanisms not yet clearly recognized. We report the case of a 59-year-old post-menopausal woman, affected by bone marrow edema associated with early osteonecrosis of the femoral head with secondary appearance of a rare migrant bone edema of the hip acetabulum. Clinical evaluation and magnetic resonance imaging were used to monitor the outcome of the patient. Pre-treatment clinical evaluation revealed pain upon stepping with the left limb, reduced range of motion of spine and hip, and hip pain during passive rotation. Magnetic resonance imaging showed diffuse signal alteration of the head and neck of the left femur in relation to bone edema, associated with an unclear small cephalic area of the femoral head suggestive of initial osteonecrosis. A further computed tomography scan was performed that did not reveal any alterations in bone profile, interruption of the cortex, or trabecular bone collapse. We immediately started a multimodal conservative treatment administering neridronate (100 mg, intravenously) combined with calcium and vitamin D supplementation and biophysical therapies (magnetotherapy and extracorporeal shockwave therapy). We also instructed the patient not to bear the load on the affected lower limb during standing and walking, using crutches. After 2 months, a notable regression of pain with improvement in mobility was observed. Magnetic resonance imaging revealed complete regression of edema at the head and neck of the femur; however, the new appearance of acetabular bone edema of the ipsilateral acetabular roof was detected. After 4 months, a third magnetic resonance imaging showed the disappearance of the femoral head and acetabular roof defects as well as the complete clinical recovery of the patient. An early diagnosis and intervention are essential to conservatively treat cases of bone marrow edema syndrome.
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Affiliation(s)
- Cristiano Sconza
- Department of Rehabilitation, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Francesco Coletta
- Department of Rehabilitation, IRCCS Humanitas Research Hospital, Milan, Italy.,Physical Medicine and Rehabilitation School, University of Milan, Milan, Italy
| | - Nicola Magarelli
- Department of Radiology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Maria Cristina D'Agostino
- Department of Rehabilitation, IRCCS Humanitas Research Hospital, Milan, Italy.,Ortho-Rehabilitation Department, IRCCS Humanitas Research Hospital, Shock Waves Center, Milan, Italy
| | | | - Berardo Di Matteo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Stefano Respizzi
- Department of Rehabilitation, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Gherardo Mazziotti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Endocrinology, Diabetology and Andrology Unit, Metabolic Bone Diseases and Osteoporosis Section, IRCCS Humanitas Research Hospital, Milan, Italy
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Ergözen S, Kaya E. AVASCULAR NECROSIS DUE TO CORTICOSTEROID THERAPY IN COVID-19 AS A SYNDEMIC. CENTRAL ASIAN JOURNAL OF MEDICAL HYPOTHESES AND ETHICS 2021. [DOI: 10.47316/cajmhe.2021.2.2.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
To date, over 163 million confirmed cases of COVID-19 and over 3.3 million deaths from COVID-19 have been reported by the World Health Organization (WHO). However, there is still no specific treatment for the disease. Some empirical and supportive medications have been used thus far, including antivirals, antipyretics, antibiotics, and corticosteroids. Corticosteroids are anti-inflammatory and immunosuppressive medications that are used to treat several diseases. These agents can produce undesirable and occasionally severe systemic adverse effects. Although the occurrence and severity of most adverse effects are related to the dose and duration of the corticosteroid therapy, avascular necrosis is not directly associated with this dose and duration, and may occur without osteoporosis. Corticosteroids are not recommended for routine use in COVID-19 patients by the WHO. However, these medications have been widely used for their treatment. Avascular necrosis is a progressive and incapacitating condition. The causes of avascular necrosis are categorized into traumatic and non-traumatic. The majority of non-traumatic cases are associated with the use of corticosteroids. Early diagnosis and treatment is crucial owing to the rapidly progressive nature of the disease. Severe COVID-19 patients are at risk of avascular necrosis due to corticosteroid therapy. The hypothesis presented herein suggests that hyperbaric oxygenation in combination with adequate calcium and vitamin D supplementation and individualized exercise may be an effective, safe, and noninvasive treatment modality, preventing from the progression of avascular necrosis.
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11
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Rhatomy S, Dilogo IH. Core Decompression and Biological Treatment in Osteonecrosis of the Hip due to Systemic Lupus Erythematosus, 8-year Follow-up: A Case Report. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Osteonecrosis most commonly affects the femoral head, especially in middle-aged adults. It can be caused by trauma, chronic inflammation, or infection. It leads to collapse of the entire femoral head and culminates with total hip replacement.
CASE REPORT: A 29-year-old female with systemic lupus erythematosus (SLE) had a chief complaint of bilateral hip pain. She was diagnosed with early osteonecrosis of the femoral head (FICAT stage II) using magnetic resonance imaging and core decompression surgery was performed using three small diameter (4 mm) drillings and added biological treatment. She was evaluated with a visual analog scale (VAS), Harris hip score (HHS), and plain radiography in the pre-operative stage and post-operative follow-up.
RESULTS: Functional outcome at 8-year follow-up showed improvement with significantly decreased VAS (pre-operative: 5, post-operative: 0), significant improvement of HHS from 52.725 points (poor) pre-operative to 92.025 points (excellent) post-operative, and subsided femoral head lesion.
CONCLUSIONS: Surgical decompression and biological treatment result in decreased intraosseous pressure and enhanced osteogenesis. It can restrict the SLE disease progression and limit the number of cell death.
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Paderno E, Zanon V, Vezzani G, Giacon TA, Bernasek TL, Camporesi EM, Bosco G. Evidence-Supported HBO Therapy in Femoral Head Necrosis: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062888. [PMID: 33808951 PMCID: PMC7999152 DOI: 10.3390/ijerph18062888] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 12/19/2022]
Abstract
Although many studies have shown that hyperbaric oxygen (HBO) therapy can significantly improve symptoms and quality of life of patients affected by femoral head necrosis, this therapy is not worldwide approved yet. This meta-analysis was performed to evaluate its clinical effect. Relevant studies published before May 2020 were systematically searched using terms related to HBO and femoral head necrosis. Fixed and random-effects models were used to estimate the odds ratio (OR) with 95% confidence intervals (CI). Subgroup analyses and publication bias tests were carried out to explore potential study heterogeneity and bias. Ten studies involving 353 controls and 368 HBO-treated cases were included, most of which were conducted on Asian population. The clinical effect in the HBO therapy group was 3.84 times higher than in the control group (OR = 3.84, 95% CI (2.10, 7.02), p < 0.00001). Subgroup analyses showed that the clinical effect of HBO therapy was statistically significant in the Asian subpopulation which represented most of the subjects (OR = 3.53, 95% CI (1.87, 6.64), p < 0.00001), but not in the non-Asian subpopulation, probably because of insufficient numerosity (OR = 7.41, 95% CI (0.73, 75.71), p = 0.09). The results of this meta-analysis suggest that patients with femoral head necrosis treated with HBO therapy can achieve a significant clinical improvement.
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Affiliation(s)
- Emma Paderno
- Environmental and Respiratory Physiology Lab and II Level Master in Diving and Hyperbaric Medicine, Department of Biomedical Sciences, University of Padova, 35122 Padova, Italy; (E.P.); (G.V.); (G.B.)
- DHMU at ICCB, Istituti Ospedalieri Bresciani, GSD—University and Research Hospitals, 25128 Brescia, Italy
| | - Vincenzo Zanon
- Environmental and Respiratory Physiology Lab and II Level Master in Diving and Hyperbaric Medicine, Department of Biomedical Sciences, University of Padova, 35122 Padova, Italy; (E.P.); (G.V.); (G.B.)
- DHMU at ICCB, Istituti Ospedalieri Bresciani, GSD—University and Research Hospitals, 25128 Brescia, Italy
- Correspondence: (V.Z.); (T.A.G.)
| | - Giuliano Vezzani
- Environmental and Respiratory Physiology Lab and II Level Master in Diving and Hyperbaric Medicine, Department of Biomedical Sciences, University of Padova, 35122 Padova, Italy; (E.P.); (G.V.); (G.B.)
| | - Tommaso Antonio Giacon
- Environmental and Respiratory Physiology Lab and II Level Master in Diving and Hyperbaric Medicine, Department of Biomedical Sciences, University of Padova, 35122 Padova, Italy; (E.P.); (G.V.); (G.B.)
- Correspondence: (V.Z.); (T.A.G.)
| | - Thomas L. Bernasek
- Adult Reconstruction, Florida Orthopaedic Institute, Tampa, FL 33625, USA;
| | | | - Gerardo Bosco
- Environmental and Respiratory Physiology Lab and II Level Master in Diving and Hyperbaric Medicine, Department of Biomedical Sciences, University of Padova, 35122 Padova, Italy; (E.P.); (G.V.); (G.B.)
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13
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Jin Y, Zhu HX, Wei BF. Reduced serum and local LncRNA MALAT1 expressions are linked with disease severity in patients with non-traumatic osteonecrosis of the femoral head. Technol Health Care 2020; 29:479-488. [PMID: 32716338 DOI: 10.3233/thc-202244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study was performed to illustrate the potential relationship between reduced serum and local LncRNA MALAT1 expressions with disease severity in patients with non-traumatic osteonecrosis of the femoral head (ONFH). METHODS A total of 104 patients with non-traumatic ONFH and 100 healthy controls were consecutively recruited from our hospital. Serum and local LncRNA MALAT1 expressions were detected using real-time polymerase chain reaction (RT-PCR). Radiographic progression was defined by Ficat classification. Clinical severity was evaluated by Visual Analog Scale (VAS) and Harris Hip Score (HHS). Receiver operating characteristic (ROC) curve was carried out to determine the diagnostic value of MALAT1 in the radiographic progression. RESULTS Serum LncRNA MALAT1 expressions were significantly lower in non-traumatic ONFH patients than in healthy controls. In addition, local MALAT1 expressions in non-traumatic ONFH tissue were significantly lower in the affected area than in the non-affected area. Ficat grade 4 has significantly lower serum and local LncRNA MALAT1 expressions in comparison with grade 3, and Ficat grade 3 showed markedly decreased serum and local LncRNA MALAT1 expressions compared with grade 2. Serum and local LncRNA MALAT1 expressions were significantly and negatively associated with VAS and positively related to the HHS. Further ROC curve analysis indicated that serum MALAT1 may act as a decent indicator in the diagnosis of non-traumatic ONFH. CONCLUSIONS Decreased serum and local MALAT1 expressions may reflect disease severity in non-traumatic ONFH patients.
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Affiliation(s)
- Yan Jin
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Department of Rehabilitation, Linyi People's Hospital, Linyi, Shandong, China
| | - Hong-Xun Zhu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Department of Orthopedics, Linyi People's Hospital, Linyi, Shandong, China
| | - Biao-Fang Wei
- Department of Orthopedics, Linyi People's Hospital, Linyi, Shandong, China
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14
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Mont MA, Salem HS, Piuzzi NS, Goodman SB, Jones LC. Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today?: A 5-Year Update. J Bone Joint Surg Am 2020; 102:1084-1099. [PMID: 32282421 PMCID: PMC7508290 DOI: 10.2106/jbjs.19.01271] [Citation(s) in RCA: 162] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➢. Clinicians should exercise a high level of suspicion in at-risk patients (those who use corticosteroids, consume excessive alcohol, have sickle cell disease, etc.) in order to diagnose osteonecrosis of the femoral head in its earliest stage. ➢. Nonoperative treatment modalities have generally been ineffective at halting progression. Thus, nonoperative treatment is not appropriate in early stages when one is attempting to preserve the native joint, except potentially on rare occasions for small-sized, medially located lesions, which may heal without surgery. ➢. Joint-preserving procedures should be attempted in early-stage lesions to save the femoral head. ➢. Cell-based augmentation of joint-preserving procedures continues to show promising results, and thus should be considered as an ancillary treatment method that may improve clinical outcomes. ➢. The outcomes of total hip arthroplasty in the setting of osteonecrosis are excellent, with results similar to those in patients who have an underlying diagnosis of osteoarthritis.
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Affiliation(s)
- Michael A. Mont
- Lenox Hill Hospital, New York, NY,Cleveland Clinic, Cleveland, Ohio,Email address for M.A. Mont:
| | | | | | | | - Lynne C. Jones
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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15
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Wang C, Xie Q, Yang L, Liu J, Liu D, Li Z, Gong K, Yin L, Wang W, Guo Z, Zheng W. A 3D printed porous titanium alloy rod with biogenic lamellar configuration for treatment of the early-stage femoral head osteonecrosis in sheep. J Mech Behav Biomed Mater 2020; 106:103738. [PMID: 32250947 DOI: 10.1016/j.jmbbm.2020.103738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/11/2020] [Accepted: 03/02/2020] [Indexed: 12/14/2022]
Abstract
There is no ideal implant for mechanical strut on early-stage osteonecrosis of the femoral head (ONFH) after core decompression. In this study, a biogenic trabecular porous titanium rod with lamellar configuration was designed and fabricated using selective laser melting technique. Early-stage ONFH of sheep induced by cryo-insult were dealt with core decompression combined with rod insertion (Rod group) and core decompression alone (CD group) after X-ray evaluation was used to assess the necrotic region one months after cryo-intervention. Bone integration and ingrowth of the two groups were investigated and compared. Early-stage ONFH intervened with the rod gained better bone ingrowth than CD 3 and 6 months after the intervention, as evidenced by radiographic, micro-CT and histological evaluation. X-ray images showed compact integration between rods and peripheral bone, evidenced by no radiolucent lines encircling the rods at 3 and 6 months. Micro-CT and histological images showed that the new bone had grown into the centre of rods along the metal at 3 months, whereas the new bone grew mainly at the periphery of the decompressive channel. Micro-CT analysis show that the ratios of bone volume to total volume (BV/TV) of volume of interest (VOI) in Rod group was 890.0% and 438.1% higher than CD group at 3 (0.198 ± 0.0094 VS 0.020 ± 0.0058, p < 0.05, n = 3) and 6 (0.226 ± 0.0166 VS 0.042 ± 0.0061, p < 0.05, n = 3) months respectively. Histological analysis showed that the BV/TV of VOI in Rod group was 881.0% and 413.3% higher than CD group at 3 (0.206 ± 0.0102 VS 0.021 ± 0.0061, p < 0.05, n = 3) and 6 (0.231 ± 0.0156 VS 0.045 ± 0.0059, p < 0.05, n = 3) months respectively. The mechanical tests revealed that the maximum load of Rod group was 57.6% larger than CD group at 6 months (4505.25 ± 443.86 N VS 2858.25 ± 512.91 N, p < 0.05, n = 3). These favourable short-term results can provide insight on treatment of early-stage ONFH.
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Affiliation(s)
- Cairu Wang
- Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China; Department of Orthopaedics, The General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, China
| | - Qingyun Xie
- Department of Orthopaedics, The General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, China
| | - Lanbo Yang
- Department of Orthopaedics, Henan Provincial Orthopaedic Hospital, Luoyang, Henan, 471000, China
| | - Jinbiao Liu
- Department of Orthopaedics, The General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, China
| | - Da Liu
- Department of Orthopaedics, The General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, China
| | - Zhiqiang Li
- Department of Orthopaedics, The General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, China
| | - Kai Gong
- Department of Orthopaedics, The General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, China
| | - Li Yin
- Department of Orthopaedics, The General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, China
| | - Wei Wang
- Department of Orthopaedics, The General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, China
| | - Zheng Guo
- Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China.
| | - Wei Zheng
- Department of Orthopaedics, The General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, China.
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Yao T, Yin ZS, Huang W, Ding ZF, Cheng C. Microarray profiling of circular RNAs in steroid-associated osteonecrosis of the femoral head: Observational study. Medicine (Baltimore) 2020; 99:e19465. [PMID: 32150104 PMCID: PMC7478599 DOI: 10.1097/md.0000000000019465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The aim of this study was to elucidate the molecular mechanisms and to identify the differential expression of circular RNAs (circRNAs) for steroid-associated osteonecrosis of the femoral head (SONFH) using bioinformatics analysis.circRNA microarray was performed with 3 SONFH tissues and the adjacent normal tissues, and differentially expressed circRNA were identified by limma package in R. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed using the Database for Annotation, Visualization and Integrated Discovery database. In addition, a differentially expressed genes (DEG)-associated circRNA/microRNA (miRNA) interaction was predicted by combination of TargetScan and miRanda, and the circRNA/miRNA interaction network generated by the cytoscape software.A total of 647 differentially expressed circRNAs, including 433 upregulated and 214 downregulated circRNA were identified. The most enriched GO terms for upregulated and downregulated circRNA were extracellular matrix organization and leukocyte activation in biological process; extracellular matrix and spindle pole in cellular component; integrin binding and ATP binding in molecular function, and KEGG pathway enrichment analyses showed that the upregulated and downregulated circRNA were strongly associated with Protein digestion and absorption and Cell cycle. Moreover, a total of 212 differentially expressed messenger RNAs (mRNAs), including 113 upregulated and 99 downregulated genes were identified. In addition, from the analysis of miRNA, long noncoding RNAs, mRNA, and circRNA networks, we found that hsa_circ_0008136 and hsa_circ_0074758 were respectively the upregulated and downregulated circRNA with highest degrees.The identified circRNA and mRNA could be implicated in the progression of human SONFH. The findings could lead to a better understanding of SONFH pathogenesis.
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Affiliation(s)
- Tao Yao
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University
- Department of Orthopaedics, The First People's Hospital of Hefei, the Third Affiliated Hospital of Anhui Medical University
| | - Zong-Sheng Yin
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University
| | - Wei Huang
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University
- Department of Orthopaedics, Anhui Provincial Hospital, Hefei, Anhui, China
| | - Zhen-Fei Ding
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University
| | - Chao Cheng
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University
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Maruyama M, Lin T, Pan CC, Moeinzadeh S, Takagi M, Yang YP, Goodman SB. Cell-Based and Scaffold-Based Therapies for Joint Preservation in Early-Stage Osteonecrosis of the Femoral Head. JBJS Rev 2019; 7:e5. [DOI: 10.2106/jbjs.rvw.18.00202] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
Osteonecrosis of the femoral head most commonly arises from trauma or corticosteroid and alcohol use but is also associated with blood dyscrasias and metabolic and coagulation disorders. Initial evaluation includes a history and physical examination and plain radiographs. Early-stage osteonecrosis is best evaluated by MRI. The Ficat and Arlet classification system is the most widely used. Nonoperative treatment has been studied using bisphosphonates, anticoagulants, vasodilators, statins, and biophysical modalities. Operative treatment includes core decompression with or without adjuvants, such as autologous bone marrow, whereas total hip arthroplasty is reserved for advanced-stage osteonecrosis in older patients or those who have failed joint-preserving treatment.
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19
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Ji QH, Qiao XF, Wang SF, Zhao P, Liu SC, Xue Y, Qiao JM, Li YB. Effectiveness of neuromuscular electrical stimulation and ibuprofen for pain caused by necrosis of the femoral head: A retrospective study. Medicine (Baltimore) 2019; 98:e14812. [PMID: 30882660 PMCID: PMC6426472 DOI: 10.1097/md.0000000000014812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This retrospective study analyzed the effectiveness of neuromuscular electrical stimulation (NMES) for pain relief caused by necrosis of femoral head (NFH).Totally, 80 cases of patients with NFH were analyzed and then were assigned to a treatment group or a control group in this study. Of these, 40 cases in the treatment group received ibuprofen and NMES therapy. The other 40 cases in the control group received ibuprofen alone. Cases in both groups were treated for a total of 6 weeks. The primary outcome of pain intensity was measured by a visual analog scale (VAS). The secondary outcome was assessed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). In addition, adverse events (AEs) were also recorded in each case. All outcomes were evaluated before and after the treatment.After treatment, patients in the treatment group showed more effectiveness in pain relief, as measured by VAS (P < .01) and WOMAC sub-pain scale (P < .01), except stiffness, as evaluated by WOMAC sub-stiffness scale (P = .07), and function, as assessed by WOMAC sub-function scale (P = .09), than patients in the control group. Additionally, no significant differences in AEs were detected between 2 groups.This study found that NMES may be helpful for pain relief in patients with NFH.
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Affiliation(s)
- Qing-Hui Ji
- First Ward of Orthopedics Department, First Affiliated Hospital of Jiamusi University
| | - Xiao-Feng Qiao
- First Ward of Orthopedics Department, First Affiliated Hospital of Jiamusi University
| | - Shou-Feng Wang
- First Ward of Orthopedics Department, First Affiliated Hospital of Jiamusi University
| | - Peng Zhao
- Department of Orthopedics, Jiamusi Central Hospital
| | - Shi-Chen Liu
- First Ward of Orthopedics Department, First Affiliated Hospital of Jiamusi University
| | - Yu Xue
- Department of Surgery, Second Affiliated Hospital of Jiamusi University, Jiamusi
| | - Jian-Min Qiao
- First Ward of Orthopedics Department, First Affiliated Hospital of Jiamusi University
| | - Yan-Bao Li
- Department of Orthopedics, Handan Central Hospital, Handan, China
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20
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Abstract
Avascular necrosis (AVN) of the talus bone is a progressive and debilitating consequence of trauma or exposure to a variety of risk factors. The Ficat classification describes current understanding of the natural history of AVN, including preclinical, preradiographic, precollapse, postcollapse, and arthritic stages. The size and location of the avascular region likely determines risk of progression; however, symptoms do not correlate with stage. Patients may be minimally symptomatic despite diffuse involvement for long periods. Joint-sparing strategies have shown promise but do not universally prevent progression of the disease. When bone structure fails, joint-sacrificing strategies may be required.
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Affiliation(s)
- Andrew Haskell
- Departments of Orthopedic Surgery and Sports Medicine, Palo Alto Medical Foundation, 301 Industrial Road, San Carlos, CA 94070, USA.
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21
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LncRNA expression profiling of BMSCs in osteonecrosis of the femoral head associated with increased adipogenic and decreased osteogenic differentiation. Sci Rep 2018; 8:9127. [PMID: 29904151 PMCID: PMC6002551 DOI: 10.1038/s41598-018-27501-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 05/29/2018] [Indexed: 12/20/2022] Open
Abstract
Long noncoding RNAs (lncRNAs) are critical gene expression regulators and are involved in several bone diseases. To explore the potential roles of lncRNAs in osteonecrosis of the femoral head (ONFH), we investigated for the first time the lncRNA expression profile of bone marrow mesenchymal stem cells (BMSCs) from patients with steroid-induced ONFH (SONFH) with microarray and bioinformatics analysis. A total of 1878 lncRNAs and 838 mRNAs were significantly up-regulated while 1842 lncRNAs and 1937 mRNAs were statistically down-regulated in the SONFH group compared with control group. The results validated by qRT-PCR were consistent with the microarray profiling data, especially involved in upregulation and downregulation of critical lncRNAs as well as mRNAs expression related to adipogenic and osteogenic differentiation. Pathway analyses revealed 40 signaling pathways with significant differences, especially the signaling pathways to regulate stem cell pluripotency. The CNC and ceRNA network indicated that lncRNA RP1-193H18.2, MALAT1 and HOTAIR were associated with abnormal osteogenic and adipogenic differentiation of BMSCs in the patients with SONFH. Our results suggest the lncRNA expression profiles were closely associated with the abnormal adipogenic and osteogenic transdifferentiation of BMSCs during the development of SONFH and explore a new insight into the molecular mechanisms of SONFH.
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Yu X, Zhang D, Chen X, Yang J, Shi L, Pang Q. Effectiveness of various hip preservation treatments for non-traumatic osteonecrosis of the femoral head: A network meta-analysis of randomized controlled trials. J Orthop Sci 2018; 23:356-364. [PMID: 29291916 DOI: 10.1016/j.jos.2017.12.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 11/09/2017] [Accepted: 12/09/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Non-traumatic osteonecrosis of the femoral head (ONFH) is a refractory osteonecrosis disease caused by an abnormal blood supply to bone tissue. However, therapeutic hip preservation strategies are diverse, and the therapeutic outcomes are not ideal. OBJECTIVE A network meta-analysis was performed to assess the effect of hip preservation treatments on non-traumatic ONFH. METHODS We searched public electronic databases through May 15, 2017 using the following keywords: "femoral head necrosis osteonecrosis"; "femoral head osteonecrosis"; "osteonecrosis of femoral head"; "avascular necrosis of femoral head"; "necrosis of femoral"; and "random*". The primary outcome in the present analysis was the treatment failure rate. Secondary outcomes included the Harris hip and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. RESULTS We included 21 articles assessing a total of 1415 hips in our analysis. In the network meta-analysis, the treatments were ranked by the surface under the cumulative ranking curve (SUCRA). Core decompression (CD) plus cytotherapy was most likely to reduce the treatment failure rate (SUCRA score = 18.9%), followed by alendronate treatment (SUCRA score = 17.8%), cocktail treatments (SUCRA score = 15.6%), extracorporeal shock wave therapy (ESWT) plus alendronate (SUCRA score = 15.4%), and avascular biomaterials plus cytotherapy (SUCRA score = 13.8%) in a frequentist framework; similar results were obtained in a Bayesian framework. For the secondary outcomes, ESWT was most likely to improve the Harris hip score (SUCRA score = 33.7%), followed by ESWT plus alendronate (SUCRA score = 33.1%) and cocktail (SUCRA score = 19.6%) treatments in a frequentist framework. A traditional analysis showed that the effect of CD plus cytotherapy was significantly better than the effect of CD alone in improving the WOMAC score (SMD, -6.01; 95% CI, -7.81 to -4.22; p < 0.001). CONCLUSION CD plus cytotherapy is a relatively superior treatment for reducing treatment failure rates in early and intermediate ONFH patients, and ESWT is the most effective treatment for improving Harris hip scores.
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Affiliation(s)
- Xiao Yu
- Department of Orthopedics, Ningbo No. 2 Hospital, Zhejiang, 315010, China
| | - Difeng Zhang
- Medical School of Ningbo University, Zhejiang, 315211, China
| | - Xianjun Chen
- Department of Orthopedics, Ningbo No. 2 Hospital, Zhejiang, 315010, China
| | - Ji Yang
- Department of Orthopedics, Ningbo No. 2 Hospital, Zhejiang, 315010, China
| | - Lin Shi
- Department of Orthopedics, Ningbo No. 2 Hospital, Zhejiang, 315010, China
| | - Qingjiang Pang
- Department of Orthopedics, Ningbo No. 2 Hospital, Zhejiang, 315010, China.
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