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De Berardinis L, Qordja F, Farinelli L, Faragalli A, Gesuita R, Gigante AP. Is Primary Bone Marrow Edema of the Knee Associated with Thyroid Disorders? A Retrospective Clinical Study. J Clin Med 2022; 11:jcm11195973. [PMID: 36233839 PMCID: PMC9570638 DOI: 10.3390/jcm11195973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/30/2022] [Accepted: 10/10/2022] [Indexed: 11/29/2022] Open
Abstract
Primary bone marrow edema (BME) of the knee is still an elusive condition. This retrospective study was undertaken to gain insight into its characteristic features. The records of 48 patients with primary BME of the knee diagnosed by magnetic resonance imaging were reviewed. Demographic data, medical history, current medications, pain type, smoking and drinking habits, allergies, occupation, sports practiced, environmental factors, and life events predating symptom onset were examined. Data analysis demonstrated that 56.3% of patients had experienced a stressful event before BME pain onset and that 50% suffered from thyroid disorders. Standard conservative treatment resulted in pain resolution irrespective of the use of anti-inflammatories. However, most patients reported new persistent symptoms: dysesthesia/hypoesthesia on palpation in the skin area overlying the previous edema and a reduced ipsilateral patellar reflex. To our knowledge, this is the first study characterizing a substantial cohort of patients with BME. We found that middle-aged, sedentary, and slightly overweight women smokers are the typical patients with primary BME of the knee. The appearance and persistence of cutaneous dysesthesia/hypoesthesia at the site of the earlier lesion and ipsilateral patellar hyporeflexia implicate an autonomous nervous system dysfunction in BME pathogenesis and warrant further investigation.
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Affiliation(s)
- Luca De Berardinis
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, Italy
| | - Fjorela Qordja
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, Italy
| | - Luca Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, Italy
| | - Andrea Faragalli
- Centre of Epidemiology, Biostatistics and Medical Information Technology, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, Italy
| | - Rosaria Gesuita
- Centre of Epidemiology, Biostatistics and Medical Information Technology, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, Italy
| | - Antonio Pompilio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, Italy
- Correspondence: ; Tel.: +39-071-596-3080
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Xu SH, Tang JS, Shen XY, Niu ZX, Xiao JL. Osteoradionecrosis of the Hip, a Troublesome Complication of Radiation Therapy: Case Series and Systematic Review. Front Med (Lausanne) 2022; 9:858929. [PMID: 35402457 PMCID: PMC8990133 DOI: 10.3389/fmed.2022.858929] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Osteoradionecrosis of the hip is a serious complication of radiotherapy that is easily overlooked by physicians and patients in the early stages. There are relatively few reports on this subject, so there is no clear scientific consensus for the pathogenesis, early diagnosis, and clinical treatment of hip osteoradionecrosis. In this paper, we report two cases of hip osteoradionecrosis and systematically review the related literature. Case Presentation We report two cases of hip osteoradionecrosis. One patient successfully underwent total hip arthroplasty in our hospital and recovered well postoperatively. Another patient although we offered a variety of surgical options for this patient, the patient was worried that the bone loss would lead to poor prosthesis fixation, resulting in prosthesis loosening and infection, and therefore ultimately refused surgical treatment. Conclusion With the development of radiological techniques, the incidence of hip osteoradionecrosis is decreasing year by year, but early diagnosis and rational treatment remain challenging. The effects of non-surgical treatment are limited. Early prevention, early detection, and early intervention are crucial to delay or prevent the emergence of more serious complications.
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Affiliation(s)
- Sheng-hao Xu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jin-shuo Tang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xian-yue Shen
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Zhi-xin Niu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jian-lin Xiao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Jian-lin Xiao, ; orcid.org/0000-0001-7175-2726
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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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/26/2022] [Indexed: 11/06/2022] Open
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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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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Paoletta M, Moretti A, Liguori S, Bertone M, Toro G, Iolascon G. Transient osteoporosis of the hip and subclinical hypothyroidism: an unusual dangerous duet? Case report and pathogenetic hypothesis. BMC Musculoskelet Disord 2020; 21:543. [PMID: 32791961 PMCID: PMC7427076 DOI: 10.1186/s12891-020-03574-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Transient osteoporosis of the hip (TOH) is a rare and temporary clinical condition characterised by bone marrow edema (BME), severe pain, and functional limitation. It commonly occurs in middle-aged men or in women in the last trimester of pregnancy. TOH usually resolves with conservative therapy but may predispose to hip fracture or progression to avascular necrosis (AVN). Etiology is still unclear, although several pathophysiological mechanisms underpinning this condition has been proposed. We describe the management of an unusual case of TOH occurred in a patient with subclinical hypothyroidism. CASE PRESENTATION A clinical case of a 46-year-old man with severe pain in the left anterior thigh is presented. After a comprehensive clinical and radiological approach, a TOH was diagnosed. Moreover, biochemical assessment suggested the presence of subclinical hypothyroidism. After 3 months of treatment with clodronate, physical therapy and hormone replacement therapy (HRT) a significant improvement of clinical and radiological outcomes was observed. CONCLUSION Several pathological conditions have been related to development of TOH. In our case, we suggested for the first time a role of subclinical hypothyroidism as novel contributory factor for the onset of this condition, providing pathophysiological mechanisms and a scientific rationale for pharmacological treatment.
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Affiliation(s)
- Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via De Crecchio 4, 80138, Naples, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via De Crecchio 4, 80138, Naples, Italy.
| | - Sara Liguori
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via De Crecchio 4, 80138, Naples, Italy
| | - Matteo Bertone
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via De Crecchio 4, 80138, Naples, Italy
| | - Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via De Crecchio 4, 80138, Naples, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via De Crecchio 4, 80138, Naples, Italy
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Zhao D, Zhang F, Wang B, Liu B, Li L, Kim SY, Goodman SB, Hernigou P, Cui Q, Lineaweaver WC, Xu J, Drescher WR, Qin L. Guidelines for clinical diagnosis and treatment of osteonecrosis of the femoral head in adults (2019 version). J Orthop Translat 2020; 21:100-110. [PMID: 32309135 PMCID: PMC7152793 DOI: 10.1016/j.jot.2019.12.004] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/29/2019] [Accepted: 12/05/2019] [Indexed: 12/26/2022] Open
Abstract
Osteonecrosis of the femoral head (ONFH) is a common and refractory disease in orthopaedic clinics. The number of patients with ONFH is increasing worldwide every year. There are an estimated 8.12 million patients with nontraumatic osteonecrosis in China alone. Treatment of nontraumatic osteonecrosis has always been a clinical challenge for orthopaedic surgeons. To further standardize diagnosis and treatment of ONFH, these guidelines provide not only basic diagnosis, treatment, and evaluation systems for ONFH but also expert advice and standards in many aspects, including epidemiology, aetiology, diagnostic criteria, pathological staging, prevention and treatment options, and postoperative rehabilitation. The aetiological factors of ONFH can currently be divided into two major categories: traumatic and nontraumatic; however, the specific pathological mechanism of ONFH is not completely clear. Currently, the staging system of ONFH formulated by the Association Research Circulation Osseous is widely used in clinical practice. Based on the changes in the intraosseous blood supply at different stages, the corresponding nonsurgical and surgical treatments are recommended, and when there are risk factors for possible ONFH, certain preventive measures to avoid the occurrence of osteonecrosis are recommended. These guidelines provide brief classification criteria and treatment regimen for osteonecrosis. Specification of the aetiology, treatment plan based on comprehensive consideration of the different stages of osteonecrosis, hip function, age, and occupation of the patients are important steps in diagnosis and developing treatment strategies. TRANSLATIONAL POTENTIAL OF THIS ARTICLE New advances in the epidemiology, etiology, pathophysiology, imaging, diagnosis and treatment of ONFH have been renewed in this revision. This guideline can be used for reference by orthopedic professionals and researchers, and for standardized diagnosis and treatment management under the clinical guidance, which is conducive to the prevention, treatment and further research of ONFH, improving the diagnosis and treatment level, making patients' symptoms under good control, and improving their quality of life.
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Key Words
- ARCO, Association Research Circulation Osseous
- BMES, Bone marrow oedema syndrome
- CT, Computed tomography
- DSA, Digital subtraction angiography
- Diagnosis
- Guideline
- MRI, Magnetic resonance imaging
- ONFH, Osteonecrosis of the femoral head
- Osteonecrosis of the femoral head (ONFH)
- PET, Positron emission tomography
- RHS, Reconstruction Hip Scores
- SPECT, Single-photon emission computed tomography
- T1WI, T1-weighted images
- Treatment
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Affiliation(s)
- Dewei Zhao
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, PR China
| | - Feng Zhang
- JMS Burn and Reconstructive Center, Jackson, MS, USA
| | - Benjie Wang
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, PR China
| | - Baoyi Liu
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, PR China
| | - Lu Li
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, PR China
| | - Shin-Yoon Kim
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, South Korea
| | - Stuart B. Goodman
- Department of Orthopaedic Surgery and (by Courtesy) Bioengineering, Stanford University Medical Center Outpatient Center, Redwood City, CA, 94063, USA
| | - Philippe Hernigou
- Department of Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France
| | - Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Virginia, 22903, USA
| | | | - Jiake Xu
- School of Pathology and Laboratory Medicine, The University of Western Australia, Perth, Western Australia, 6009, Australia
| | - Wolf R. Drescher
- Department of Orthopaedic Surgery of the Lower Limb and Arthroplasty, Rummelsberg Hospital, D-90592, Schwarzenbruck, Germany
| | - Ling Qin
- Musculoskeletal Research Laboratory, Department of Orthopedics & Traumatology, The Chinese University of Hong Kong, PR China
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Ye Y, Peng Y, He P, Zhang Q, Xu D. Urinary miRNAs as biomarkers for idiopathic osteonecrosis of femoral head: A multicentre study. J Orthop Translat 2020; 26:54-59. [PMID: 33437623 PMCID: PMC7773953 DOI: 10.1016/j.jot.2020.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/15/2019] [Accepted: 01/21/2020] [Indexed: 02/06/2023] Open
Abstract
Objectives Urinary microRNAs (miRNAs) have shown great diagnostic and prognostic values for multiple diseases. The profile of urinary miRNAs in patients with idiopathic osteonecrosis of femoral head (ONFH) is currently unclear. Methods We first randomly chose ten patients with each Association Research Circulation Osseous (ARCO) stage (I, II, III and IV) and ten healthy participants from the entire cohorts for initial screening. The miRNA polymerase chain reaction (PCR) array was then performed to identify the differentially abundant miRNAs in urine of these participants. We then verified the findings in the entire cohort. Clinical features including age, gender, bone mass index (BMI), lesion size and stages were recorded. We then analysed the association between the level of urinary miRNAs and clinical features. Results Our data indicated that there were 13 differentially abundant miRNAs among all groups. Urinary miR-150 demonstrated the highest diagnostic value among all candidates. Urinary miR-185 and miR-133a increased by ARCO staging. The levels of urinary miR-4824 abruptly decreased after femoral head collapse (ARCO stage III and IV). Urinary miR-144 was the only marker that correlated with lesion size. Conclusions The levels of urinary miRNAs are valuable biomarkers for idiopathic ONFH. Given the noninvasive nature of this test, it is potentially useful for diagnosis and monitoring of idiopathic ONFH progression. The translational potential of this article This article gives novel methods for ONFH diagnosis and progression monitoring in a convenient and non-invasive way.
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Affiliation(s)
- Yongheng Ye
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510080, China
| | - Yue Peng
- Department of Otorhinolaryngology Head and Neck Surgery, Zhuhai People's Hospital, Zhuhai, Guangdong Province, 519000, China
| | - Peiheng He
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510080, China
| | - Qinqin Zhang
- Department of Thyroid and Breast Surgery, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, 541002, China
| | - Dongliang Xu
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510080, China
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Electrical stimulation-based bone fracture treatment, if it works so well why do not more surgeons use it? Eur J Trauma Emerg Surg 2019; 46:245-264. [PMID: 30955053 DOI: 10.1007/s00068-019-01127-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 03/29/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Electrical stimulation (EStim) has been proven to promote bone healing in experimental settings and has been used clinically for many years and yet it has not become a mainstream clinical treatment. METHODS To better understand this discrepancy we reviewed 72 animal and 69 clinical studies published between 1978 and 2017, and separately asked 161 orthopedic surgeons worldwide about their awareness, experience, and acceptance of EStim for treating fracture patients. RESULTS Of the 72 animal studies, 77% reported positive outcomes, and the most common model, bone, fracture type, and method of administering EStim were dog, tibia, large bone defects, and DC, respectively. Of the 69 clinical studies, 73% reported positive outcomes, and the most common bone treated, fracture type, and method of administration were tibia, delayed/non-unions, and PEMF, respectively. Of the 161 survey respondents, most (73%) were aware of the positive outcomes reported in the literature, yet only 32% used EStim in their patients. The most common fracture they treated was delayed/non-unions, and the greatest problems with EStim were high costs and inconsistent results. CONCLUSION Despite their awareness of EStim's pro-fracture healing effects few orthopedic surgeons use it in their patients. Our review of the literature and survey indicate that this is due to confusion in the literature due to the great variation in methods reported, and the inconsistent results associated with this treatment approach. In spite of this surgeons seem to be open to using this treatment if advancements in the technology were able to provide an easy to use, cost-effective method to deliver EStim in their fracture patients.
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Massari L, Benazzo F, Falez F, Perugia D, Pietrogrande L, Setti S, Osti R, Vaienti E, Ruosi C, Cadossi R. Biophysical stimulation of bone and cartilage: state of the art and future perspectives. INTERNATIONAL ORTHOPAEDICS 2019; 43:539-551. [PMID: 30645684 PMCID: PMC6399199 DOI: 10.1007/s00264-018-4274-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/03/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Biophysical stimulation is a non-invasive therapy used in orthopaedic practice to increase and enhance reparative and anabolic activities of tissue. METHODS A sistematic web-based search for papers was conducted using the following titles: (1) pulsed electromagnetic field (PEMF), capacitively coupled electrical field (CCEF), low intensity pulsed ultrasound system (LIPUS) and biophysical stimulation; (2) bone cells, bone tissue, fracture, non-union, prosthesis and vertebral fracture; and (3) chondrocyte, synoviocytes, joint chondroprotection, arthroscopy and knee arthroplasty. RESULTS Pre-clinical studies have shown that the site of interaction of biophysical stimuli is the cell membrane. Its effect on bone tissue is to increase proliferation, synthesis and release of growth factors. On articular cells, it creates a strong A2A and A3 adenosine-agonist effect inducing an anti-inflammatory and chondroprotective result. In treated animals, it has been shown that the mineralisation rate of newly formed bone is almost doubled, the progression of the osteoarthritic cartilage degeneration is inhibited and quality of cartilage is preserved. Biophysical stimulation has been used in the clinical setting to promote the healing of fractures and non-unions. It has been successfully used on joint pathologies for its beneficial effect on improving function in early OA and after knee surgery to limit the inflammation of periarticular tissues. DISCUSSION The pooled result of the studies in this review revealed the efficacy of biophysical stimulation for bone healing and joint chondroprotection based on proven methodological quality. CONCLUSION The orthopaedic community has played a central role in the development and understanding of the importance of the physical stimuli. Biophysical stimulation requires care and precision in use if it is to ensure the success expected of it by physicians and patients.
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Affiliation(s)
- Leo Massari
- University of Ferrara, Via Vigne 4, 44121, Ferrara, Italy.
| | - Franco Benazzo
- IRCCS Foundation "San Matteo" Hospital, University of Pavia, 27100, Pavia, Italy
| | | | | | | | | | | | | | - Carlo Ruosi
- Federico II University Naples, 80100, Naples, Italy
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Bosco G, Vezzani G, Enten G, Manelli D, Rao N, Camporesi EM. Femoral condylar necrosis: treatment with hyperbaric oxygen therapy. Arthroplast Today 2018; 4:510-515. [PMID: 30560184 PMCID: PMC6287235 DOI: 10.1016/j.artd.2018.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/21/2018] [Accepted: 02/22/2018] [Indexed: 11/30/2022] Open
Abstract
Background Osteonecrosis of the knee (ONK) is a form of aseptic necrosis resulting from ischemia to subchondral bone tissue. Typically, treatment is invasive. Hyperbaric oxygen therapy (HBOT) may provide a noninvasive alternative by improving oxygenation and reperfusion of ischemic areas. This study evaluates the efficacy of HBOT in a series of ONK patients. Methods This retrospective study evaluates 37 ONK patients (29 male, 8 female; mean age ± 1 standard deviation: 54 ± 14); 83.7% of patients presented with Aglietti stage I-II; 16.3% presented with Aglietti stage III. Patients were treated with HBOT once a day, 5 days a week, at 2.5 atmosphere absolute with 100% inspired oxygen by mask for an average of 67.9 ± 15 sessions. Magnetic resonance imaging was performed before HBOT, within 1 year after completion of HBOT, and in 14 patients, 7 years after treatment. Oxford Knee Scores (OKSs) were recorded before HBOT and at the end of each HBOT treatment cycle. Results After the 30 sessions of HBOT, 86% of patients experienced improvement in their OKS, 11% worsened, and 3% did not change. All patients improved in OKS after 50 sessions. Magnetic resonance imaging evaluation 1 year after HBOT completion showed that edema at the femoral condyle had resolved in all but 1 patient. Conclusions HBOT is beneficial for treating ONK. Patients experienced improvements in pain and mobility as demonstrated by improvement in OKS. Radiographic improvements were also seen upon post-treatment follow-up. Aglietti staging for the entire sample saw an aggregate decrease (P < .01) from 1.7 ± 0.7 to 0.3 ± 0.6.
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Affiliation(s)
- Gerardo Bosco
- Department of Physiology, University of Padova, Padova, Italy
| | | | - Garrett Enten
- TEAMHealth Anesthesia Research Institute, Tampa, FL, USA
| | - Daniele Manelli
- Department of Physiology, University of Padova, Padova, Italy
| | - Nisha Rao
- Department of Radiology, University of South Florida (USF), Tampa, FL, USA
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11
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[Conservative treatment of atraumatic femoral head necrosis]. DER ORTHOPADE 2018; 47:735-744. [PMID: 30097686 DOI: 10.1007/s00132-018-3616-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Femoral head necrosis is a progressive disease that can progress within a relatively short time. Therefore, an early and clear diagnosis including stage classification and treatment is necessary to prevent or delay the onset of the femoral head and joint destruction. TREATMENT In addition to the identification of possible risk factors and treatment, the question of the available treatment options arises. The present article deals with conservative treatment options and presents the published results in the sense of the currently available evidence and against the background of the S3 guideline on atraumatic femoral head necrosis. The results of physical therapy, drug therapy (iloprost and bisphosphonates ), electrotherapy, shockwave therapy, etc. are presented. In the early stages of femoral head necrosis with low expansion, alendronate gives positive results. Iloprost is also a successful conservative treatment option in the early stages of atraumatic femoral head necrosis (ARCO I and II). In stages ARCO III and IV, Ilomedin is no longer indicated. Anticoagulants, such as enoxaparin, have demonstrated an arthroprotective effect.
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Kawai T, Shanjani Y, Fazeli S, Behn AW, Okuzu Y, Goodman SB, Yang YP. Customized, degradable, functionally graded scaffold for potential treatment of early stage osteonecrosis of the femoral head. J Orthop Res 2018; 36:1002-1011. [PMID: 28782831 PMCID: PMC5924591 DOI: 10.1002/jor.23673] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/24/2017] [Indexed: 02/04/2023]
Abstract
Osteonecrosis of the femoral head (ONFH) is a debilitating disease that results in progressive collapse of the femoral head and subsequent degenerative arthritis. Few treatments provide both sufficient mechanical support and biological cues for regeneration of bone and vascularity when the femoral head is still round and therefore salvageable. We designed and 3D printed a functionally graded scaffold (FGS) made of polycaprolactone (PCL) and β-tricalcium phosphate (β-TCP) with spatially controlled porosity, degradation, and mechanical strength properties to reconstruct necrotic bone tissue in the femoral head. The FGS was designed to have low porosity segments (15% in proximal and distal segments) and a high porosity segment (60% in middle segment) according to the desired mechanical and osteoconductive properties at each specific site after implantation into the femoral head. The FGS was inserted into a bone tunnel drilled in rabbit femoral neck and head, and at 8 weeks after implantation, the tissue formation as well as scaffold degradation was analyzed. Micro-CT analysis demonstrated that the FGS-filled group had a significantly higher bone ingrowth ratio compared to the empty-tunnel group, and the difference was higher at the distal low porosity segments. The in vivo degradation rate of the scaffold was higher in the proximal and distal segments than in the middle segment. Histological analysis of both non-decalcified and calcified samples clearly indicated new bone ingrowth and bone marrow-containing bone formation across the FGS. A 3D printed PCL-β-TCP FGS appears to be a promising customized resorbable load-bearing implant for treatment of early stage ONFH. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1002-1011, 2018.
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Affiliation(s)
- Toshiyuki Kawai
- Department of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Stanford, 94305, California
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku Kyoto, 606-8507, Japan
| | - Yaser Shanjani
- Department of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Stanford, 94305, California
| | - Saba Fazeli
- Department of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Stanford, 94305, California
- Department of Mechanical Engineering, Stanford University, 440 Escondido Mall, Stanford, 94305, California
| | - Anthony W Behn
- Department of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Stanford, 94305, California
| | - Yaichiro Okuzu
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku Kyoto, 606-8507, Japan
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Stanford, 94305, California
- Department of Bioengineering, Stanford University, 318 Campus Drive, Stanford, 94305, California
| | - Yunzhi P Yang
- Department of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Stanford, 94305, California
- Department of Bioengineering, Stanford University, 318 Campus Drive, Stanford, 94305, California
- Department of Materials Science and Engineering, Stanford University, 496 Lomita Mall, Stanford, 94305, California
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13
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Chinese Guideline for the Diagnosis and Treatment of Osteonecrosis of the Femoral Head in Adults. Orthop Surg 2017; 9:3-12. [PMID: 28371498 DOI: 10.1111/os.12302] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 09/04/2016] [Indexed: 01/15/2023] Open
Abstract
The treatment of adult osteonecrosis of the femoral head (ONFH), with 8.12 million patients in China, remains a challenge to surgeons. To standardize and improve the efficacy of the treatment of ONFH, Chinese specialists updated the experts' suggestions in March 2015, and an experts' consensus was given to provide a current basis for the diagnosis, treatment and evaluation of ONFH. The current guideline provides recommendations for ONFH with respect to epidemiology, etiology, diagnostic criteria, differential diagnosis, staging, treatment, as well as rehabilitation. Risk factors of non-traumatic ONFH include corticosteroid use, alcohol abuse, dysbarism, sickle cell disease and autoimmune disease and others, but the etiology remains unclear. The Association Research Circulation Osseous (ARCO) staging system, including plain radiograph, magnetic resonance imaging, radionuclide examination, and histological findings, is frequently used in staging ONFH. A staging and classification system was proposed by Chinese scholars in recent years. The major differential diagnoses include mid-late term osteoarthritis, transient osteoporosis, and subchondral insufficiency fracture. Management alternatives for ONFH consist of non-operative treatment and operative treatment. Core decompression is currently the most common procedure used in the early stages of ONFH. Vascularized bone grafting is the recommended treatment for ARCO early stage III ONFH. This guideline gives a brief account of principles for selection of treatment for ONFH, and stage, classification, volume of necrosis, joint function, age of the patient, patient occupation, and other factors should be taken into consideration.
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14
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Bagheri L, Pellati A, Rizzo P, Aquila G, Massari L, De Mattei M, Ongaro A. Notch pathway is active during osteogenic differentiation of human bone marrow mesenchymal stem cells induced by pulsed electromagnetic fields. J Tissue Eng Regen Med 2017; 12:304-315. [PMID: 28482141 DOI: 10.1002/term.2455] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 01/26/2017] [Accepted: 05/04/2017] [Indexed: 01/16/2023]
Abstract
Pulsed electromagnetic fields (PEMFs) have been used to treat bone diseases, particularly nonunion healing. Although it is known that PEMFs promote the osteogenic differentiation of human mesenchymal stem cells (hMSCs), to date PEMF molecular mechanisms remain not clearly elucidated. The Notch signalling is a highly conserved pathway that regulates cell fate decisions and skeletal development. The aim of this study was to investigate if the known PEMF-induced osteogenic effects may involve the modulation of the Notch pathway. To this purpose, during in vitro osteogenic differentiation of bone marrow hMSCs in the absence and in the presence of PEMFs, osteogenic markers (alkaline phosphatase activity, osteocalcin and matrix mineralization), the messenger ribonucleic acid expression of osteogenic transcription factors (Runx2, Dlx5, Osterix) as well as of Notch receptors (Notch1-4), their ligands (Jagged1, Dll1 and Dll4) and nuclear target genes (Hes1, Hes5, Hey1, Hey2) were investigated. PEMFs stimulated all osteogenic markers and increased the expression of Notch4, Dll4, Hey1, Hes1 and Hes5 in osteogenic medium compared to control. In the presence of DAPT and SAHM1, used as Notch pathway inhibitors, the expression of the osteogenic markers, including Runx2, Dlx5, Osterix, as well as Hes1 and Hes5 were significantly inhibited, both in unexposed and PEMF-exposed hMSCs. These results suggest that activation of Notch pathway is required for PEMFs-stimulated osteogenic differentiation. These new findings may be useful to improve autologous cell-based regeneration of bone defects in orthopaedics.
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Affiliation(s)
- Leila Bagheri
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Agnese Pellati
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Paola Rizzo
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Giorgio Aquila
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy
| | - Leo Massari
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Monica De Mattei
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Alessia Ongaro
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
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Al-Jabri T, Tan JYQ, Tong GY, Shenoy R, Kayani B, Parratt T, Khan T. The role of electrical stimulation in the management of avascular necrosis of the femoral head in adults: a systematic review. BMC Musculoskelet Disord 2017; 18:319. [PMID: 28754159 PMCID: PMC5534113 DOI: 10.1186/s12891-017-1663-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 07/09/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Avascular necrosis of the femoral head causes significant morbidity and occurs in up to 20,000 people per year. A variety of nonoperative and operative measures have been trialled however a definitive treatment algorithm is yet to be established. Young adults in many cases have undergone multiple surgical procedures in their lifetime with increasing risks of complications. Less invasive techniques may help reduce the number of operations required and positively influence the natural history of the disease process. Our aim was to navigate the literature and examine the results of electrical stimulation of the femoral head in avascular necrosis. METHODS The following defined search strategy was used to perform a systematic review using MEDLINE and Google Scholar databases: ((avascular necrosis) OR (osteonecrosis)) AND (femoral head) AND ((electrical stimulation) OR (capacitive coupling) OR (pulsed electromagnetic fields)). Articles were reviewed and data compiled into tables for analysis. RESULTS Fourty six articles were identified with a total of 10 articles meeting the inclusion criteria. 8 articles were prospective studies and 2 were retrospective. Early Ficat stages showed the best responses to treatment via pulsed electromagnetic fields with improvements in both clinical and radiographic parameters. Direct current and capacitative coupling have had a more ambiguous outcome. CONCLUSIONS Pulsed electromagnetic fields may have a role in the management of early avascular necrosis. The paucity of clinical studies into this technique indicates a need for further studies.
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Affiliation(s)
- Talal Al-Jabri
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
| | | | | | - Ravikiran Shenoy
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - Babar Kayani
- Great Ormond Street Hospital, Great Ormond St, London, WC1N 3JH, UK
| | - Timothy Parratt
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - Tahir Khan
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
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Kennon JC, Smith JP, Crosby LA. Core decompression and arthroplasty outcomes for atraumatic osteonecrosis of the humeral head. J Shoulder Elbow Surg 2016; 25:1442-8. [PMID: 27085764 DOI: 10.1016/j.jse.2016.01.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/07/2016] [Accepted: 01/22/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Humeral head osteonecrosis treatment varies depending on the stage and symptoms. Successful outcomes for humeral head core decompression for stage I/II disease in chronic steroid-induced (CSI) osteonecrosis have been reported, but fewer data exist for sickle cell disease (SCD) etiology. Resurfacing and hemiarthroplasty or total shoulder arthroplasty (TSA) are common for advanced collapse, with mixed results. METHODS We evaluate radiographic and functional outcomes after procedures for humeral head atraumatic avascular necrosis (HAAVN), decompression efficacy in CSI and SCD populations, and report outcomes of advanced disease requiring arthroplasty. Twenty-five shoulders were treated surgically for HAAVN. Post-traumatic AVN patients were excluded. Stage I/II disease received core decompression and ultrasound bone stimulation. Stage III received surface replacement or hemiarthroplasty, and arthroplasty was performed for stage IV/V. Radiographs and clinical scores were recorded preoperatively and postoperatively. RESULTS Included were 25 HAAVN shoulders (13 SCD and 12 CSI). Eleven shoulders (stage I/II disease) underwent core decompression. Seven of 8 shoulders (88%) progressed to stage III/IV after decompression. All SCD patients progressed to collapse. The procedure in 19 shoulders was surface replacement, hemiarthroplasty, or TSA. Constant, American Shoulder and Elbow Surgeons, Simple Shoulder Test-12, and University of California Los Angeles Shoulder scores were significantly higher at 1- and 2-year follow-up with arthroplasty; 13 of 16 arthroplasty patients (81%) had satisfactory to excellent results. One surface replacement was revised to reverse TSA. CONCLUSIONS Results suggest core decompression for AVN in SCD patients does not alter osteonecrosis progression and humeral head collapse. Resurfacing and hemiarthroplasty are viable treatment options for stage III, whereas shoulder replacement for stage IV/V disease appears to offer better functional results.
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Affiliation(s)
- Justin C Kennon
- Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, GA, USA
| | - Jeffrey P Smith
- Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, GA, USA
| | - Lynn A Crosby
- Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, GA, USA.
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17
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Beckmann J, Roth A, Niethard C, Mauch F, Best R, Maus U. [Bone marrow edema and atraumatic necrosis of the femoral head : Therapy]. DER ORTHOPADE 2016; 44:662-671. [PMID: 26245631 DOI: 10.1007/s00132-015-3146-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND An increase in interstitial bony fluid occurs in bone-marrow edema (BME). The exact pathogenetic processes still remain unknown. BME is an unspecific finding that can occur on its own or accompany multiple diseases and pathologies. GOAL Literature review and presentation of new guidelines. MATERIAL AND METHODS This is a narrative literature review followed by current advice for the therapy of atraumatic osteonecrosis of the hip, based on the recently published S3-guidelines for this disease. RESULTS AND DISCUSSION The differentiation of at least 3 different etiologies is proposed (mechanic, reactive and ischemic). Difficult, but important, is the distinction between the mostly painful, but benign entities (BME syndrome, bone bruise) and the progressive pathologies (osteonecrosis, arthritis, CRPS, tumour). Treatment options are dependent on etiology and clinic and can often be symptomatic. Core decompression is the surgical gold standard, leading to immediate pressure relief and therefore reduction in pain. Recently, it was shown that intravenous administration of Iloprost and bisphosphonates are also effective in achieving a reduction of BME and pain, with considerable improvement in the accompanying symptoms. The combination of core decompression and infusion seems to be another possible optimization ofthe therapy, in particular in the treatment of osteonecrosis.
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Affiliation(s)
- J Beckmann
- Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Deutschland.
| | - A Roth
- Bereich Endoprothetik/Orthopädie, Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universität Leipzig AöR, Leipzig, Deutschland
| | - C Niethard
- Orthopädische Gemeinschaftspraxis, Heinsberg, Deutschland
| | - F Mauch
- Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Deutschland
| | - R Best
- Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Deutschland
| | - U Maus
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinik für Orthopädie und spezielle orthopädische Chirurgie, Pius-Hospital Oldenburg, Oldenburg, Deutschland
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18
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Klumpp R, Trevisan C. Aseptic osteonecrosis of the hip in the adult: current evidence on conservative treatment. ACTA ACUST UNITED AC 2016; 12:39-42. [PMID: 27134631 DOI: 10.11138/ccmbm/2015.12.3s.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Treatment of Avascular Osteonecrosis (AVN) of the femoral head to prevent progression to an arthritic hip is a challenging subject. Many conservative treatment options have been proposed in the literature. Weight bearing restriction as a stand-alone therapy is insufficient in preventing disease progression but it may be useful when combined with pharmacological agents or surgery. Bisphosphonate treatment in AVN might be efficient in early stages of disease, however there are no clear recommendations on length of treatment and therapeutic dosage and, considered the limited evidence and potential side effects of treatment, it could be considered in a pre-collapse stage in selected cases. Current literature suggests that low molecular weight heparin could lower disease progression in idiopathic AVN with quality of evidence being very low. Also the evidence to support the use of statins or vasodilators in the treatment of osteonecrosis is very low and their use cannot be recommended. Extracorporeal shock wave therapy may improve pain and function in early stages of disease with a low evidence, but there doesn't seem to be a significant change in time to the occurrence of femoral head collapse. Only one study has been conducted with pulsed electromagnetic fields therefore no recommendation can be given on clinical use of PEF in AVN. Evidence on hyperbaric oxygen therapy in the treatment of AVN is very limited and the high cost of treatment and the limited availability of structures that can provide the service poses other concerns about its feasibility. Based on current evidence, conservative treatment may be considered in early stages of asymptomatic AVN instead of observation only.
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Affiliation(s)
- Raymond Klumpp
- Orthopedics and Traumatology, AO Bolognini, Seriate (BG), Italy
| | - Carlo Trevisan
- Orthopedics and Traumatology, AO Bolognini, Seriate (BG), Italy
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Roth A, Beckmann J, Bohndorf K, Fischer A, Heiß C, Kenn W, Jäger M, Maus U, Nöth U, Peters KM, Rader C, Reppenhagen S, Smolenski U, Tingart M, Kopp I, Sirotin I, Breusch SJ. S3-Guideline non-traumatic adult femoral head necrosis. Arch Orthop Trauma Surg 2016; 136:165-74. [PMID: 26667621 DOI: 10.1007/s00402-015-2375-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The treatment of adult non-traumatic avascular necrosis of the femoral head (AVN; N-ANFH) within an estimated incidence of 5000-7000 cases per annum in Germany remains a challenge. Risk factors include steroids, alcohol abuse, chemotherapy and immunosuppressive medication, but a genetic predisposition has been suggested. Early diagnosis of this often bilateral disease process is essential for successful conservative or joint preserving surgical management. In this review, we present the update German consensus S3 guideline "diagnosis and management for N-ANFH" as a concise summary. MATERIALS AND METHODS This systematic review is based on the published literature from January 1, 1970 to April 31, 2013 (German and English language). Inclusion criteria were systematic reviews, meta-analyses and relevant peer review publications. We identified a total of 3715 related publications, of which 422 were suitable according to the SIGN criteria, but only 159 fulfilled our inclusion criteria. RESULTS AND CONCLUSIONS Clinical suspicion of N-ANFH mandates radiographic evaluation. If radiographs are normal MRI scans are recommended, which should be evaluated according to the ARCO-classification. Differential diagnoses include transient osteoporosis, bone bruise, insufficiency fracture and destructive arthropathy. Untreated, subchondral fractures commonly occur within 2 years, during which the risk for contralateral involvement is high-thereafter unlikely. Conservative management with Ilomedin and Alendronat can be tried, but other pharmacological or physical treatments are inappropriate. No specific joint preserving procedure can be recommended, but core decompression should be considered in early stages if necrosis is <30 %. In ARCO stages IIIc or IV total hip arthroplasty (THA) should be contemplated, which offers similar outcome compared to osteoarthritis. Young age is the main risk factor for higher revision rates after THA for N-ANFH.
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Affiliation(s)
- A Roth
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie; Bereich Endoprothetik/Orthopädie, Universitätsklinik Leipzig AöR, Liebigstraße 20, 04103, Leipzig, Germany.
| | - J Beckmann
- Sektion Endoprothetik, Sportklinik Stuttgart, Stuttgart, Germany
| | - K Bohndorf
- Universitätsklinik für Radiologie und Nuklearmedizin, Exzellenzzentrum für Hochfeld MR, Medizinische Universität Wien, Vienna, Austria.,Christian Doppler Laboratory for Molecular Imaging, Medizinische Universität Wien, Vienna, Austria
| | - A Fischer
- Abteilung für Physikalische und Rehabilitative Medizin, Klinikum Burgenlandkreis GmbH, Naumburg, Germany
| | - C Heiß
- Klinik für Unfallchirurgie, Universitätsklinikum Gießen-Marburg, Marburg, Germany
| | - W Kenn
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - M Jäger
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Essen-Duisburg, Essen, Germany
| | - U Maus
- Klinik für Orthopädie und orthopädische Chirurgie, Universitätsklinik für Orthopädie und Unfallchirurgie, Pius-Hospital, Oldenburg, Germany
| | - U Nöth
- Klinik für Orthopädie und Unfallchirurgie, Evangelisches Waldkrankenhaus Spandau, Berlin, Germany
| | - K M Peters
- Orthopädie und Osteologie, Dr. Becker Rhein-Sieg-Klinik, Nümbrecht, Germany
| | - C Rader
- Praxisklinik Orthopädie Aachen, Franziskushospital Aachen, Aachen, Germany
| | - S Reppenhagen
- Orthopädische Klinik König-Ludwig-Haus, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - U Smolenski
- Institut für Physiotherapie, Friedrich-Schiller Universität Jena, Jena, Germany
| | - M Tingart
- Klinik für Orthopädie, Universitätsklinikum Aachen, Aachen, Germany
| | - I Kopp
- AWMF-Institut, Philipps-Universität Marburg, Marburg, Germany
| | - I Sirotin
- Pirogov-Universität Moskau, 64. Städtisches Krankenhaus, Moscow, Russia
| | - S J Breusch
- FRCS Ed, Orthopaedic Department, Edinburgh Royal Infirmary, Edinburgh, UK
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Review of various treatment options and potential therapies for osteonecrosis of the femoral head. J Orthop Translat 2015; 4:57-70. [PMID: 30035066 PMCID: PMC5987013 DOI: 10.1016/j.jot.2015.09.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 09/05/2015] [Accepted: 09/21/2015] [Indexed: 12/20/2022] Open
Abstract
Size and location of the lesion, subchondral collapse occurrence, and articular cartilage involvement are general disease progression criteria for direct osteonecrosis of the femoral head (ONFH) classifications. Treatment options for ONFH are usually based on individual factors and lesion characteristics. Although spontaneous repair of ONFH occurs in some cases, untreated ONFH is unlikely to escape the fate of subchondral collapse and usually ends up with total hip arthroplasty. Operations to preserve the femoral head, e.g., core decompression and bone grafting, are usually recommended in younger patients. They are helpful to relieve pain and improve function in the affected femoral head without subchondral collapse, however, poor prognosis after surgical procedures remains the major problem for ONFH. Pharmacological and physical therapies only work in the early stage of ONFH and have also been recommended as a supplement or prevention treatment for osteonecrosis. Following advances in basic science, many new insights focus on bone tissue engineering to optimize therapies and facilitate prognosis of ONFH. In this review, disease classifications, current treatment options, potential therapies, and the relevant translational barriers are reviewed in the context of clinical application and preclinical exploration, which would provide guidance for preferable treatment options and translation into novel therapies.
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21
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Single-pulsed electromagnetic field therapy increases osteogenic differentiation through Wnt signaling pathway and sclerostin downregulation. Bioelectromagnetics 2015; 36:494-505. [DOI: 10.1002/bem.21933] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 07/15/2015] [Indexed: 01/20/2023]
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Albers A, Carli A, Routy B, Harvey EJ, Séguin C. Treatment with acetylsalicylic acid prevents short to mid-term radiographic progression of nontraumatic osteonecrosis of the femoral head: a pilot study. Can J Surg 2015; 58:198-205. [PMID: 26011853 DOI: 10.1503/cjs.016814] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Nontraumatic osteonecrosis of the femoral head (ONFH) is a progressive disease in young adults producing substantial morbidity and frequently resulting in total hip arthroplasty. Although hip-preserving surgical procedures represent the current mainstay of treatment for early disease, medical therapies targeting specific pathways in the ONFH pathogenesis could help prevent disease progression while producing less morbidity. Acetylsalicylic acid (ASA) is a promising alternative to other therapies for ONFH owing to its anti-inflammatory and antithrombotic mechanisms of action and its relatively benign side effect profile. METHODS We followed a prospective cohort of 10 patients (12 hips) with precollapse ONFH who were given ASA to prevent disease progression. Their outcomes were compared with those of a historic control group taken from the literature. RESULTS Progression occurred in 1 of 12 (8%) patients taking ASA compared with 30 of 45 (66.6%) controls (p = 0.002) at a mean follow-up of 3.7 years. Patients taking ASA also tended to exhibit decreased femoral head involvement at the end of therapy. CONCLUSION This hypothesis-generating study leads us to believe that ASA may be a simple and effective treatment option for delaying disease progression in patients with early-stage ONFH.
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Affiliation(s)
- Anthony Albers
- The Department of Surgery, Division of Orthopaedic Surgery, McGill University Health Centre, Montreal General Hospital, Montréal, Que
| | - Alberto Carli
- The Department of Surgery, Division of Orthopaedic Surgery, McGill University Health Centre, Montreal General Hospital, Montréal, Que
| | - Bertrand Routy
- The Department of Medicine, Divisions of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ont
| | - Edward J Harvey
- The Department of Surgery, Division of Orthopaedic Surgery, McGill University Health Centre, Montreal General Hospital, Montréal, Que
| | - Chantal Séguin
- The Department of Medicine, Division of Haematology and Oncology, McGill University Health Centre, Montreal General Hospital, Montréal, Que
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Bilge O, Doral MN, Yel M, Karalezli N, Miniaci A. Treatment of osteonecrosis of the femoral head with focal anatomic-resurfacing implantation (HemiCAP): preliminary results of an alternative option. J Orthop Surg Res 2015; 10:56. [PMID: 25924980 PMCID: PMC4423414 DOI: 10.1186/s13018-015-0199-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/15/2015] [Indexed: 12/21/2022] Open
Abstract
Background The optimal treatment of osteonecrosis of the femoral head has not been established yet. The aim of this study was to report preliminary clinical results of focal anatomic-resurfacing implantation for the treatment of osteonecrosis of the femoral head. Methods Five patients (four male, one female) with seven surgical procedures, ages between 37 and 52 with an average age of 45.2 (+/− 7.2), diagnosed as femoral head avascular necrosis and who were unresponsive to conservative management or had failed previous surgical treatments were treated with a focal anatomic femoral head resurfacing between the years 2011–2012 and were retrospectively reviewed. Five patients with at least two years of follow-up, one left hip, two right hips, and two patients with bilateral hip surgery were included in this review. After safe surgical dislocation of the hip, full exposure of the femoral head was established. A focal-resurfacing implant matching patient anatomy and femoral head curvature was performed accordingly. Neither intraoperative or postoperative complications nor revision ensued. Visual analogue scores and Harris Hip Scores were recorded both preoperatively and at postoperative 2 years for all seven surgeries. Results The mean follow-up period was 26.6 +/− 3.8 months, with a range between 24–33 months. The mean visual analogue scores were 8.9 +/− 0.9 preoperatively and 2.3 +/− 1.0 postoperatively at year two (p = 0.017). Harris Hip Scores at postoperative follow-up were found to improve significantly from good to excellent scores (86.0 +/− 7.9), compared with preoperative poor scores (26.7 +/− 11.8) (p = 0.018). The clinical improvements in visual analogue scores (VAS) and Harris Hip Scores were also found to correlate with each other (p < 0.05). Conclusions In the present study, the alternative technique of focal anatomic hip resurfacing with HemiCAP® yielded preliminary successful results for the treatment of osteonecrosis of the femoral head. To the best of our knowledge, this is the first case series in the literature, reporting functional clinical results with the use of a focal anatomic-resurfacing implant for the treatment of focal femoral head osteonecrosis.
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Affiliation(s)
- Onur Bilge
- Department of Orthopaedics and Traumatology, Konya Necmettin Erbakan University, Meram Faculty of Medicine, Meram, 42080, Konya, Turkey.
| | - Mahmut Nedim Doral
- Department of Orthopaedics and Traumatology, Hacettepe University, Faculty of Medicine, 06230, Ankara, Turkey.
| | - Mustafa Yel
- Department of Orthopaedics and Traumatology, Konya Necmettin Erbakan University, Meram Faculty of Medicine, Meram, 42080, Konya, Turkey.
| | - Nazim Karalezli
- Department of Orthopaedics and Traumatology, Konya Necmettin Erbakan University, Meram Faculty of Medicine, Meram, 42080, Konya, Turkey.
| | - Anthony Miniaci
- Cleveland Clinic Sports Health Center, 5555 Transportation Blvd, Garfield Heights, Ohio, 44125, USA.
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Gurion R, Tangpricha V, Yow E, Schanberg LE, McComsey GA, Robinson AB. Avascular necrosis in pediatric systemic lupus erythematosus: a brief report and review of the literature. Pediatr Rheumatol Online J 2015; 13:13. [PMID: 25902709 PMCID: PMC4415214 DOI: 10.1186/s12969-015-0008-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 04/08/2015] [Indexed: 01/21/2023] Open
Abstract
UNLABELLED Avascular necrosis (AVN) occurs in several chronic illnesses, including systemic lupus erythematosus (SLE), but can also occur in healthy children. There are multiple theories to explain why and how AVN occurs, but an exact mechanism has yet to be unraveled. AVN in the pediatric lupus population is understudied. The Atherosclerosis Prevention in Pediatric Lupus Erythematosus (APPLE) trial, provides an excellent venue to conduct an exploratory analysis to assess associations between AVN and demographics, SLE disease activity and vitamin D deficiency. Herein we present a brief report describing our findings, as well as reviewing the literature on AVN in SLE and other entities. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00065806.
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Affiliation(s)
- Reut Gurion
- Division of Pediatric Infectious Diseases, Rheumatology and Global Health, Department of Pediatrics, Rainbow Babies and Children's Hospital/Case Medical Center, Cleveland, OH, USA.
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA. .,Atlanta VA Medical Center, Decatur, Georgia, USA.
| | - Eric Yow
- Duke Clinical Research Institute, Durham, North Carolina, USA.
| | - Laura E Schanberg
- Division of Pediatric Rheumatology, Duke University Medical Center, Durham, NC, 27710, USA.
| | - Grace A McComsey
- Division of Pediatric Infectious Diseases, Rheumatology and Global Health, Department of Pediatrics, Rainbow Babies and Children's Hospital/Case Medical Center, Cleveland, OH, USA. .,Division of Medicine, University Hospital Case Medical Center, 1100 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Angela Byun Robinson
- Division of Pediatric Infectious Diseases, Rheumatology and Global Health, Department of Pediatrics, Rainbow Babies and Children's Hospital/Case Medical Center, Cleveland, OH, USA.
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Ikegami A, Ueshima K, Saito M, Ikoma K, Fujioka M, Hayashi S, Ishida M, Fujiwara H, Mazda O, Kubo T. Femoral perfusion after pulsed electromagnetic field stimulation in a steroid-induced osteonecrosis model. Bioelectromagnetics 2015; 36:349-57. [PMID: 25808585 DOI: 10.1002/bem.21910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 02/22/2015] [Indexed: 11/07/2022]
Abstract
This study was designed to evaluate femoral perfusion after pulsed electromagnetic field (PEMF) stimulation in a steroid-induced osteonecrosis rabbit model by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Steroid-induced osteonecrosis was produced by single intramuscular injection of methylprednisolone in 15 rabbits. Eight rabbits underwent PEMF stimulation (PEMF group) and seven did not (control group). DCE-MRI was performed before PEMF stimulation, immediately before steroid administration, and 1, 5, 10, and 14 days after steroid administration. Regions of interest were set in the bilateral proximal femora. Enhancement ratio (ER), initial slope (IS), and area under the curve (AUC) were analyzed. ER, IS, and AUC in the control group significantly decreased after steroid administration compared with before administration (P<0.05). In PEMF group, IS significantly decreased; however, ER and AUC showed no significant differences after steroid administration compared with before. ER and IS in PEMF group were higher than in control group until 10th day, and AUC was higher until 5th day after steroid administration (P<0.05). PEMF stimulation restrains the decrease in blood flow after steroid administration.
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Affiliation(s)
- Akira Ikegami
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichiro Ueshima
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masazumi Saito
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuya Ikoma
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mikihiro Fujioka
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shigeki Hayashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masashi Ishida
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroyoshi Fujiwara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osam Mazda
- Department of Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshikazu Kubo
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Koren L, Ginesin E, Melamed Y, Norman D, Levin D, Peled E. Hyperbaric oxygen for stage I and II femoral head osteonecrosis. Orthopedics 2015; 38:e200-5. [PMID: 25760507 DOI: 10.3928/01477447-20150305-57] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 05/13/2014] [Indexed: 02/03/2023]
Abstract
Hyperbaric oxygen therapy is a suggested joint-preserving treatment for symptomatic early-stage osteonecrosis of the femoral head. Limited studies of this treatment have been published. The goal of this study was to evaluate the effectiveness of this treatment in a relatively large patient cohort. The authors reviewed the files of 68 patients with 78 symptomatic joints with Steinberg stage I and II osteonecrosis of the femoral head. All patients were treated with hyperbaric oxygen at the authors' medical health center. Pretreatment and immediate posttreatment magnetic resonance imaging (MRI) findings were compared. On follow-up, a telephone interview was conducted to determine the survival of the joint. Modified Harris Hip Score and Short Form 12 health survey (SF-12) questionnaires of the start of treatment and at follow-up were obtained and evaluated for statistically significant differences. Half of the joints were stage 1 and half were stage II. Seventy-four joints underwent both pre- and posttreatment MRI. Eighty-eight percent of joints showed improvement posttreatment. On follow-up at a mean of 11.1±5.1 years, 54 patients (58 joints) were located and answered the questionnaires. At the time of follow-up, 93% of the joints survived. Mean Harris Hip Score improved from 21 to 81 (P<.0001), the mean physical component of the SF-12 improved from 24 to 46 (P<.0001), and the mean mental component of the SF-12 improved from 54 to 59 (P<.0001). The authors concluded that hyperbaric oxygen treatment is effective in preserving the hip joint in stage I and II osteonecrosis of the femoral head.
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Abstract
Osteonecrosis of femoral head (ONFH) is a disabling condition of young individuals with ill-defined etiology and pathogenesis. Remains untreated, about 70-80% of the patients progress to secondary hip arthritis. Both operative and nonoperative treatments have been described with variable success rate. Early diagnosis and treatment is the key for success in preserving the hip joint. Once femoral head collapses (>2 mm) or if there is secondary degeneration, hip conservation procedures become ineffective and arthroplasty remains the only better option. We reviewed 157 studies that evaluate different treatment modalities of ONFH and then a final consensus on treatment was made.
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Affiliation(s)
- Sujit Kumar Tripathy
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
- Address for correspondence: Dr. Sujit Kumar Tripathy, Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar - 751 019, Odisha, India. E-mail:
| | - Tarun Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ramesh Kumar Sen
- Department of Orthopedics, Fortis Hospital, Mohali, Punjab, India
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Ehmke TA, Cherian JJ, Wu ES, Jauregui JJ, Banerjee S, Mont MA. Treatment of Osteonecrosis in Systemic Lupus Erythematosus: A Review. Curr Rheumatol Rep 2014; 16:441. [DOI: 10.1007/s11926-014-0441-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Windisch C, Kolb W, Röhner E, Wagner M, Roth A, Matziolis G, Wagner A. Invasive electromagnetic field treatment in osteonecrosis of the femoral head: a prospective cohort study. Open Orthop J 2014; 8:125-9. [PMID: 24987486 PMCID: PMC4076618 DOI: 10.2174/1874325020140515001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 04/27/2014] [Accepted: 05/10/2014] [Indexed: 11/22/2022] Open
Abstract
Introduction : The purpose of this prospective cohort study was to compare the surgical treatment of non-ONFH in adulthood by curettage and bone grafting with treatment by curettage and bone grafting in combination with invasive electromagnetic field treatment using Magnetodyn®. This was assessed by examining whether electromagnetic field treatment has a positive additive effect on the clinical parameters modified Harris Hip Score according to Haddad, Cook and Brinker, Merle d'Aubigné hip score and visual analogue scale, and on the subsequent need for treatment by total hip arthroplasty. Materials and Methodology : The prospective, non-randomised study included 35 patients with unilateral or bilateral osteonecrosis of the femoral head. These were divided into two groups according to the surgical treatment regime and assessed over a 12-month follow-up period. The study group (Group 1) comprised 19 patients (14 men and 5 women) with a total of 22 non-ONFH, who underwent minimally invasive curettage, bone grafting and electromagnetic field treatment (Magnetodyn®) by implantation of a bipolar induction screw. The control group (Group 2) comprised 16 patients (12 men and 4 women) with a total of 18 non-ONFH, who underwent minimally invasive curettage and bone grafting without Magnetodyn® therapy. At the initial pre-operative examination and the 6 and 12-month follow-up, all patients were assessed by clinical examination and radiological monitoring, and by bilateral hip MRI. The clinical evaluation was based on the modified Harris Hip Score according to Haddad, Cook and Brinker, the Merle d`Aubigné hip score and the visual analogue scale (VAS). Results : At the time of follow-up, total hip arthroplasty (THA) had been performed in four patients in Group 1 (18%). In Group 2, four patients (22%) had received a THA (n.s.). Both procedures led to an improvement in the clinical scores (Harris Hip Score, Merle d`Aubigné score and VAS), although no significant difference was observed. Conclusion : The authors conclude that electromagnetic field treatment with Magnetodyn®, using the special signal protocol applied here, as an adjunct to curettage and autologous bone grafting to treat non-ONFH, does not produce better clinical results and does not offer better prophylaxis for the avoidance of total hip arthroplasty over all ARCO stages.
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Affiliation(s)
- C Windisch
- Department of Orthopaedic Surgery, Friedrich-Schiller-University Jena at Rudolf-Elle-Hospital Eisenberg, Klosterlausnitzer Str. 81, Eisenberg, Germany
| | - W Kolb
- Department of Trauma and Orthopaedic Surgery, Bethesda Hospital, Stuttgart, Germany
| | - E Röhner
- Department of Orthopaedic Surgery, Friedrich-Schiller-University Jena at Rudolf-Elle-Hospital Eisenberg, Klosterlausnitzer Str. 81, Eisenberg, Germany
| | - M Wagner
- Department of Orthopaedic Surgery, Friedrich-Schiller-University Jena at Rudolf-Elle-Hospital Eisenberg, Klosterlausnitzer Str. 81, Eisenberg, Germany
| | - A Roth
- Department of Orthopaedic Surgery, Friedrich-Schiller-University Jena at Rudolf-Elle-Hospital Eisenberg, Klosterlausnitzer Str. 81, Eisenberg, Germany
| | - G Matziolis
- Department of Orthopaedic Surgery, Friedrich-Schiller-University Jena at Rudolf-Elle-Hospital Eisenberg, Klosterlausnitzer Str. 81, Eisenberg, Germany
| | - A Wagner
- Department of Orthopaedic Surgery, Friedrich-Schiller-University Jena at Rudolf-Elle-Hospital Eisenberg, Klosterlausnitzer Str. 81, Eisenberg, Germany
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Fu YC, Lin CC, Chang JK, Chen CH, Tai IC, Wang GJ, Ho ML. A novel single pulsed electromagnetic field stimulates osteogenesis of bone marrow mesenchymal stem cells and bone repair. PLoS One 2014; 9:e91581. [PMID: 24632682 PMCID: PMC3954729 DOI: 10.1371/journal.pone.0091581] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 02/12/2014] [Indexed: 11/28/2022] Open
Abstract
Pulsed electromagnetic field (PEMF) has been successfully applied to accelerate fracture repair since 1979. Recent studies suggest that PEMF might be used as a nonoperative treatment for the early stages of osteonecrosis. However, PEMF treatment requires a minimum of ten hours per day for the duration of the treatment. In this study, we modified the protocol of the single-pulsed electromagnetic field (SPEMF) that only requires a 3-minute daily treatment. In the in vitro study, cell proliferation and osteogenic differentiation was evaluated in the hBMSCs. In the in vivo study, new bone formation and revascularization were evaluated in the necrotic bone graft. Results from the in vitro study showed no significant cytotoxic effects on the hBMSCs after 5 days of SPEMF treatment (1 Tesla, 30 pulses per day). hBMSC proliferation was enhanced in the SPEMF-treated groups after 2 and 4 days of treatment. The osteogenic differentiation of hBMSCs was significantly increased in the SPEMF-treated groups after 3–7 days of treatment. Mineralization also increased after 10, 15, 20, and 25 days of treatment in SPEMF-treated groups compared to the control group. The 7-day short-course treatment achieved similar effects on proliferation and osteogenesis as the 25-day treatment. Results from the in vivo study also demonstrated that both the 7-day and 25-day treatments of SPEMF increased callus formation around the necrotic bone and also increased new vessel formation and osteocyte numbers in the grafted necrotic bone at the 2nd and 4th weeks after surgery. In conclusion, the newly developed SPEMF accelerates osteogenic differentiation of cultured hBMSCs and enhances bone repair, neo-vascularization, and cell growth in necrotic bone in mice. The potential clinical advantage of the SPEMF is the short daily application and the shorter treatment course. We suggest that SPEMF may be used to treat fractures and the early stages of osteonecrosis.
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Affiliation(s)
- Yin-Chih Fu
- Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Orthopaedics, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Orthopaedics, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Chun Lin
- Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Physiology, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Je-Ken Chang
- Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Orthopaedics, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Hwan Chen
- Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Orthopaedics, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Chun Tai
- Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Physiology, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Gwo-Jaw Wang
- Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Orthopaedics, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Ling Ho
- Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Orthopaedics, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Physiology, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail:
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Li JP, Chen S, Peng H, Zhou JL, Fang HS. Pulsed electromagnetic fields protect the balance between adipogenesis and osteogenesis on steroid-induced osteonecrosis of femoral head at the pre-collapse stage in rats. Bioelectromagnetics 2014; 35:170-80. [PMID: 24421074 DOI: 10.1002/bem.21833] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 11/08/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Jian-Ping Li
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People's Republic of, China
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Shigemura T, Nakamura J, Shimizu K, Iida S, Oinuma K, Kishida S, Ohtori S, Takahashi K. Articular collapse and surgical frequency in corticosteroid-associated osteonecrosis of the femoral head and the knee: an MRI-based prospective study. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s12570-013-0216-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ellenrieder M, Tischer T, Kreuz P, Fröhlich S, Fritsche A, Mittelmeier W. Arthroskopisch gestützte Behandlung der aseptischen Hüftkopfnekrose. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2013; 25:85-94. [DOI: 10.1007/s00064-011-0072-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Marcheggiani Muccioli GM, Grassi A, Setti S, Filardo G, Zambelli L, Bonanzinga T, Rimondi E, Busacca M, Zaffagnini S. Conservative treatment of spontaneous osteonecrosis of the knee in the early stage: pulsed electromagnetic fields therapy. Eur J Radiol 2012; 82:530-7. [PMID: 23219192 DOI: 10.1016/j.ejrad.2012.11.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 11/05/2012] [Accepted: 11/08/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND HYPOTHESIS pulsed electromagnetic fields treatment might improve symptoms in the early stage of spontaneous osteonecrosis of the knee. METHODS Twenty-eight patients (19M/9F, age 49.8±16.4 years) suffering from symptomatic (pain) Koshino stage I spontaneous osteonecrosis of the knee, confirmed by magnetic resonance imaging (MRI) were treated with local pulsed electromagnetic fields therapy (6 h daily for 90 days). Clinical evaluation: baseline, 6- and 24-month follow-up by VAS for pain, knee society score (KSS), Tegner and EQ-5D scales. MRI evaluation: baseline and 6-month follow-up, measuring bone marrow lesion's areas and grading these lesions by WORMS score. Failures: patients undergoing knee arthroplasty. RESULTS Pain significantly reduced at 6 months (from 73.2±20.7 to 29.6±21.3, p<0.0001), which remained almost unchanged at final follow-up (27.0±25.1). KSS significantly increased in first 6 months (from 34.0±13.3 to 76.1±15.9, p<0.0001) and was slightly reduced at final follow-up (72.5±13.5, p=0.0044). Tegner median level increased from baseline to 6-month follow-up (1(1-1) and 3(3-4), respectively, p<0.0001) and remained stable. EQ-5D improved significantly throughout the 24 months (0.32±0.33, baseline; 0.74±0.23, 6-month follow-up (p<0.0001); 0.86±0.15, 24-month follow-up (p=0.0071)). MRI evaluation: significant reduction of total WORMS mean score (p<0.0001) and mean femoral bone marrow lesion's area (p<0.05). This area reduction was present in 85% and was correlated to WORMS grading both for femur, tibia and total joint (p<0.05). Four failures (14.3%) at 24-month follow-up. CONCLUSIONS Pulsed electromagnetic fields stimulation significantly reduced knee pain and necrosis area in Koshino stage I spontaneous osteonecrosis of the knee already in the first 6 months, preserving 86% of knees from prosthetic surgery at 24-month follow-up. No correlation was found between MRI and clinical scores. LEVEL OF EVIDENCE Level IV; case series.
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Affiliation(s)
- G M Marcheggiani Muccioli
- Isituto Ortopedico Rizzoli, University of Bologna, III Orthopaedic and Traumatologic Clinic and Biomechanics Laboratory Via di Barbiano, 1/10, 40136 Bologna (BO), Italy.
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Ballas SK, Kesen MR, Goldberg MF, Lutty GA, Dampier C, Osunkwo I, Wang WC, Hoppe C, Hagar W, Darbari DS, Malik P. Beyond the definitions of the phenotypic complications of sickle cell disease: an update on management. ScientificWorldJournal 2012; 2012:949535. [PMID: 22924029 PMCID: PMC3415156 DOI: 10.1100/2012/949535] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 04/01/2012] [Indexed: 12/25/2022] Open
Abstract
The sickle hemoglobin is an abnormal hemoglobin due to point mutation (GAG → GTG) in exon 1 of the β globin gene resulting in the substitution of glutamic acid by valine at position 6 of the β globin polypeptide chain. Although the molecular lesion is a single-point mutation, the sickle gene is pleiotropic in nature causing multiple phenotypic expressions that constitute the various complications of sickle cell disease in general and sickle cell anemia in particular. The disease itself is chronic in nature but many of its complications are acute such as the recurrent acute painful crises (its hallmark), acute chest syndrome, and priapism. These complications vary considerably among patients, in the same patient with time, among countries and with age and sex. To date, there is no well-established consensus among providers on the management of the complications of sickle cell disease due in part to lack of evidence and in part to differences in the experience of providers. It is the aim of this paper to review available current approaches to manage the major complications of sickle cell disease. We hope that this will establish another preliminary forum among providers that may eventually lead the way to better outcomes.
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Affiliation(s)
- Samir K Ballas
- Cardeza Foundation and Department of Medicine, Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA 19107, USA.
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Vulpiani MC, Vetrano M, Trischitta D, Scarcello L, Chizzi F, Argento G, Saraceni VM, Maffulli N, Ferretti A. Extracorporeal shock wave therapy in early osteonecrosis of the femoral head: prospective clinical study with long-term follow-up. Arch Orthop Trauma Surg 2012; 132:499-508. [PMID: 22228278 DOI: 10.1007/s00402-011-1444-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Extracorporeal shock wave therapy (ESWT) may exert beneficial effects in avascular necrosis of femoral head (AVNFH). PATIENTS The current study evaluated the effectiveness of ESWT in reducing pain and in slowing down the progression of bone damage in 36 patients with unilateral AVNFH of stage Association Research Circulation Osseous (ARCO) I, II and III. At the beginning of the study, 10 hips were classified as stage I, 11 as stage II and 15 as stage III. Each treatment cycle included four sessions, with 2,400 impulses each administered at 0.50 mJ/mm(2), at 48-72 h intervals. Follow-up examinations were scheduled at 3, 6, 12 and then 24 months. METHOD Clinical assessments included assessment of pain scores, Harris Hip Scores and Roles and Maudsley score. Plain radiographs and magnetic resonances of the hip were used to evaluate the size of the lesion, the extent of collapse of subchondral bone, and degenerative changes of the hip joint. RESULTS Patients from ARCO stage I group and stage II group achieved significantly better results than patients from ARCO stage III group at all follow-up time points (p < 0.005). During the follow-up period, 10 of the 15 stage III ARCO patients received an arthroplasty. ARCO stages I and II lesions were unchanged on radiographs and on magnetic resonance images. CONCLUSION ESWT in ARCO stages I and II may help to prevent progression of the area of avascular necrosis and manage pain.
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Affiliation(s)
- Maria Chiara Vulpiani
- Physical Medicine and Rehabilitation Unit, Sapienza University School of Medicine, Sant'Andrea Hospital, Rome, Italy.
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Solarino G, Piazzolla A, Notarnicola A, Moretti L, Tafuri S, De Giorgi S, Moretti B. Long-term results of 32-mm alumina-on-alumina THA for avascular necrosis of the femoral head. J Orthop Traumatol 2012; 13:21-7. [PMID: 22249776 PMCID: PMC3284675 DOI: 10.1007/s10195-011-0174-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 12/04/2011] [Indexed: 11/17/2022] Open
Abstract
Background Ceramic bearings in total hip arthroplasty (THA) have been introduced in clinical practice to minimize the problem of polyethylene particle–induced osteolysis. The aim of the study is to report the results of 68 consecutive alumina-on-alumina THAs done in 61 patients for avascular necrosis (AVN) of the femoral head. Materials and methods In all implants a press-fit cup was used; it was combined with a 32-mm alumina head and with titanium-alloy stems. The mean age at surgery was 50 years. At an average follow-up of 13 years two hips have been revised, one for periprosthetic infection and one for excessive abduction of the cup. Results No revision for aseptic loosening is recorded; one anatomical cementless femoral stem had radiological evidence of definite aseptic loosening. No dislocations occurred, and no osteolysis was observed. Conclusions The results support the application of alumina-alumina THA for long-lasting replacements.
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Affiliation(s)
- Giuseppe Solarino
- Department of Neuroscience and Sense Organs, Orthopaedic and Traumatology Unit, Faculty of Medicine and Surgery, General Hospital, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
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Ding S, Peng H, Fang HS, Zhou JL, Wang Z. Pulsed electromagnetic fields stimulation prevents steroid-induced osteonecrosis in rats. BMC Musculoskelet Disord 2011; 12:215. [PMID: 21958301 PMCID: PMC3192716 DOI: 10.1186/1471-2474-12-215] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 09/29/2011] [Indexed: 11/18/2022] Open
Abstract
Background Pulsed electromagnetic fields (PEMF) stimulation has been used successfully to treat nonunion fractures and femoral head osteonecrosis, but relatively little is known about its effects on preventing steroid-induced osteonecrosis. The purpose of the study was to investigate the effects of PEMF stimulation on the prevention of steroid-induced osteonecrosis in rats and explore the underlying mechanisms. Methods Seventy-two male adult Wistar rats were divided into three groups and treated as follows. (1) PEMF stimulation group (PEMF group, n = 24): intravenously injected with lipopolysaccharide (LPS, 10 μg/kg) on day 0 and intramuscularly injected with methylprednisolone acetate (MPSL, 20 mg/kg) on days 1, 2 and 3, then subjected to PEMF stimulation 4 h per day for 1 to 8 weeks. (2) Methylprednisolone-treated group (MPSL group, n = 24): injected the same dose of LPS and MPSL as the PEMF group but without exposure to PEMF. (3) Control group (PS group, n = 24): injected 0.9% saline in the same mode at the same time points. The incidence of osteonecrosis, serum lipid levels and the mRNA and protein expression of transforming growth factor β1 (TGF-β1) in the proximal femur were measured 1, 2, 4 and 8 weeks after the last MPSL (or saline) injection. Results The incidence of osteonecrosis in the PEMF group (29%) was significantly lower than that observed in the MPSL group (75%), while no osteonecrosis was observed in the PS group. The serum lipid levels were significantly lower in the PEMF and PS groups than in the MPSL group. Compared with the MPSL and PS groups, the mRNA expression of TGF-β1 increased, reaching a peak 1 week after PEMF treatment, and remained high for 4 weeks, then declined at 8 weeks, whereas the protein expression of TGF-β1 increased, reaching a peak at 2 weeks after PEMF treatment, and remained high for 8 weeks. Conclusions PEMF stimulation can prevent steroid-induced osteonecrosis in rats, and the underlying mechanisms involve decreased serum lipid levels and increased expression of TGF-β1.
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Affiliation(s)
- Shuai Ding
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People's Republic of China
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Aimaiti A, Wufuer M, Wang YH, Saiyiti M, Cui L, Yusufu A. Can bisphenol A diglycidyl ether (BADGE) administration prevent steroid-induced femoral head osteonecrosis in the early stage? Med Hypotheses 2011; 77:282-5. [PMID: 21620573 DOI: 10.1016/j.mehy.2011.04.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 04/13/2011] [Accepted: 04/28/2011] [Indexed: 12/01/2022]
Abstract
Steroid-induced osteonecrosis of the femoral head (ONFH) is associated with increase of intraosseous pressure caused by elevating of adipogenesis and fat cell hypertrophy in the bone marrow, which subsequently decreases the blood flow in the femoral head and finally resulting in bone ischemia. The early femoral head-preserving method has mainly focused on the conventional core decompression procedure. However, it only achieves a slight decrease in intra-medullary pressure with limited clinical outcome. The crucial point in prevention is to achieve a thorough decompression of intra-medullary pressure and improvement of microcirculation of the femoral head. Bisphenol-A-diglycidyl ether (BADGE), an antagonism of PPAR-γ(Peroxisome proliferator-activated receptor gamma), has been shown to successfully reverse bone marrow adipogenesis and fat cell hypertrophy, enhances proliferation of osteoblasts, inhibit osteoclastogenesis. Therefore, we hypothesized that BADGE administration may be an appropriate novel method for the prevention of early stage steroid-induced ONFH.
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Affiliation(s)
- Abudusaimi Aimaiti
- Department of Micro-Reconstructive Surgery, The First Teaching Hospital of Xinjiang Medical University, Urumqi 830054, PR China
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Zhang D, Pan X, Ohno S, Osuga T, Sawada S, Sato K. No effects of pulsed electromagnetic fields on expression of cell adhesion molecules (integrin, CD44) and matrix metalloproteinase-2/9 in osteosarcoma cell lines. Bioelectromagnetics 2011; 32:463-73. [DOI: 10.1002/bem.20647] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 12/20/2010] [Indexed: 11/09/2022]
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Yan SG, Huang LY, Cai XZ. Low-intensity pulsed ultrasound: A potential non-invasive therapy for femoral head osteonecrosis. Med Hypotheses 2011; 76:4-7. [DOI: 10.1016/j.mehy.2010.08.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 07/29/2010] [Accepted: 08/12/2010] [Indexed: 11/17/2022]
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Mayer-Wagner S, Passberger A, Sievers B, Aigner J, Summer B, Schiergens TS, Jansson V, Müller PE. Effects of low frequency electromagnetic fields on the chondrogenic differentiation of human mesenchymal stem cells. Bioelectromagnetics 2010; 32:283-90. [PMID: 21452358 DOI: 10.1002/bem.20633] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Accepted: 11/01/2010] [Indexed: 01/20/2023]
Abstract
Electromagnetic fields (EMF) have been shown to exert beneficial effects on cartilage tissue. Nowadays, differentiated human mesenchymal stem cells (hMSCs) are discussed as an alternative approach for cartilage repair. Therefore, the aim of this study was to examine the impact of EMF on hMSCs during chondrogenic differentiation. HMSCs at cell passages five and six were differentiated in pellet cultures in vitro under the addition of human fibroblast growth factor 2 (FGF-2) and human transforming growth factor-β(3) (TGF-β(3) ). Cultures were exposed to homogeneous sinusoidal extremely low-frequency magnetic fields (5 mT) produced by a solenoid or were kept in a control system. After 3 weeks of culture, chondrogenesis was assessed by toluidine blue and safranin-O staining, immunohistochemistry, quantitative real-time polymerase chain reaction (PCR) for cartilage-specific proteins, and a DMMB dye-binding assay for glycosaminoglycans. Under EMF, hMSCs showed a significant increase in collagen type II expression at passage 6. Aggrecan and SOX9 expression did not change significantly after EMF exposure. Collagen type X expression decreased under electromagnetic stimulation. Pellet cultures at passage 5 that had been treated with EMF provided a higher glycosaminoglycan (GAG)/DNA content than cultures that had not been exposed to EMF. Chondrogenic differentiation of hMSCs may be improved by EMF regarding collagen type II expression and GAG content of cultures. EMF might be a way to stimulate and maintain chondrogenesis of hMSCs and, therefore, provide a new step in regenerative medicine regarding tissue engineering of cartilage.
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Affiliation(s)
- Susanne Mayer-Wagner
- Department of Orthopaedic Surgery, Campus Großhadern, Ludwig-Maximilians-University, Munich, Germany.
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Sollazzo V, Palmieri A, Pezzetti F, Massari L, Carinci F. Effects of pulsed electromagnetic fields on human osteoblastlike cells (MG-63): a pilot study. Clin Orthop Relat Res 2010; 468:2260-77. [PMID: 20387020 PMCID: PMC2895828 DOI: 10.1007/s11999-010-1341-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 03/25/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although pulsed electromagnetic fields (PEMFs) are used to treat delayed unions and nonunions, their mechanisms of action are not completely clear. However, PEMFs are known to affect the expression of certain genes. QUESTIONS/PURPOSES We asked (1) whether PEMFs affect gene expression in human osteoblastlike cells (MG63) in vitro, and (2) whether and to what extent stimulation by PEMFs induce cell proliferation and differentiation in MG-63 cultures. METHODS We cultured two groups of MG63 cells. One group was treated with PEMFs for 18 hours whereas the second was maintained in the same culture condition without PEMFs (control). Gene expression was evaluated throughout cDNA microarray analysis containing 19,000 genes spanning a substantial fraction of the human genome. RESULTS PEMFs induced the upregulation of important genes related to bone formation (HOXA10, AKT1), genes at the transductional level (CALM1, P2RX7), genes for cytoskeletal components (FN1, VCL), and collagenous (COL1A2) and noncollagenous (SPARC) matrix components. However, PEMF induced downregulation of genes related to the degradation of extracellular matrix (MMP-11, DUSP4). CONCLUSIONS AND CLINICAL RELEVANCE PEMFs appear to induce cell proliferation and differentiation. Furthermore, PEMFs promote extracellular matrix production and mineralization while decreasing matrix degradation and absorption. Our data suggest specific mechanisms of the observed clinical effect of PEMFs, and thus specific approaches for use in regenerative medicine.
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Affiliation(s)
- Vincenzo Sollazzo
- Istituto di Clinica Ortopedica Università di Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy
| | - Annalisa Palmieri
- Istituto di Chirurgia Maxillo Facciale Università di Ferrara, Ferrara, Italy
| | - Furio Pezzetti
- Istituto di Istologia ed Embriologia Generale Università di Bologna, Bologna, Italy
| | - Leo Massari
- Istituto di Clinica Ortopedica Università di Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy
| | - Francesco Carinci
- Istituto di Chirurgia Maxillo Facciale Università di Ferrara, Ferrara, Italy
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The use of extracorporeal shock waves in the treatment of osteonecrosis of the femoral head: a systematic review. Clin Rheumatol 2009; 28:1247-51. [PMID: 19609482 DOI: 10.1007/s10067-009-1231-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Accepted: 07/07/2009] [Indexed: 12/22/2022]
Abstract
Osteonecrosis is a progressive clinical condition with significant morbidity, which primarily affects weight-bearing joints and is characterized by the death of the bone, or part of it, because of insufficient circulation. The hip is the most common compromised joint. In osteonecrosis of the femoral head (ONFH), the collapse of the femoral head is a result of mechanically weak bone submitted to a load of weight, and can be associated with incapacitating pain and immobility. Both nonsurgical and surgical treatment options have been used with differing levels of success, and nonoperative treatment modalities such as bisphosphonates, statins, anticoagulants, and extracorporeal shock wave therapy (ESWT) for early-stage disease have been described, but exact indications have not been established yet. The aim of this study was to make a systematic review of the use of ESWT in the treatment of ONFH. MEDLINE, LILACS, and Scielo databases were searched using the keywords "shock wave", "osteonecrosis", "avascular necrosis", "aseptic necrosis" and "femoral head". The search period was between 1966 and 2009. Only five articles that fulfilled the previously established criteria were obtained. Of these five articles, two were randomized clinical trials, one open label study, one comparative prospective study, and one was a case report. The present review demonstrated that there are no controlled and double-blind studies about the efficacy of ESWT in the treatment of ONFH. On the other hand, the published noncontrolled studies appear to demonstrate some favorable result, which justifies new research in this area.
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Current literature: an educational tool to study osteonecrosis for the Orthopaedic In-Training Examination? Orthop Clin North Am 2009; 40:299-304. [PMID: 19358916 DOI: 10.1016/j.ocl.2008.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The Orthopaedic In-Training Examination (OITE) is used to evaluate the knowledge of residents and focuses on relevant information supported by current scientific literature. The purpose of this study was to assess the relevance of current literature as a study tool for the exam, especially for osteonecrosis-related material. A systematic review was conducted of the OITE and relevant journals to compare the proportion and characterization of questions and published studies related to osteonecrosis and other frequently tested subject areas over a 5-year period (2002 to 2006). This review suggests that the OITE and literature are generally similar in content. However, there may be some differences, especially in subspecialty journals, due to the emphasis of a specific subject area and non-validated procedures which makes them a less preferred resource for OITE preparation.
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Abstract
In osteonecrosis the success of interventions that forestall or prevent femoral head collapse and maintain hip function would represent a substantial achievement in the treatment of this disease. A review of recent literature regarding bisphosphonate, anticoagulant, and vasodilators and biophysical modalities have demonstrated efficacy in reducing pain and delaying disease progression in early stage osteonecrosis. Though it has been considered still insufficient, to support their routine use in the treatment or prevention of osteonecrosis of the hip. Core decompression with modification of technique is still one of the safest and most commonly employed procedures with evidence based success in the pre-collapse stage of AVN of femoral head. The additional use of bone morphogenic protein, and bone marrow stem cells may provide the opportunity to enhance the results of core decompression. At present, the use of large vascularised cortical grafts, the other surgical procedure with high success rate is still not common due to technical difficulty in surgery. Likewise osteotomies are also not getting common as arthroplasty is getting more acceptable, so is awaited without any intermediate big surgical interventions.
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Affiliation(s)
- Ramesh Kumar Sen
- Department of Orthopaedics, PGIMER Chandigarh, India,Address for correspondence: Dr. Ramesh Sen, 201 B, 24 A Chandigarh, India. E-mail:
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Abstract
Osteonecrosis of the femoral head is the endpoint of a disease process that results from insufficient blood flow and bone-tissue necrosis, leading to joint instability, collapse of the femoral head, arthritis of the joint, and total hip replacement. Pain is the most frequent clinical symptom. Both bone tissue and cartilage suffer when osteonecrosis of the femoral head develops. Stimulation with pulsed electromagnetic fields (PEMFs) has been shown to be useful for enhancing bone repair and for exerting a chondroprotective effect on articular cartilage. Two Italian studies on the treatment of avascular necrosis of the femoral head with PEMFs were presented in this review. In the first study, 68 patients suffering from avascular necrosis of the femoral head were treated with PEMFs in combination with core decompression and autologous bone grafts. The second one is a retrospective analysis of the results of treatment with PEMFs of 76 hips in 66 patients with osteonecrosis of the femoral head. In both studies clinical information and diagnostic imaging were collected at the beginning of the treatment and at the time of follow up. Statistical analysis was performed using chi-square test. Both authors hypothesize that the short-term effect of PEMF stimulation may be to protect the articular cartilage from the catabolic effect of inflammation and subchondral bone-marrow edema. The long-term effect of PEMF stimulation may be to promote osteogenic activity at the necrotic area and prevent trabecular fracture and subchondral bone collapse. PEMF stimulation represents an important therapeutic opportunity to resolve the Ficat stage-I or II disease or at least to delay the time until joint replacement becomes necessary.
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Affiliation(s)
- Massari Leo
- Department of Biomedical Sciences and Advanced Therapies, Orthopaedic Clinic, University of Ferrara, Italy,Address for correspondence: Dr. Leo Massari, Department of Biomedical Sciences and Advanced Therapies, Orthopaedic Clinic, University of Ferrara, Corso della Giovecca, 44100 Ferrara, Italy. E-mail:
| | - Fini Milena
- Laboratory of Experimental Surgery, Rizzoli Orthopaedic Institute, Bologna, Italy
| | | | | | - Traina GianCarlo
- Department of Biomedical Sciences and Advanced Therapies, Orthopaedic Clinic, University of Ferrara, Italy
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Ishida M, Fujioka M, Takahashi KA, Arai Y, Kubo T. Electromagnetic fields: a novel prophylaxis for steroid-induced osteonecrosis. Clin Orthop Relat Res 2008; 466:1068-73. [PMID: 18350347 PMCID: PMC2311468 DOI: 10.1007/s11999-008-0182-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Accepted: 02/05/2008] [Indexed: 01/31/2023]
Abstract
Establishing a means to prevent osteonecrosis after corticosteroid administration is an important theme. We asked whether pulsed electromagnetic field stimulation, a noninvasive treatment, could prevent osteonecrosis. Ninety rabbits were divided into four treatment groups: (1) exposure of 10 hours per day to electromagnetic stimulation for 1 week, followed by injection of methylprednisolone (20 mg/kg), and exposure of 10 hours per day to electromagnetism for a further 4 weeks (n = 40); (2) methylprednisolone injection only (n = 40); (3) no treatment (n = 5); and (4) exposure of 10 hours per day to electromagnetism for 5 weeks (n = 5). After 5 weeks, we harvested and histologically examined femurs bilaterally. The frequency of osteonecrosis was lower in the steroid-electromagnetism group (15/40) than in the steroid-only group (26/40). No necrotic lesions were found in the two control groups. We observed no clear effects of electromagnetism on the number, location, extent, and repair of necrotic lesions and intramedullary fat cell size in affected rabbits. Pulsed electromagnetic field stimulation reportedly augments angiogenesis factors and dilates blood vessels; these effects may lower the frequency of osteonecrosis. Exposure to pulsed electromagnetic field stimulation before corticosteroid administration could be an effective means to reduce the risk of osteonecrosis.
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Affiliation(s)
- Masashi Ishida
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566 Japan
| | - Mikihiro Fujioka
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566 Japan
| | - Kenji A. Takahashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566 Japan
| | - Yuji Arai
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566 Japan
| | - Toshikazu Kubo
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566 Japan
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