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Mutlu M, Zora H, Bayrak G, Bilgen ÖF. Osseoscopy-assisted core decompression and debridement in the treatment of avascular necrosis of the femoral head. Medicine (Baltimore) 2024; 103:e38043. [PMID: 38728470 PMCID: PMC11081539 DOI: 10.1097/md.0000000000038043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
Core decompression of the femoral head is a standard surgical procedure used in the early stages of the femoral head avascular necrosis (AVN) (Steinberg I to III). This study aimed to determine whether the advantages of osseoscopy-assisted core decompression using a standard arthroscopic set up in the early stages of AVN of the femoral head. Twelve hips of 12 patients who underwent osseoscopy-assisted core decompression and debridement with the diagnosis of AVN of the femoral head were reviewed between 2019 and 2021. The etiology was idiopathic in 2 patients; ten had a history of steroid use. The preoperative and postoperative first month Harris Hip Score (HHS) and visual analogue scale (VAS) were recorded. Standard X-rays, computerized tomography, and magnetic resonance imaging (MRI) were noted at preoperatively and sixth month follow-ups. In a 1-year follow-up, X-rays and MRIs were reviewed. All patients significantly improved in the VAS and HHS after the osseoscopy-assisted core decompression (P = .002). Two of the 12 patients with an initial stage of Steinberg IIC and IIB and one with Steinberg IA had a progressive femoral collapse and, therefore, had a total hip replacement at the end of the follow-up. Nine patients (75%) had satisfactory functional and radiological results in 1-year of follow-up. However, 3 patients (25%) culminated in total hip arthroplasty in a 1-year follow-up. Using an arthroscopic set up during osseoscopy-assisted core decompression surgery of the femoral head AVN has the benefits of direct visualization and accurate debridement of the involved area. The osseoscopy-assisted core decompression technique avoids excessive debridement of the healthy bone tissue adjacent to the necrotic area.
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Affiliation(s)
- Müren Mutlu
- Department of Orthopaedics and Traumatology, Private Medicabil Hospital, Bursa, Türkiye
| | - Hakan Zora
- Department of Orthopaedics and Traumatology, Private Medicabil Hospital, Bursa, Türkiye
| | - Gökhan Bayrak
- Muş Alparslan University, Department of Physiotherapy and Rehabilitation of the Faculty of Health Sciences, Muş, Türkiye
| | - Ömer Faruk Bilgen
- Department of Orthopaedics and Traumatology, Private Medicabil Hospital, Bursa, Türkiye
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Hernigou P, Homma Y, Hernigou J, Flouzat Lachaniette CH, Rouard H, Verrier S. Mesenchymal Stem Cell Therapy for Bone Repair of Human Hip Osteonecrosis with Bilateral Match-Control Evaluation: Impact of Tissue Source, Cell Count, Disease Stage, and Volume Size on 908 Hips. Cells 2024; 13:776. [PMID: 38727312 PMCID: PMC11083454 DOI: 10.3390/cells13090776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/22/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
We investigated the impact of mesenchymal stem cell (MSC) therapy on treating bilateral human hip osteonecrosis, analyzing 908 cases. This study assesses factors such as tissue source and cell count, comparing core decompression with various cell therapies. This research emphasizes bone repair according to pre-treatment conditions and the specificities of cell therapy in osteonecrosis repair, indicating a potential for improved bone repair strategies in hips without femoral head collapse. This study utilized a single-center retrospective analysis to investigate the efficacy of cellular approaches in the bone repair of osteonecrosis. It examined the impact on bone repair of tissue source (autologous bone marrow concentrate, allogeneic expanded, autologous expanded), cell quantity (from none in core decompression alone to millions in cell therapy), and osteonecrosis stage and volume. Excluding hips with femoral head collapse, it focused on patients who had bilateral hip osteonecrosis, both pre-operative and post-operative MRIs, and a follow-up of over five years. The analysis divided these patients into seven groups based on match control treatment variations in bilateral hip osteonecrosis, primarily investigating the outcomes between core decompression, washing effect, and different tissue sources of MSCs. Younger patients (<30 years) demonstrated significantly better repair volumes, particularly in stage II lesions, than older counterparts. Additionally, bone repair volume increased with the number of implanted MSCs up to 1,000,000, beyond which no additional benefits were observed. No significant difference was observed in repair outcomes between different sources of MSCs (BMAC, allogenic, or expanded cells). The study also highlighted that a 'washing effect' was beneficial, particularly for larger-volume osteonecrosis when combined with core decompression. Partial bone repair was the more frequent event observed, while total bone repair of osteonecrosis was rare. The volume and stage of osteonecrosis, alongside the number of injected cells, significantly affected treatment outcomes. In summary, this study provides comprehensive insights into the effectiveness and variables influencing the use of mesenchymal stem cells in treating human hip osteonecrosis. It emphasizes the potential of cell therapy while acknowledging the complexity and variability of results based on factors such as age, cell count, and disease stage.
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Affiliation(s)
- Philippe Hernigou
- Orthopedic Department, University Paris East, Hopital Henri Mondor, 94000 Creteil, France;
| | - Yasuhiro Homma
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo 113-8421, Japan;
| | - Jacques Hernigou
- Department of Orthopaedic Surgery and Traumatology, EpiCURA Baudour Hornu Ath Hospital, 7331 Hainaut, Belgium;
| | | | - Helène Rouard
- Établissement Français du Sang, University Paris East, 94000 Creteil, France;
| | - Sophie Verrier
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland;
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Chen J, Jin W, Zhong C, Cai W, Huang L, Zhou J, Peng H. Human umbilical cord mesenchymal stem cells promote steroid-induced osteonecrosis of the femoral head repair by improving microvascular endothelial cell function. Aging (Albany NY) 2024; 16:205794. [PMID: 38696318 DOI: 10.18632/aging.205794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/10/2024] [Indexed: 05/04/2024]
Abstract
Recently, there has been growing interest in using cell therapy through core decompression (CD) to treat osteonecrosis of the femoral head (ONFH). Our study aimed to investigate the effectiveness and mechanism of human umbilical cord mesenchymal stem cells (hUCMSCs) in treating steroid-induced ONFH. We constructed a steroid-induced ONFH rabbit model as well as dexamethasone (Dex)-treated bone microvascular endothelial cells (BMECs) model of human femoral head. We injected hUCMSCs into the rabbit femoral head via CD. The effects of hUCMSCs on steroid-induced ONFH rabbit model and Dex-treated BMECs were evaluated via micro-CT, microangiography, histology, immunohistochemistry, wound healing, tube formation, and western blotting assay. Furthermore, we conducted single-cell RNA sequencing (scRNA-seq) to examine the characteristics of endothelial cells, the activation of signaling pathways, and inter-cellular communication in ONFH. Our data reveal that hUCMSCs improved the femoral head microstructure and bone repair and promoted angiogenesis in the steroid-induced ONFH rabbit model. Importantly, hUCMSCs improved the migration ability and angioplasty of Dex-treated BMECs by secreting COL6A2 to activate FAK/PI3K/AKT signaling pathway via integrin α1β1.
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Affiliation(s)
- Junwen Chen
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan 430062, China
| | - Wenyi Jin
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan 430062, China
- Department of Biomedical Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong 999077, Hong Kong Special Administrative Region
| | - Changheng Zhong
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan 430062, China
| | - Wenxiang Cai
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan 430062, China
| | - Liangkun Huang
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan 430062, China
| | - Jianlin Zhou
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan 430062, China
| | - Hao Peng
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan 430062, China
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Kale A, Kumar S. A New Horizon in Hip Health: Using an Innovative Variable Loop Curette for Core Decompression and Bone Marrow Aspirate Concentrate in the Management of Pre-collapse Avascular Necrosis of the Hip. Cureus 2024; 16:e54763. [PMID: 38523967 PMCID: PMC10961095 DOI: 10.7759/cureus.54763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
Avascular necrosis (AVN) of the femoral head, or osteonecrosis (ON), is a debilitating condition characterized by disrupted blood supply to the hip joint, leading to subchondral bone necrosis, joint collapse, and arthritis. Emerging evidence suggests that the long-term use of corticosteroids, particularly in the context of COVID-19 treatment, may contribute to AVN development. This case report presents a male in his 50s with bilateral hip pain and a history of corticosteroid use. The patient underwent core decompression (CD) with a bone marrow aspirate concentrate (BMAC) infusion using the innovative curette technique. Postoperatively, he followed a structured rehabilitation protocol and experienced significant pain relief and improved function. Reviewing existing literature, CD with BMAC using innovative curettes emerges as a promising approach for pre-collapse AVN management, preserving hip function, and delaying the necessity for total hip arthroplasty (THA). This case highlights the potential benefits of this technique in early-stage AVN, emphasizing its role in improving functional outcomes and limiting disease progression.
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Affiliation(s)
- Amit Kale
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Sushant Kumar
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital And Research Centre, Pune, IND
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Pakhan AA, Phansopkar P, Boob MA. Rehabilitation to Complement Unique Single-Stage Core Decompression and Total Hip Arthroplasty in Bilateral Avascular Necrosis: A Case Report. Cureus 2024; 16:e52914. [PMID: 38406129 PMCID: PMC10893823 DOI: 10.7759/cureus.52914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Avascular necrosis (AVN), a debilitating condition characterized by bone tissue death due to inadequate blood supply, can severely impact the hip joint, leading to pain, limited mobility, and joint dysfunction. The complex blood supply and mechanical stress on the hip make it particularly vulnerable to AVN. Early detection is challenging as AVN may remain asymptomatic initially, but as it progresses, it results in severe joint degeneration. This case report outlines the management of a 38-year-old male patient with a dermatomyositis history who presented with bilateral hip pain attributed to AVN. Radiological investigations diagnosed grade 2 AVN in the left hip and grade 3 AVN in the right hip. The patient underwent core decompression for the left hip to halt disease progression and total hip arthroplasty (THA) for the right hip to alleviate pain and restore function. A structured three-week rehabilitation program was tailored to each surgical procedure, with pre-and post-treatment assessments revealing notable improvements in pain relief, range of motion (ROM), and muscle strength. This case underscores the importance of early diagnosis, personalized surgical interventions, and comprehensive rehabilitation in managing AVN in dermatomyositis patients. Physiotherapy is vital pre- and post-operatively to enhance physical function, strength, and mobility. Rehabilitation also plays a crucial role in postoperative recovery, early mobilization, and functional restoration. The multifaceted approach employed in this case highlights the need for a comprehensive strategy when managing AVN in dermatomyositis patients, providing valuable insights for similar cases.
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Affiliation(s)
- Arjavi A Pakhan
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Pratik Phansopkar
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Manali A Boob
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Tsubosaka M, Maruyama M, Lui E, Kushioka J, Toya M, Gao Q, Shen H, Li X, Chow SKH, Zhang N, Yang YP, Goodman SB. Preclinical models for studying corticosteroid-induced osteonecrosis of the femoral head. J Biomed Mater Res B Appl Biomater 2024; 112:e35360. [PMID: 38247252 DOI: 10.1002/jbm.b.35360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 11/02/2023] [Accepted: 11/27/2023] [Indexed: 01/23/2024]
Abstract
Nontraumatic osteonecrosis of the femoral head (ONFH) is a refractory condition that commonly results in femoral head collapse and degenerative arthritis of the hip. In the early stages, surgical procedures for hip preservation, including core decompression (CD), have been developed to prevent progressive collapse of the femoral head. Optimization of bone regeneration and biological augmentation may further enhance the therapeutic efficacy of CD for ONFH. Thus, combining CD with cell-based therapy has recently been proposed. In fact, patients treated with cell-based therapy using autologous bone marrow concentrate demonstrate improved survivorship of the femoral head, compared with conventional CD alone. Preclinical research studies to investigate adjunctive therapies for CD often utilize the rabbit model of corticosteroid-induced ONFH. Mesenchymal stem cells (MSCs) are known to promote osteogenesis and angiogenesis, and decrease inflammation in bone. Local drug delivery systems have the potential to achieve targeted therapeutic effects by precisely controlling the drug release rate. Scaffolds can provide an osteoconductive structural framework to facilitate the repair of osteonecrotic bone tissue. We focused on the combination of both cell-based and scaffold-based therapies for bone tissue regeneration in ONFH. We hypothesized that combining CD and osteoconductive scaffolds would provide mechanical strength and structural cell guidance; and that combining CD and genetically modified (GM) MSCs to express relevant cytokines, chemokines, and growth factors would promote bone tissue repair. We developed GM MSCs that overexpress the anti-inflammatory, pro-reconstructive cytokines platelet-derived growth factor-BB to provide MSCs with additional benefits and investigated the efficacy of combinations of these GM MSCs and scaffolds for treatment of ONFH in skeletally mature male New Zealand white rabbits. In the future, the long-term safety, efficacy, durability, and cost-effectiveness of these and other biological and mechanical treatments must be demonstrated for the patients affected by ONFH.
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Affiliation(s)
- Masanori Tsubosaka
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Masahiro Maruyama
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Elaine Lui
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
- Department of Mechanical Engineering, Stanford University School of Engineering, Stanford, California, USA
| | - Junichi Kushioka
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Masakazu Toya
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Qi Gao
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Huaishuang Shen
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Xueping Li
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Simon Kwoon-Ho Chow
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Ning Zhang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Yunzhi Peter Yang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
- Department of Material Science and Engineering, Stanford University School of Medicine, Stanford, California, USA
- Department of Bioengineering, Stanford University School of Medicine, Stanford, California, USA
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
- Department of Bioengineering, Stanford University School of Medicine, Stanford, California, USA
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Goyal S, Shrivastav S, Ambade R, Pundkar A, Lohiya A. New Technique of Reverse Bone Grafting With Core Decompression and Enriching With Regenerative Medicine Techniques for Grade 2 and Grade 3 Avascular Necrosis of Both Hips. Cureus 2023; 15:e51425. [PMID: 38299138 PMCID: PMC10828746 DOI: 10.7759/cureus.51425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/26/2023] [Indexed: 02/02/2024] Open
Abstract
Early avascular necrosis (AVN) of the hip poses a significant clinical challenge, requiring prompt recognition and intervention to mitigate long-term complications. A case report describing a 30-year-old man with bilateral hip AVN is presented here. In addition, to reverse bone grafting and core decompression of both hips, the patient had platelet-rich plasma (PRP) infiltration in the right hip and bone marrow aspirate concentrate (BMAC) infiltration in the left hip. This method attempted to stop the disease's development and promote hip regeneration in both. Significant pain reduction and postoperative functional gains in both hips are seen in this instance. These results highlight the potential of combined orthopedic and regenerative therapies in young individuals with hip AVN and highlight the necessity of early intervention for maintaining long-term hip function.
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Affiliation(s)
- Saksham Goyal
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sandeep Shrivastav
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ratnakar Ambade
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aditya Pundkar
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashutosh Lohiya
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Çavuş MC, Afacan MY, Zeytunlu A, Yapar A. Bilateral Femur and Humerus Avascular Necrosis Associated With Corticosteroids: A Rare Case Presentation. Cureus 2023; 15:e50834. [PMID: 38249259 PMCID: PMC10797227 DOI: 10.7759/cureus.50834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Avascular necrosis of the bone is a pathology characterized by compromised blood circulation, leading to necrosis due to insufficient vascular nourishment. Within the realm of orthopedics and traumatology, instances of avascular necrosis are steadily increasing. Notably, the escalating use of corticosteroids in managing inflammatory diseases and acute respiratory distress syndrome associated with the COVID-19 pandemic has resulted in a surge of outpatient referrals concerning cases of glucocorticoid-associated avascular necrosis. This study aims to elucidate the management of avascular necrosis following oral corticosteroid use in a young and otherwise healthy male patient, impacting both humeral and femoral heads bilaterally. A 26-year-old adult male, devoid of chronic health conditions, received a diagnosis of bilateral avascular necrosis in humeral and femoral heads within two years following a one-month course of oral corticosteroids. The patient underwent a comprehensive treatment regimen, encompassing hyperbaric oxygen therapy, oral antiplatelet therapy, a tailored physical therapy and rehabilitation program, and bilateral core decompression surgery for both hip joints. During the three-year follow-up, the patient exhibited a favorable response to treatment, demonstrating a complete and painless range of motion in both shoulder and hip joints. This case serves to underscore a crucial point: femoral head avascular necrosis may not invariably manifest as the initial bone affected, and a substantial time lapse may transpire between corticosteroid use and the onset of clinical symptoms. We emphasize the critical importance of not dismissing complaints pertaining to other bones in patients with a confirmed diagnosis and stress the significance of prompt detection in avascular necrosis. Furthermore, this study highlights the necessity for heightened vigilance in instances of orthopedic grievances among individuals with a history of corticosteroid use, particularly those related to the pandemic and inflammatory diseases, to facilitate early diagnosis and intervention for avascular necrosis.
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Affiliation(s)
- Mert Can Çavuş
- Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, TUR
| | - Muhammed Yusuf Afacan
- Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, TUR
| | - Arda Zeytunlu
- General Practice, Antalya Kepez District Health Department, Antalya, TUR
| | - Aliekber Yapar
- Department of Orthopaedics and Traumatology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, TUR
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Lee S, Zheng H, Park SM, Kim HJ, Yeom JS. A Randomized Controlled Trial of Vertebral Body Decompression Procedure Versus Conservative Treatment for Painful Vertebral Compression Fracture. Medicina (Kaunas) 2023; 59:1848. [PMID: 37893566 PMCID: PMC10608657 DOI: 10.3390/medicina59101848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/12/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
Background: Traditional treatment modalities for vertebral compression fractures (VCFs) include bed rest, pain medications, muscle relaxants, back braces, and physical therapy. In cases where conservative treatment proves ineffective, a new procedure called core decompression of the vertebral body is explored. Core decompression of the vertebral body has the potential to lower and stabilize the intraosseous pressure, resulting in enhanced blood circulation, which contributes to pain reduction. In this trial, we evaluated the efficacy of core decompression of the vertebral body in patients with painful VCFs compared with conventional conservative treatment. Methods: This prospective randomized controlled trial was conducted at a tertiary education hospital between June 2017 and May 2020. The participants were randomly assigned in a 1:1 ratio to one of two treatment groups: the core decompression group and the conservative treatment group. The primary outcome measure was the visual analog scale (VAS) pain score of the back 3 months after the procedure. Secondary outcome measures included the Oswestry Disability Index (ODI) for lumbar disabilities, the European Quality of Life-5 Dimensions (EQ-5D) score for quality of life, and radiographic outcomes such as changes in compression rate. Results: All patients underwent the assigned intervention (48 core decompression and 50 conservative treatments). At both 1 month and 3 months, there were no significant differences between the core decompression group and conservative treatment group in VAS pain score (adjusted treatment effect: -0.1 and 2.0; 95% confidence interval [CI]: -7.5 to 7.3 and -5.6 to 9.6; p = 0.970 and p = 0.601, respectively). In addition, there were no significant inter-group differences in ODI and EQ-5D scores throughout the follow-up period (p = 0.917 and 0.704, respectively). Conclusion: Core decompression of the vertebral body did not demonstrate any significant improvement in pain and disability compared to conventional conservative treatment.
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Affiliation(s)
| | | | - Sang-Min Park
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si 13620, Republic of Korea
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Mei J, Jiang ZP, Pang LL, Huang Y, Gong Y, Zhu J, Zhang LW. Core decompression vs. allogenic non-vascularized bone grafting in patients with osteonecrosis of the femoral head. Front Surg 2023; 10:1219835. [PMID: 37711137 PMCID: PMC10499510 DOI: 10.3389/fsurg.2023.1219835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/07/2023] [Indexed: 09/16/2023] Open
Abstract
Background Core decompression and allogenic non-vascularized bone grafting are used in the early stage of osteonecrosis of the femoral head for a period. Since the comparison of the core decompression and allogenic non-vascularized bone grafting are less reported, the purpose of our study was to investigate the difference of two procedures in patients with the osteonecrosis of the femoral head. Methods Between January 2018 and January 2019, 59 patients (64 hips) were divided into core decompression group and non-vascularized bone grafting group according to their procedures. The primary outcomes are visual analog score (VAS) and Harris hip score. Survivorship was analyzed with the collapse of the femoral head or conversion to total hip arthroplasty (THA) as the endpoint. Results At the final follow-up, two hips underwent THA in the core decompression group and three hips in the allogenic non-vascularized bone grafting group. The radiographic survival rates were 76.9% and 77.3%, respectively, in both groups. The VAS of the core decompression group was 6.08 ± 1.164 and 3.30 ± 1.431 before and 2 years after operation (P < 0.05), respectively. The VAS of the allogenic non-vascularized bone grafting group was 6.00 ± 1.209 and 3.15 ± 1.537 before and 2 years after operation (P < 0.05), respectively. The Harris hip score of the core decompression group was 52.49 ± 6.496 before operation, and 2 years after operation, it increased by 81.14 ± 8.548 (P < 0.05); The Harris hip score of allogenic the non-vascularized bone grafting group was 53.56 ± 5.925 and 81.33 ± 7.243 before and 2 years after operation (P < 0.05), respectively. In the core decompression group, body mass index (BMI) >25 kg/m2 was correlated with the collapse of femoral head or conversion to THA [P < 0.05; 95% confidence interval (CI), 0.006-1.334], and Association Research Circulation Osseous (ARCO) III was correlated with the collapse of femoral head or conversion to THA (P < 0.05; 95% CI, 2.514-809.650). In the allogenic non-vascularized bone grafting group, age, BMI, and ARCO stage were significantly associated with the collapse of femoral head or conversion to THA (P > 0.05). Conclusion The clinical survival rate of the femoral head in the core decompression group was slightly better than that in the allogenic non-vascularized bone grafting group. There was no significant difference in the radiographic survival rate of the femoral head between the two groups. Both groups can alleviate pain and improve functional of patients, but there was no significant difference in the degree of improvement. In the core decompression group, BMI >25 kg/m2 and ARCO III correlated with the collapse of femoral head or conversion to THA. In the allogenic non-vascularized bone grafting group, no association was found between age, BMI, and ARCO stage and the collapse of femoral head or conversion to THA. Level of evidence III.
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Affiliation(s)
- Jin Mei
- Yiyang First Traditional Chinese Medicine Hospital, Yiyang, China
| | - Zai-ping Jiang
- Yiyang First Traditional Chinese Medicine Hospital, Yiyang, China
| | - Li-li Pang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yingtao Huang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yu Gong
- Hunan Provincial People's Hospital, Changsha, China
| | - Jun Zhu
- Hunan University of Traditional Chinese Medicine, Changsha, China
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Tsubosaka M, Maruyama M, Lui E, Moeinzadeh S, Huang EE, Kushioka J, Hirata H, Jain C, Storaci HW, Chan C, Toya M, Gao Q, Teissier V, Shen H, Li X, Zhang N, Matsumoto T, Kuroda R, Goodman SB, Yang YP. The efficiency of genetically modified mesenchymal stromal cells combined with a functionally graded scaffold for bone regeneration in corticosteroid-induced osteonecrosis of the femoral head in rabbits. J Biomed Mater Res A 2023; 111:1120-1134. [PMID: 36606330 PMCID: PMC10277231 DOI: 10.1002/jbm.a.37495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/18/2022] [Accepted: 12/27/2022] [Indexed: 01/07/2023]
Abstract
Core decompression (CD) with mesenchymal stromal cells (MSCs) is an effective therapy for early-stage osteonecrosis of the femoral head (ONFH). Preconditioning of MSCs, using inflammatory mediators, is widely used in immunology and various cell therapies. We developed a three-dimensional printed functionally graded scaffold (FGS), made of β-TCP and PCL, for cell delivery at a specific location. The present study examined the efficacy of CD treatments with genetically modified (GM) MSCs over-expressing PDGF-BB (PDGF-MSCs) or GM MSCs co-over-expressing IL-4 and PDGF-BB and preconditioned for three days of exposure to lipopolysaccharide and tumor necrosis factor-alpha (IL-4-PDGF-pMSCs) using the FGS for treating steroid-induced ONFH in rabbits. We compared CD without cell-therapy, with IL-4-PDGF-pMSCs alone, and with FGS loaded with PDGF-MSCs or IL-4-PDGF-pMSCs. For the area inside the CD, the bone volume in the CD alone was higher than in both FGS groups. The IL-4-PDGF-pMSCs alone and FGS + PDGF-MSCs reduced the occurrence of empty lacunae and improved osteoclastogenesis. There was no significant difference in angiogenesis among the four groups. The combined effect of GM MSCs or pMSCs and the FGS was not superior to the effect of each alone. To establish an important adjunctive therapy for CD for early ONFH in the future, it is necessary and essential to develop an FGS that delivers biologics appropriately and provides structural and mechanical support.
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Affiliation(s)
- Masanori Tsubosaka
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Masahiro Maruyama
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Elaine Lui
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Seyedsina Moeinzadeh
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Elijah Ejun Huang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Junichi Kushioka
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Hirohito Hirata
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Charu Jain
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Hunter W. Storaci
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Calvin Chan
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Masakazu Toya
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Qi Gao
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Victoria Teissier
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Huaishuang Shen
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Xueping Li
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Ning Zhang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Stuart B. Goodman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Department of Bioengineering, Stanford University School of Medicine, Stanford, CA, USA
| | - Yunzhi Peter Yang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Department of Material Science and Engineering, Stanford University School of Medicine, Stanford, CA, USA
- Department of Bioengineering, Stanford University School of Medicine, Stanford, CA, USA
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Woerner M, Voelkl K, Bliemel C, Ferner F, Weber M, Renkawitz T, Grifka J, Craiovan B. Comparison of two joint-preserving treatments for osteonecrosis of the femoral head: core decompression and core decompression with additional cancellous bone grafting. J Int Med Res 2023; 51:3000605231190453. [PMID: 37585739 PMCID: PMC10416661 DOI: 10.1177/03000605231190453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 07/11/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE Femoral head necrosis (FHN) affects mostly young and active people. The most common operative therapy is core decompression (CD) with optional cancellous bone grafting (CBG). Because little information is available on the long-term results of these procedures, we investigated the effectiveness of CD and CD + CBG in patients with ARCO stage II FHN in terms of postoperative pain, range of motion, patient-reported outcome measures (Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score, EuroQol 5D, and Short Form 36 Questionnaire), and disease progression. METHODS We retrospectively compared 11 patients treated with CD alone 48.0 months (range, 26.3-68.5 months) postoperatively versus 11 patients treated with CD + CBG 69.2 months (range, 38.0-92.9 months) postoperatively. All patients were assessed according to a routine clinical protocol involving a clinical examination, questionnaires, and radiological imaging (X-ray and magnetic resonance imaging). RESULTS The clinical and radiological results showed no significant differences between the two groups. Both interventions demonstrated equal results according to clinical scores. CONCLUSIONS Our data may encourage application of the less invasive technique of CD alone without CBG, which is more surgically demanding. Further prospective studies with longer follow-up are necessary to clarify the risk factors for therapy failure.
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Affiliation(s)
- Michael Woerner
- Klinikum Bamberg, Klinik für Orthopädie und Unfallchirurgie, Buger Strasse 80, Bamberg
- Universitätsklinikum Regensburg Klinik für Orthopädie, Kaiser-Karl V-Allee 3, Bad Abbach
- Universitätsklinikum Regensburg, Klinik für Orthopädie, Kaiser-Karl V-Allee 3, Bad Abbach
| | - Korbinian Voelkl
- Universitätsklinikum Regensburg Klinik für Orthopädie, Kaiser-Karl V-Allee 3, Bad Abbach
| | - Christopher Bliemel
- Universitätsklinikum Marburg, Klinik für Orthopädie und Unfallchirurgie, Baldingertrasse, Marburg
| | - Felix Ferner
- Klinikum Lichtenfels, Klinik für Orthopädie und Unfallchirurgie, Professor-Arneth-Straße 2b, Lichtenfels
| | - Markus Weber
- Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg
| | - Tobias Renkawitz
- Universitätsklinikum Heidelberg, Klinik für Orthopädie, Schlierbacher Landstraße 200a, Heidelberg
| | - Joachim Grifka
- Universitätsklinikum Regensburg Klinik für Orthopädie, Kaiser-Karl V-Allee 3, Bad Abbach
| | - Benjamin Craiovan
- Universitätsklinikum Regensburg Klinik für Orthopädie, Kaiser-Karl V-Allee 3, Bad Abbach
- Universitätsklinikum Marburg, Klinik für Orthopädie und Unfallchirurgie, Baldingertrasse, Marburg
- Universitätsklinikum Regensburg, Klinik für Orthopädie, Kaiser-Karl V-Allee 3, Bad Abbach
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Ivković A, Glavčić M, Vuletić F, Janković S. Core Decompression Combined with Intraosseous Autologous Conditioned Plasma Injections Decreases Pain and Improves Function in Patients with Symptomatic Knee Bone Marrow Lesions. Biomedicines 2023; 11:1799. [PMID: 37509439 PMCID: PMC10376709 DOI: 10.3390/biomedicines11071799] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
The purpose of this prospective case series was to determine the effectiveness of using a combination of the core decompression and injection of autologous conditioned plasma (ACP) for the treatment of symptomatic knee bone marrow lesions (BML), as well as to report on the preliminary clinical results based on magnetic resonance imaging (MRI) and patient-reported outcomes (PROMs). Patients with OA-related BML who failed to improve on conservative treatment for three months underwent an identical procedure consisting of arthroscopy, core decompression, and the intraosseous injection of ACP and were followed up for 12 months. A statistically significant reduction in pain and an improvement in function, as measured by the Numeric Pain Rating Scale (NPRS) and Knee Injury and Osteoarthritis Outcome Score (KOOS), was observed at one-week follow-up (8.3 ± 0.8 to 1.5 ± 1.0; p ≤ 0.001 and 33.4 ± 10.6 to 53.9 ± 13.6; p ≤ 0.001 respectively). After six weeks, weight-bearing was allowed, but the trend did not change-the NPRS continued to be low (average 1.4 on 12-month follow-up) and the total KOOS increased 44.6 points from the baseline (average 78.0 on 12-month follow-up). The Whole-Organ Magnetic Resonance Imaging Score improved from 66.1 ± 19.4 prior to surgery to 58.0 ± 15.9 (p < 0.001) after 3 months. In our study, there was no control group, randomisation was not performed, and the sample size was relatively small. A combination of core decompression and the intraosseous injection of ACP into the affected subchondral area proved to be a safe and effective procedure that provides rapid pain relief and a significant increase in joint function up to one year postoperatively.
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Affiliation(s)
- Alan Ivković
- Department of Orthopaedics and Trauma Surgery, University Hospital "Sveti Duh", 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Clinical Medicine, University of Applied Health Sciences, 10000 Zagreb, Croatia
| | - Marin Glavčić
- Department of Orthopaedic and Trauma Surgery, University Hospital "Dubrava", 10000 Zagreb, Croatia
| | - Filip Vuletić
- Department of Orthopaedics and Trauma Surgery, University Hospital "Sveti Duh", 10000 Zagreb, Croatia
| | - Saša Janković
- Department of Orthopaedics and Trauma Surgery, University Hospital "Sveti Duh", 10000 Zagreb, Croatia
- Faculty of Kinesiology, University of Zagreb, 10000 Zagreb, Croatia
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Ng MK, Gordon AM, Lam A, Piuzzi N, Erez O, Scuderi G, Mont MA. Surgical Trends for Managing Knee Osteonecrosis: A 2010 to 2020 United States Nationwide Study. J Arthroplasty 2023; 38:S125-S130. [PMID: 36738865 DOI: 10.1016/j.arth.2023.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/02/2023] [Accepted: 01/24/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Knee osteonecrosis (ON) is rare, with an estimated incidence of 0.01-0.17 per 1,000 person years. Our study aimed to do the following: 1) quantify total operative procedures with rates normalized to the United States population; 2) compare arthroplasty versus joint-preserving procedural trends; and 3) determine rates of specific operative techniques/demographics in patients aged <50 versus >50 years. METHODS Using a nationwide database, 8,269 patients diagnosed with knee ON underwent surgical treatment from 2010 to 2020. Documented surgical procedures included total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), and core decompression. Primary outcomes included procedural utilization with subanalyses comparing arthroplasty versus joint-preserving procedures, and age-stratified by under/over 50 years. Linear regressions were evaluated for trends in procedural volumes over time. RESULTS From 2010 to 2014, 0.54% of all knee procedures were to treat ON compared to 0.71% from 2015 to 2020 (P < .001). Overall rates of TKA (85.4%) and UKA (10.3%) far exceeded rates of joint preserving procedures (4.3%). Comparing 2010-2014 with 2015-2019, joint-preserving procedures proportionally increased (0.7 to 5.0%, P < .001). Patients <50 years had significantly more joint-preserving procedures (19.5 versus 2.7%). Overall, TKA was the most common procedure (7,062; 85.40%), following by UKA 853; 10.32%) and core decompression (354; 4.28%). CONCLUSION To our knowledge, this is the first study to characterize surgical trends in management of knee ON. Overall surgical volume for knee ON has continued to increase, outpacing population growth. Patients who have knee ON are most commonly managed with arthroplasty procedures, specifically TKA. Younger aged patients (<50 years) are more likely to undergo joint-preserving procedures, namely core decompression.
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Affiliation(s)
- Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Adam M Gordon
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Aaron Lam
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Nicolas Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Orry Erez
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Giles Scuderi
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
| | - Michael A Mont
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York; Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
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Singh H, Agarwal KK, Tyagi S, Rampurwala A, Singh A, Bhrambhatt P, Unjia R, Agarwal N, Rampurwala AJ. An Evaluation of Core Decompression and Cancellous Bone Grafting for Early-Stage Avascular Necrosis of the Femoral Head. Cureus 2023; 15:e37878. [PMID: 37214077 PMCID: PMC10199657 DOI: 10.7759/cureus.37878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/23/2023] Open
Abstract
Background Avascular necrosis (AVN) is characterized by bone death due to impaired blood supply leading to its collapse causing pain and suboptimal joint function. The blood supply of the femoral head is so tenuous that even a slight vascular injury can predispose to AVN. Hence, AVN is commonly seen in the femoral head. Core decompression can arrest or even reverse the process of AVN and can avoid femoral head collapse and its sequelae. A lateral trochanteric approach is used for core decompression. The necrotic bone is removed from the femoral head. The use of a non-vascularized bone graft is more attractive than a vascularized graft because it is significantly less technically challenging. The regenerative properties due to the presence of osteoblasts in the trabecular bone and the ability to procure a large amount of graft make the iliac crest the gold standard site of cancellous bone graft harvesting. Core decompression can be considered an effective treatment modality in early-stage AVN (up to stage 2B) of the femoral head. Methodology A prospective, interventional study was conducted in a tertiary care teaching hospital in southern Rajasthan, India. 20 Patients with AVN of the femoral head (up to grade 2B of Ficat and Arlet classification) who met the inclusion and exclusion criteria and presented to the orthopedic outpatient department of our institute were included in this study. Patients were treated with core decompression and cancellous bone grafting with a graft taken from the iliac crest. The Harris Hip Score (HHS) and Visual Analog Scale (VAS) score were used to assess the outcomes. Results In our study, the majority (50%) of the patients were in the 20-30-year age group, making it the most common age group with a male predominance (85%). In this study, the final result was calculated according to the HHS and VAS scores. The mean HHS was 69.45 preoperatively and 83.55 at six months postoperatively. Similarly, the mean VAS score was 6.3 preoperatively and 3.8 at six months postoperatively. Conclusions Core decompression with cancellous bone grafting is a promising procedure in stages 1 and 2 as it reduces the symptoms in the majority of cases and improves functional outcomes.
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Affiliation(s)
- Harpreet Singh
- Department of Orthopaedics, Geetanjali Medical College & Hospital, Udaipur, IND
| | - Kamal Kumar Agarwal
- Department of Orthopaedics, Geetanjali Medical College & Hospital, Udaipur, IND
| | - Sangam Tyagi
- Department of Orthopaedics, Geetanjali Medical College & Hospital, Udaipur, IND
| | - Ammar Rampurwala
- Department of Orthopaedics, Geetanjali Medical College & Hospital, Udaipur, IND
| | - Amritesh Singh
- Department of Orthopaedics, Geetanjali Medical College & Hospital, Udaipur, IND
- Department of Orthopaedics, University College of Medical Sciences, Guru Teg Bahadur Hospital, Delhi, IND
| | - Purvesh Bhrambhatt
- Department of Orthopaedics, Geetanjali Medical College & Hospital, Udaipur, IND
| | - Rishit Unjia
- Department of Orthopaedics, Geetanjali Medical College & Hospital, Udaipur, IND
| | - Neel Agarwal
- Department of Orthopaedics, Geetanjali Medical College & Hospital, Udaipur, IND
| | - Aliasgar J Rampurwala
- Department of Orthopaedics, Parul Institute of Medical Sciences and Research, Vadodara, IND
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Wei C, Yang M, Chu K, Huo J, Chen X, Liu B, Li H. The indications for core decompression surgery in patients with ARCO stage I-II osteonecrosis of the femoral head: a new, comprehensive prediction system. BMC Musculoskelet Disord 2023; 24:242. [PMID: 36997998 PMCID: PMC10061868 DOI: 10.1186/s12891-023-06321-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/14/2023] [Indexed: 04/01/2023] Open
Abstract
Background Core decompression (CD) is considered the most popular treatment method for patients with Association Research Circulation Osseous (ARCO) stage I-II osteonecrosis of the femoral head (ONFH). However, the definitive indication for CD is currently not well established. Methods This was a retrospective cohort study. Patients who were diagnosed with ARCO stage I-II ONFH and who underwent CD were included. According to the prognosis, the patients were divided into two groups: collapse of the femoral head after CD and noncollapse of the femoral head. Independent risk factors for the failure of CD treatment were identified. Subsequently, a new scoring system that included all these risk factors was built to help estimate the individual risk of CD failure in patients who were planning to undergo CD. Results The study included 1537 hips after decompression surgery. The overall failure rate of CD surgery was 52.44%. Seven independent prognostic factors for failed CD surgery were identified, such as male sex (HR = 75.449; 95% confidence interval (CI), 42.863-132.807), Aetiology (Idiopathic HR = 2.762; 95% CI, 2.016–3.788, Steroid-induced HR = 2.543; 95% CI, 1.852–3.685), if the patient had a seated occupation (HR = 3.937; 95% CI, 2.712–5.716), age (HR = 1.045; 95% CI, 1.032–1.058), haemoglobin level (HR = 0.909; 95% CI, 0.897–0.922), disease duration (HR = 1.217; 95% CI, 1.169–1.267) and the combined necrosis angle (HR = 1.025; 95% CI, 1.022–1.028). The final scoring system included these seven risk factors, and the area under the curve of this scoring system was 0.935 (95% confidential interval = 0.922–0.948). Conclusion This new scoring system might provide evidence-based medical proof for determining whether a patient with ARCO stage I - II ONFH might benefit from CD surgery. This scoring system is crucial for making clinical decisions. Consequently, this scoring system is recommended before CD surgery, which could help determine the potential prognosis of patients.
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Affiliation(s)
- Congcong Wei
- Department of Joint Surgery, No. 215 Hospital of Shaanxi Nuclear Industry, No.35, West Weiyang Road, Xianyang, Shaanxi Province China
| | - Meng Yang
- grid.452209.80000 0004 1799 0194Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province P.R. China
| | - Kun Chu
- grid.452209.80000 0004 1799 0194Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province P.R. China
| | - Jia Huo
- grid.452209.80000 0004 1799 0194Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province P.R. China
| | - Xiao Chen
- grid.452209.80000 0004 1799 0194Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province P.R. China
| | - Bo Liu
- grid.452209.80000 0004 1799 0194Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province P.R. China
| | - Huijie Li
- grid.452209.80000 0004 1799 0194Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province P.R. China
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Ng MK, Gordon AM, Piuzzi NS, Wong CHJ, Jones LC, Mont MA. Trends in Surgical Management of Osteonecrosis of the Femoral Head: A 2010 to 2020 Nationwide Study. J Arthroplasty 2023:S0883-5403(23)00322-4. [PMID: 37001624 DOI: 10.1016/j.arth.2023.03.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/13/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The incidence of osteonecrosis of the femoral head (ONFH) is estimated at more than 20,000 patients annually in the US. Our study aimed to provide a 10-year analysis: 1) evaluating total operative procedures with rates normalized to the population; 2) determining trends of arthroplasty versus joint-preserving procedures; and 3) quantifying specific operative techniques in patients <50 versus >50 years of age. METHODS A total of 64,739 patients who were diagnosed with ONFH and underwent hip surgery were identified from a nationwide database between 2010 and 2020. The percentage of patients managed by each operative procedure was calculated and normalized to the overall population annually. Patients were grouped into joint-preserving versus non-joint-preserving (arthroplasty) procedures, and divided by age under/over 50 years. Linear regression modeling was performed to evaluate trends/differences in procedural volume by year. RESULTS The number of operative procedures to treat ONFH has relatively declined from 2010 to 2020. The relative proportion of joint-preserving procedures increased (8.6% to 11.2%) during this time period. There were significantly more joint-preserving procedures in patients aged <50 years relative to >50 years (15.3% versus 2.7%, P < .001). Overall, THA was the most common procedure (57,033;88.1%) relative to hemiarthroplasty (3,875;6.0%), core decompression (2,730;4.2%), bone graft (467;0.7%), and osteotomy (257;0.4%). CONCLUSION Surgical management of patients who have ONFH remains predominantly arthroplasty procedures (94% overall). Our findings suggest an increase in joint-preserving procedures, particularly core decompression, in patients <50 years (15.3%). Our findings provide insight into surgical management trends for ONFH, and suggest opportunities for joint-preserving procedures.
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Affiliation(s)
- Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Adam M Gordon
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Che Hang J Wong
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Lynne C Jones
- Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michael A Mont
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York; Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
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18
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Blanco JF, Garcia-Garcia FJ, Villarón EM, da Casa C, Fidalgo H, López-Parra M, Santos JA, Sánchez-Guijo F. Long-Term Results of a Phase I/II Clinical Trial of Autologous Mesenchymal Stem Cell Therapy for Femoral Head Osteonecrosis. J Clin Med 2023; 12:jcm12062117. [PMID: 36983120 PMCID: PMC10051457 DOI: 10.3390/jcm12062117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/08/2023] [Accepted: 03/01/2023] [Indexed: 03/30/2023] Open
Abstract
(1) Background: Osteonecrosis of the femoral head (ONFH) is characterized by impaired vascularization with ischemia resulting in bone cell death, leading to the deterioration of the hip joint. Mesenchymal stem/stromal cells (MSCs) are an attractive potential therapeutic approach in this setting. The aim of this study is to evaluate the clinical improvement in terms of pain and quality of life, as well as the safety of the procedure during the follow-up of patients. (2) Methods: A Phase I-II Open-Label Non-Randomized Prospective clinical trial was conducted. Eight patients with idiopathic ONFH and stage < IIC in the ARCO classification were included. Four weeks before therapy, 40 mL of autologous bone marrow was obtained, and MSCs were expanded under Good-Manufacturing-Practice (GMP) standards. Study medication consisted of a suspension of autologous BM-derived MSCs (suspended in a solution of 5-10 mL of saline and 5% human albumin) in a single dose of 0.5-1 × 106 cells/kg of the patient, administered intraosseously with a trocar and under radioscopic control. Per-protocol monitoring of patients included a postoperative period of 12 months, with a clinical and radiological assessment that included the visual analog scale (VAS), the Harris scale, the SF-36, and the radiological evolution of both hips. In addition, all patients were further followed up for eight years to assess the need for long-term total hip replacement (THR) surgery. (3) Results: Median age of patients included was 48.38 ± 7.38 years, and all patients were men. Autologous MSCs were expanded in all cases. There were no adverse effects related to cell administration. Regarding efficacy, both VAS and ODI scores improved after surgery. Radiologically, 12.5% of patients improved at the end of follow-up, whereas 50% improved clinically. No adverse effects related to the procedure were recorded, and none of the patients needed THR surgery within the first year after MSC therapy. (4) Conclusions: The use of autologous MSCs for patients with ONFH disease is feasible, safe in the long term, and potentially effective.
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Affiliation(s)
- Juan F Blanco
- Orthopaedic Surgery and Traumatology Department, University Hospital of Salamanca, 37007 Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
- Regenerative Medicine and Cell Therapy Network Center of Castilla y Leon, Gerencia Regional de Salud, 47011 Valladolid, Spain
- Health Outcomes-Oriented Cooperative Research Networks in Advanced Therapies (RICORS TERAV), Instituto de Salud Carlos III, 28220 Madrid, Spain
- Department of Medicine, University of Salamanca, 37007 Salamanca, Spain
| | - Francisco J Garcia-Garcia
- Orthopaedic Surgery and Traumatology Department, University Hospital of Salamanca, 37007 Salamanca, Spain
| | - Eva M Villarón
- Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
- Regenerative Medicine and Cell Therapy Network Center of Castilla y Leon, Gerencia Regional de Salud, 47011 Valladolid, Spain
- Health Outcomes-Oriented Cooperative Research Networks in Advanced Therapies (RICORS TERAV), Instituto de Salud Carlos III, 28220 Madrid, Spain
- Cell Therapy Unit, Hematology Department, University Hospital of Salamanca, 37007 Salamanca, Spain
| | - Carmen da Casa
- Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
| | - Helena Fidalgo
- Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
| | - Miriam López-Parra
- Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
- Regenerative Medicine and Cell Therapy Network Center of Castilla y Leon, Gerencia Regional de Salud, 47011 Valladolid, Spain
- Health Outcomes-Oriented Cooperative Research Networks in Advanced Therapies (RICORS TERAV), Instituto de Salud Carlos III, 28220 Madrid, Spain
- Cell Therapy Unit, Hematology Department, University Hospital of Salamanca, 37007 Salamanca, Spain
| | - José A Santos
- Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
- Radiology Department, University Hospital of Salamanca, 37007 Salamanca, Spain
- Department of Biomedical Sciences and Diagnostics, University of Salamanca, 37007 Salamanca, Spain
| | - Fermín Sánchez-Guijo
- Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain
- Regenerative Medicine and Cell Therapy Network Center of Castilla y Leon, Gerencia Regional de Salud, 47011 Valladolid, Spain
- Health Outcomes-Oriented Cooperative Research Networks in Advanced Therapies (RICORS TERAV), Instituto de Salud Carlos III, 28220 Madrid, Spain
- Department of Medicine, University of Salamanca, 37007 Salamanca, Spain
- Cell Therapy Unit, Hematology Department, University Hospital of Salamanca, 37007 Salamanca, Spain
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Yousif NG, Al Kilabi AEK, Hatem KK, Al-Albaseesee HH, Al-Fatlawy WAY, Alhamadani M, Nöth UA, Altmimi A. Autologous hematopoietic bone marrow and concentrated growth factor transplantation combined with core decompression in patients with avascular necrosis of the femoral head. J Med Life 2023; 16:76-90. [PMID: 36873113 PMCID: PMC9979168 DOI: 10.25122/jml-2022-0342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/09/2023] [Indexed: 03/07/2023] Open
Abstract
The study aimed to assess the effectiveness of autologous hematopoietic bone marrow and concentrated growth factor (CGF) transplantation and core decompression in patients with avascular necrosis of the femoral head (ANFH). We performed a single-center prospective study on 31 patients with non-traumatic early-stage (stage I to III) ANFH based on the 1994 classification of the Association Research Circulation Osseous (ARCO). The patients were subjected to bone marrow aspiration from the posterior iliac crest, separation, and concentration of growth factors from the bone marrow aspirate, core decompression of the femoral head, and injection of hematopoietic bone marrow and CGFs into the necrotic lesion. Patients were evaluated using the visual analogue scale, the WOMAC questionnaire, and X-ray and MRI examinations of the hip joints before, at 2, 4, and 6 months after the intervention. Patients had a mean age of 33 years (range 20-44 years), 19 (61%) of them being male and 12 (39%) females. The presentation of the disease was bilateral in 21 patients and unilateral in 10 patients. The main cause of ANFH was steroid treatment. The mean VAS and WOMAC scores were 48.37 (SD: 14.67) out of 100, and the mean VAS pain score was 50.83 out of 100 (SD: 20.46), respectively, before transplant. This value significantly improved to 22.31 (SD 12.12) of 100, and the mean VAS pain score was 21.31 of 100 (SD: 20.46) (P=0.04). MRI showed a significant improvement (P=0.012). Our results suggest that autologous hematopoietic bone marrow and CGFs transplantation with core decompression have a beneficial effect in early-stage ANFH.
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Affiliation(s)
- Nasser Ghaly Yousif
- Department of Medicine, Medical College, Al Muthanna University, Samawah, Iraq
| | | | - Karrar Kareem Hatem
- Department of Surgery, Medical College, Jabir Ibn Hayyan Medical University, Najaf, Iraq
| | | | | | | | - Ulrich Aran Nöth
- Department of Regenerative Research, College of Medicine, Colorado University, Boulder, Colorado
| | - Ahmed Altmimi
- Department of Biology, Ministry of Health, Al Muthanna, Iraq
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20
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Wang J, Xu P, Zhou L. Comparison of current treatment strategy for osteonecrosis of the femoral head from the perspective of cell therapy. Front Cell Dev Biol 2023; 11:995816. [PMID: 37035246 PMCID: PMC10073660 DOI: 10.3389/fcell.2023.995816] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Aims: The purpose of our study is to compare the effects of core decompression (CD) and bone grafting (BG) on osteonecrosis of the femoral head (ONFH). And evaluate the efficacy of CD based on cell therapy to provide guidance for the dose and number of cells. Methods: We searched PubMed, Embase, and the Cochrane Library between 2012 and 2022, with keywords including "osteonecrosis of the femoral head", "core decompression" and "bone grafting". We selected comparative studies of CD and BG, and the comparison of CD combined with bone marrow (BM) transplantation and CD alone. Changes in hip pain were assessed by VAS, hip function were assessed by HHS and WOMAC, and THA conversion rate was used as an evaluation tool for femoral head collapse. From these three aspects, the dose of bone marrow and the number of cells transplantation were subgroup analyzed. Results: Eleven studies were used to compare the efficacy of CD and BG. There was no significant difference in HHS, and the THA conversion rate of BG was significantly lower than that of CD. Thirteen CD studies based on cell therapy were included in the meta-analysis. Bone marrow aspiration concentrate (BMAC) can significantly improve VAS (mean difference (MD), 10.15; 95% confidence intervals (CI) 7.35 to 12.96, p < 0.00001) and reduce THA conversion rate (odds ratio (OR), 2.38; 95% CI 1.26 to 4.47, p = 0.007). Medium dose bone marrow fluid has a lower p-value in THA conversion rate. The p values of bone marrow mononuclear cells (BMMC) of 109 magnitude in VAS score were lower. Conclusion: In general, there is no consensus on the use of BG in the treatment of ONFH. The enhancement of cell-based CD procedure shows promising results. Using 20 mL BMAC and 109 magnitude BMMC is likely to achieve better results.
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Affiliation(s)
- Jiaqian Wang
- Department of Orthopaedic, Wuxi No 5 People's Hospital, Wuxi, Jiangsu, China
- *Correspondence: Jiaqian Wang, , Liang Zhou,
| | - Peirong Xu
- Department of Orthopaedic, Wuxi No 5 People's Hospital, Wuxi, Jiangsu, China
| | - Liang Zhou
- Department of Orthopedics, Lianshui County People’s Hospital, Huai’an, Jiangsu, China
- *Correspondence: Jiaqian Wang, , Liang Zhou,
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Ku PC, Martin-Gomez A, Gao C, Grupp R, Mears SC, Armand M. Towards 2D/3D Registration of the Preoperative MRI to Intraoperative Fluoroscopic Images for Visualization of Bone Defects. Comput Methods Biomech Biomed Eng Imaging Vis 2022; 11:1096-1105. [PMID: 37555198 PMCID: PMC10406464 DOI: 10.1080/21681163.2022.2152375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/19/2022] [Indexed: 12/23/2022]
Abstract
Magnetic Resonance Imaging (MRI) is a medical imaging modality that allows for the evaluation of soft-tissue diseases and the assessment of bone quality. Preoperative MRI volumes are used by surgeons to identify defected bones, perform the segmentation of lesions, and generate surgical plans before the surgery. Nevertheless, conventional intraoperative imaging modalities such as fluoroscopy are less sensitive in detecting potential lesions. In this work, we propose a 2D/3D registration pipeline that aims to register preoperative MRI with intraoperative 2D fluoroscopic images. To showcase the feasibility of our approach, we use the core decompression procedure as a surgical example to perform 2D/3D femur registration. The proposed registration pipeline is evaluated using digitally reconstructed radiographs (DRRs) to simulate the intraoperative fluoroscopic images. The resulting transformation from the registration is later used to create overlays of preoperative MRI annotations and planning data to provide intraoperative visual guidance to surgeons. Our results suggest that the proposed registration pipeline is capable of achieving reasonable transformation between MRI and digitally reconstructed fluoroscopic images for intraoperative visualization applications.
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Affiliation(s)
- Ping-Cheng Ku
- Biomechanical- and Image-Guided Surgical Systems (BIGSS), Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Alejandro Martin-Gomez
- Biomechanical- and Image-Guided Surgical Systems (BIGSS), Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Cong Gao
- Biomechanical- and Image-Guided Surgical Systems (BIGSS), Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Robert Grupp
- Biomechanical- and Image-Guided Surgical Systems (BIGSS), Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Simon C. Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, AR, USA
| | - Mehran Armand
- Biomechanical- and Image-Guided Surgical Systems (BIGSS), Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
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22
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Abstract
Osteonecrosis of the femoral head (ONFH) is the most prevalent musculoskeletal pathologic manifestation of sickle cell disease (SCD) resulting in an osteonecrotic event. This review aimed to summarize mechanisms involved in pathophysiology of ONFH and treatment options available in Saudi Arabia to treat SCD patients with complication of osteonecrotic event. The pathophysiology of ONFH include genetic and micro particles involvement. The progression of osteonecrosis involves reduced levels of bioactive compounds in peripheral blood mononuclear cells and elevated CD4+T circulating levels to stimulate pro-inflammatory cytokines contributing to inflammation at target site. Initial treatment approach is pharmacological agents use to mitigate risk. Further, bone morphogenetic protein stimulation initiate bone formation and treatment can be improved with the use of bone morphogenetic protein, total hip arthroplasty and cell therapies. This review provides baseline information for future studies to be carried out in Saudi Arabia to improve treatment options in SCD patients with ONFH.
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Affiliation(s)
- Mohammed L. Al-Otaibi
- From theDepartment of Orthopedic Surgery, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia.
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Bozkurt I, Yalcin N, Uluyardimci E, Akgul EA. Combination of hyperbaric oxygen and core decompression therapies improve outcomes in the treatment of hip osteonecrosis. Hip Int 2022; 32:759-765. [PMID: 33840237 DOI: 10.1177/11207000211003285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION To investigate whether combined treatment of hyperbaric oxygen (HBO) and core decompression (CD) result with better outcomes and have an additional influence on health quality scores when compared with HBO alone. METHODS 63 consecutive patients' 80 hips (43 male, 20 female, 17 bilateral), diagnosed with Stage II Osteonecrosis of the femoral head were included in our study. The mean age at presentation in the HBO and CD + HBO groups were 39.9 years and 39.2 years, respectively. The mean follow-up was 39.8 months (24-56 months) for HBO group and 43.1 months (24-58 months) for the CD + HBO group. Standard radiographs and MRI were performed initially and during controls. Clinical outcomes were assessed using the modified Harris Hip Score (HHS), the visual analogue score (VAS) and SF-36 life quality score. RESULTS 52 hips (65%) were Ficat Stage IIa and 28 hips (35%) were IIb. Totally, 46 hips (30 hips IIa, 16 hips IIb) were in HBO alone group and 34 hips (22 hips IIa, 12 hips IIb) were in CD + HBO group. Both VAS and HHSs were improved in each group after treatment (p < 0.001). When both groups were compared, this improvement was more distinct and evident in CD + HBO combination group than HBO alone group (p < 0.001). The physical function and pain components of SF-36 survey were found to be different in between two groups (p < 0.005). DISCUSSION HBO treatment decreases pain, increases functional scores for Ficat Stage II patients. Addition of HBO treatment to decompression of the femoral head improves the results better than HBO alone. In particular, reduction of pain is more prevalent for Stage IIa patients than IIb with combination of HBO and CD therapies.
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Affiliation(s)
- Ibrahim Bozkurt
- Department of Orthopaedics and Traumatology, Bilkent City Hospital, Ankara, Turkey
| | - Nadir Yalcin
- Department of Orthopaedics and Traumatology, Karabuk University Training and Research Hospital, Karabuk, Turkey
| | - Enes Uluyardimci
- Department of Orthopaedics and Traumatology, Develi State Hospital, Kayseri, Turkey
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24
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Wang J, Zhang Y, Zhao C, Zhang Q. Femoral Head Necrosis Due to Brucella Infection in China: Case Series and Literature Review. Infect Drug Resist 2022; 15:5857-5865. [PMID: 36237293 PMCID: PMC9553233 DOI: 10.2147/idr.s383584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction The causes of femoral head necrosis mainly include trauma, corticosteroid, and alcohol, among which Brucella is highly unusual. Patients and Methods This paper reported three rare cases of femoral head necrosis due to Brucella, summarizing and analyzing the epidemiological history, clinical manifestations, laboratory examinations, imaging findings, individualized therapy, and biopsy results of patients with this disease. A literature review related to brucellosis and femoral head necrosis was conducted. Results All three patients had an epidemic history of brucellosis. They suffered from hip pain and limitation of movement for months, and femoral head necrosis was confirmed by magnetic resonance imaging (MRI). Pathological Giemsa staining or real-time polymerase chain reaction (real-time PCR) confirmed Brucella melitensis (B. melitensis) as the cause of osteonecrosis. Each patient received individualized therapy according to the degree of osteonecrosis, which was based on anti-brucellosis medications and hip puncture and irrigation decompression. They were followed up for more than two years and rehabilitated well. Conclusion Brucella infection should always be considered the cause of femoral head necrosis for patients with hip pain, especially for those with an epidemic history; early diagnosis and individual stepwise therapy can prevent the progression of osteonecrosis.
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Affiliation(s)
- Jie Wang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Yao Zhang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Changsong Zhao
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Qiang Zhang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China,Correspondence: Qiang Zhang, Email
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25
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Bakshi AS, Singh M, Kaur G, Singh J, Kaur H. A Retrospective Observational Study to Compare the Outcome of Various Treatment Modalities of Idiopathic Avascular Necrosis of Hip. Int J Appl Basic Med Res 2022; 12:265-268. [PMID: 36726652 PMCID: PMC9886145 DOI: 10.4103/ijabmr.ijabmr_680_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 07/20/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022] Open
Abstract
Background Avascular necrosis (AVN) of hip of the femoral head is increasingly seen in young age, disabling them in their productive years of life. Available treatment options need to be evaluated. Aim The aim was to compare the outcome of various treatments at different stages of AVN hip. Materials and Methods A retrospective observational study was done in patients with idiopathic AVN hip, who had undergone different treatment modalities. The data of the included patients at different time intervals were compared. All patients were graded with the help of Harris Hip Score (HHS), and their outcome was evaluated. Results The age distribution of patients showed that nearly 80% of them were below the age of 50 years. The patients were presenting more often in Ficat and Arlet stage 4 compared to earlier stages. The patients in stage 1 were treated by core decompression alone, which produced good-to-excellent results in 4 of 7 (57.1%) patients. Patients in stage 2 and 3 were treated by core decompression with fibular bone grafting and had good-to-excellent results in 6 of 8 (75%) patients. In stage 4 of disease, cemented total hip replacement (THR) was done, and it produced good-to-excellent results in 13 of 15 (86.6%) patients. Conclusion In the early stage of disease, core decompression with and without bone grafting produced satisfactory results. In an advanced stage of AVN, THR is an excellent treatment option.
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Affiliation(s)
| | - Mandeep Singh
- Department of Orthopaedics, Government Medical College, Patiala, Punjab, India
| | - Gurleen Kaur
- Department of Pharmacology, Adesh Medical College and Hospital, Shahbad, Haryana, India
| | - Jaspreet Singh
- Department of Orthopaedics, Government Medical College and Hospital, Punjab, India
| | - Harsimrat Kaur
- Department of Orthopaedics, Government Medical College and Hospital, Amritsar, Punjab, India
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26
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Wu CT, Kuo FC, Yen SH, Lin PC, Wang JW, Lee MS. Impaction Bone Grafting Augmented With a Wire Coil by the Lightbulb Technique for Osteonecrosis of the Femoral Head. J Arthroplasty 2022; 37:2063-2070. [PMID: 35490978 DOI: 10.1016/j.arth.2022.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Osteonecrosis of the femoral head (ONFH) is a debilitating disease that primarily affects the hips of young adults. The purpose of this study is to report the mid-term results of impaction bone grafting augmented with a wire coil using the lightbulb technique for ONFH. METHODS From 1998 to 2016, 50 hips with late precollapsed or early postcollapsed ONFH (28 hips with Association Research Circulation Osseous [ARCO] IIC and 22 with IIIA) were treated by impaction bone grafting augmented with a wire coil using the lightbulb technique. The survival rate was analyzed with conversion to total hip arthroplasty (THA) as the end point. RESULTS Thirty-one of the 50 hips had a successful clinical result without conversion to THA at a mean follow-up of 109.2 months. The 5-year survival rate was 68%, 82.1%, and 50% for the entire cohort, ARCO stage IIC, and ARCO stage IIIA, respectively. The 19 hips that had failed were converted to THA at an average of 52.8 months. The multivariable Cox proportional hazards model showed that an ARCO stage IIIA disease, a lateral lesion, and a necrotic index ≥0.67 were the independent risk factors for conversion to THA. CONCLUSION As a head-preserving procedure, the lightbulb technique using impaction bone grafting augmented with a wire coil is worthwhile for patients in an earlier stage of disease and smaller lesion size to postpone the need for THA.
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Affiliation(s)
- Cheng-Ta Wu
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China
| | - Feng-Chih Kuo
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China
| | - Shih-Hsiang Yen
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China
| | - Po-Chun Lin
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China
| | - Jun-Wen Wang
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China; Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Mel S Lee
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China; Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China; Pao-Chien Hospital, Pingtung, Taiwan, Republic of China
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27
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Huang K, Zhang QY, He HY, Gao CX, Wang G, Yang J, Xie HQ, Zeng Y. Borderline Developmental Dysplasia of the Hip: A Risk Factor Predicting the Development and Poor Prognosis after Core Decompression for Idiopathic Osteonecrosis of the Femoral Head. Orthop Surg 2022; 14:2427-2435. [PMID: 35981313 PMCID: PMC9531061 DOI: 10.1111/os.13442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/29/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE It is unclear whether idiopathic osteonecrosis of the femoral head (ONFH) is associated with borderline developmental dysplasia of the hip (BDDH). This study aimed to compare the incidence of BDDH between patients with idiopathic ONFH and matched control subjects and determine the influence of BDDH on poor prognosis after core decompression (CD). METHODS We retrospectively examined 78 consecutive patients (111 hips) with idiopathic ONFH undergoing CD and 1:2 matched with 156 control subjects (222 hips). The anteroposterior pelvic radiographs were used to measure the acetabular anatomical parameters and divide included subjects into BDDH or non-BDDH group. The incidence of BDDH and acetabular anatomical parameters were compared between patients with idiopathic ONFH and matched controls. Clinical outcomes, such as Harris Hip Score (HHS), progression of collapse, and conversion to total hip arthroplasty (THA), were compared between patients with BDDH and without BDDH in the idiopathic ONFH group, with a mean follow-up of 72.1 ± 36.6 months. RESULTS Patients with idiopathic ONFH had a significantly higher incidence of BDDH than matched controls (29.7% vs 12.2%, p < 0.001). Less acetabular coverage was also found in patients with idiopathic ONFH than in matched controls as demonstrated by lower CEA (28.5° ± 4.7° vs 33.1° ± 5.7°, p < 0.001), AHI (82.4 ± 5.0 vs 86.3 ± 5.4, p < 0.001), ADR (299.6 ± 28.4 vs 318.8 ± 31.3, p < 0.001), and a higher sharp angle (40.0° ± 3.4° vs 37.4° ± 3.7°, p < 0.001). In patients with idiopathic ONFH, the BDDH group had a significantly lower mean HHS at the last follow-up (83.5 ± 17.4 vs 91.6 ± 9.7, p = 0.015) with a different score distribution (p = 0.004), and a lower 5-year survival rate with both clinical failure (66.7%, 95% CI 52.4%-84.9% vs 83.7%, 95% CI 75.2%-93.1%; p = 0.028) and conversion to THA (74.6%, 95% CI 60.7%-91.6% vs 92.1%, 95% CI 85.6%-99.0%; p = 0.008) as the endpoints than the non-BDDH group. CONCLUSION The incidence of BDDH was significantly higher in patients with idiopathic ONFH than matched controls, and idiopathic ONFH patients who underwent CD with BDDH had lower mean HHS as well as 5-year survival rate than those without BDDH. Therefore, BDDH should be considered a risk factor predicting the development of idiopathic ONFH as well as poor prognosis after CD.
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Affiliation(s)
- Kai Huang
- Department of Orthopedics, Orthopedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Qing-Yi Zhang
- Department of Orthopedics, Orthopedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Hui-Yu He
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Chen-Xiang Gao
- West China School of Stomatology, Sichuan University, Chengdu, China
| | - Gang Wang
- Department of Orthopedics, Orthopedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Jing Yang
- Department of Orthopedics, Orthopedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Hui-Qi Xie
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Yi Zeng
- Department of Orthopedics, Orthopedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
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28
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Tomaru Y, Yoshioka T, Sugaya H, Kumagai H, Aoto K, Wada H, Akaogi H, Yamazaki M, Mishima H. Comparison Between Concentrated Autologous Bone Marrow Aspirate Transplantation as a Hip Preserving Surgery and Natural Course in Idiopathic Osteonecrosis of the Femoral Head. Cureus 2022; 14:e24658. [PMID: 35663701 PMCID: PMC9157266 DOI: 10.7759/cureus.24658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose The purpose is to compare the therapeutic efficacy of concentrated autologous bone marrow aspirate transplantation (CABMAT) with that of observation alone for osteonecrosis of the femoral head (ONFH). Methods This single-center study included patients with idiopathic ONFH that were either treated with CABMAT (CABMAT group) or managed through observation alone (observation group) over a >2-year follow-up period. The Japanese Investigation Committee classification was used to diagnose and classify ONFH. The collapse rates for stages 1 and 2 ONFH (i.e., pre-collapse stages) and the THA conversion rates were compared between the CABMAT and observation groups. Results The CABMAT and observation groups comprised 232 (mean follow-up: 8.2 years) and 106 (mean follow-up: 6.0 years) patients, respectively. No significant intergroup differences were noted in the stages, types, and associated factors of ONFH. The collapse rates for pre-collapse stages in the CABMAT and observation groups were 67.1% and 65.3%, respectively. For stage 1, the collapse rates were significantly lower in the observation group than in the CABMAT group (p<0.05). The overall THA conversion rates in the CABMAT and observation groups were 24.3% and 41.5%, respectively (p<0.0001). For ONFH of stages 3A and 3B (collapse stages), the THA conversion rates were significantly lower in the CABMAT group (p<0.05). Conclusion Collapse rates were significantly higher for stage 1 ONFH; for collapse stages, the THA conversion rates were significantly lower in the CABMAT group than in the observation group. Therefore, observation and CABMAT are recommended for ONFH of stage 1 and for ONFH of higher stages, respectively.
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Affiliation(s)
- Yohei Tomaru
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, JPN
- Department of Orthopedic Surgery, Chiba Child and Adult Orthopedic Clinic, Chiba, JPN
| | - Tomokazu Yoshioka
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, JPN
| | - Hisashi Sugaya
- Department of Orthopedic Surgery, Tsukuba University of Technology, Tsukuba, JPN
| | - Hiroshi Kumagai
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, JPN
| | - Katsuya Aoto
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, JPN
| | - Hiroshi Wada
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, JPN
| | - Hiroshi Akaogi
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, JPN
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, JPN
| | - Hajime Mishima
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, JPN
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Tsubosaka M, Maruyama M, Huang EE, Zhang N, Utsunomiya T, Gao Q, Shen H, Li X, Kushioka J, Hirata H, Yao Z, Yang YP, Goodman SB. Effect on Osteogenic Differentiation of Genetically Modified IL4 or PDGF-BB Over-Expressing and IL4-PDGF-BB Co-Over-Expressing Bone Marrow-Derived Mesenchymal Stromal Cells In Vitro. Bioengineering (Basel) 2021; 8:bioengineering8110165. [PMID: 34821731 PMCID: PMC8614682 DOI: 10.3390/bioengineering8110165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 11/25/2022] Open
Abstract
The use of genetically modified (GM) mesenchymal stromal cells (MSCs) and preconditioned MSCs (pMSCs) may provide further opportunities to improve the outcome of core decompression (CD) for the treatment of early-stage osteonecrosis of the femoral head (ONFH). GM interleukin-4 (IL4) over-expressing MSCs (IL4-MSCs), platelet-derived growth factor (PDGF)-BB over-expressing MSCs (PDGF-BB-MSCs), and IL4-PDGF-BB co-over-expressing MSCs (IL4-PDGF-BB-MSCs) and their respective pMSCs were used in this in vitro study and compared with respect to cell proliferation and osteogenic differentiation. IL4-MSCs, PDGF-BB-MSCs, IL4-PDGF-BB-MSCs, and each pMSC treatment significantly increased cell proliferation compared to the MSC group alone. The percentage of Alizarin red-stained area in the IL4-MSC and IL4-pMSC groups was significantly lower than in the MSC group. However, the percentage of Alizarin red-stained area in the PDGF-BB-MSC group was significantly higher than in the MSC and PDGF-BB-pMSC groups. The percentage of Alizarin red-stained area in the IL4-PDGF-BB-pMSC was significantly higher than in the IL4-PDGF-BB-MSC group. There were no significant differences in the percentage of Alizarin red-stained area between the MSC and IL4-PDGF-BB-pMSC groups. The use of PDGF-BB-MSCs or IL4-PDGF-BB-pMSCs increased cell proliferation. Furthermore, PDGF-BB-MSCs promoted osteogenic differentiation. The addition of GM MSCs may provide a useful supplementary cell-based therapy to CD for treatment of ONFH.
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Affiliation(s)
- Masanori Tsubosaka
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street, Redwood City, CA 94063, USA; (M.T.); (M.M.); (E.E.H.); (N.Z.); (T.U.); (Q.G.); (H.S.); (X.L.); (J.K.); (H.H.); (Z.Y.); (Y.P.Y.)
| | - Masahiro Maruyama
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street, Redwood City, CA 94063, USA; (M.T.); (M.M.); (E.E.H.); (N.Z.); (T.U.); (Q.G.); (H.S.); (X.L.); (J.K.); (H.H.); (Z.Y.); (Y.P.Y.)
| | - Elijah Ejun Huang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street, Redwood City, CA 94063, USA; (M.T.); (M.M.); (E.E.H.); (N.Z.); (T.U.); (Q.G.); (H.S.); (X.L.); (J.K.); (H.H.); (Z.Y.); (Y.P.Y.)
| | - Ning Zhang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street, Redwood City, CA 94063, USA; (M.T.); (M.M.); (E.E.H.); (N.Z.); (T.U.); (Q.G.); (H.S.); (X.L.); (J.K.); (H.H.); (Z.Y.); (Y.P.Y.)
| | - Takeshi Utsunomiya
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street, Redwood City, CA 94063, USA; (M.T.); (M.M.); (E.E.H.); (N.Z.); (T.U.); (Q.G.); (H.S.); (X.L.); (J.K.); (H.H.); (Z.Y.); (Y.P.Y.)
| | - Qi Gao
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street, Redwood City, CA 94063, USA; (M.T.); (M.M.); (E.E.H.); (N.Z.); (T.U.); (Q.G.); (H.S.); (X.L.); (J.K.); (H.H.); (Z.Y.); (Y.P.Y.)
| | - Huaishuang Shen
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street, Redwood City, CA 94063, USA; (M.T.); (M.M.); (E.E.H.); (N.Z.); (T.U.); (Q.G.); (H.S.); (X.L.); (J.K.); (H.H.); (Z.Y.); (Y.P.Y.)
| | - Xueping Li
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street, Redwood City, CA 94063, USA; (M.T.); (M.M.); (E.E.H.); (N.Z.); (T.U.); (Q.G.); (H.S.); (X.L.); (J.K.); (H.H.); (Z.Y.); (Y.P.Y.)
| | - Junichi Kushioka
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street, Redwood City, CA 94063, USA; (M.T.); (M.M.); (E.E.H.); (N.Z.); (T.U.); (Q.G.); (H.S.); (X.L.); (J.K.); (H.H.); (Z.Y.); (Y.P.Y.)
| | - Hirohito Hirata
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street, Redwood City, CA 94063, USA; (M.T.); (M.M.); (E.E.H.); (N.Z.); (T.U.); (Q.G.); (H.S.); (X.L.); (J.K.); (H.H.); (Z.Y.); (Y.P.Y.)
| | - Zhenyu Yao
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street, Redwood City, CA 94063, USA; (M.T.); (M.M.); (E.E.H.); (N.Z.); (T.U.); (Q.G.); (H.S.); (X.L.); (J.K.); (H.H.); (Z.Y.); (Y.P.Y.)
| | - Yunzhi Peter Yang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street, Redwood City, CA 94063, USA; (M.T.); (M.M.); (E.E.H.); (N.Z.); (T.U.); (Q.G.); (H.S.); (X.L.); (J.K.); (H.H.); (Z.Y.); (Y.P.Y.)
- Department of Material Science and Engineering, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Bioengineering, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Stuart B. Goodman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street, Redwood City, CA 94063, USA; (M.T.); (M.M.); (E.E.H.); (N.Z.); (T.U.); (Q.G.); (H.S.); (X.L.); (J.K.); (H.H.); (Z.Y.); (Y.P.Y.)
- Department of Bioengineering, Stanford University School of Medicine, Stanford, CA 94305, USA
- Correspondence: ; Tel.: +1-650-498-4343
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Maruyama M, Lin T, Kaminow NI, Thio T, Storaci HW, Pan CC, Yao Z, Takagi M, Goodman SB, Yang YP. The efficacy of core decompression for steroid-associated osteonecrosis of the femoral head in rabbits. J Orthop Res 2021; 39:1441-1451. [PMID: 33095462 PMCID: PMC8204476 DOI: 10.1002/jor.24888] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/10/2020] [Accepted: 10/21/2020] [Indexed: 02/04/2023]
Abstract
Although core decompression (CD) is often performed in the early stage of osteonecrosis of the femoral head (ONFH), the procedure does not always prevent subsequent deterioration and the effects of CD are not fully clarified. The aim of this study is to evaluate the efficacy of CD for steroid-associated ONFH in rabbits. Twelve male and 12 female New Zealand rabbits were injected intramuscularly 20 mg/kg of methylprednisolone once and were divided into the disease control and CD groups. In the disease control group, rabbits had no treatment and were euthanized at 12 weeks postinjection. In the CD group, rabbits underwent left femoral CD at 4 weeks postinjection and were euthanized 8 weeks postoperatively. The left femurs were collected to perform morphological, biomechanical, and histological analysis. Bone mineral density and bone volume fraction in the femoral head in the CD group were significantly higher than in the disease control group. However, no difference in the mechanical strength was observed between the two groups. Histological analysis showed that alkaline phosphatase and CD31 positive cells significantly increased in the males after CD treatment. The number of empty lacunae in the surrounding trabecular bone was significantly higher in the CD group. The current study indicated that CD improved the morphological properties, but did not improve the mechanical strength in the femoral head at early-stage ONFH. These data suggest the need for additional biological, mechanical strategies, and therapeutic windows to improve the outcome of early-stage steroid-associated ONFH.
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Affiliation(s)
- Masahiro Maruyama
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Tzuhua Lin
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Nicolas I. Kaminow
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Timothy Thio
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Hunter W. Storaci
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Chi-Chun Pan
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA,Department of Mechanical Engineering, Stanford University School of Medicine, Stanford, California, USA
| | - Zhenyu Yao
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Stuart B. Goodman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA,Department of Bioengineering, Stanford University School of Engineering, Stanford, California, USA
| | - Yunzhi P. Yang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA,Department of Bioengineering, Stanford University School of Engineering, Stanford, California, USA,Department of Material Science and Engineering, Stanford University School of Medicine, Stanford, California, USA
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Assaf E, Bdeir M, Mohs E, Dally FJ, Gravius S, Weis CA, Darwich A. Singleton-Merten syndrome: A rare cause of femoral head necrosis. Am J Med Genet A 2021; 185:3170-3175. [PMID: 34189824 DOI: 10.1002/ajmg.a.62395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/19/2021] [Accepted: 05/27/2021] [Indexed: 12/30/2022]
Abstract
Singleton-Merten syndrome (SMS) is a type I interferonopathy. In this report, we disclose the first-to the best of our knowledge-direct association of SMS with femoral head necrosis (FHN). The following case report presents the condition of a 38-year-old male suffering from SMS with FHN, characterized by acute symptoms and rapid disease progression. As per the recommendations of the Association Research Circulation Osseous (ARCO) and the S3-guidelines, we successfully treated the FHN with core decompression. Our histological results correlate with the changes described in medical literature in patients with SMS and MDA5-knockout in vivo experiments such as osteopenia, widened medullary cavity, and thin cortical bone. Moreover, the conducted immunohistochemistry shows strong CD56 positivity of the osteoblasts and osteocytes, as well as significant CD68 and CD163 positivity of the middle-sized osteoclasts. Collectively, these findings suggest an underlying syndrome in the FHN. A six-month post-operative follow-up revealed complete recovery with the absence of the initial symptoms and ability to resume normal daily activities. Taken together, our findings suggest that SMS is an additional cause of FHN in young adults. Early detection and adequate treatment using well-established joint-preserving techniques demonstrate a favorable improvement of the patient's clinical condition.
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Affiliation(s)
- Elio Assaf
- Department of Orthopedics and Trauma Surgery, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Mohamad Bdeir
- Department of Orthopedics and Trauma Surgery, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Elisabeth Mohs
- Department of Orthopedics and Trauma Surgery, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Franz-Joseph Dally
- Department of Orthopedics and Trauma Surgery, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Sascha Gravius
- Department of Orthopedics and Trauma Surgery, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Cleo-Aron Weis
- Institute of Pathology, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Ali Darwich
- Department of Orthopedics and Trauma Surgery, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
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Kuroda Y, Tanaka T, Miyagawa T, Hamada H, Abe H, Ito-Ihara T, Asada R, Fujimoto Y, Takahashi D, Tetsunaga T, Kaneuji A, Takagi M, Inaba Y, Morita S, Sugano N, Tanaka S, Matsuda S, Akiyama H. Recombinant human FGF-2 for the treatment of early-stage osteonecrosis of the femoral head: TRION, a single-arm, multicenter, Phase II trial. Regen Med 2021; 16:535-548. [PMID: 34075804 DOI: 10.2217/rme-2021-0049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim: This study aimed to evaluate the 2-year outcomes from a clinical trial of recombinant human FGF-2 (rhFGF-2) for osteonecrosis of the femoral head (ONFH). Patients & methods: Sixty-four patients with nontraumatic, precollapse and large ONFHs were percutaneously administered with 800 μg rhFGF-2 contained in gelatin hydrogel. Setting the end point of radiological collapse, we analyzed the joint preservation period of the historical control. Changes in two validated clinical scores, bone regeneration and safety were evaluated. Results: Radiological joint preservation time was significantly higher in the rhFGF-2 group than in the control group. The ONFHs tended to improve to smaller ONFHs. The postoperative clinical scores significantly improved. Thirteen serious adverse events showed recovery. Conclusion: rhFGF-2 treatment increases joint preservation time with clinical efficacy, radiological bone regeneration and safety.
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Affiliation(s)
- Yutaka Kuroda
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takeyuki Tanaka
- Department of Orthopedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Takaki Miyagawa
- Department of Orthopedic Surgery, Gifu University, Gifu, 501-1194, Japan
| | - Hidetoshi Hamada
- Department of Orthopedic Surgery, Osaka University, Osaka, 565-0871, Japan
| | - Hiroyasu Abe
- Department of Biomedical Statistics & Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, 606-8507, Japan
| | - Toshiko Ito-Ihara
- The Clinical & Translational Research Center, Kyoto Prefectural University of Medicine, Kyoto, 602-0841, Japan
| | - Ryuta Asada
- Innovative & Clinical Research Promotion Center, Graduate School of Medicine, Gifu University, Gifu, 501-1194, Japan
| | - Yusuke Fujimoto
- Department of Medical Joint Materials, Graduate School of Medical & Dental Sciences, Kagoshima University, Kagoshima, 890-8520, Japan
| | - Daisuke Takahashi
- Department of Orthopedic Surgery, Faculty of Medicine & Graduate School of Medicine, Hokkaido University, Hokkaido, 060-8648, Japan
| | - Tomonori Tetsunaga
- Department of Orthopedic Surgery, Okayama University, Okayama, 700-0914, Japan
| | - Ayumi Kaneuji
- Department of Orthopedic Surgery, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Michiaki Takagi
- Department of Orthopedic Surgery, Yamagata University Faculty of Medicine, Yamagata, 990-2331, Japan
| | - Yutaka Inaba
- Department of Orthopedic Surgery, Yokohama City University, Kanagawa, 236-0004, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics & Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, 606-8507, Japan
| | - Nobuhiko Sugano
- Department of Orthopedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan
| | - Sakae Tanaka
- Department of Orthopedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Shuichi Matsuda
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Haruhiko Akiyama
- Department of Orthopedic Surgery, Gifu University, Gifu, 501-1194, Japan
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Jindal K, Aggarwal S, Kumar P, Rathod P. Core decompression with bone marrow aspirate concentrate in post collapse avascular necrosis of hip: A systematic review and meta-analysis. J Clin Orthop Trauma 2021; 17:78-87. [PMID: 33717975 PMCID: PMC7919970 DOI: 10.1016/j.jcot.2021.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/02/2021] [Accepted: 02/10/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Avascular necrosis (AVN) of femoral head is commonly seen in middle age groups and in its advanced stages, it is a common indication for total hip replacements (THRs). These patients invariably require revision surgeries in their lifetime and modalities to delay the first arthroplasty are necessary. Core decompression (CD) with bone marrow aspirate concentrate (BMAC) have proved successful in early stages of AVN, but their role in advanced stages remains unclear. The present review was done to assess the same. RESEARCH QUESTION Is CD and BMAC combination effective in delaying radiographic progression and THRs in post collapse stages of AVN hip? METHODOLOGY A systematic review and meta-analysis was conducted to determine the overall efficacy of CD and BMAC in post collapse stages of AVN hip and to specifically compare primary outcomes like radiographic progression along with need of THR, with CD alone.Three data bases (PubMed, EMBASE and SCOPUS) were searched to identify relevant articles. RESULTS The present review included 12 studies with 3 studies included in the meta-analysis. There were 270 hips across the 12 studies out of which 196 hips were treated with CD + BMAC. PRIMARY OUTCOMES 39.8% cases worsened from stage 3 to stage 4, while the overall incidence of THR in stages 3 and 4 was 38.3%. On comparison with CD alone the combination of CD + BMAC did not show any enhanced efficacy in either delaying progression (Odds ratio of 1.41 (95% CI = 0.55-3.62) or in conversion to THR (Odds Ratio: 0. 92; 95% CI = 0.41-2.06). CONCLUSION CD can be considered in stage 3 of AVN in younger population to delay the need of arthroplasty, before severe head distortion and arthritis sets in, and can be supplemented with bone strut grafts or tantalum rods, for supporting the articular cartilage. BMAC that has shown better results in early AVN, has not shown any additional benefits when compared to CD alone in advanced cases.
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Affiliation(s)
- Karan Jindal
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Aggarwal
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prasoon Kumar
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pratik Rathod
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Boontanapibul K, Huddleston JI, Amanatullah DF, Maloney WJ, Goodman SB. Modified Kerboul Angle Predicts Outcome of Core Decompression With or Without Additional Cell Therapy. J Arthroplasty 2021; 36:1879-1886. [PMID: 33618954 DOI: 10.1016/j.arth.2021.01.075] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Core decompression is the most common procedure for early-stage osteonecrosis of the femoral head (ONFH). This study investigated outcomes of core decompression with/without bone marrow aspirate concentrate (BMAC), based on the Kerboul combined necrotic angles using magnetic resonance imaging. METHODS We reviewed 66 patients (83 hips) with early ONFH, Association Research Circulation Osseous stages I-IIIa, who underwent core decompression alone (26 patients, 33 hips) or in combination with BMAC (40 patients, 50 hips). Survival rate and progressive collapse were analyzed using the Kaplan-Meier method, and conversion to total hip arthroplasty (THA) was evaluated. Subgroup analyses based on the modified Kerboul angle were performed: grade I (<200°), grade II (200°-249°), grade III (250°-299°), and grade IV (≥300°). RESULTS Mean follow-up was 36 ± 23 months. Femoral head collapse with BMAC (16 hips, 32%) was significantly lower than without BMAC (19 hips, 58%, P = .019). Conversion THA was significantly lower with BMAC (28%) than without (58%, P = .007). Survival rates among groups showed significant differences (P = .017). In grade I, 0/12 hips with BMAC collapsed while 3/9 (33%) without BMAC collapsed (P = .063); in grade II, 2/16 hips (12%) with BMAC collapsed while 7/13 (54%) without BMAC collapsed (P = .023). There was no significant difference in collapse with (64%) or without (82%) BMAC in grade III-IV hips (P = .256). CONCLUSION Core decompression with/without BMAC had a high failure rate, by increasing disease progression and the necessity for THA, for combined necrotic angles >250°. In our study, addition of BMAC had more reliable outcomes than isolated core decompression for precollapse ONFH if the combined necrotic angles were <250°.
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Affiliation(s)
- Krit Boontanapibul
- Department of Orthopaedic Surgery, Stanford University Medical Center Outpatient Center, Redwood City, CA; Department of Orthopaedic Surgery, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | - James I Huddleston
- Department of Orthopaedic Surgery, Stanford University Medical Center Outpatient Center, Redwood City, CA
| | - Derek F Amanatullah
- Department of Orthopaedic Surgery, Stanford University Medical Center Outpatient Center, Redwood City, CA
| | - William J Maloney
- Department of Orthopaedic Surgery, Stanford University Medical Center Outpatient Center, Redwood City, CA
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University Medical Center Outpatient Center, Redwood City, CA
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Wang G, Xin H, Tian G, Sheng K, Zhang N, Sun S. Core decompression combined with implantation of β-tricalcium phosphate modified by a BMSC affinity cyclic peptide for the treatment of early osteonecrosis of the femoral head. Am J Transl Res 2021; 13:967-978. [PMID: 33841633 PMCID: PMC8014422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 01/23/2021] [Indexed: 06/12/2023]
Abstract
Early intervention of osteonecrosis of the femoral head (ONFH) is very important. At present, the therapeutic effect on early ONFH is not completely satisfactory. D7 peptide has special affinity towards bone marrow mesenchymal stem cell (BMSC). Taking advantage of the adsorption/freeze-drying strategy, we constructed D7 cyclic peptide-modified β-tricalcium phosphate (β-TCP) scaffolds. The functional β-TCP scaffolds can enhance adhesion, spreading and proliferation of BMSCs compared with unmodified β-TCP scaffolds, which was comfired in cytological experiments. In rabbit model of early ONFH, functional β-TCP scaffolds were stuffed into the cavities after core decompression (CD). Radiographic and histological examination confirmed that CD followed by filling of functional β-TCP scaffolds can obviously improve the therapeutic effect of early ONFH. Our study provides a new option for curing early ONFH.
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Affiliation(s)
- Guozong Wang
- Department of Joint Surgery, People’s Hospital of RizhaoRizhao 276800, Shandong, China
| | - Hua Xin
- Department of Neurology, People’s Hospital of RizhaoRizhao 276800, Shandong, China
| | - Guanghao Tian
- Department of Internal Medicine, Lixia People’s HospitalJinan 250014, Shandong, China
| | - Kuisheng Sheng
- Department of Orthopedics, Rizhao City Traditional Chinese Medicine HospitalRizhao 276800, Shandong, China
| | - Nianping Zhang
- The Teaching and Research Section of Surgery, The First Clinical College of Shandong University of Traditional Chinese MedicineJinan 250355, Shandong, China
| | - Shui Sun
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan 250021, Shandong, China
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Aggarwal AK, Poornalingam K, Jain A, Prakash M. Combining Platelet-Rich Plasma Instillation With Core Decompression Improves Functional Outcome and Delays Progression in Early-Stage Avascular Necrosis of Femoral Head: a 4.5- to 6-Year Prospective Randomized Comparative Study. J Arthroplasty 2021; 36:54-61. [PMID: 32741710 DOI: 10.1016/j.arth.2020.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 06/28/2020] [Accepted: 07/06/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Avascular necrosis of femoral head is a debilitating disease frequently progressing to femoral head collapse and joint destruction. The efficacy of core decompression (CD) remains controversial. METHODS About 40 consecutive age-matched and gender-matched patients (53 hips) were randomized into 2 groups by computer-generated algorithm table in a prospective randomized double-blinded comparative study. Group A (platelet-rich plasma [PRP] with CD) included 19 patients (25 hips), and group B (CD only) included 21 patients (28 hips). Postoperative Harris Hip Score and magnetic resonance imaging to quantify the necrotic area by using modified Kerboul angle were done and evaluated. Mean follow-up was 64.3 months (range, 54-72) and 63.7 months (range, 56-72) in groups A and B, respectively. RESULTS There was statistically significant difference between PRP and control groups in pain score (P = .00), functional score (P = .02), and Harris Hip Score (P = .00) at final follow-up. There was no progression in stage 1 disease. Stage 2 disease showed 24% progression in group A and 43% progression in group B. The difference was statistically significant (P = .025). Survivorship from femoral head collapse, any procedure, and total hip arthroplasty was 84%/68% (P = .00), 76%/57% (P = .02), and 92%/78% (P = .01) in 2 groups, which was statistically significant. CONCLUSION PRP use after CD provides significant pain relief, better midterm functional outcome, retards the progression, and enhances the survivorship free from reoperation for hip arthroplasty and femoral head collapse in early stages of avascular necrosis of hip than CD alone.
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Affiliation(s)
- Aditya K Aggarwal
- Department of Orthopaedic Surgery, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - K Poornalingam
- Department of Orthopaedic Surgery, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ashish Jain
- Department of Transfusion Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Mahesh Prakash
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Migliorini F, Maffulli N, Eschweiler J, Tingart M, Baroncini A. Core decompression isolated or combined with bone marrow-derived cell therapies for femoral head osteonecrosis. Expert Opin Biol Ther 2020; 21:423-430. [PMID: 33297783 DOI: 10.1080/14712598.2021.1862790] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objectives: The regenerative capabilities of bone marrow-derived cell therapies (BMCTs) have been employed in combination with core decompression (CD) in the management of osteonecrosis of the femoral head to prevent or delay the necessity of total hip arthroplasty (THA).Methods: The authors conducted a meta-analysis to compare the results of level of evidence I trials comparing CD with and without BMCTs.Results: Overall, 579 procedures were analyzed: 265 in the CD group and 263 in the CD + BMCTs group. Comparability concerning age and gender, drill size, etiology, and grade of OFNH was found (P > 0.1). At a mean follow up of 82.29 (24 to 360) months, the VAS scored favourably for the CD + BMCTs group (mean difference: -12.88; P < 0.0001), as well the rate of THA (odd ratio: -0.14; P < 0.0001). Time to failure (P = 0.4) and to THA (P = 0.9) was similar between the two groups, as was the rate of failure (P = 0.3).Conclusion: In patients with femoral head osteonecrosis, core decompression combined with BMCTs demonstrated reduced pain and lower rate of total hip arthroplasty compared to core decompression as an isolated procedure.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England.,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, London, England
| | - Jörg Eschweiler
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany
| | - Alice Baroncini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany
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Rocchi M, Del Piccolo N, Mazzotta A, Giavaresi G, Fini M, Facchini F, Stagni C, Dallari D. Core decompression with bone chips allograft in combination with fibrin platelet-rich plasma and concentrated autologous mesenchymal stromal cells, isolated from bone marrow: results for the treatment of avascular necrosis of the femoral head after 2 years minimum follow-up. Hip Int 2020; 30:3-12. [PMID: 33267692 DOI: 10.1177/1120700020964996] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Avascular necrosis of femoral head (AVN) is 1 of the main factors causing disability in young adults. Hip prosthesis can be considered an effective treatment of the painful symptoms but it is a major surgical intervention for this type of population. Thus, a large space should be left to therapeutic alternatives such as regenerative medicine.This retrospective study evaluates 52 AVN treated by core decompression, bone chips allograft, fibrin platelet-rich plasma (PRF) and concentrated autologous mesenchymal stromal cells (MSCs). METHODS The AVN was diagnosed using magnetic resonance imaging (MRI) and graded according to ARCO classification: a patient was classified stage 1 (21 patients), stage 3 (26 patients), and 4 patients were classified as stage 4. We evaluated patients with functional scores (Harris Hip Score) and radiological analysis at 3, 6, 12 and 24 months after the procedure. Patients requiring prosthetic replacement of the joint were included; in these cases, follow-up was interrupted at the time of the joint replacement procedure. RESULTS Our statistical analysis showed differences between survived and failed treatments, in terms of patient profile and ARCO radiological classification.The best result occurred in patients with ARCO grades 1 and 2, while the more advanced grades showed a high failure rate. It is interesting to note that ARCO quantification, conceived as the joint surface involved in the necrosis, has a negative influence on the outcome of the procedure. Indeed, patients affected by ARCO 3a, where necrosis involved a small portion of the femoral epiphysis and the collapse of the articular surface was limited to 2 mm, showed results similar to those obtained in patients with ARCO 1 and 2. CONCLUSIONS In conclusion, compared with the alternative technique of decompression, our data suggest that post-collapse cases with a small area of necrosis and the use of bone grafts may show better results compared to those of the literature.
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Affiliation(s)
- Martina Rocchi
- Reconstructive Orthopaedic Surgery Innovative Techniques - Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Nicoladrea Del Piccolo
- Reconstructive Orthopaedic Surgery Innovative Techniques - Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandro Mazzotta
- Reconstructive Orthopaedic Surgery Innovative Techniques - Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gianluca Giavaresi
- Laboratory of Preclinical and Surgical Studies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Milena Fini
- Laboratory of Preclinical and Surgical Studies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Fabio Facchini
- Intensive Care and Pain Therapy, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cesare Stagni
- Reconstructive Orthopaedic Surgery Innovative Techniques - Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Dante Dallari
- Reconstructive Orthopaedic Surgery Innovative Techniques - Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Wang SL, Hu YB, Chen H, Tao B, Bu GY, Zhang YQ, Zhang JS. Efficacy of bone marrow stem cells combined with core decompression in the treatment of osteonecrosis of the femoral head: A PRISMA-compliant meta-analysis. Medicine (Baltimore) 2020; 99:e20509. [PMID: 32569171 PMCID: PMC7310908 DOI: 10.1097/md.0000000000020509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This study used the meta-analytic approach to assess the safety and treatment efficacy of bone marrow stem cells (BMSCs) with core decompression (CD) for osteonecrosis of the femoral head (ONFH) based on randomized controlled trials (RCTs). METHODS Electronic database of PubMed, Embase, Google Scholar, China National Knowledge Infrastructure (CNKI), and Wanfang database was searched up to December 26, 2019 for relevant RCTs about combined utilization of BMSCs and CD versus CD alone for ONFH. Gray literature sources were also searched. We conducted a meta-analysis following the guidelines of the Cochrane Reviewer's Handbook. Two independent reviewers performed the data extraction and assessed study quality. Our outcomes included the Harris hip scores (HHS) at 12 months, HHS at 24 months, necrotic area of femoral head, conversion to total hip arthroplasty (THA), visual analog pain scale at final follow-up, and adverse effects. The meta-analysis was performed with Stata 12.0. RESULTS A total of 15 published studies with 688 patients fulfilled the requirements of inclusion criteria. Across all populations, participants in combined utilization of BMSCs group showed a statistical significance with higher HHS at 12 months (standard mean difference [SMD] 0.53, 95% confidence interval [CI] 0.29-0.77) and 24 months (SMD 0.57, 95% CI 0.36-0.77). Similarly, participants in combined utilization of BMSCs group had more advantages in reducing necrotic area of femoral head (SMD -1.05, 95% CI -1.73 to -0.38) and the rate of conversion to THA (risk ratio [RR] = 0.53, 95% CI 0.38-0.74, P = .000). No significant differences were identified regarding postoperative adverse effects postoperatively (RR = 1.03, 95% CI 0.64-1.67, P = .893). CONCLUSION Compared with CD treated alone in the treatment of ONFH, combined utilization of CD and autologous BMSCs implantation has a better pain relief and clinical outcomes and can delay the collapse of the femoral head more effectively.
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Affiliation(s)
- Shao-lei Wang
- Department of Orthopedic Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang
| | - Yuan-bin Hu
- Department of Orthopedics, Zhongda Hospital, Southeast University, Nanjing Jiangsu
| | - Hao Chen
- Department of Bone and Joint Surgery, Shandong Energy Zaozhuang Mining Group Central Hospital, Zaozhuang, Shandong
| | - Bo Tao
- Department of Orthopedics, Wuxi No. 2 People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu
| | - Guo-yun Bu
- Department of Orthopedic of Tianjin Hospital, Tianjn
| | - Yong-qiang Zhang
- Department of Orthopedics, First People's Hospital of Wuhu City, Wuhu
| | - Jin-song Zhang
- Department of Orthopedics, Fuzhou Second Hospital affiliated to Xiamen University, Fuzhou, Fujian Province, China
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Döring M, Kluba T, Cabanillas Stanchi KM, Kahle P, Lenglinger K, Tsiflikas I, Treuner C, Vaegler M, Mezger M, Erbacher A, Schumm M, Lang P, Handgretinger R, Müller I. Longtime Outcome After Intraosseous Application of Autologous Mesenchymal Stromal Cells in Pediatric Patients and Young Adults with Avascular Necrosis After Steroid or Chemotherapy. Stem Cells Dev 2020; 29:811-822. [PMID: 32295491 DOI: 10.1089/scd.2020.0019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Avascular necrosis (AVN) is a severe complication of immunosuppressant therapy or chemotherapy. A beneficial AVN therapy with core decompression (CD) and intraosseous infusion of mesenchymal stromal cells (MSCs) has been described in adult patients, but there are only few data on MSC applications in pediatric and young adult patients (PYAP). Between 2006 and 2015, 14 AVN lesions of 10 PYAP (6 females) with a median age of 16.9 years (range 8.5-25.8 years) received CD and intraosseous application of autologous MSCs. Data of these patients were analyzed regarding efficacy, safety, and feasibility of this procedure as AVN therapy and compared with a control group of 13 AVN lesions of 11 PYAP (5 females) with a median age of 17.9 years (range 13.5-27.5 years) who received CD only. During the follow-up analysis [MSC group: median 3.1 (1.6-5.8) years after CD; CD group: median 2.0 (1.5-8.5) years after CD], relative lesion sizes (as assessed by magnetic resonance imaging) compared with the initial lesion volume, were significantly lower (P < 0.05) in the MSC group (volume reduction to a median of 18.5%) when compared with the CD group (58.0%). One lesion in the MSC group comprised a complete remission. Size progression was not observed in either group. Clinical improvement (pain, mobility) was not significantly different between the two groups. None of the patients experienced treatment-related adverse effects. CD and additional MSC application was regarded safe, effective, feasible, and superior in reducing the lesion size when compared with CD only. Prospective, randomized clinical trials are needed to further evaluate these findings.
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Affiliation(s)
- Michaela Döring
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tuebingen-Children's Hospital Tuebingen, Tuebingen, Germany
| | - Torsten Kluba
- Department of Orthopedic Surgery, Städtisches Klinikum Dresden, Dresden, Germany
| | - Karin Melanie Cabanillas Stanchi
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tuebingen-Children's Hospital Tuebingen, Tuebingen, Germany
| | - Peter Kahle
- Department of Orthopedics, University Hospital Tuebingen, Tuebingen, Germany
| | - Katrin Lenglinger
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tuebingen-Children's Hospital Tuebingen, Tuebingen, Germany
| | - Ilias Tsiflikas
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Claudia Treuner
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tuebingen-Children's Hospital Tuebingen, Tuebingen, Germany
| | - Martin Vaegler
- Charité - Universitätsmedizin Berlin, Campus Berlin Buch, Experimental and Clinical Research Center, Zellkulturlabor für Klinische Prüfung ZKP, Berlin, Germany
| | - Markus Mezger
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tuebingen-Children's Hospital Tuebingen, Tuebingen, Germany
| | - Annika Erbacher
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tuebingen-Children's Hospital Tuebingen, Tuebingen, Germany
| | - Michael Schumm
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tuebingen-Children's Hospital Tuebingen, Tuebingen, Germany
| | - Peter Lang
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tuebingen-Children's Hospital Tuebingen, Tuebingen, Germany
| | - Rupert Handgretinger
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tuebingen-Children's Hospital Tuebingen, Tuebingen, Germany
| | - Ingo Müller
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tuebingen-Children's Hospital Tuebingen, Tuebingen, Germany
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Bashaireh KM, Aldarwish FM, Al-Omari AA, Albashaireh MA, Hajjat M, Al-Ebbini MA, Aleshawi AJ. Transient Osteoporosis of the Hip: Risk and Therapy. Open Access Rheumatol 2020; 12:1-8. [PMID: 32021501 PMCID: PMC6957100 DOI: 10.2147/oarrr.s236324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/18/2019] [Indexed: 11/28/2022] Open
Abstract
Objective The aim of this study was to investigate the impact of occupation in patients with transient osteoporosis of the hip (TOH). The study also compares two different types of management for this condition: conservative treatment and surgical drilling. Methods This was a retrospective case series study. The medical records for patients diagnosed with TOH at our institution within the period 2012–2017 were retrieved. General demographic data, clinical features, and diagnostic modalities were obtained. In addition, management procedures and their associated prognostic factors were acquired. The effectiveness of these procedures was assessed by the number of days of sick leave, the time needed for full recovery and the number of recurrences of TOH. Also, pain responses at 24 hrs, 48 hrs, and at 1 week were estimated subjectively through a “pain score” out of 10, and objectively through the degree of improvement in daily activity. The patients had a regular follow-up at 4- to 6-week intervals. Results In total, 15 cases of TOH, 14 men and one woman, were enrolled in the study. The mean age of the patients was 41 years (range 26–59 years). Out of the 15 cases, nine were healthcare professionals (eight physicians and one nurse). Ten patients underwent hip drilling for core decompression and five patients were treated conservatively. The time needed for full recovery was 5.8 weeks for those who underwent drilling, and 48.3 weeks for three patients receiving conservative treatment. The other two patients who were treated conservatively had not achieved full or near-full recovery at the time of reporting this study. Conclusion Physicians may be at increased risk of developing TOH. Further studies should be conducted to examine the role of this occupation as a risk factor. In addition, hip drilling should be considered as an effective treatment modality, especially in those patients who seek a faster recovery.
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Affiliation(s)
- Khaldoon M Bashaireh
- Department of Special Surgery, Division of Orthopedics, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Fa'ek M Aldarwish
- Department of Special Surgery, Division of Orthopedics, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Ali A Al-Omari
- Department of Special Surgery, Division of Orthopedics, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Moath A Albashaireh
- Department of Special Surgery, Division of Orthopedics, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Mai Hajjat
- Princess Rahma Pediatric Hospital, Jordanian Ministry of Health, Irbid, Jordan
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Xian H, Luo D, Wang L, Cheng W, Zhai W, Lian K, Lin D. Platelet-Rich Plasma-Incorporated Autologous Granular Bone Grafts Improve Outcomes of Post-Traumatic Osteonecrosis of the Femoral Head. J Arthroplasty 2020; 35:325-330. [PMID: 31587979 DOI: 10.1016/j.arth.2019.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/24/2019] [Accepted: 09/02/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND To investigate the effects of platelet-rich plasma (PRP)-incorporated autologous granular bone grafts for treatment in the precollapse stages (Association of Research Circulation Osseous stage II-III) of posttraumatic osteonecrosis of the femoral head. METHODS A total of 46 patients were eligible and enrolled in the study. Twenty-four patients were treated with core decompression and PRP-incorporated autologous granular bone grafting (treatment group), and 22 patients were treated with core decompression and autologous granular bone grafting (control group). During a minimum follow-up duration of 36 months, X-ray and computed tomography were used to evaluate the radiological results, and the Harris hip score (HHS) and visual analog scale were chosen to assess the clinical results. RESULTS Both the treatment and control groups had a significantly improved HHS (P < .001). The minimum clinically important difference for the HHS was reached in 91.7% of the treatment group and 68.2% of the control group (P < .05). The HHS and visual analog scale in the treatment group were significantly improved than that in the control group at the last follow-up (P < .05). Successful clinical and radiological results were achieved 87.5% and 79.2% in the treatment group compared with 59.1% and 50.0% in the control group (P < .05), respectively. The survival rates based on the requirement for further hip surgery as an endpoint were higher in the treatment group in comparison to those in the control group (P < .05). CONCLUSION PRP-incorporated autologous granular bone grafting is a safe and effective procedure for treatment in the precollapse stages (Association of Research Circulation Osseous stage II-III) of posttraumatic osteonecrosis of the femoral head.
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Affiliation(s)
- Hang Xian
- Department of Orthopaedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Deqing Luo
- Department of Orthopaedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Lei Wang
- Department of Orthopaedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Weike Cheng
- Department of Orthopaedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Wenliang Zhai
- Department of Orthopaedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Kejian Lian
- Department of Orthopaedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Dasheng Lin
- Department of Orthopaedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
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Abstract
Osteonecrosis of the femoral head is a poorly understood condition that may lead to progressive destruction of the hip joint. Its incidence is common between the third and fifth decades of life and it is the diagnosis behind 5–18% of annually performed total hip arthroplasties (THAs) in the USA. Regarding the high rate of complications of THA in that age group, authors have agreed on the importance of joint-preservation techniques for this disease but techniques vary to establish a generally accepted algorithmic approach. Surgical head-preserving procedures, core decompression with or without graft, stem cell augmentation, or biologic adjuncts, vascularized bone grafting, and proximal femoral osteotomies have all been published on with heterogeneous results and with limited evidence to date. Consensus states that the prognosis of patients with osteonecrosis of the femoral head can be significantly improved with early diagnosis and timely intervention.
Cite this article: EFORT Open Rev 2019;4:647-658. DOI: 10.1302/2058-5241.4.180073
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Affiliation(s)
- Bülent Atilla
- Hacettepe University Department of Orthopaedics and Traumatology, Ankara, Turkey
| | - Sancar Bakırcıoğlu
- Hacettepe University Department of Orthopaedics and Traumatology, Ankara, Turkey
| | - Alexander J Shope
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Javad Parvızı
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Wang L, Xu L, Peng C, Teng G, Wang Y, Xie X, Wu D. The effect of bone marrow mesenchymal stem cell and nano-hydroxyapatite/collagen I/poly-L-lactic acid scaffold implantation on the treatment of avascular necrosis of the femoral head in rabbits. Exp Ther Med 2019; 18:2021-2028. [PMID: 31452701 PMCID: PMC6704490 DOI: 10.3892/etm.2019.7800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 06/20/2019] [Indexed: 11/06/2022] Open
Abstract
For avascular necrosis of the femoral head (ANFH), repair and regeneration are difficult because of the edema and high pressure caused by continuous ischemia and hypoxia. Core decompression (CD) is a classic method for treating early ANFH before the collapse of the femoral head; however, its effect is still controversial. To improve the therapeutic effect of CD on ANFH, a novel tissue-engineered bone (TEB) was constructed by combining bone marrow mesenchymal stem cells (BMSCs) with nano-hydroxyapatite/collagen I/poly-L-lactic acid (nHAC/PLA) scaffolds and implanting the TEB into the bone tunnel of CD. Cell attachment was observed by scanning electron microscopy and hematoxylin and eosin staining. The authors' previous studies confirmed that nHAC/PLA is an excellent scaffold material with favorable biocompatibility and no cytotoxicity. A total of 24 New Zealand rabbits with ANFH were randomly divided into three groups, as follows: Group A (n=8), pure CD; group B (n=8), CD+nHAC/PLA; and group C (n=8), CD+BMSCs-nHAC/PLA. The favorable effect of BMSCs-nHAC/PLA on angiogenesis and bone formation in necrotic areas was further evaluated via radiographic and histological analyses. Computerized tomography (CT) scanning and H&E staining showed more capillaries and new osteoid tissue in group C compared with in groups B and A. Micro-CT showed that the new bone coverage rate and implanted material degradation degree were each increased in group C compared with in group B. These results indicate that BMSCs-nHAC/PLA scaffolds may improve the curative effect of CD and provide a strategy for treating ANFH.
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Affiliation(s)
- Le Wang
- Department of Spinal Surgery, Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Leixin Xu
- Department of Orthopedics, The Fourth People's Hospital, Heze, Shandong 274100, P.R. China
| | - Changliang Peng
- Department of Spinal Surgery, Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Guoxin Teng
- Department of Pathology, Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Yu Wang
- Department of Radiology, Affiliated Hospital of Shandong Traditional Chinese Medicine University, Jinan, Shandong 250012, P.R. China
| | - Xiaoshuai Xie
- Department of Kidney Transplantation, Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Dongjin Wu
- Department of Spinal Surgery, Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
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Serong S, Haversath M, Jäger M, Landgraeber S. Prevalence of CAM deformity and its influence on therapy success in patients with osteonecrosis of the femoral head. J Tissue Eng Regen Med 2019; 13:546-554. [PMID: 30636359 DOI: 10.1002/term.2794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 12/17/2018] [Indexed: 12/19/2022]
Abstract
Osteonecrosis of the femoral head (ONFH) and CAM-type femoroacetabular impingement (FAI) present two different pathologies of the hip joint. The aim of this study is to describe the prevalence of CAM-FAI in a collective of ONFH hips and to evaluate its influence on ONFH therapy outcome. A cohort of 86 ONFH hips with a mean follow-up of 46.7 months (±20.5) after advanced core decompression (ACD) was evaluated regarding CAM deformity by measuring the alpha angle (α) and head-neck offset. The influence of CAM-type FAI was investigated using the Kaplan-Meier estimator and the Cox regression model. The mean α was 60.4° (±13.8) with 41 hips (47.7%) being ≥60°. The mean head-neck offset was 4.5 mm (±3.2), with 78 hips (90.7%) being ≤9 mm. Survival analysis indicated noticeably better ACD results for α < 60° versus α ≥ 60° (p = 0.07). Treatment failure within the first 2 years was statistically estimated as 27.7% for α < 60° versus 40.7% for α ≥ 60°: The hazard ratio for α ≥ 60° was 1.94. Head-neck offset-dependent survival showed better, though not significant, results for offset >9 mm (p = 0.38, hazard ratio 1.89 for offsets ≤9 mm). The prevalence of CAM-type deformity is greatly increased in patients with concomitant ONFH. There is a strong indication that CAM-type FAI has a negative influence on ONFH therapy outcome. The risk that ONFH treatment will fail seems to be twice as high for α ≥ 60° as for α < 60°. We recommend cotreatment of pathological head-neck offset in patients with ONFH.
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Affiliation(s)
- Sebastian Serong
- Department of Orthopaedics and Traumatology, University of Duisburg-Essen, Essen, Germany.,Department of Orthopaedics and Orthopaedic Surgery, Saarland University, Homburg, Germany
| | - Marcel Haversath
- Department of Orthopaedics and Traumatology, University of Duisburg-Essen, Essen, Germany
| | - Marcus Jäger
- Department of Orthopaedics and Traumatology, University of Duisburg-Essen, Essen, Germany
| | - Stefan Landgraeber
- Department of Orthopaedics and Traumatology, University of Duisburg-Essen, Essen, Germany.,Department of Orthopaedics and Orthopaedic Surgery, Saarland University, Homburg, Germany
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Lakshminarayana S, Dhammi IK, Jain AK, Bhayana H, Kumar S, Anshuman R. Outcomes of Core Decompression with or without Nonvascularized Fibular Grafting in Avascular Necrosis of Femoral Head: Short Term Followup study. Indian J Orthop 2019; 53:420-425. [PMID: 31080281 PMCID: PMC6501632 DOI: 10.4103/ortho.ijortho_310_18] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Avascular necrosis (AVN) of the femoral head usually occurs in the third to fifth decade. The treatment options depend on the stage of disease varying from nonoperative treatment to surgical procedure including core decompression (CD) with or without nonvascularized or vascularized fibular graft, muscle pedicle bone grafting, osteotomies, and arthroplasty. Finite life of the total hip arthroplasty (THA) prosthesis limits its use in young adults or in middle aged. In this study, we envisage to evaluate the clinicoradiological outcomes of CD and nonvascularized fibular grafting in early stages of AVN femoral head. MATERIALS AND METHODS Our study is longitudinal observational study including 76 hips (46 patients) in the age group of 18-48 years (mean 30.07 years). Ficat and Arlet staging system was used and only early stages, that is, Stage 1 (n = 36 hips) and Stage 2 (n = 40 hips) were included in the study. The cases with traumatic AVN were excluded. All patients in Stage 1 underwent CD (Group 1) and those in Stage 2 underwent CD and fibular grafting (Group 2). Preoperative Harris Hip Score (HHS), visual analog score (VAS), plain radiographs, and magnetic resonance imaging (MRI) were compared with serial postoperative HHS, VAS, plain radiographs, and MRI taken at different intervals. RESULTS Average period of followup was 53.5 months (44-63 months). Radiological progression was not seen in 55 hips out of 76 hips (72.3%), whereas 21 hips (27.6%) demonstrated signs of progression and collapse. Failure of surgery was defined as progression of the disease, which was 25% (n = 9) in Group 1and 30% (n = 12) Group 2. Median values of HHS at the end of the followup in Group 1 was 77 and in Group 2 was 71.5 compared to the preoperative HHS of 48 and 62 in Group 1 and 2, respectively. Median values of VAS at the end of the followup in Stage 1 was 0 and in Stage 2 was 2 compared to the preoperative VAS of 6 and 8 in Group 1 and Group 2, respectively. CONCLUSION CD with or without fibular grafting is effective in preserving the sphericity of the femoral head and to delay the progression of the AVN of femoral head in the early stages, that is, Stage 1 and Stage 2 and aids in the early revascularization of ischemic femoral head and is a useful modality to negate or delay the requirement of THA.
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Affiliation(s)
- Sumanth Lakshminarayana
- Department of Orthopaedics, UCMS and GTB Hospital, New Delhi, India,Address for correspondence: Dr. Sumanth Lakshminarayana, Flat No-59D, Pocket F, GTB Enclave, New Delhi - 110 095, India. E-mail:
| | - Ish Kumar Dhammi
- Department of Orthopaedics, UCMS and GTB Hospital, New Delhi, India
| | - Anil K Jain
- Department of Orthopaedics, UCMS and GTB Hospital, New Delhi, India
| | - Himanshu Bhayana
- Department of Orthopaedics, UCMS and GTB Hospital, New Delhi, India
| | - Sapan Kumar
- Department of Orthopaedics, UCMS and GTB Hospital, New Delhi, India
| | - Rahul Anshuman
- Department of Orthopaedics, UCMS and GTB Hospital, New Delhi, India
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Talmaç MA, Kanar M, Sönmez MM, Özdemir HM, Dırvar F, Tenekecioğlu Y. The Results of Core Decompression Treatment in Avascular Necrosis of the Femoral Head. Sisli Etfal Hastan Tip Bul 2018; 52:249-53. [PMID: 32774086 DOI: 10.14744/SEMB.2018.47135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 04/25/2018] [Indexed: 12/02/2022]
Abstract
Objective: Avascular necrosis of the femoral head (AVNFH) is a progressive disease seen in young, active patients, leaving significant disability in the joint when untreated. We retrospectively examined the results of patients with early stage AVNFH who had been operated in our clinic. Methods: In our study, 65 hips of 46 patients were evaluated retrospectively. These patients were evaluated clinically by the Merle d’Aubigné–Postel Score and Harris Hip Score. The patients were radiologically staged according to the criteria by Ficat and Arlet with hip anterior-posterior and lateral graphs and magnetic resonance imaging. Results: The mean follow-up period of the patient group was 73 months, and the mean age of the patients was 35 years. Of these patients, 59% were female and 41% were male; 41% had bilateral and 40% had right hip involvement. One of the patients developed AVNFH while she was pregnant, 7 were idiopathic, and 38 (81%) developed AVNFH due to steroid use. According to the Ficat and Arlet classification, 18 hips were found to be stage 1, 37 hips stage 2, and 9 hips stage 3 during admission. From the etiological point of view, 81% of the patients developed AVNFH while using steroid and 19% had idiopathic AVNFH. As for clinical improvement of the patients, the Harris Hip Score increased from 58 to 90 in idiopathic patients and 55 to 83 among steroid users. The Merle d’Aubigné–Postel classification scores increased from 6 to 15 in the idiopathic group and from 6 to 13 among steroid users. Radiologically, according to the Ficat and Arlet stage, progression was seen in all stages. Of the patients, 38.8% in stage 1, 70.2% in stage 2, and 88.8% in stage 3 showed progression, whereas 20% demonstrated rapid progression and needed total hip prosthesis. All patients who demonstrated progression were on chronic steroid therapy. The mean time to conversion to total hip replacement was 27 months. Conclusion: Osteonecrosis is a disease associated with high morbidity. Early diagnosis can reduce morbidity and improve a patient’s quality of life. Core decompression has the effect of stopping the progression of AVNFH in the early (stage 1) stages, although it has a significant and long-term palliative effect in all stages. Most of the young and active patients with AVNFH still do not have any ideal method for treatment today, but core decompression in the early stages has been seen to reduce morbidity. It is a time-saving attempt before the final treatment, which is hip arthroplasty, is performed.
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Hao YQ, Guo H, Zhu T, Xu ZC, Qi HD, Lu C, Yuan PW. Core decompression, lesion clearance and bone graft in combination with Tongluo Shenggu decoction for the treatment of osteonecrosis of the femoral head: A retrospective cohort study. Medicine (Baltimore) 2018; 97:e12674. [PMID: 30313059 PMCID: PMC6203527 DOI: 10.1097/md.0000000000012674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to evaluate the clinical effect of core decompression (CD), lesion clearance, and bone graft in combination with Tongluo Shenggu decoction for the treatment of osteonecrosis of the femoral head (ONFH).A total of 75 patients (92 hips), with ONFH at Association Research Circulation Osseous (ARCO) stages II to IIIA, were studied and divided into treatment group and control group. In control group, patients were treated with the CD in combination with autologous or artificial ceramic bone graft. In treatment group, patients were treated with the above method combined with Tongluo Shenggu decoction. Patients were followed-up at 1 month, 6 months, and 24 months after surgery. The visual analogue scale (VAS) scores, Harris Hip Score (HSS), and total effective rates were measured and recorded.The total effective rate of the treatment group was significantly higher than that of the control group (97.2% vs. 89.9%, P < .05). Compared with preoperative, the VAS and HSS scores were both improved at final follow-up, and there was significant difference between 2 groups (P < .01).The combination of CD, lesion clearance, and the bone graft with Tongluo Shenggu decoction is safe and effective for the treatment of ONFH, owing to which it can provide higher postoperative functional outcomes, reduce pain, and achieve smaller osteonecrosis area and better bone changes.
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Affiliation(s)
- Yang-Quan Hao
- Department of osteonecrosis and joint reconstruction, Honghui Hospital, Xi’an Jiaotong University, Xi’an
| | - Hao Guo
- Department of osteonecrosis and joint reconstruction, Honghui Hospital, Xi’an Jiaotong University, Xi’an
| | - Tian Zhu
- Graduate School, Shaanxi university of Chinese medicine, Shiji Ave, Xi’an-xianyang New Ecomic Zone
| | - Zhao-Chen Xu
- Graduate School, Shaanxi university of Chinese medicine, Shiji Ave, Xi’an-xianyang New Ecomic Zone
| | - Han-Deng Qi
- Graduate School, Shaanxi university of Chinese medicine, Shiji Ave, Xi’an-xianyang New Ecomic Zone
| | - Chao Lu
- Department of osteonecrosis and joint reconstruction, Honghui Hospital, Xi’an Jiaotong University, Xi’an
| | - Pu-Wei Yuan
- Department of Orthopedics, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shanxi Province, P.R. China
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Abstract
Femoral head osteonecrosis is a condition caused by a compromise of the blood supply of the femoral head. The precarious blood supply of the head and its role as a major weight-bearing joint makes it one of the most common bones to be affected by osteonecrosis. We describe the etiology, clinical presentation, investigations and common management options used nowadays to treat it.
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Affiliation(s)
- Shakoor A Baig
- Trauma & Orthopaedics, Leicester Royal Infirmary, Leicester, GBR
| | - M N Baig
- Trauma & Orthopaedic Surgery, Galway University Hospital, Galway, IRL
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Fornell S, Ribera J, Mella M, Carranza A, Serrano-Toledano D, Domecq G. Effects of electrical stimulation in the treatment of osteonecrosis of the femoral head. Hip Int 2018; 28:434-41. [PMID: 29048692 DOI: 10.5301/hipint.5000581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The aim of this study was to examine whether the use of an internal electrostimulator could improve the results obtained with core decompression alone in the treatment of osteonecrosis of the femoral head. METHODS We performed a retrospective study of 41 patients (55 hips) treated for osteonecrosis of the femoral head between 2005 and 2014. Mean follow-up time was 56 (12-108) months. We recorded 3 parameters: time to recurrence of pain, time to conversion to arthroplasty and time to radiographic failure. Survival was estimated using the Kaplan-Meier method. The equality of the survival distributions was determined by the Log rank test. RESULTS Implanted electrostimulator was a factor that increased the survival of hips in a pre-op Steinberg stage of II or below, while it remained unchanged if the stage was III or higher. CONCLUSIONS The addition of an internal electrostimulator provides increased survival compared to core decompression alone at stages below III.
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