• 3D printing technology
• Bone tissue engineering scaffolds
• Osteonecrosis of the femoral head
• Personalized treatment

• Humans
• Male
• Female
• Middle Aged
• Arthroplasty, Replacement, Hip/statistics & numerical data
• Decompression, Surgical/methods
• Adult
• Incidence
• Femur Head Necrosis/surgery
• Risk Factors
• Taiwan/epidemiology
• Retrospective Studies
• Aged
• Reoperation/statistics & numerical data

• Additive manufacturing
• Hip-preserving procedure
• Osteonecrosis of femoral head
• Tantalum rod implant

• Humans
• Tantalum
• Femur Head Necrosis/surgery
• Male
• Female
• Adult
• Middle Aged
• Porosity
• Bone Transplantation/methods
• Prosthesis Design
• Finite Element Analysis
• Treatment Outcome
• Young Adult

• 2020MSXM054 Joint Project of Chongqing Science and Technology Commission
• CX2019JS202 New Technology Cultivation Project of Military Medicine

• Avascular necrosis of the femoral head
• Bioadaptability
• Bone regeneration
• Clinical trial
• Vascularization
• β-TCP

• Femoral head osteonecrosis
• Hip
• Prognostic factors

• biomaterials
• bone tissue engineering
• osteonecrosis of the femoral head
• regenerative therapy

• National Natural Science Foundation of China

• coagulation function
• femur head necrosis
• idiopathic necrosis of the femoral head
• lipid metabolism
• propensity score matching

• concentrated autologous bone marrow aspirate transplantation
• core decompression
• joint-preserving surgery
• mesenchymal stem cells
• osteonecrosis of the femoral head

• Osteonecrosis of the femoral head
• Porous tantalum rod implantation
• Survival analysis
• Total hip arthroplasty

• additive manufacturing
• bone tissue engineering
• clinical application
• porous tantalum
• surface modification

• 81860477 National Natural Science Foundation of China
• 81860480 National Natural Science Foundation of China

The failure of porous tantalum rods applied to patients with osteonecrosis of the femoral head (ONFH) has been increasingly reported during the last few years. Very few studies have reported methods for implant removal. This study aimed at comparing 2 procedures used for the removal of a failed tantalum rod during conversion to total hip arthroplasty (THA).

A total of 65 patients (65 hips), who underwent THA after failed implantation of a tantalum rod between June 2007 and December 2016, were retrospectively evaluated. These patients were classified into 2 groups depending on whether the antegrade approach (removal of the tantalum rod from the tip to the butt at the lateral femoral cortex, n=27) or retrograde approach (removal of the tantalum rod from the butt at the lateral femoral cortex to the proximal tip, n=38) was used for rod extraction. These 2 groups were compared for incision length, operation time, blood loss, fracture, tantalum debris, Harris hip scores, and the presence of osteolysis and/or radiolucency.

These 2 groups did not present any significant differences in terms of Harris hip score and incision length. However, the operation time (P=0.000), blood loss (P=0.000), amount of tantalum debris (P=0.000), and presence of radiolucency (P=0.046) were greater for the retrograde approach than for the antegrade approach.

The risk of conversion to THA following failed tantalum rod implantation is high. In such cases, the antegrade procedure was found to be a simple and efficient method for removing the trabecular metal rod with the use of a trephine.

The aim of the study was to explore the feasibility and early effect of digital design combined with 3-dimensional (3D) printing technique in the transplantation of vascular pedicled iliac bone flap in the treatment of avascular necrosis of the femoral head.

• Biogenic lamellar configuration
• Bone integration and ingrowth
• Osteonecrosis of the femoral head
• Porous titanium alloy
• Sheep

• ARCO, Association Research Circulation Osseous
• BMES, Bone marrow oedema syndrome
• CT, Computed tomography
• DSA, Digital subtraction angiography
• Diagnosis
• Guideline
• MRI, Magnetic resonance imaging
• ONFH, Osteonecrosis of the femoral head
• Osteonecrosis of the femoral head (ONFH)
• PET, Positron emission tomography
• RHS, Reconstruction Hip Scores
• SPECT, Single-photon emission computed tomography
• T1WI, T1-weighted images
• Treatment

• biomaterials
• femoral head
• osteonecrosis
• repair

• Bone marrow mesenchymal stem cells
• Cytocompatibility
• MAPK/ERK signaling pathway
• Osteogenic differentiation
• Porous tantalum

• Porous tantalum rod
• early stage
• femoral head
• osteonecrosis
• total hip arthroplasty (THA)

Osteonecrosis of the femoral head was gradually concerned as a global disease for its progression to collapse of the femoral head, ultimately causing the arthritic change. Due to the high incidence of this disease in young people, arthroplasty tends to be suspected for its uncertain long-term efficiency. Vascularized pedicle iliac bone grafts, as a hip-preserving surgery, were regarded as an effective option in hip-preserving protocol since the 1970s. Nevertheless, there exist no unified standards widely agreed as the optimal operative program since the lack and heterogeneity of related studies. Thus, we execute this systematic review to synthesize and analyze existing studies, and further suggest a direction of future researches.

Data were collected by searching electronic database (PubMed, Embase, and Cochrane Library) and including the eligible studies of all types of clinical researches except case report. Through our extraction and synthesis of included study results in respect of clinical evaluation (rating scales), radiographic evaluation, joint survival rate, viability of implanted flap, and complications by transform varied assessment method into a unified standard, we qualitatively analyze and discuss the efficacy of VPIBG according to the quality of individual study and the heterogeneity across the included studies.

Our systematic review includes 1 RCT, 2 case-control studies, and 13 case series studies, resulting in a significant improvement of postoperative scores. Minority of hips progressed for joint replacement. Some researches suggested a high collapse rate in the collapsed femoral head before the operation. Compared with some other hip-preserving surgeries, the complications of VPIBG are relatively slight and barely affect clinical efficiency.

A better clinic response was obtained after this treatment, especially in femoral heads before the appearance of a crescent sign. The fixation of the implanted iliac bone flap increases the clinical effect. The majority of complications were slight and rarely affected clinical efficacy.

The online version of this article (10.1186/s13018-019-1262-2) contains supplementary material, which is available to authorized users.

• Bone grafts
• Femoral head
• Osteonecrosis
• Systematic review
• Vascularized pedicle ilium

Background and methods: A Cu-doped composite scaffold of nano calcium-deficient hydroxyapatite (n-CDHA)/multi(amino acid) copolymer (MAC) was prepared. The structure, porosity, morphology and compressive strength of the scaffolds were characterized, the in vitro degradability in phosphate-buffered solution (PBS) and cell responses to the scaffolds were investigated, and in vivo stimulation of bone formation were analyzed.

Results: The scaffolds showed the compressive strength of approximately 12 MPa and total porosity of about 81%. Weight loss of the composite scaffolds was 63% after 16-week immersion in PBS. Cu release in scaffolds showed a marked dependence on the initial amount in the scaffolds over time. Cu-doped n-CDHA/MAC scaffolds with the content of Cu 0.5% and 1% in mass ratio showed better cell responses to proliferation and differentiation of rat bone marrow stromal cells (rBMSCs) than that with no Cu. After 12-week implantation in rabbits, 1% Cu-doped n-CDHA/MAC showed better ability of angiogenesis and osteogenesis compared to 0% Cu-doped n-CDHA/MAC.

Conclusion: The 1% Cu-doped n-CDHA/MAC composite scaffold showed good capacity of angiogenesis and osteogenesis, and the Cu showed positive effects on cell growth and osteogenesis. And it has potential to be used as bone regeneration scaffolds.

• calcium-deficient hydroxyapatite
• copper
• cytocompatibility
• degradability
• multi-(amino acid) copolymer
• osteogenesis

• Bio-Gide collagen membrane
• Bone marrow stromal stem cells
• Full-thickness articular cartilage defect
• Osteonecrosis of femoral head
• Porous tantalum

• Core decompression
• Osteonecrosis of the femoral head
• Tantalum rods

• Diagnosis
• Guideline
• Osteonecrosis of the femoral head (ONFH)
• Treatment

• Adult
• Diagnosis, Differential
• Femur Head Necrosis/diagnostic imaging
• Femur Head Necrosis/etiology
• Femur Head Necrosis/therapy
• Humans
• Magnetic Resonance Imaging/methods
• Radiography/methods
• Risk Factors
• Tomography, Emission-Computed/methods
• Tomography, X-Ray Computed/methods

• Avascular necrosis
• Hip
• Osteonecrosis
• Review

The aim of this study was to determine long term follow up of the patients who had femoral head osteonecrosis and had been treated with free vascularized fibular grafting.

We retrospectively reviewed 28 hips of 21 patients who had undergone free vascularized fibular grafting for the treatment of osteonecrosis of femoral head. There were 16 male and 5 female patients. The mean age of the patients at the time of surgery was 30.7 years (between 15 and 53 years). The mean follow-up time was 7.6 years (between 5 years and 9.2 years).

During follow-up, one patient died because of leukemia, and one patient was lost. The remaining 26 hips of 19 patients were evaluated. According to the Ficat classification, at the time of surgery, 17 hips were in grade 2 and 9 hips were in grade 3. The post-operative Harris hip scores in grade II disease were excellent in 12 patients, good in 3 patients, and fair in 1 patient. In grade III disease, 1 patient was excellent, 5 patients were good, and 1 patient was fair. There was a significant increase in HHS scores (61 ± 9.7 vs 84 ± 17.8, p < 0.001).

Free vascularized fibular grafting yields extremely good results, particularly in pre-collapse stages of disease in young patients. The operation time does not mark increased if the surgical team is “familiar” with the procedure, and the residual fibular defect of the donor site does not impair the functions of daily living.

Level IV, Therapeutic study.

• Free vascularized fibular grafting
• Osteonecrosis of the femoral head

This is a retrospective analysis of the clinical effects of transplant of mesenchymal stem cells (MSCs) derived from human umbilical cord-derived MSCs (hUC-MSCs) for the treatment of osteonecrosis of the femoral head (ONFH). The biological characteristics of hUC-MSCs were assessed using flow cytometry. Nine eligible patients were enrolled in the study as they adhered to the Association Research Circulation Osseous (ARCO) classification of stage II–IIIa, and hUC-MSCs were grafted by intra-arterial infusion. Organize effective perfusion was assessed using the oxygen delivery index (ODI). The results showed that the ODI was increased at three days post-operation. The MRI results revealed that at 12 and 24 months after treatment, the necrotic volume of the femoral heads was significantly reduced. No obvious abnormalities were observed. Taken together, these data indicate that intra-arterially infused hUC-MSCs migrate into the necrotic field of femoral heads and differentiate into osteoblasts, thus improving the necrosis of femoral heads. This finding suggested that intra-arterial infusion of hUC-MSCs MSCs is a feasible and relatively safe method for the treatment of femoral head necrosis.

Nontraumatic osteonecrosis of the femoral head (NONFH) is a debilitating disease that represents a significant financial burden for both individuals and healthcare systems. Despite its significance, however, its prevalence in the Chinese general population remains unknown. This study aimed to investigate the prevalence of NONFH and its associated risk factors in the Chinese population.

A nationally representative survey of 30,030 respondents was undertaken from June 2012 to August 2013. All participants underwent a questionnaire investigation, physical examination of hip, and bilateral hip joint X-ray and/or magnetic resonance imaging examination. Blood samples were taken after overnight fasting to test serum total cholesterol, triglyceride, and high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels. We then used multivariate logistic regression analysis to investigate the associations between various metabolic, demographic, and lifestyle-related variables and NONFH.

NONFH was diagnosed in 218 subjects (0.725%) and the estimated NONFH cases were 8.12 million among Chinese people aged 15 years and over. The prevalence of NONFH was significantly higher in males than in females (1.02% vs. 0.51%, χ² = 24.997, P < 0.001). Among NONFH patients, North residents were subjected to higher prevalence of NONFH than that of South residents (0.85% vs. 0.61%, χ² = 5.847, P = 0.016). Our multivariate regression analysis showed that high blood levels of triglycerides, total cholesterol, LDL-cholesterol, and non-HDL-cholesterol, male, urban residence, family history of osteonecrosis of the femoral head, heavy smoking, alcohol abuse and glucocorticoid intake, overweight, and obesity were all significantly associated with an increased risk of NONFH.

Our findings highlight that NONFH is a significant public health challenge in China and underscore the need for policy measures on the national level. Furthermore, NONFH shares a number of risk factors with atherosclerosis.

• Femoral head
• Osteonecrosis
• Porous tantalum osteonecrosis implant
• Total hip arthroplasty

AIM: To study a modified porous tantalum technique for the treatment of osteonecrosis of the femoral head.

METHODS: The porous tantalum rod was combined with endoscopy, curettage, autologous bone grafting and use of bone marrow aspirates from iliac crest aspiration in 49 patients (58 hips) with a mean age of 38 years. The majority of the patients had idiopathic osteonecrosis, followed by corticosteroid-induced osteonecrosis. Thirty-eight hips were of Steinberg stage II disease and 20 hips were of stage III disease. Patients were followed for 5 years and were evaluated clinically with the Merle D’Aubigne and Postel score and radiologically. The primary outcome of the study was survival based on the conversion to total hip arthroplasty (THA). Secondary outcomes included deterioration of the osteonecrosis to a higher disease stage at 5 years compared to the preoperative period and identification of factors that were associated with survival. The Kaplan-Meier survival analysis was performed to evaluate the survivorship of the prosthesis, and the Fisher exact test was performed to test associations between various parameters with survival.

RESULTS: No patient developed any serious intraoperative or postoperative complication including implant loosening or migration and donor site morbidity. During the 5-year follow up, 1 patient died, 7 patients had disease progression and 4 hips were converted to THA. The 5-year survival based on conversion to THA was 93.1% and the respective rate based on disease progression was 87.9%. Stage II disease was associated with statistically significant better survival rates compared to stage III disease (P = 0.04). The comparison between idiopathic and non-idiopathic osteonecrosis and between steroid-induced and non-steroid-induced osteonecrosis did not showed any statistically significant difference in survival rates. The clinical evaluation revealed statistically significantly improved Merle d’Aubigne scores at 12 mo postoperatively compared to the preoperative period (P < 0.001). The mean preoperative Merle d’Aubigne score was 13.0 (SD: 1.8). The respective score at 12 mo improved to 17.0 (SD: 2.0). The 12-mo mean score was retained at 5 years.

CONCLUSION: The modified porous tantalum rod technique presented here showed encouraging outcomes. The survival rates based on conversion to THA are the lowest reported in the published literature.

• Avascular necrosis
• Femoral head
• Tantalum rod
• Survival
• Bone grafting

Avascular necrosis of femoral head and nonunion is a major complication after the treatment of displaced femoral neck fracture in young adults.

The purpose of this study was to introduce a new technique using biodegradable magnesium screws and vascularised iliac grafting for displaced femoral neck fracture in young adults.

Totally 19 patients with displaced femoral neck fracture treated with this technique were retrospectively reviewed. The major steps of this technique included the harvesting of vascularized iliac graft, fixing of the fracture and biodegradable magnesium screws combined with vascularized iliac grafting implantation.

All patients were followed for an average of 16 months (range: 8–24 months). Clinical and radiological outcomes were evaluated. In 18 cases (94.7 %), the hip union was achieved at an average duration of 4.1 months (range: 3.6-5 months). The nonunion was observed in 1 hip (5.3 %) and the revision to a hip replacement was conducted after twelve months of the operation. According to the Harris hip score (HHS) that was available for 17 hips with satisfactory union, excellent results were achieved in 14 cases (HHS ≥ 90), fair results in 3 cases (HHS: 80–90), and poor result in 1 hip (HHS < 80). No patient developed avascular necrosis of femoral head after operation.

Biodegradable magnesium screws and vascularized iliac grafting based on the ascending branch of lateral femoral circumflex artery for displaced femoral neck fracture in young adults can provide the satisfactory results with a low rate of complications including avascular necrosis and nonunion.

This prospective and randomized controlled study was registered in the Chinese Clinical Trial Registry (ChiCTR-TRC-13003238). Date of registration: 2013-3-21.

The potential regenerative role of different orthobiologics is becoming more recognized for the treatment of chronic and degenerative musculoskeletal conditions. Over the last few years there has been an increasing number of publications on cell therapy and other orthobiologics for the treatment of avascular necrosis of the femoral head and other hip conditions with promising short–term clinical results. In this article, we have used a systematic search of the literature to identify potentially relevant topics on orthobiologics and then selected those most applicable to hip preservation surgery. We identified several innovative strategies and present a summary of the currently available evidence on their potential role in hip preservation surgery. For many of these treatment strategies there was a lack of clinical evidence and therefore we suggest that there is a need for comparative studies in this field.

Tantalum rod implantation with vascularized iliac grafting has been reported to be an effective method for the treatment of young patients with osteonecrosis of the femoral head (ONFH) to avert the need for total hip arthroplasty (THA). However, there have been unsatisfactory success rates for end-stage ONFH. The authors describe a modified technique using bone marrow mesenchymal stem cells (BMMSCs) associated with porous tantalum rod implantation combined with vascularized iliac grafting for the treatment of end-stage ONFH. A total of 24 patients (31 hips) with end-stage ONFH were treated with surgery; ARCO IIIc stage was observed in 19 hips and ARCO IV stage was observed in 12 hips. All patients were followed for a mean time of 64.35 ± 13.03 months (range 26–78). Operations on only five hips were converted to THA. The joint-preserving success rate of the entire group was 89.47% for ARCO stage IIIc and 75% for ARCO stage IV. The mean Harris hip score of the 31 hips improved significantly from 38.74 ± 5.88 points (range 22–50) to 77.23 ± 14.75 points (range 33–95). This intervention was safe and effective in delaying or avoiding total hip replacement for end-stage ONFH.

Steroid-associated osteonecrosis (SAON) is a common orthopaedic problem caused by administration of corticosteroids prescribed for many nonorthopaedic medical conditions. We summarised different pathophysiologies of SAON which have adverse effects on multiple systems such as bone marrow stem cells (BMSCs) pool, bone matrix, cell apoptosis, lipid metabolism, and angiogenesis. Different animal models were introduced to mimic the pathophysiology of SAON and for testing the efficacy of both prevention and treatment effects of various chemical drugs, biological, and physical therapies. According to the classification of SAON, several prevention and treatment methods are applied at the different stages of SAON. For the current period, Chinese herbs may also have the potential to prevent the occurrence of SAON. In the future, genetic analysis might also be helpful to effectively predict the development of ON and provide information for personalised prevention and treatment of patients with SAON.

• osteonecrosis
• pathophysiology
• prevention
• steroid
• treatment

• Biological performance
• Dental implant
• Osseoincorporation
• Porous tantalum
• Surface modification