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Quan H, Ren C, He Y, Wang F, Dong S, Jiang H. Application of Biomaterials in Treating Early Osteonecrosis of the Femoral Head: Research Progress and Future Perspectives. Acta Biomater 2023; 164:15-73. [PMID: 37080444 DOI: 10.1016/j.actbio.2023.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/24/2023] [Accepted: 04/05/2023] [Indexed: 04/22/2023]
Abstract
Osteonecrosis of the femoral head (ONFH), a progressive pathological process of femoral head ischemia and osteocyte necrosis, is a refractory orthopedic disease caused by multiple etiologies and there is no complete cure at present. With the extension of ONFH duration, osteocyte apoptosis and trabecular bone loss can decrease the load-bearing capacity of the femoral head, which leads to the collapse of the articular cartilage and subchondral bone. Therefore, an urgent clinical need exists to develop effective treatment strategies of early-stage ONFH for maintaining the hip joint function and preventing femoral head collapse. In recent years, extensive attention has been paid to the application of diverse biomaterials in treating early ONFH for sustaining the normal morphology and function of the autologous femoral head, and slowing disease progression. Herein, we review the research progress of bone grafts, metallic materials, bioceramics, bioglasses and polymer materials for early ONFH treatment, and discuss the biological mechanisms of bone repair and regeneration in the femoral-head necrotic area. We propose suggestions for future research directions, from a special perspective of improving the local microenvironment in femoral head by facilitating vessel-associated osteoclasts (VAOs) generation and coupling of bone-specific angiogenesis and osteogenesis, as well as inhibiting bone-associated osteoclasts (BAOs) and BAO-mediated bone resorption. This review can provide ideas for the research, development, and clinical application of biomaterials for treating early ONFH. STATEMENT OF SIGNIFICANCE: We believe that at least three aspects of this manuscript make it interesting to readers of the Acta Biomaterialia. First, we briefly summarize the incidence, pathogenesis, risk factors, classification criteria and treatment of early osteonecrosis of the femoral head (ONFH). Second, we review the research progress in biomaterials for early ONFH treatment and the biological mechanisms of bone repair and regeneration in femoral-head necrotic area. Third, we propose future research progress on improving the local microenvironment in femoral head by facilitating vessel-associated osteoclasts generation and coupling of bone-specific angiogenesis and osteogenesis, as well as inhibiting bone-associated osteoclasts and bone resorption. We hope this review can provide ideas for the research, development, and clinical application of biomaterials for treating early ONFH.
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Affiliation(s)
- Hongyu Quan
- Department of Biomedical Materials Science, School of Biomedical Engineering, Third Military Medical University, Chongqing, 400038, China; College of Bioengineering, Chongqing University, Chongqing, 400044, China
| | - Chencan Ren
- Department of Biomedical Materials Science, School of Biomedical Engineering, Third Military Medical University, Chongqing, 400038, China; College of Bioengineering, Chongqing University, Chongqing, 400044, China
| | - Yuwei He
- Department of Biomedical Materials Science, School of Biomedical Engineering, Third Military Medical University, Chongqing, 400038, China
| | - Fuyou Wang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
| | - Shiwu Dong
- Department of Biomedical Materials Science, School of Biomedical Engineering, Third Military Medical University, Chongqing, 400038, China; State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing 400038, China.
| | - Hong Jiang
- Department of Biomedical Materials Science, School of Biomedical Engineering, Third Military Medical University, Chongqing, 400038, China.
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Zhang Y, Li M, Liu S, Liu B, Wu X, Han Y, Wu T. Comparison of minimally-invasive fibular supporting of T-type with traditional bloody iliac flap metastasis for osteonecrosis of the femoral head at ARCO stage II. Heliyon 2022; 8:e12212. [PMID: 36561685 PMCID: PMC9764185 DOI: 10.1016/j.heliyon.2022.e12212] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 09/26/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose Our research mainly evaluates the clinical efficacy of two surgical methods in the treatment of osteonecrosis of the femoral head (ONFH) at ARCO stage II, aiming to provide optimal hip-preserving treatment of ONFH. Method From October 2018 to September 2020, 48 patients (59 hips) met the inclusion criteria and randomized. 24 cases (29 hips) in experimental group were treated with minimally-invasive fibular supporting of T-type; 24 cases (30 hips) in control group were treated with traditional bloody iliac flap metastasis. We will compare some intraoperative and postoperative conditions. Result The operation time in experimental group was 37 (6) minutes, in control group was 130 (21.75) minutes; the length of surgical incision in two groups was 3.7 (0.7) cm and 12.85 (2.68) cm. The intraoperative blood loss in two groups was 69 (21) ml and 363 (87) ml; the postoperative VAS score of the experimental group on day 1, day 3, day 7 after surgery was 5.5 (2), 3.5 (1), 0 (1); the control group was 6 (1.75), 4 (1), 3 (1). The data differences between above groups have statistically significant. The follow-up time of two groups was (33.86 ± 5.66) months and (35.67 ± 4.69) months. The bone graft healing time in two groups was (14.21 ± 1.93) months and (13.83 ± 2.34) months. The Harris hip scores of two groups at the last follow-up were 90 (7.5) and 86.5 (8.5). The survival rates of two groups were 79.31% (23/29) and 76.67% (23/30). The difference was no statistically significant in above groups (P > 0.05). Conclusion The two different bone graft implantation showed satisfactory early outcomes. Compared to the control group, the experimental group has the advantages of lesser pain, lesser blood loss, lesser trauma and shorter operation time. It may be a choice as bone graft for the treatment of ONFH at early stage.
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Ding H, Wang Y, Lu Y. [Treatment of osteonecrosis of the femoral head with vascularized bone grafting]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:381-386. [PMID: 33719249 DOI: 10.7507/1002-1892.202006053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the current progress of vascularized bone grafting in the treatment of osteonecrosis of the femoral head (ONFH), and to provide reference for treatment of ONFH. Methods The literature at home and abroad on the treatment of ONFH with vascularized bone grafting was reviewed, and the mechanism, operating methods and effectiveness, indications, and complications were summarized. Results Vascularized bone grafting is a commonly used clinical hip-preserving operation. By replacing necrotic bone tissue with vascularized bone, it can rebuild the blood circulation system, promote the healing of the necrotic area, and provide biomechanical support for the necrotic area of the femoral head, prevent the joint surface collapse. The main operations include the vascularized iliac bone flap grafting, the vascularized greater trochanter bone flap grafting, and the vascularized fibular grafting. The clinical application has achieved certain effectiveness, and the different procedures are suitable for different types of patients. The procedures need to be selected based on the patient's overall condition, the cause of ONFH, the necrosis stage, and the degree of the evaluation. Conclusion Vascularized bone grafting has a definite effectiveness in the treatment of ONFH in the young and middle-aged. It can significantly improve hip joint function, control the further development of the disease to a great extent, effectively delay or even avoid hip arthroplasty. It is a reliable hip-preserving operation worthy of promotion.
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Affiliation(s)
- Haibo Ding
- Tianjin Medical University, Tianjin, 300070, P.R.China
| | - Yang Wang
- Tianjin Medical University, Tianjin, 300070, P.R.China
| | - Yun Lu
- Department of Hand and Foot Surgery and Reparative and Reconstructive, Tianjin Union Medical Center, Tianjin, 300121, P.R.China
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