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Lou Y, Wu J, Zhong Y, Tong P, Du W. Etiology, pathology, and treatment of osteonecrosis of the femoral head in adolescents: A comprehensive review. Medicine (Baltimore) 2024; 103:e39102. [PMID: 39058826 PMCID: PMC11272257 DOI: 10.1097/md.0000000000039102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
Femoral head necrosis is a common refractory disease in orthopedics, and shows a trend of getting younger. The occurrence of femoral head necrosis in adolescents is related to the use of glucocorticoids, autoimmune diseases, trauma, and other factors. Because adolescent patients are in the period of physical development, high activity requirements, and have fertility needs in the future, treatment is relatively difficult. Early artificial joint replacement may have problems such as wear and loosening, so total hip replacement is not the preferred treatment for adolescent patients with femoral head necrosis. This article will elaborate the research progress of femoral head necrosis in adolescents from 3 aspects, and summarize the benefits and side effects of core decompression combined with autologous stem cell transplantation in the treatment of early femoral head necrosis, so as to provide clinical ideas for the treatment of femoral head necrosis in adolescents.
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Affiliation(s)
- Yuhan Lou
- Jinhua Hospital of Traditional Chinese Medicine, Jinhua, China
| | - Jiawen Wu
- Jinhua Hospital of Traditional Chinese Medicine, Jinhua, China
| | - Ying Zhong
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Peijian Tong
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Wenxi Du
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Homma Y, Yamasaki T, Tashiro K, Okada Y, Shirogane Y, Watari T, Hayashi K, Baba T, Nagata K, Yanagisawa N, Ohtsu H, Fujiwara N, Ando J, Yamaji K, Tamura N, Ishijima M. Autologous concentrated bone marrow injection for precollapse osteonecrosis of the femoral head concurrent with contralateral total hip arthroplasty: protocol for a clinical trial. BMJ Open 2024; 14:e082243. [PMID: 38719293 PMCID: PMC11086415 DOI: 10.1136/bmjopen-2023-082243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION The femoral head contralateral to the collapsed femoral head requiring total hip arthroplasty (THA) often manifests in the precollapse stage of osteonecrosis of the femoral head (ONFH). It is not yet demonstrated how autologous concentrated bone marrow injection may prevent collapse of the femoral head concurrent with contralateral THA. The primary objective is to evaluate the efficacy of autologous concentrated bone marrow injection for the contralateral, non-collapsed, femoral head in patients with bilateral ONFH, with the ipsilateral collapsed femoral head undergoing THA. METHODS AND ANALYSIS This is a multicentre, prospective, non-randomised, historical-data controlled study. We will recruit patients with ONFH who are scheduled for THA and possess a non-collapsed contralateral femoral head. Autologous bone marrow will be collected using a point-of-care device. After concentration, the bone marrow will be injected into the non-collapsed femoral head following the completion of THA in the contralateral hip. The primary outcome is the percentage of femoral head collapse evaluated by an independent data monitoring committee using plain X-rays in two directions 2 years after autologous concentrated bone marrow injection. Postinjection safety, adverse events, pain and hip function will also be assessed. The patients will be evaluated preoperatively, and at 6 months, 1 year and 2 years postoperatively. ETHICS AND DISSEMINATION This protocol has been approved by the Certified Committee for Regenerative Medicine of Tokyo Medical and Dental University and Japan's Ministry of Healthy, Labour and Welfare and will be performed as a class III regenerative medicine protocol, in accordance with Japan's Act on the Safety of Regenerative Medicine. The results of this study will be submitted to a peer-review journal for publication. The results of this study are expected to provide evidence to support the inclusion of autologous concentrated bone marrow injections in the non-collapsed femoral head in Japan's national insurance coverage. TRIAL REGISTRATION NUMBER jRCTc032200229.
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Affiliation(s)
- Yasuhiro Homma
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
- Department of Community Medicine and Research for Bone and Joint Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Ken Tashiro
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshiki Okada
- Department of Orthopaedic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Yuichi Shirogane
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Taiji Watari
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Koju Hayashi
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomonori Baba
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
- Department of Pathophysiology for Locomotive Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazufumi Nagata
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | | | - Hiroshi Ohtsu
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Naho Fujiwara
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Jun Ando
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
- Department of Cell Therapy and Transfusion Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ken Yamaji
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Naoto Tamura
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Yokota S, Ishizu H, Miyazaki T, Takahashi D, Iwasaki N, Shimizu T. Osteoporosis, Osteoarthritis, and Subchondral Insufficiency Fracture: Recent Insights. Biomedicines 2024; 12:843. [PMID: 38672197 PMCID: PMC11048726 DOI: 10.3390/biomedicines12040843] [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: 03/02/2024] [Revised: 03/31/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
The increased incidence of osteoarthritis (OA), particularly knee and hip OA, and osteoporosis (OP), owing to population aging, have escalated the medical expense burden. Osteoarthritis is more prevalent in older women, and the involvement of subchondral bone fragility spotlights its association with OP. Notably, subchondral insufficiency fracture (SIF) may represent a more pronounced condition of OA pathophysiology. This review summarizes the relationship between OA and OP, incorporating recent insights into SIF. Progressive SIF leads to joint collapse and secondary OA and is associated with OP. Furthermore, the thinning and fragility of subchondral bone in early-stage OA suggest that SIF may be a subtype of OA (osteoporosis-related OA, OPOA) characterized by significant subchondral bone damage. The high bone mineral density observed in OA may be overestimated due to osteophytes and sclerosis and can potentially contribute to OPOA. The incidence of OPOA is expected to increase along with population aging. Therefore, prioritizing OP screening, early interventions for patients with early-stage OA, and fracture prevention measures such as rehabilitation, fracture liaison services, nutritional management, and medication guidance are essential.
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Affiliation(s)
| | | | | | | | | | - Tomohiro Shimizu
- Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (S.Y.); (H.I.); (T.M.); (D.T.); (N.I.)
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Tramś E, Kamiński R. Molecular Biology of Meniscal Healing: A Narrative Review. Int J Mol Sci 2024; 25:768. [PMID: 38255841 PMCID: PMC10815262 DOI: 10.3390/ijms25020768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/26/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
This review provides insights at the molecular level into the current and old methods for treating meniscal injuries. Meniscal injuries have been found to have a substantial impact on the progression of osteoarthritis. In line with the "save the meniscus" approach, meniscectomy is considered a last-resort treatment. Nevertheless, it is important to note that mechanical repair alone may not achieve the complete restoration of the meniscus. A deep understanding of the healing pathways could lead to future improvements in meniscal healing. The inclusion of cytokines and chemokines has the potential to facilitate the process of tear repair or impede the inflammatory catabolic cascade. MicroRNA (miRNA) could serve as a potential biomarker for meniscal degeneration, and RNA injections might promote collagen and growth factor production. The critical aspect of the healing process is angiogenesis within the inner zone of the meniscus. The use of collagen scaffolds and the implantation of autologous meniscus fragments have been successfully integrated into clinical settings. These findings are encouraging and underscore the need for well-designed clinical trials to explore the most effective factors that can enhance the process of meniscal repair.
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Affiliation(s)
| | - Rafał Kamiński
- Centre of Postgraduate Medical Education, Department of Musculoskeletal Trauma and Orthopaedics, Gruca Orthopaedic and Trauma Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland;
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Jia C, Zhang R, Wang J, Zhang B, Zhang H, Kang L, Zhou L, Shen C. Biomechanical Study of 3 Osteoconductive Materials Applied in Pedicle Augmentation and Revision for Osteoporotic Vertebrae: Allograft Bone Particles, Calcium Phosphate Cement, Demineralized Bone Matrix. Neurospine 2023; 20:1407-1420. [PMID: 38171307 PMCID: PMC10762407 DOI: 10.14245/ns.2346760.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/05/2023] [Accepted: 09/17/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE This study assessed biomechanical properties of pedicle screws enhanced or revised with 3 materials. We aimed to compare the efficacy of these materials in pedicle augmentation and revision. METHODS One hundred twenty human cadaveric vertebrae were utilized for in vitro testing. Vertebrae bone density was evaluated. Allograft bone particles (ABP), calcium phosphate cement (CPC), and demineralized bone matrix (DBM) were used to augment or revise pedicle screw. Post the implantation of pedicle screws, parameters such as insertional torque, pullout strength, cycles to failure and failure load were measured using specialized instruments. RESULTS ABP, CPC, and DBM significantly enhanced biomechanical properties of the screws. CPC augmentation showed superior properties compared to ABP or DBM. ABP-augmented screws had higher cycles to failure and failure loads than DBM-augmented screws, with no difference in pullout strength. CPC-revised screws exhibited similar strength to the original screws, while ABP-revised screws showed comparable cycles to failure and failure loads but lower pullout strength. DBM-revised screws did not match the original screws' strength. CONCLUSION ABP, CPC, and DBM effectively improve pedicle screw stability for pedicle augmentation. CPC demonstrated the highest efficacy, followed by ABP, while DBM was less effective. For pedicle revision, CPC is recommended as the primary choice, with ABP as an alternative. However, using DBM for pedicle revision is not recommended.
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Affiliation(s)
- Chongyu Jia
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Renjie Zhang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jiaqi Wang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Bo Zhang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Huaqing Zhang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Liang Kang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Luping Zhou
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Cailiang Shen
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Laboratory of Spinal and Spinal Cord Injury Regeneration and Repair, the First Affiliated Hospital of Anhui Medical University, Hefei, China
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Bernetti A, Agostini F, Paoloni M, Raele MV, Farì G, Megna M, Mangone M. Could Hyaluronic Acid Be Considered as a Senomorphic Agent in Knee Osteoarthritis? A Systematic Review. Biomedicines 2023; 11:2858. [PMID: 37893231 PMCID: PMC10604344 DOI: 10.3390/biomedicines11102858] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) is one of the most common causes of disability in elderly patients and tends to be a major burden on social and health care spending. Despite its severe socioeconomic impact, KOA remains, to date, an incurable disease. Due to its proper characteristics, KOA represents a favorable disease model for experimenting with senotherapeutics, a group of treatments that counteract the development of age-related disorders and chronic diseases. In recent years, the use of intra-articular hyaluronic acid (IAHA) in the treatment of diseases related to the wear and tear of the articular cartilage has been gaining popularity. Given its ability in joint lubrification, shock absorption, and cell signaling, our aim is to investigate, through the existing scientific literature, its potential role as a senomorphic agent, emphasizing its crucial function in KOA patients. Indeed, senomorphics are a particular group of senotherapeutics capable of modulating the functions and morphology of senescent cells to those of young cells or delaying the progression of young cells to senescent cells in tissues. METHODS A search in the scientific literature (PubMed, Cochrane Library, and Google Scholar) was carried out from 2019 to 2023, thus the last 5 years. RESULTS One hundred thirty-eight articles were found concerning the role of hyaluronic acid injections in KOA patients. In these studies, its therapeutic efficacy, its anti-inflammatory properties, and its low risk of side effects emerged. CONCLUSION IAHA injections are a valuable treatment option for KOA while they can provide pain relief, improve joint function, and slow the progression of joint degeneration. The inhibitory effect of HA on MMP13 and its action as a senomorphic agent suggests that it may have additional benefits beyond its lubricating and shock-absorbing properties. In order to clarify its mechanisms of action and to optimize its clinical use, further studies are definitely needed.
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Affiliation(s)
- Andrea Bernetti
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA), Università del Salento, 73100 Lecce, Italy;
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00189 Rome, Italy; (F.A.); (M.P.); (M.M.)
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00189 Rome, Italy; (F.A.); (M.P.); (M.M.)
| | - Maria Vittoria Raele
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.V.R.); (M.M.)
| | - Giacomo Farì
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA), Università del Salento, 73100 Lecce, Italy;
| | - Marisa Megna
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.V.R.); (M.M.)
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00189 Rome, Italy; (F.A.); (M.P.); (M.M.)
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Bauer C, Moser LB, Kern D, Jeyakumar V, Nehrer S. The Combination of Glucocorticoids and Hyaluronic Acid Enhances Efficacy in IL-1β/IL-17-Treated Bovine Osteochondral Grafts Compared with Individual Application. Int J Mol Sci 2023; 24:14338. [PMID: 37762639 PMCID: PMC10531904 DOI: 10.3390/ijms241814338] [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: 08/17/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Patients with knee osteoarthritis often receive glucocorticoid (GC) or hyaluronic acid (HA) injections to alleviate symptoms. This study evaluated the impact of Triamcinolone Hexacetonide (a GC), HA, and a combination of both on bovine osteochondral grafts exposed to IL-1β and IL-17 in an ex vivo culture. Metabolic activity increased with GC treatment. GCs and GCs/HA counteracted cytokine effects, with gene expressions similar to untreated controls, while HA alone did not. However, HA improved the coefficient of friction after two weeks. The highest friction values were observed in GC-containing and cytokine-treated groups. Cytokine treatment reduced tissue proteoglycan content, which HA could mitigate, especially in the GC/HA combination. This combo also effectively controlled proteoglycan release, supported by reduced sGAG release. Cytokine treatment led to surface cell death, while GCs, HA, or their combination showed protective effects against inflammation. The GC/HA combination had the best overall results, suggesting its potential as a superior treatment option for osteoarthritis.
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Affiliation(s)
- Christoph Bauer
- Center for Regenerative Medicine, University for Continuing Education Krems, 3500 Krems, Austria
| | - Lukas B. Moser
- Department of Orthopedics, University Hospital Krems, 3500 Krems, Austria
| | - Daniela Kern
- Center for Regenerative Medicine, University for Continuing Education Krems, 3500 Krems, Austria
| | - Vivek Jeyakumar
- Center for Regenerative Medicine, University for Continuing Education Krems, 3500 Krems, Austria
| | - Stefan Nehrer
- Center for Regenerative Medicine, University for Continuing Education Krems, 3500 Krems, Austria
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Poiana IR, Dobre R, Popescu RI, Pituru SM, Bucur A. Utility of Cone-Beam Computed Tomography in the Detection of Low Bone Mass-A Systematic Review. J Clin Med 2023; 12:5890. [PMID: 37762831 PMCID: PMC10531931 DOI: 10.3390/jcm12185890] [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: 08/21/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Cone-beam computed tomography (CBCT) is widely used in the preoperative qualitative and quantitative assessment of dental implant sites, offering dimensional accuracy, spatial resolution, gray density, and contrast comparable to those of classical CT scan, yet with disputable ability to determine bone mass density. MATERIALS AND METHODS A systematic review of the literature was performed using the PubMed and SCOPUS databases, with terms referring to low bone mass and cone-beam computed tomography (CBCT). RESULTS Sixteen studies were included in the review. The results show different perspectives, but the evidence favors the use of CBCT, combined with dual-energy X-ray absorptiometry bone density scan (DXA) evaluation, for the assessment of the osteoporosis status of the aging population and, more specifically, in postmenopausal women. Radiographic density (RD) values of the dens and the left part of the first cervical vertebra show the strongest correlation coefficients and the highest sensitivity, specificity, and accuracy for predicting osteoporosis (OP) in the lumbar vertebrae and the femoral neck. CONCLUSIONS Our review suggests the potential of CBCT as a screening tool for patients with low bone mass using different radiomorphometric indices. Linear measurements of the inferior mandibular cortex were lower in osteoporotic individuals, indicating the perspective of CBCT also as a diagnostic tool for this disease.
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Affiliation(s)
- Ioana Ruxandra Poiana
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.R.P.); (R.-I.P.); (S.-M.P.); (A.B.)
| | - Ramona Dobre
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.R.P.); (R.-I.P.); (S.-M.P.); (A.B.)
- Department of Endocrinology, National Institute of Endocrinology C. I. Parhon, 011853 Bucharest, Romania
| | - Razvan-Ionut Popescu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.R.P.); (R.-I.P.); (S.-M.P.); (A.B.)
- Department of Endocrinology, National Institute of Endocrinology C. I. Parhon, 011853 Bucharest, Romania
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 050659 Bucharest, Romania
| | - Silviu-Mirel Pituru
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.R.P.); (R.-I.P.); (S.-M.P.); (A.B.)
| | - Alexandru Bucur
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.R.P.); (R.-I.P.); (S.-M.P.); (A.B.)
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Limelette M, De Fourmestraux C, Despas C, Lafragette A, Veziers J, Le Guennec Y, Touzot-Jourde G, Lefevre FX, Verron E, Bouler JM, Bujoli B, Gauthier O. Calcium Phosphate Cements Combined with Blood as a Promising Tool for the Treatment of Bone Marrow Lesions. J Funct Biomater 2023; 14:jfb14040204. [PMID: 37103294 PMCID: PMC10143268 DOI: 10.3390/jfb14040204] [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: 02/24/2023] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023] Open
Abstract
The solid phase of a commercial calcium phosphate (Graftys® HBS) was combined with ovine or human blood stabilized either with sodium citrate or sodium heparin. The presence of blood delayed the setting reaction of the cement by ca. 7-15 h, depending on the nature of the blood and blood stabilizer. This phenomenon was found to be directly related to the particle size of the HBS solid phase, since prolonged grinding of the latter resulted in a shortened setting time (10-30 min). Even though ca. 10 h were necessary for the HBS blood composite to harden, its cohesion right after injection was improved when compared to the HBS reference as well as its injectability. A fibrin-based material was gradually formed in the HBS blood composite to end-up, after ca. 100 h, with a dense 3D organic network present in the intergranular space, thus affecting the microstructure of the composite. Indeed, SEM analyses of polished cross-sections showed areas of low mineral density (over 10-20 µm) spread in the whole volume of the HBS blood composite. Most importantly, when the two cement formulations were injected in the tibial subchondral cancellous bone in a bone marrow lesion ovine model, quantitative SEM analyses showed a highly significant difference between the HBS reference versus its analogue combined with blood. After a 4-month implantation, histological analyses clearly showed that the HBS blood composite underwent high resorption (remaining cement: ca. 13.1 ± 7.3%) and new bone formation (newly formed bone: 41.8 ± 14.7%). This was in sharp contrast with the case of the HBS reference for which a low resorption rate was observed (remaining cement: 79.0 ± 6.9%; newly formed bone: 8.6 ± 4.8%). This study suggested that the particular microstructure, induced by the use of blood as the HBS liquid phase, favored quicker colonization of the implant and acceleration of its replacement by newly formed bone. For this reason, the HBS blood composite might be worth considering as a potentially suitable material for subchondroplasty.
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Affiliation(s)
- Maxence Limelette
- CNRS, CEISAM, UMR 6230, Nantes Université, 44000 Nantes, France
- Graftys SA, Eiffel Park, Pôle d'activités d'Aix en Provence, 13080 Aix en Provence, France
| | - Claire De Fourmestraux
- Department of Small Animal and Equine Surgery and Anesthesia, Nantes-Atlantic College of Veterinary Medicine, Food Science and Engineering (ONIRIS), 44307 Nantes, France
- Regenerative Medicine and Skeleton, INSERM, University Hospital (CHU), UMR 1229-RMeS, Nantes University, 44000 Nantes, France
| | - Christelle Despas
- LCPME, CNRS UMR 7564, Université de Lorraine, 54800 Villers Lès Nancy, France
| | - Audrey Lafragette
- Department of Small Animal and Equine Surgery and Anesthesia, Nantes-Atlantic College of Veterinary Medicine, Food Science and Engineering (ONIRIS), 44307 Nantes, France
| | - Joelle Veziers
- Regenerative Medicine and Skeleton, INSERM, University Hospital (CHU), UMR 1229-RMeS, Nantes University, 44000 Nantes, France
| | - Yohan Le Guennec
- Regenerative Medicine and Skeleton, INSERM, University Hospital (CHU), UMR 1229-RMeS, Nantes University, 44000 Nantes, France
| | - Gwenola Touzot-Jourde
- Department of Small Animal and Equine Surgery and Anesthesia, Nantes-Atlantic College of Veterinary Medicine, Food Science and Engineering (ONIRIS), 44307 Nantes, France
- Regenerative Medicine and Skeleton, INSERM, University Hospital (CHU), UMR 1229-RMeS, Nantes University, 44000 Nantes, France
| | | | - Elise Verron
- CNRS, CEISAM, UMR 6230, Nantes Université, 44000 Nantes, France
| | | | - Bruno Bujoli
- CNRS, CEISAM, UMR 6230, Nantes Université, 44000 Nantes, France
| | - Olivier Gauthier
- Department of Small Animal and Equine Surgery and Anesthesia, Nantes-Atlantic College of Veterinary Medicine, Food Science and Engineering (ONIRIS), 44307 Nantes, France
- Regenerative Medicine and Skeleton, INSERM, University Hospital (CHU), UMR 1229-RMeS, Nantes University, 44000 Nantes, France
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