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Shen X, Luo J, Tang X, Chen B, Qin Y, Zhou Y, Xiao J. Deep Learning Approach for Diagnosing Early Osteonecrosis of the Femoral Head Based on Magnetic Resonance Imaging. J Arthroplasty 2023; 38:2044-2050. [PMID: 36243276 DOI: 10.1016/j.arth.2022.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The diagnosis of early osteonecrosis of the femoral head (ONFH) based on magnetic resonance imaging (MRI) is challenging due to variability in the surgeon's experience level. This study developed an MRI-based deep learning system to detect early ONFH and evaluated its feasibility in the clinic. METHODS We retrospectively evaluated clinical MRIs of the hips that were performed in our institution from January 2019 to June 2022 and collected all MRIs diagnosed with early ONFH. An advanced convolutional neural network (CNN) was trained and optimized; then, the diagnostic performance of the CNN was evaluated according to its accuracy, sensitivity, and specificity. We also further compared the CNN's performance with that of orthopaedic surgeons. RESULTS Overall, 11,061 images were retrospectively included in the present study and were divided into three datasets with ratio 7:2:1. The area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity of the CNN model for identifying early ONFH were 0.98, 98.4, 97.6, and 98.6%, respectively. In our review panel, the averaged accuracy, sensitivity, and specificity for identifying ONFH were 91.7, 87.0, and 94.1% for attending orthopaedic surgeons; 87.1, 84.0, and 89.3% for resident orthopaedic surgeons; and 97.1, 96.0, and 97.9% for deputy chief orthopaedic surgeons, respectively. CONCLUSION The deep learning system showed a comparable performance to that of deputy chief orthopaedic surgeons in identifying early ONFH. The success of deep learning diagnosis of ONFH might be conducive to assisting less-experienced surgeons, especially in large-scale medical imaging screening and community scenarios lacking consulting experts.
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Affiliation(s)
- Xianyue Shen
- Department of Orthopedics, The Second Hospital of Jilin University
| | - Jia Luo
- College of software, Jilin University
| | - Xiongfeng Tang
- Department of Orthopedics, The Second Hospital of Jilin University
| | - Bo Chen
- Department of Orthopedics, The Second Hospital of Jilin University
| | - Yanguo Qin
- Department of Orthopedics, The Second Hospital of Jilin University
| | - You Zhou
- College of software, Jilin University
| | - Jianlin Xiao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin province, PR China
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Liang D, Pei J, Zhang X, Chen X. Clinical outcomes of autologous platelet-rich plasma and bone marrow mononuclear cells grafting combined with core decompression for Association Research Circulation Osseous II-IIIA stage non-traumatic osteonecrosis of the femoral head. INTERNATIONAL ORTHOPAEDICS 2023; 47:2181-2188. [PMID: 36951976 DOI: 10.1007/s00264-023-05779-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE This study aimed to investigate the efficacy and safety of autologous platelet-rich plasma (PRP) and bone marrow mononuclear cells (BMMCs) grafting combined with core decompression (CD) in the treatment of Association Research Circulation Osseous (ARCO) II-IIIA stage non-traumatic osteonecrosis of the femoral head (ONFH). METHODS The clinical data of 44 patients (44 hips) with non-traumatic ONFH from December 2018 to December 2019 were retrospectively reviewed. Twenty-four patients underwent CD combined with autologous PRP and BMMCs grafting (PRP+BMMCs group), and 20 patients underwent core decompression alone (CD group). During a minimum follow-up of 36 months, radiographic outcomes were evaluated using X-ray, radiographic failure rates were compared, and Harris hip score (HHS) and visual analog scale (VAS) were selected to evaluate clinical outcomes. The percentage of patients with minimal clinically important difference (MCID) in both groups was analyzed. Clinical failure was defined as further total hip arthroplasty (THA) with Kaplan-Meier survival analysis. Surgical complications were recorded. RESULTS All patients had well healed wounds, and no complications such as infection and thrombosis occurred. HHS and VAS scores in both the PRP+BMMCs and CD groups were better than those preoperatively (P<0.05). At the last follow-up, the HHS and VAS scores of the PRP+BMMCs group were significantly better than those of the CD group (P<0.05). In ARCO II-IIIA stage, 66.7% of the PRP+BMMCs group and 30.0% of the CD group achieved the MCID (P<0.05). The clinical and imaging failure rates in the PRP+BMMCs group were 12.5% and 20.8%, respectively, compared with 40.0% and 50.0% in the CD group (P<0.05). In ARCO II stage, the MCID, clinical and imaging failure rates of PRP+BMMCs group and CD group were 66.7% and 33.3% (P<0.05), 4.8% and 33.3% (P<0.05), 14.3% and 44.4% (P<0.05), respectively. The PRP+BMMCs group had better hip survival rate compared with CD group (P<0.05). CONCLUSION CD combined with autologous PRP and BMMCs grafting is a safe and effective method for the treatment of ARCO II-IIIA stage non-traumatic ONFH, especially for ARCO II stage, effectively reducing the collapse rate of the femoral head and delaying or even avoiding THA.
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Affiliation(s)
- Dawei Liang
- Zhengzhou Medical Hospital District, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Zhengzhou, 450000, China
| | - Jia Pei
- Zhengzhou Medical Hospital District, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Zhengzhou, 450000, China
| | - Xiaohui Zhang
- Zhengzhou Medical Hospital District, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Zhengzhou, 450000, China
| | - Xiantao Chen
- Luoyang Medical Hospital District, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang, 471000, China.
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Quan H, Ren C, He Y, Wang F, Dong S, Jiang H. Application of Biomaterials in Treating Early Osteonecrosis of the Femoral Head: Research Progress and Future Perspectives. Acta Biomater 2023; 164:15-73. [PMID: 37080444 DOI: 10.1016/j.actbio.2023.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/24/2023] [Accepted: 04/05/2023] [Indexed: 04/22/2023]
Abstract
Osteonecrosis of the femoral head (ONFH), a progressive pathological process of femoral head ischemia and osteocyte necrosis, is a refractory orthopedic disease caused by multiple etiologies and there is no complete cure at present. With the extension of ONFH duration, osteocyte apoptosis and trabecular bone loss can decrease the load-bearing capacity of the femoral head, which leads to the collapse of the articular cartilage and subchondral bone. Therefore, an urgent clinical need exists to develop effective treatment strategies of early-stage ONFH for maintaining the hip joint function and preventing femoral head collapse. In recent years, extensive attention has been paid to the application of diverse biomaterials in treating early ONFH for sustaining the normal morphology and function of the autologous femoral head, and slowing disease progression. Herein, we review the research progress of bone grafts, metallic materials, bioceramics, bioglasses and polymer materials for early ONFH treatment, and discuss the biological mechanisms of bone repair and regeneration in the femoral-head necrotic area. We propose suggestions for future research directions, from a special perspective of improving the local microenvironment in femoral head by facilitating vessel-associated osteoclasts (VAOs) generation and coupling of bone-specific angiogenesis and osteogenesis, as well as inhibiting bone-associated osteoclasts (BAOs) and BAO-mediated bone resorption. This review can provide ideas for the research, development, and clinical application of biomaterials for treating early ONFH. STATEMENT OF SIGNIFICANCE: We believe that at least three aspects of this manuscript make it interesting to readers of the Acta Biomaterialia. First, we briefly summarize the incidence, pathogenesis, risk factors, classification criteria and treatment of early osteonecrosis of the femoral head (ONFH). Second, we review the research progress in biomaterials for early ONFH treatment and the biological mechanisms of bone repair and regeneration in femoral-head necrotic area. Third, we propose future research progress on improving the local microenvironment in femoral head by facilitating vessel-associated osteoclasts generation and coupling of bone-specific angiogenesis and osteogenesis, as well as inhibiting bone-associated osteoclasts and bone resorption. We hope this review can provide ideas for the research, development, and clinical application of biomaterials for treating early ONFH.
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Affiliation(s)
- Hongyu Quan
- Department of Biomedical Materials Science, School of Biomedical Engineering, Third Military Medical University, Chongqing, 400038, China; College of Bioengineering, Chongqing University, Chongqing, 400044, China
| | - Chencan Ren
- Department of Biomedical Materials Science, School of Biomedical Engineering, Third Military Medical University, Chongqing, 400038, China; College of Bioengineering, Chongqing University, Chongqing, 400044, China
| | - Yuwei He
- Department of Biomedical Materials Science, School of Biomedical Engineering, Third Military Medical University, Chongqing, 400038, China
| | - Fuyou Wang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
| | - Shiwu Dong
- Department of Biomedical Materials Science, School of Biomedical Engineering, Third Military Medical University, Chongqing, 400038, China; State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing 400038, China.
| | - Hong Jiang
- Department of Biomedical Materials Science, School of Biomedical Engineering, Third Military Medical University, Chongqing, 400038, China.
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Li J, Mo L, Bai G, Wang Z, Zhang H, Li J. One in five patients require conversion to arthroplasty after non-vascularized bone grafts in patients with osteonecrosis of the femoral head: a systematic review. J Orthop Surg Res 2023; 18:77. [PMID: 36721188 PMCID: PMC9887751 DOI: 10.1186/s13018-023-03544-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/15/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Non-vascularized bone grafting (NVBG) has demonstrated to treat osteonecrosis of the femoral head (ONFH). There are a number of articles updating the use of NVBG to treat the ONFH, but the percentage of patients subsequently undergoing a total hip arthroplasty (THA) is controversial. METHODS Several electronic databases, including PubMed, Embase, Web of Science, and Cochrane databases, were searched to find studies using NVBG to treat ONFH. The pooled rate and 95% confidence interval (CI) were used to assess the conversion rate to THA after NVBG. In addition, we performed subgroup, sensitivity, and publication bias analysis. RESULTS A total of 37 studies describing 2599 hips were included. The mean weighted follow-up time was 50.5 months and the mean age at surgery was 36.3 years. The conversion rate to THA after NVBG was 21% (95%CI: 17% to 25%), and subgroup analyzes indicated lightbulb, trapdoor and Phemister techniques incidences with THA of 15%, 19%, and 24%, respectively. CONCLUSIONS This study preliminarily obtained the general trend of the survival rate of NVBG patients, but these results should be interpreted cautiously. Pooled results from 2599 hips and of these nearly 80% with early stage of osteonecrosis, showed that approximately 21% of patients underwent a THA following NVBG. NVBG treatment for patient with ONFH appears to defer or at least delay the need for THA.
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Affiliation(s)
- Jianxiong Li
- grid.411866.c0000 0000 8848 7685Guangzhou University of Chinese Medicine, Guangzhou, Guangdong China
| | - Liang Mo
- grid.411866.c0000 0000 8848 7685Guangzhou University of Chinese Medicine, Guangzhou, Guangdong China
| | - Guowen Bai
- grid.411866.c0000 0000 8848 7685Guangzhou University of Chinese Medicine, Guangzhou, Guangdong China
| | - Zhangzheng Wang
- grid.411866.c0000 0000 8848 7685Guangzhou University of Chinese Medicine, Guangzhou, Guangdong China
| | - Hua Zhang
- grid.412595.eThe First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong China
| | - Jie Li
- grid.412595.eThe First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong China
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Xiong HZ, Deng YH, Jin Y, Wang AH, Hong S. An all-arthroscopic light bulb technique to treat osteonecrosis of the femoral head through outside-in fashion without distraction: A case report. Front Surg 2022; 9:944480. [PMID: 36311922 PMCID: PMC9608540 DOI: 10.3389/fsurg.2022.944480] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/21/2022] [Indexed: 11/18/2022] Open
Abstract
The technique of distraction has been widely used in hip arthroscopy for opening joint spaces. However, an all-arthroscopic light bulb technique through outside-in fashion without distraction has not been reported for the treatment of osteonecrosis of the femoral head (ONFH). A 29-year-old man was admitted to our department with hip pain and limited range of motion (ROM) in both hips over 4 months. X-rays, computed tomography (CT), and magnetic resonance imaging (MRI) showed a mixed appearance, including sclerosis and cysts on the anterosuperior site of the bilateral femoral heads. The patient had an 11-year history of liquor intake. In addition, no other pathologies were found before the operation. After diagnosing bilateral ONFH (stage II) according to the Ficat classification, the patient underwent an all-arthroscopic light bulb technique through outside-in fashion without distraction because of failing conservative treatment. At the 2-year postoperative follow-up, the patient had neither pain nor limitation of ROM. The postoperative x-ray, CT, and MRI revealed a well-healed area of the previous bone grafting in the bilateral femoral heads. An all-arthroscopic light bulb technique through outside-in fashion without distraction can be a feasible method for the treatment of early-stage ONFH. This case reminds us that distraction- and perforation-related complications may be avoided in patients with ONFH without the concomitant pathologies of the central compartment.
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Affiliation(s)
- Hua-zhang Xiong
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yu-hong Deng
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Ying Jin
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - An-hong Wang
- Department of Orthopedic Surgery, People’s Hospital of Yinjiang Tujia and Miao Autonomous County, Yinjiang, China
| | - Song Hong
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China,Correspondence: Song Hong
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