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Yadav NK, Pradhan P, Pratap Singh MA, Kumar S, Yadav A. Evaluation of the Tensor Fascia Lata Muscle Pedicle Bone Grafting Technique in the Management of Avascular Necrosis of the Femoral Head: An Observational Clinical Study. Cureus 2024; 16:e64902. [PMID: 39156323 PMCID: PMC11330687 DOI: 10.7759/cureus.64902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 07/19/2024] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND Osteonecrosis of the hip is defined as necrosis of the bone tissue due to some form of vascular insult, subsequently leading to the collapse of the femoral head and secondary osteoarthritis, which leads to pain and impaired joint function. This disease is widely known to affect middle-aged groups; however, in the Indian population, even younger people are more commonly affected. The disease has a debilitating effect on the activities of daily living (ADL) and the productivity of individuals and has financial consequences. With the increased utilization of magnetic resonance imaging (MRI) in society, the disease is diagnosed in its early stages. Hip-preserving surgery like tensor fascia lata (TFL) muscle pedicle iliac bone grafting should be given a chance to preserve the native femoral head. METHODOLOGY At a tertiary care teaching hospital in Gorakhpur, India, an observational clinical study was carried out. This study comprised 40 patients, ages 18-50 years, with femoral head osteonecrosis (stages II and III of the Ficat-Arlet staging system), who came to our institute's orthopedic outpatient department. Patients were treated with multiple drillings, curettage, and cheilectomy of the femoral head, in addition to TFL muscle pedicle bone grafting. The Harris hip score (HHS) was utilized to assess the clinical results, and the radiological assessment focused on signs of revascularization. RESULT In our study, the most prevalent age group was 20-30 years (67.5%), with a male predominance (85%). Among our cohort of 40 patients, the HHS indicated excellent outcomes (90-100) in 14 cases (35%), good outcomes (80-89) in 19 cases (47.5%), fair outcomes (70-79) in six cases (15%), and poor outcomes (<70) in one case (2.5%), at the time of the final follow-up. The final follow-up period varied from one to 10 years. CONCLUSION TFL muscle pedicle bone grafting procedure provides excellent clinical and radiological outcomes, especially in young patients in whom femoral head-preserving surgery is preferred over total hip arthroplasty. This procedure is effective in both early and advanced stages of femoral head osteonecrosis, provided there are no arthritic changes. It reduces symptoms and improves functional outcomes.
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Affiliation(s)
- Navin Kumar Yadav
- Department of Orthopaedics, Baba Raghav Das Medical College, Gorakhpur, IND
| | - Pavan Pradhan
- Department of Orthopaedics, Baba Raghav Das Medical College, Gorakhpur, IND
| | | | - Surendra Kumar
- Department of Orthopaedics, Baba Raghav Das Medical College, Gorakhpur, IND
| | - Ashok Yadav
- Department of Orthopaedics, Baba Raghav Das Medical College, Gorakhpur, IND
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Zhang J, Guo S, Yu D, Cheng CK. Subtracting-adding strategy for necrotic lesion segmentation in osteonecrosis of the femoral head. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03073-7. [PMID: 38430380 DOI: 10.1007/s11548-024-03073-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 02/09/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE Osteonecrosis of the femoral head (ONFH) is a severe bone disease that can progressively lead to hip dysfunction. Accurately segmenting the necrotic lesion helps in diagnosing and treating ONFH. This paper aims at enhancing deep learning models for necrosis segmentation. METHODS Necrotic lesions of ONFH are confined to the femoral head. Considering this domain knowledge, we introduce a preprocessing procedure, termed the "subtracting-adding" strategy, which explicitly incorporates this domain knowledge into the downstream deep neural network input. This strategy first removes the voxels outside the predefined volume of interest to "subtract" irrelevant information, and then it concatenates the bone mask with raw data to "add" anatomical structure information. RESULTS Each of the tested off-the-shelf networks performed better with the help of the "subtracting-adding" strategy. The dice similarity coefficients increased by 10.93%, 9.23%, 9.38% and 1.60% for FCN, HRNet, SegNet and UNet, respectively. The improvements in FCN and HRNet were statistically significant. CONCLUSIONS The "subtracting-adding" strategy enhances the performance of general-purpose networks in necrotic lesion segmentation. This strategy is compatible with various semantic segmentation networks, alleviating the need to design task-specific models.
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Affiliation(s)
- Jiping Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Sijia Guo
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Degang Yu
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200240, China.
| | - Cheng-Kung Cheng
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China.
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, 200030, China.
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He XM, He MC, Yang P, Zhang QW, Chen ZQ, He W, Wei QS. The Therapeutic Effect of Huo Xue Tong Luo Capsules in Association Research Circulation Osseous (ARCO) Stage II Osteonecrosis of the Femoral Head: A Clinical Study With an Average Follow-up Period of 7.95 Years. Front Pharmacol 2021; 12:773758. [PMID: 34899331 PMCID: PMC8652332 DOI: 10.3389/fphar.2021.773758] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Huo Xue Tong Luo (HXTL) capsules are an oral preparation that could relieve pain and ameliorate osteonecrosis in patients with asymptomatic osteonecrosis of femoral head (ONFH). We wanted to verify whether it could be a treatment option for ARCO stage II ONFH. Methods: A total of 44 patients (66 hips) with ARCO stage II ONFH were recruited from June 1996 to October 2013 (clinical trial registry number: ChiCTR-RPC-15006,290). HXTL capsules were given under a specific protocol, and the endpoint was set as femoral head collapse. The clinical indicators [including visual analog scale (VAS) and Harris Hip Score (HHS)] and radiological indicators [including Tonnis classification, ARCO stage, Japanese Investigation Committee (JIC) classification, lateral preserved angle (LPA), anterior preserved angle (APA), and combined preserved angle (CPA)] before and after treatment were compared. Kaplan–Meier survival analysis and Cox regression analysis were used to identify the risk factors associated with femoral head collapse. Result: Twenty-six males and 18 females with an average age of 38.3 ± 2.8 were followed for an average of 7.95 years. Forty-six of the 66 (69.7%) hips had no progression in pain or collapse, and patients exhibited a higher HHS (p < 0.05) after therapy. Twenty of the 66 (30.3%) hips progressed in Tonnis classification and ARCO stage, but only one of the 66 (1.5%) hips required total hip arthroplasty (THA). The Kaplan–Meier survivorship curve suggested that the survival rates were 96.97% at 5 years, 69.15% at 10 years, and 40.33% at 15 years. Patients with type A necrotic lesions on anteroposterior (AP) and frog-leg lateral (FLL) radiographs revealed 100% survival rates. Multivariate Cox regression analysis revealed that patients with an LPA ≤ 60.9 exhibited a 3.87 times higher risk of collapse of the femoral head [95% confidence interval (CI), 1.241–5.673] than did those patients with an LPA>60.9. Conclusion: HXTL capsules could be a treatment option for ARCO stage II ONFH, resulting in improved hip function and delayed progression to femoral head collapse, especially when the anterior and lateral portions of the femoral head were not affected. However, an LPA of less than 60.9° may be a risk factor for collapse of the femoral head. Clinical Trial Registration:http://www.chictr.org.cn/showproj.aspx?proj=10829, identifier ChiCTR-OPC-15007030
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Affiliation(s)
- Xiao-Ming He
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China.,Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Min-Cong He
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China.,Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peng Yang
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China.,Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qing-Wen Zhang
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China.,Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhen-Qiu Chen
- The Third Orthopaedic Region, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei He
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China.,Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiu-Shi Wei
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China.,Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Günay C, Özçelik A. Is Stage 2 idiopathic osteonecrosis of the hip joint associated with version angles on imaging methods? Jt Dis Relat Surg 2021; 32:611-616. [PMID: 34842092 PMCID: PMC8650656 DOI: 10.52312/jdrs.2021.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/24/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives
In this study, we aimed to investigate whether anatomical variations of acetabulum were associated to idiopathic osteonecrosis (ON) of the femoral head. Patients and methods
Between January 2014 and March 2020, a total of 46 patients (32 males, 14 females; mean age: 43 years; range, 18 to 66 years) who were diagnosed with unilateral or bilateral ON of the hip joint and 44 healthy age- and sex-matched controls (30 males, 14 females; mean age: 46 years; range, 18 to 79 years) with no signs of ON of the hip joint were retrospectively analyzed. For both groups, measurements were taken of the anatomic parameters, including the acetabular version angle (VA), the sharp angle (SA), and the center-edge angle (CEA) on anteroposterior pelvic radiographs and magnetic resonance imaging (MRI) scans. Results
The mean VA of both hips was found to be significantly smaller in Group 1 than in Group 2 on both MRI and X-ray (14.9±4.1 and 14.4±3.1 vs. 17.3±3.9 and 18.0±3.7, respectively; p=0.004, p<0.001). The mean SA of both hips was found to be significantly smaller in Group 1 than in Group 2 on both MRI and X-ray (39.0±2.9 and 38.9±2.8 vs. 41.6±3.9 and 40.8±4.9, respectively; p=0.001, p=0.036). The mean CEA of both hips was found to be significantly larger in ON group than in control group on both MRI and X-ray (36.7±6.1 and 36.9±7.0 vs. 32.0±6.0 and 31.5±7.5, respectively; p<0.001, p=0.001). Conclusion
Version angles were found to be smaller in patients with ON and more acetabular coverage was observed. Greater coverage of the acetabulum may indicate early collapses of the femoral head even in Stage 2 ON patients. The smaller version angles may be associated with ON.
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Affiliation(s)
- Cüneyd Günay
- Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı, 26040 Meşelik, Eskişehir, Türkiye.
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Ergözen S, Kaya E. AVASCULAR NECROSIS DUE TO CORTICOSTEROID THERAPY IN COVID-19 AS A SYNDEMIC. CENTRAL ASIAN JOURNAL OF MEDICAL HYPOTHESES AND ETHICS 2021. [DOI: 10.47316/cajmhe.2021.2.2.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
To date, over 163 million confirmed cases of COVID-19 and over 3.3 million deaths from COVID-19 have been reported by the World Health Organization (WHO). However, there is still no specific treatment for the disease. Some empirical and supportive medications have been used thus far, including antivirals, antipyretics, antibiotics, and corticosteroids. Corticosteroids are anti-inflammatory and immunosuppressive medications that are used to treat several diseases. These agents can produce undesirable and occasionally severe systemic adverse effects. Although the occurrence and severity of most adverse effects are related to the dose and duration of the corticosteroid therapy, avascular necrosis is not directly associated with this dose and duration, and may occur without osteoporosis. Corticosteroids are not recommended for routine use in COVID-19 patients by the WHO. However, these medications have been widely used for their treatment. Avascular necrosis is a progressive and incapacitating condition. The causes of avascular necrosis are categorized into traumatic and non-traumatic. The majority of non-traumatic cases are associated with the use of corticosteroids. Early diagnosis and treatment is crucial owing to the rapidly progressive nature of the disease. Severe COVID-19 patients are at risk of avascular necrosis due to corticosteroid therapy. The hypothesis presented herein suggests that hyperbaric oxygenation in combination with adequate calcium and vitamin D supplementation and individualized exercise may be an effective, safe, and noninvasive treatment modality, preventing from the progression of avascular necrosis.
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Boontanapibul K, Steere JT, Amanatullah DF, Huddleston JI, Maloney WJ, Goodman SB. Initial Presentation and Progression of Secondary Osteonecrosis of the Knee. J Arthroplasty 2020; 35:2798-2806. [PMID: 32527695 DOI: 10.1016/j.arth.2020.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/24/2020] [Accepted: 05/11/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Early detection and intervention are critical to maintaining the native articular cartilage before collapse in secondary osteonecrosis of the knee (SOK). We conducted a retrospective study documenting the initial stage of presentation and the progression of SOK. METHODS Our database was reviewed for patients younger than 65 years of age diagnosed with atraumatic SOK between 2002 and 2018. Demographic data, plain radiographs as well as MRI at initial evaluation, and initial treatment were classified and analyzed. RESULTS One hundred four patients with 164 knees were identified. Mean age was 39 ± 16 years. Females (64%) with bilateral disease (58%) predominated. Seventy-five percent of patients had a history of corticosteroid use, of which 41% were diagnosed with hematologic malignancy and lupus. Fifteen percent of patients had a history of ethanol abuse. At initial presentation, 55% of patients were diagnosed with Ficat-Arlet stage I/II, while 45% were diagnosed with Ficat-Arlet stage III/IV. We found a significant difference in the mean age of patients at early stage of SOK with corticosteroid use (31 ± 12 years of age) when compared to ethanol use (43 ± 13 years of age, P = .02). Treatments included observation (57%), joint preservation surgery (20%), and total knee arthroplasty (23%). CONCLUSION Nearly half of patients presented at late stage compromising the potential for joint preservation. The difference in age of referral by over a decade, based on etiology of SOK, suggests a strong provider-based referral or screening bias may be present. Hence, a multidisciplinary approach to earlier detection and referral may be a more effective strategy for preventing the progression of SOK.
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Affiliation(s)
- Krit Boontanapibul
- Stanford University Medical Center Outpatient Center, Redwood City, CA; Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Joshua T Steere
- Stanford University Medical Center Outpatient Center, Redwood City, CA
| | | | | | - William J Maloney
- Stanford University Medical Center Outpatient Center, Redwood City, CA
| | - Stuart B Goodman
- Stanford University Medical Center Outpatient Center, Redwood City, CA
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Chen YY, Wu XS, Tian YY, Zhao P, Sun SW, Yang CB. Evaluation of Femoral Head Perfusion by Contrast-Enhanced Ultrasound in a Rabbit Model of Steroid-Induced Osteonecrosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:987-995. [PMID: 31789475 DOI: 10.1002/jum.15184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 11/03/2019] [Accepted: 11/10/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To study the technical feasibility of contrast-enhanced ultrasound (CEUS) in evaluating femoral head perfusion in a rabbit model of steroid-induced femoral head osteonecrosis. METHODS Twenty rabbits were divided randomly into a control group (n = 8) and an experimental group (n = 12). Rabbits in the experimental group were induced by lipopolysaccharide and methylprednisolone to build a model of steroid-induced femoral head osteonecrosis. Contrast-enhanced ultrasound examinations were performed at 3 and 5 weeks after induction. Then, pathologic examinations and microvessel density (MVD) calculations were performed on the excised rabbit femoral heads. RESULTS The MVD of the experimental group decreased significantly 3 and 5 weeks after induction compared with that of the control group. According to the CEUS examination results, significant differences existed in the ascending slope, descending slope, mean transit time, and time to peak between the groups at 5 weeks (P < .05). A correlation analysis showed that the descending slope had a certain correlation with the MVD (correlation coefficient, 0.376). A receiver operating characteristic curve was used to analyze the capacity of the CEUS parameters to predict the occurrence of osteonecrosis. The areas under the curve for the ascending slope and descending slope were 0.758 and 0.760, respectively (P < .05). CONCLUSIONS Contrast-enhanced ultrasound can visualize the microcirculation in steroid-induced osteonecrosis of the femoral head in rabbits and may be a useful imaging method for the early monitoring and prediction of femoral head osteonecrosis.
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Affiliation(s)
- Yu-Yi Chen
- Department of Ultrasound, Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, China
| | - Xian-Sheng Wu
- Guangdong Medical Laboratory Animal Center, Foshan, China
| | - Yuan-Yuan Tian
- Department of Ultrasound, Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, China
| | - Ping Zhao
- Department of Ultrasound, Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, China
| | - Shu-Wei Sun
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Cheng-Bin Yang
- Guangzhou University of Chinese Medicine, Guangzhou, China
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Abstract
Osteonecrosis of the femoral head is a disabling pathology affecting a young population (average age at treatment, 33 to 38 years) and is the most important cause of total hip arthroplasty in this population. It reflects the endpoint of various disease processes that result in a decrease of the femoral head blood flow.The physiopathology reflects an alteration of the vascularization of the fine blood vessels irrigating the anterior and superior part of the femoral head. This zone of necrosis is the source of the loss of joint congruence that leads to premature wear of the hip.Several different types of medication have been developed to reverse the process of ischemia and/or restore the vascularization of the femoral head. There is no consensus yet on a particular treatment.The surgical treatments aim to preserve the joint as far as the diagnosis could be made before the appearance of a zone of necrosis and the loss of joint congruence. They consist of bone marrow decompressions, osteotomies around the hip, vascular or non-vascular grafts.Future therapies include the use of biologically active molecules as well as implants impregnated with biologically active tissue. Cite this article: EFORT Open Rev 2019;4:85-97. DOI: 10.1302/2058-5241.4.180036.
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Affiliation(s)
- Daniel Petek
- Clinic of Orthopaedics and Trauma Surgery, HFR-Fribourg District Hospitals, Fribourg, Switzerland
| | - Didier Hannouche
- Clinic of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Domizio Suva
- Clinic of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
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