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Zhang C, Li Y, Li Z, Wang J, He W, He H. The Prognostic Value of Antero-lateral Femoral Head Preservation Extension in Post-Collapse Femoral Head Necrosis. J Arthroplasty 2025:S0883-5403(25)00485-1. [PMID: 40348142 DOI: 10.1016/j.arth.2025.04.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Revised: 04/30/2025] [Accepted: 04/30/2025] [Indexed: 05/14/2025] Open
Abstract
BACKGROUND The extent of antero-lateral wall preservation is crucial for early osteonecrosis of the femoral head (ONFH) prognosis. This study aimed to assess the predictive value of the anterior preserved angle (APA) and lateral preserved angle (LPA) of the femoral head in post-collapse ONFH prognosis. METHODS There were 77 patients (102 hips) who had Association Research Circulation Osseous stage IIIA ONFH enrolled in this study, with an average follow-up of 7.3 years. Hips were categorized into the favorable and poor function groups based on the Harris hip score and whether a conversion to total hip arthroplasty occurred during follow-up. The LPA and APA were measured to quantify unaffected antero-lateral femoral head regions. Univariate and multivariate analyses were conducted to identify independent factors associated with hip function status. Cutoff values of LPA and APA were determined from receiver operating characteristic curves for predicting favorable hip function, while the survival rates were assessed using Kaplan-Meier survival analysis. RESULTS Ultimately, there were 49 hips in the poor function group and 52 hips in the favorable function group. Multivariate COX regression analysis identified both LPA and APA as independent protective factors for hip function. Cutoff values were 44.6° for LPA and 41.1° for APA, respectively. The 10-year survival rates with poor joint function as the endpoint were 87.5% for LPA ≥ 44.6° and 17.6% for LPA < 44.6° as well as 88.1% for APA ≥ 41.1° and 23.4% for APA < 41.1°. Similar results were obtained when considering collapse progression and secondary osteoarthritis changes as endpoints, respectively. Additionally, a satisfactory prognosis was observed when LPA ≥ 44.6° was combined with APA ≥ 41.1°. CONCLUSIONS In ONFH, femoral head collapse does not necessarily indicate a poor prognosis. Specifically, cases with LPA ≥ 44.6° and APA ≥ 41.1° are expected to have a favorable prognosis, enabling long-term "survival with collapse."
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Affiliation(s)
- Cheng Zhang
- Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No.6 Wangjing Zhonghuannan Road, Chaoyang District, Beijing 100102, China
| | - Yan Li
- Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No.6 Wangjing Zhonghuannan Road, Chaoyang District, Beijing 100102, China
| | - Ziqi Li
- Guangdong research institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou 510405, Guangdong, China; Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China
| | - Junyu Wang
- Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No.6 Wangjing Zhonghuannan Road, Chaoyang District, Beijing 100102, China
| | - Wei He
- Guangdong research institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou 510405, Guangdong, China; Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China
| | - Haijun He
- Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No.6 Wangjing Zhonghuannan Road, Chaoyang District, Beijing 100102, China.
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Otaka K, Osawa Y, Takegami Y, Iida H, Funahashi H, Imagama S. Fatty infiltration of periarticular muscles in patients with osteonecrosis of the femoral head. INTERNATIONAL ORTHOPAEDICS 2025; 49:1073-1080. [PMID: 39976738 PMCID: PMC12003464 DOI: 10.1007/s00264-025-06457-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2025] [Accepted: 02/12/2025] [Indexed: 04/17/2025]
Abstract
PURPOSE Muscle mass and fatty infiltration can be assessed on computed tomography (CT) images using the cross-sectional area (CSA) and computed tomography attenuation value (CTV). Femoral head collapse in osteonecrosis of the femoral head (ONFH) may affect both values. We investigated factors influencing the CSA and CTV of the periarticular muscles in patients with ONFH. METHODS Overall, 101 patients with ONFH with unilateral hip pain (stage 2, 24 patients; stage 3 A, 49 patients; and stage 3B, 28 patients) were included. The CSA and mean CTV of the bilateral gluteus maximus (Gmax), gluteus medius (Gmed), gluteus minimus (Gmin), and iliopsoas (IP) muscles were measured using CT cross-sections. Bilateral comparisons and associations with Japanese Investigation Committee (JIC) stage were analysed. Multiple regression analysis was used to evaluate factors associated with the CSA and CTV. RESULTS On the symptomatic side, the CSA was significantly lower for the Gmax, Gmed, and IP, whereas the CTV was significantly lower for all tested muscles (all p < 0.01). The CTV, but not the CSA, of the Gmax, Gmed, and Gmin was significantly associated with the JIC stage severity bilaterally (all p < 0.01). Multiple regression analysis showed significant associations of the CTV with age, sex, and JIC stage (all p < 0.01). CONCLUSION Symptomatic ONFH leads to decreased muscle mass and increased fatty infiltration. Femoral head collapse progression is associated with a decrease in the CTV. Periarticular muscle assessment, including on the contralateral side, is important in patients with ONFH, particularly in older women.
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Liu G, Cao R, Liu Q, Li H, Yan P, Wang K, Tian R, Yang P. M2 macrophages-derived exosomes for osteonecrosis of femoral head treatment: modulating neutrophil extracellular traps formation and endothelial phenotype transition. Bone Res 2025; 13:42. [PMID: 40169566 PMCID: PMC11961764 DOI: 10.1038/s41413-025-00412-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 01/15/2025] [Accepted: 01/21/2025] [Indexed: 04/03/2025] Open
Abstract
Exosomes have shown good potential in ischemic injury disease treatments. However, evidence about their effect and molecular mechanisms in osteonecrosis of femoral head (ONFH) treatment is still limited. Here, we revealed the cell biology characters of ONFH osteonecrosis area bone tissue in single cell scale and thus identified a novel ONFH treatment approach based on M2 macrophages-derived exosomes (M2-Exos). We further show that M2-Exos are highly effective in the treatment of ONFH by modulating the phenotypes communication between neutrophil and endothelium including neutrophil extracellular traps formation and endothelial phenotype transition. Additionally, we identified that M2-Exos' therapeutic effect is attributed to the high content of miR-93-5p and constructed miR-93-5p overexpression model in vitro and in vivo based on lentivirus and adeno-associated virus respectively. Then we found miR-93-5p can not only reduce neutrophil extracellular traps formation but also improve angiogenic ability of endothelial cells. These results provided a new theoretical basis for the clinical application of ONFH therapeutic exosomes.
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Affiliation(s)
- Guanzhi Liu
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ruomu Cao
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qimeng Liu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Heng Li
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Peng Yan
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kunzheng Wang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Run Tian
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
| | - Pei Yang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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Tal N, Bannykh S, Learch T, Mamelak AN, Cooper O. Avascular Necrosis in Patients With Cushing Syndrome. JCEM CASE REPORTS 2025; 3:luaf001. [PMID: 39911682 PMCID: PMC11795648 DOI: 10.1210/jcemcr/luaf001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Indexed: 02/07/2025]
Abstract
Cushing syndrome (CS) results from prolonged exposure to excess glucocorticoids, leading to a range of clinical manifestations including avascular necrosis (AVN), a rare complication of CS. Although AVN is often associated with exogenous glucocorticoid treatment, it can occur in endogenous CS but may be unrecognized because of its rarity and possibly from a subclinical presentation. We describe a case of a 71-year-old male with florid Cushing disease who initially presented with bilateral hip AVN and later developed bilateral shoulder AVN despite achieving biochemical remission following transsphenoidal surgery and adjuvant stereotactic photon radiosurgery. AVN in endogenous CS is underreported, and guidance on routine screening is lacking. Our case underscores the importance of considering AVN in patients with CS, especially in those with persistent or recurrent joint symptoms and markedly elevated cortisol levels. Early detection of AVN is crucial as it can lead to irreversible joint damage and disability if untreated. Screening strategies should be explored to identify high-risk patients who are diagnosed with CS for timely intervention, thereby preventing long-term morbidity associated with AVN.
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Affiliation(s)
- Noa Tal
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Serguei Bannykh
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Thomas Learch
- Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Adam N Mamelak
- Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Odelia Cooper
- Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Uesugi Y, Sakai T, Ando W, Seki T, Hayashi S, Sugano N. A 5-Year Longitudinal Assessment of Quality of Life in Patients Who Have Osteonecrosis of the Femoral Head Undergoing Total Hip Arthroplasty: A Multicenter Study. J Arthroplasty 2025:S0883-5403(25)00017-8. [PMID: 39824234 DOI: 10.1016/j.arth.2025.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 12/23/2024] [Accepted: 01/07/2025] [Indexed: 01/20/2025] Open
Abstract
BACKGROUND The effects of surgical treatment on the quality of life (QOL) of patients who have osteonecrosis of the femoral head (ONFH) have been rarely reported. This multicenter study aimed to elucidate the longitudinal QOL in patients who have ONFH undergoing total hip arthroplasty. METHODS Self-assessment QOL questionnaires, including the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), Oxford Hip Score (OHS), and 12-Item Short-Form Health Survey Version 2 (SF-12v2), were administered to 124 patients at 6 months, 1 year, 2 years, and 5 years postoperatively. These scores were compared according to age, sex, and associated factors from preoperative status to 2 years postoperatively (study 1) and from 2 to 5 years postoperatively (study 2). RESULTS Postoperative JHEQ satisfaction, pain, movement, mental, OHS, and SF-12v2 physical component summary (PCS) scores significantly improved 6 months postoperatively. The satisfaction level and OHS in men and patients aged < 60 years continuously improved significantly until 2 years postoperatively. Postoperative JHEQ movement scores gradually improved in patients aged ≥ 60 years. The SF-12v2 role component summary scores improved significantly 2 years postoperatively. Compared to the scores at postoperative 2 years, JHEQ satisfaction level in the patients aged ≥ 60 years and patients who had corticosteroid-associated ONFH, JHEQ pain and mental scores in women and corticosteroid-associated patients, and JHEQ movement and OHS in women improved significantly at 5 years postoperatively. Women showed better pain visual analog scale for up to 5 years postoperatively. The PCS at postoperative 2 years was significantly better in alcohol-associated patients than in patients who have corticosteroid-associated ONFH; however, there were no significant differences at 5 years postoperatively. The PCS was significantly better in patients aged < 60 years and in women at 5 years postoperatively. CONCLUSIONS Longitudinal change in QOL scores of patients who have ONFH who underwent total hip arthroplasty indicated different improvement patterns according to age, sex, and associated factors.
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Affiliation(s)
- Yuko Uesugi
- Department of Nursing, Kinjo Gakuin University, Nagoya, Japan
| | - Takashi Sakai
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Wataru Ando
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Aichi Medical Center, Okazaki, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Japan
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Casale M, Toro G, Porcelli F, Quota A, Rosso R, Spadola V, Arcioni F, Campisi S, Roberti D, Perrotta S. Long-term outcomes of avascular necrosis in sickle cell disease using joint-specific patient-reported outcome measures: Results from a multicentre study. Br J Haematol 2025; 206:310-319. [PMID: 39344565 PMCID: PMC11739771 DOI: 10.1111/bjh.19802] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 09/19/2024] [Indexed: 10/01/2024]
Abstract
Avascular necrosis (AVN) is a prevalent and progressive complication in young patients with sickle cell disease (SCD), but no study evaluated the long-term subjective and objective outcome measures. Oxford hip score (OHS) and Oxford shoulder scores (OSS) are validated joint-specific patient-reported outcome measures (PROMs). In this prospective multicentre study, 47 SCD patients with pre-existing diagnosis of AVN occurred at a median age of 35.9 (24.2-47.6) filled out the OHS and OSS at median follow-up of 9.4 years (4.5-12.9). No patient died after diagnosis of AVN. Hip AVN was present in 34 (72%) patients, with bilateral involvement in 25 (74%); 26 (59%) underwent total hip arthroplasty (THA) at a median age of 34.6 (22.6-49.5); and 4 (15%) required re-surgery. OHS revealed moderate to severe impairment both in patients underwent THA and no hip surgery. Shoulder AVN was present in 13 (6%) patients and OSS revealed mild to moderate impairment. A high rate of compromised joint function and pain was observed 10 years after diagnosis of AVN regardless of the type of treatment, outlying the need to improve the management of this sickle-related complication. OHS and OSS are validated joint-specific PROMs easy to use in all SCD centres.
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Affiliation(s)
- Maddalena Casale
- Department of Woman, Child and General and Specialized SurgeryUniversity of Campania ‘Luigi Vanvitelli’NaplesItaly
| | - Giuseppe Toro
- Department of Medical and Surgical Specialties and DentistryUniversity of Campania ‘Luigi Vanvitelli’NaplesItaly
| | - Federica Porcelli
- Department of Woman, Child and General and Specialized SurgeryUniversity of Campania ‘Luigi Vanvitelli’NaplesItaly
| | | | - Rosamaria Rosso
- Talassemia UnitAOU Policlinico G.Rodolico‐San Marco di CataniaCataniaItaly
| | - Vincenzo Spadola
- Thalassemia CentreHospital “Giovanni Paolo II” RagusaRagusaItaly
| | | | - Saveria Campisi
- Thalassemia UnitHospital “Umberto Primo” SiracusaSiracusaItaly
| | - Domenico Roberti
- Department of Woman, Child and General and Specialized SurgeryUniversity of Campania ‘Luigi Vanvitelli’NaplesItaly
| | - Silverio Perrotta
- Department of Woman, Child and General and Specialized SurgeryUniversity of Campania ‘Luigi Vanvitelli’NaplesItaly
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Dubé MD, Emara AK, Deren ME, Pasqualini I, Rullan PJ, Tidd J, Piuzzi NS. Techniques of core decompression in the treatment of idiopathic avascular necrosis of the femoral head. Arch Orthop Trauma Surg 2024; 145:82. [PMID: 39708161 DOI: 10.1007/s00402-024-05732-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Accepted: 12/10/2024] [Indexed: 12/23/2024]
Abstract
Core decompression was developed as a joint-preserving procedure for patients with early-stage osteonecrosis of the femoral head. Previous studies indicated a high success rate that outperforms nonoperative management of pre-collapse hips. The traditional single-tunnel core decompression technique uses a cannulated drill bit inserted into the lateral cortex of the proximal femur. Multiple small drilling was introduced to decrease the risk of fracture through a less invasive technique. Adjunctive therapeutics such as tantalum rods, bone-grafting, orthobiologic (e,g, bone marrow aspirate concentrate, mesenchymal stem cells, platelet-rich plasma, and human umbilical cord mesenchymal stem cell extracts) as well as electric stimulation have all been studied. No consensus regarding the ideal treatment has been reached. This review analyzes the advantages and disadvantages of current core decompression techniques to provide orthopaedic surgeons with direction in managing patients with avascular necrosis of the femoral head.
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Affiliation(s)
- Michael D Dubé
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew E Deren
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Pedro J Rullan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Joshua Tidd
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, 44195, USA.
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Ave, Suite A40, Cleveland, OH, 44195, USA.
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Zamzam M, Bakarman KA, Alaujan AA, Houdane A, AlKhayyal YA, Al Zaid H, Alsiddiky A, Alzain K, Alhuzaimi F, Aldarsouni FG. Assessing Avascular Necrosis Risk and Outcomes After Open Reduction for Developmental Dysplasia of the Hip in Children. Cureus 2024; 16:e75808. [PMID: 39816296 PMCID: PMC11734834 DOI: 10.7759/cureus.75808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2024] [Indexed: 01/18/2025] Open
Abstract
Background Avascular necrosis (AVN) of the femoral head is a serious complication after surgical treatment of developmental dysplasia of the hip (DDH). The main objective of this study is to identify the incidence of AVN and to define AVN risk factors. The study also aims to identify the effects of AVN and other factors on final clinical and radiological outcomes. Methods All patients in the study were managed according to King Saud University protocol for surgical treatment of DDH. Occurrence of AVN was reported. All affected hips were evaluated clinically and radiologically after six and 12 months and at final follow-up. Significant variables from the univariate analysis were entered into multivariate regression models. Results A total of 131 patients were included in the study involving 189 hips with DDH. AVN was diagnosed postoperatively in 23 (12%) hips. In the multivariate regression analysis, the presence of AVN (p=0.002), prolonged casting (p=0.016) and the need for a second surgery (p=0.029) were strong determinants of unsatisfactory clinical outcomes. Worse radiological outcomes were significantly associated with the presence of AVN (p=0.002), previous trials of closed reduction (p=0.032) and the need for a second surgery (p=0.013). In the last multivariate regression model, a previous trial of closed reduction (p=0.001), absence of an ossified femoral head (OFH) (p=< 0.001), prolonged casting (p=0.038), and the need for second surgery (p=0) were strong risk factors for AVN. Conclusions The current study highlighted the factors responsible for AVN occurrence after open DDH reduction. The factors which are strong determinants of unsatisfactory clinical and radiological outcomes were identified. Overcoming these factors is mandatory to improve the results.
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Affiliation(s)
| | | | | | | | | | - Homoud Al Zaid
- Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | | | | | | | - Fayez G Aldarsouni
- General Surgery, Prince Sultan Military Medical City, Riyadh, SAU
- Trauma Surgery, King Saud Medical City, Riyadh, SAU
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Fang GZ, Lin J, Cao LH, Liu TS, Ma YH, Yang L. Changes in postoperative depression and anxiety and their relationship with recovery from femoral head necrosis: A longitudinal study. World J Psychiatry 2024; 14:1506-1512. [DOI: 10.5498/wjp.v14.i10.1506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 08/23/2024] [Accepted: 08/26/2024] [Indexed: 10/17/2024] Open
Abstract
BACKGROUND Femoral head necrosis (FHN) can significantly affect patients' psychological well-being and functional outcomes. However, the long-term relationship between postoperative depression, anxiety, and functional recovery in patients with FHN remains unclear.
AIM To investigate the dynamic changes in postoperative depression and anxiety and their relationship with functional recovery in patients with FHN for 3 years.
METHODS Ninety-three patients with FHN who underwent surgical treatment in March 2020 to 2023 were enrolled in this longitudinal study. Depression and anxiety status were assessed using the hospital anxiety and depression scale (HADS) at baseline, 6 months, 1, 2, and 3 years postoperatively. Functional recovery was evaluated using the Harris hip score (HHS). The dynamic changes in HADS and HHS were analyzed using repeated measures ANOVA; the relationship between depression/anxiety status and functional recovery was examined using Pearson’s correlation analysis.
RESULTS The mean HADS-depression (HADS-D) and HADS-anxiety (HADS-A) scores significantly improved over time (P < 0.001). The prevalence of depression and anxiety decreased from 36.6% and 41.9% at baseline to 10.8% and 12.9%, respectively, at 3 years postoperatively. The mean HHS increased significantly from 52.3 ± 10.5 at baseline to 88.1 ± 7.2 at 3 years postoperatively (P < 0.001). Significant negative correlations were found between HADS-D/HADS-A scores and HHS at all time points (P < 0.05).
CONCLUSION The severity of depression and anxiety negatively correlated with functional recovery, highlighting the importance of psychological interventions in the management of patients with FHN.
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Affiliation(s)
- Guo-Zheng Fang
- Department of Orthopedics, Shanghai Baoshan Luodian Hospital, Shanghai 201908, China
| | - Jie Lin
- Department of Orthopedics, Shanghai Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200082, China
| | - Lie-Hu Cao
- Department of Orthopedics, Shanghai Baoshan Luodian Hospital, Shanghai 201908, China
| | - Tong-Sheng Liu
- Department of Orthopedics, Shanghai Baoshan Luodian Hospital, Shanghai 201908, China
| | - Yu-Hong Ma
- Department of Orthopedics, Shanghai Baoshan Luodian Hospital, Shanghai 201908, China
| | - Lu Yang
- Department of Orthopedics, Shanghai Baoshan Luodian Hospital, Shanghai 201908, China
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Zhang C, Xiong B, Wang J, Li Y, Xie B, Liu D, Zhang G, Chen W, He H. Factors influencing the survival status of the hip joint in post-collapse femoral head necrosis. J Orthop Surg Res 2024; 19:472. [PMID: 39127688 DOI: 10.1186/s13018-024-04964-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Despite hip function typically deteriorating in the post-collapse stage of osteonecrosis of the femoral head (ONFH), some patients can still demonstrate long-term favorable hip function, a state termed "survival with collapse". This study aims to identify the characteristics of patients suitable for "survival with collapse" in cases of ONFH. METHODS This cross-sectional study included 65 patients (87 hips) diagnosed with post-collapse ONFH for ≥ 3 years (average 9.1 years, range 3-23 years). Hip function was assessed using the Harris Hip Score (HHS). Demographic, clinical, and radiographic data were compared between the favorable group (HHS > 80) and the poor group (HHS ≤ 80). Independent protective factors for hip function were identified by multivariate analysis and receiver operating characteristic (ROC) curve analysis was further applied to evaluate these factors' diagnostic efficacy. RESULTS The favorable and poor groups included 46 and 41 hips, respectively. Significant differences were found in body mass index (BMI), Association Research Circulation Osseous (ARCO) stage, collapse degree, Japanese Investigation Committee (JIC) classification, necrotic size, and hip subluxation between the two groups (p < 0.05). Multivariate logistic regression identified collapse < 3 mm(OR:14.49, 95%CI: 3.52-59.68, p < 0.001), JIC types B (OR: 11.08, 95% CI: 1.07-115.12, p < 0.05) and C1(OR: 5.18, 95% CI: 1.47-18.20, p < 0.05) as independent protective factors for hip function, while BMI (OR: 0.76, 95% CI: 0.59-0.97, p = 0.029) was an independent risk factor. ROC curve analysis demonstrated that both collapse degree (AUC = 0.798, sensitivity = 91.3%, specificity = 68.3%, p < 0.0001) and JIC classification (AUC = 0.787, sensitivity = 80.4%, specificity = 73.2%, p < 0.0001) had satisfactory diagnostic value for hip function. Combining JIC classification and collapse degree (AUC = 0.868, sensitivity = 76.1%, specificity = 85.4%, p < 0.0001) significantly enhanced diagnostic efficacy compared to using either alone (p < 0.05). CONCLUSION In ONFH, femoral head collapse does not necessarily determine a poor prognosis. Patients with mild collapse (< 3 mm) and preserved anterolateral wall are more likely to retain satisfactory hip function, making them candidates for "survival with collapse."
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Affiliation(s)
- Cheng Zhang
- Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No.6 Wangjing Zhonghuannan Road, Chaoyang District, Beijing, 100102, China
| | - Binglang Xiong
- Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No.6 Wangjing Zhonghuannan Road, Chaoyang District, Beijing, 100102, China
| | - Junyu Wang
- Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No.6 Wangjing Zhonghuannan Road, Chaoyang District, Beijing, 100102, China
| | - Yan Li
- Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No.6 Wangjing Zhonghuannan Road, Chaoyang District, Beijing, 100102, China
| | - Bin Xie
- Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No.6 Wangjing Zhonghuannan Road, Chaoyang District, Beijing, 100102, China
| | - Daobing Liu
- Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No.6 Wangjing Zhonghuannan Road, Chaoyang District, Beijing, 100102, China
| | - Guangyi Zhang
- Beijing University of Chinese Medicine, No.11 North Third Ring Road East, Chaoyang District, Beijing, 100029, China
| | - Weiheng Chen
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, No.51 Xiaoguan Street, outside Andingmen, Chaoyang District, Beijing, 100029, China
| | - Haijun He
- Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, No.6 Wangjing Zhonghuannan Road, Chaoyang District, Beijing, 100102, China.
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Bu P, Xie W, Wang S, Yang Z, Peng K, Zhang W, Hu S. EGFL6 activates the ERK signaling to improve angiogenesis and osteogenesis of BMSCs in patients with steroid-induced osteonecrosis of the femoral head. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:4287-4298. [PMID: 38085290 DOI: 10.1007/s00210-023-02880-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/30/2023] [Indexed: 05/23/2024]
Abstract
Recently, epidermal growth factor-like domain protein 6 (EGFL6) was proposed as a candidate gene for coupling angiogenesis to osteogenesis during bone repair; however, the exact role and underlying mechanism are largely unknown. Here, using immunohistochemical and Western blotting analyses, we found that EGFL6 was downregulated in the femoral head tissue of patients with steroid-induced osteonecrosis of the femoral head (SONFH) compared to patients with traumatic femoral neck fracture (FNF), accompanied by significantly downregulation of osteogenic and angiogenic marker genes. Then, bone marrow mesenchymal stem cells (BMSCs) were isolated from the FNF and the SONFH patients, respectively, and after identification by immunofluorescence staining surface markers, the effect of EGFL6 on their abilities of osteogenic differentiation and angiogenesis was evaluated. Our results of alizarin red staining and tubular formation experiment revealed that BMSCs from the SONFH patients (SONFH-BMSCs) displayed an obviously weaker ability of osteogenesis than FNF-BMSCs, and EGFL6 overexpression improved the abilities of osteogenic differentiation and angiogenesis of SONFH-BMSCs. Moreover, EGFL6 overexpression activated extracellular signal-regulated kinases 1/2 (ERK1/2). ERK1/2 inhibitor U0126 reversed the promoting effect of EGFL6 overexpression on the expression of osteogenesis and angiogenesis-related genes in the SONFH femoral head. In conclusion, EGFL6 plays a protective role in SONFH, it promotes osteogenesis and angiogenesis of BMSCs, and its effect is likely to be related to ERK1/2 activation.
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Affiliation(s)
- Penghui Bu
- School of Clinical Medicine, Xi'an Medical University, Xi'an, 710054, China
| | - Weipeng Xie
- School of Clinical Medicine, Xi'an Medical University, Xi'an, 710054, China
| | - Sicheng Wang
- School of Clinical Medicine, Xi'an Medical University, Xi'an, 710054, China
| | - Zhi Yang
- Department of Joint Surgery, Xi'an Hong Hui Hospital, Xi'an Jiaotong University, 555 East Youyi Road, Beilin District, Xi'an, 710054, China
| | - Kan Peng
- Department of Joint Surgery, Xi'an Hong Hui Hospital, Xi'an Jiaotong University, 555 East Youyi Road, Beilin District, Xi'an, 710054, China
| | - Weisong Zhang
- Department of Joint Surgery, Xi'an Hong Hui Hospital, Xi'an Jiaotong University, 555 East Youyi Road, Beilin District, Xi'an, 710054, China
| | - Shouye Hu
- Department of Joint Surgery, Xi'an Hong Hui Hospital, Xi'an Jiaotong University, 555 East Youyi Road, Beilin District, Xi'an, 710054, China.
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12
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Shoji T, Shozen H, Ueki S, Kaneta H, Yaunaga Y, Adachi N. Evaluation of the long-term patient-reported outcomes after hip arthroplasty or joint preserving with Sugioka femoral osteotomy in patients with femoral head osteonecrosis. INTERNATIONAL ORTHOPAEDICS 2024; 48:1201-1208. [PMID: 38376531 PMCID: PMC11001741 DOI: 10.1007/s00264-024-06118-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE This study retrospectively evaluated long-term clinical outcomes and patient-reported outcome measures (PROMs) in patients with osteonecrosis of the femoral head (ONFH) who underwent transtrochanteric rotational osteotomy (TRO), curved varus osteotomy (CVO), and total hip arthroplasty (THA). METHODS We retrospectively reviewed the 109 hips in 96 patients (46 men, 50 women) who underwent CVO, TRO, or THA for ONFH treatment. The mean follow-up period for the TRO, CVO, and THA groups was 14.8, 11.5, and 13.3 years, respectively. RESULTS The THA conversion rate of the TRO patients was significantly higher than that of the patients with CVO, and the final clinical scores in the patients with TRO did not improve compared with preoperative scores. Postoperative PROMs showed that the total and pain scores of the patients with THA were significantly higher than those of patients with TRO and CVO, while the PROM score did not change between patients with TRO and CVO. The analysis further showed that the preoperative type C2, stage 3A, or postoperative type C1 and C2 were significant predictors of decreased final PROM scores. CONCLUSION This study found that CVO and THA are clinically effective treatments for ONFH, with significant improvements compared with preoperative scores. However, THA was associated with significantly higher PROMs and pain scores than those of CVO and TRO in long-term follow-up. Furthermore, our results suggest that postoperative PROMs depend mainly on the preoperative level of collapse and postoperative transposed intact ratio of the articular surface of the femoral head.
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Affiliation(s)
- Takeshi Shoji
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
| | - Hideki Shozen
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Shinichi Ueki
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Hiroki Kaneta
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Yuji Yaunaga
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi, Saijo-Town, Higashi-Hiroshima, 739-0036, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
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13
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Nakamura J, Fukushima W, Ando W, Hagiwara S, Kawarai Y, Shiko Y, Kawasaki Y, Sakai T, Ito K, Arishima Y, Chosa E, Fujimoto Y, Fujiwara K, Hasegawa Y, Hayashi S, Imagama T, Inaba Y, Ishibashi Y, Ishidou Y, Ito H, Ito H, Ito J, Jinno T, Kabata T, Kaku N, Kaneuji A, Kishida S, Kobayashi S, Komiya S, Kubo T, Majima T, Mashima N, Mawatari M, Miki H, Miyatake K, Motomura G, Nagoya S, Nakamura H, Nakamura Y, Nakanishi R, Nakashima Y, Nakasone S, Nishii T, Nishiyama T, Ohta Y, Ohzono K, Osaki M, Sasaki K, Seki T, Shishido T, Shoji T, Sudo A, Takagi M, Takahashi D, Takao M, Tanaka S, Tanaka T, Tetsunaga T, Ueshima K, Yamamoto K, Yamamoto T, Yamamoto Y, Yamasaki T, Yasunaga Y, Sugano N. Time elapsed from definitive diagnosis to surgery for osteonecrosis of the femoral head: a nationwide observational study in Japan. BMJ Open 2024; 14:e082342. [PMID: 38553078 PMCID: PMC10982743 DOI: 10.1136/bmjopen-2023-082342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/19/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES This study documents the time elapsed from the diagnosis of osteonecrosis of the femoral head (ONFH) to surgery, exploring the factors that influence ONFH severity. DESIGN Retrospective observational study of a nationwide database. SETTING The Kaplan-Meier method with log-rank tests was applied to examine the period from definitive diagnosis of ONFH to surgery using any surgery as the end point. For bilateral cases, the date of the first surgery was the endpoint. PARTICIPANTS This study included 2074 ONFH cases registered in 34 university hospitals and highly specialised hospitals of the multicentre sentinel monitoring system of the Japanese Investigation Committee between 1997 and 2018. MAIN OUTCOME MEASURE The primary outcome was the time from diagnosis to surgery. The secondary outcome was the proportion of subjects remaining without surgery at 3, 6 and 9 months, and at 1, 2 and 5 years after diagnosis. RESULTS The median time to surgery was 9 months (IQR 4-22 months) after diagnosis of ONFH. The time to surgery was significantly shorter in the alcohol alone group and the combined corticosteroid and alcohol group than in the corticosteroid alone group (p=0.018 and p<0.001, respectively), in early stage ONFH with no or mild joint destruction (stages II and III, p<0.001), and with joint preserving surgery (p<0.001). The proportion without surgery was 75.8% at 3 months, 59.6% at 6 months, 48.2% at 9 months, 40.5% at 1 year, 22.2% at 2 years and 8.3% at 5 years. CONCLUSION ONFH has been considered to be an intractable disease that often requires surgical treatment, but the fact that surgery was performed in more than half of the patients within 9 months from diagnosis suggests severe disease with a significant clinical impact. TRIAL REGISTRATION NUMBER Chiba University ID1049.
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Affiliation(s)
- Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Wakaba Fukushima
- Department of Public Health, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Orthopaedic Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Shigeo Hagiwara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuya Kawarai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Centre, Chiba University Hospital, Chiba, Japan
- Faculty of Nursing, Japanese Red Cross College of Nursing, Tokyo, Japan
| | - Takashi Sakai
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Kazuya Ito
- Department of Public Health, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Graduate School of Nursing, Osaka Metropolitan University, Osaka, Japan
| | - Yoshiya Arishima
- Department of Orthopaedic Surgery, Kagoshima University, Kagoshima, Japan
| | - Etsuo Chosa
- Department of Orthopaedic Surgery, Miyazaki University, Miyazaki, Japan
| | - Yusuke Fujimoto
- Department of Orthopaedic Surgery, Kagoshima University, Kagoshima, Japan
| | - Kazuo Fujiwara
- Department of Orthopaedic Surgery, Okayama University, Okayama, Japan
| | | | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University, Kobe, Japan
| | - Takashi Imagama
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | | | - Yasuhiro Ishidou
- Department of Orthopaedic Surgery, Kagoshima University, Kagoshima, Japan
| | - Hideya Ito
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Ito
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Juji Ito
- Department of Orthopaedic Surgery, Yamagata University, Yamagata, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tamon Kabata
- Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan
| | - Nobuhiro Kaku
- Department of Orthopaedic Surgery, Oita University, Yufu, Japan
| | - Ayumi Kaneuji
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Japan
| | - Shunji Kishida
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seneki Kobayashi
- Department of Orthopaedic Surgery, Suwa Red Cross Hospital, Suwa, Japan
| | - Setsuro Komiya
- Department of Orthopaedic Surgery, Kagoshima University, Kagoshima, Japan
| | - Toshikazu Kubo
- Department of Orthopaedic Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tokifumi Majima
- Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | - Naohiko Mashima
- Department of Orthopaedic Surgery, Ehime University, Toon, Japan
| | | | - Hidenobu Miki
- Department of Orthopaedic Surgery, Osaka National Hospital, Osaka, Japan
| | - Kazumasa Miyatake
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Satoshi Nagoya
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University, Osaka, Japan
| | | | - Ryosuke Nakanishi
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | | | - Satoshi Nakasone
- Department of Orthopaedic Surgery, Ryukyu University, Nakagami-gun, Japan
| | - Takashi Nishii
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - Yoichi Ohta
- Department of Orthopaedic Surgery, Osaka Metropolitan University, Osaka, Japan
| | - Kenji Ohzono
- Department of Orthopaedic Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Makoto Osaki
- Department of Orthopaedic Surgery, Nagasaki University, Nagasaki, Japan
| | - Kan Sasaki
- Department of Orthopaedic Surgery, Yamagata University, Yamagata, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University, Nagoya, Japan
- Depatrment of Orthopedic Surgery, Aichi Medical University Medical Centre, Okazaki, Japan
| | - Takaaki Shishido
- Department of Orthopaedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takeshi Shoji
- Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University, Tsu, Japan
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University, Yamagata, Japan
| | - Daisuke Takahashi
- Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | - Masaki Takao
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Orthopaedic Surgery, Ehime University, Toon, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Takeyuki Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | | | - Keiichiro Ueshima
- Department of Orthopaedic Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kengo Yamamoto
- Department of Orthopaedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
- Department of Orthopaedic Surgery, Fukuoka University, Fukuoka, Japan
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University, Hirosaki, Japan
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Yuji Yasunaga
- Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
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14
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Wang T, Wu D, Li C, Cheng X, Yang Z, Zhang Y, Zhu Y. Comparison of outcomes after total hip arthroplasty between patients with osteonecrosis of the femoral head in Association Research Circulation Osseous stage III and stage IV: a five-year follow-up study. J Orthop Surg Res 2024; 19:170. [PMID: 38449033 PMCID: PMC10918874 DOI: 10.1186/s13018-024-04617-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/06/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND No large cohort study has evaluated the surgical outcomes of THA between different stages of ONFH patients. This study aimed to compare the surgical outcomes of ONFH patients who underwent THA in ARCO stage III versus IV, in terms of operative parameters, one-year hip function assessments and postoperative at least five-year complications, to inform optimized management of ONFH. METHOD From our prospectively collected database, 876 patients undergoing THA between October 2014 and April 2017 were analyzed and divided into ARCO stage III group (n = 383) and ARCO stage IV group(n = 493). Details of demographics, medical record information, adverse events and clinical scores of both groups were collected and compared. Proper univariate analysis was used for the analysis. RESULT There were no statistically significant differences in baseline characteristics between the two groups. Compared to ARCO stage IV patients, ARCO stage III patients showed a shorter operative time (p < 0.01), less bleeding (p < 0.01), fewer one-year readmissions (p = 0.026) and complications (p = 0.040), and significantly higher HHS (p < 0.01) one year after THA. In addition, ARCO stage IV patients seem more likely to suffer prosthesis dislocation (p = 0.031). CONCLUSION Although ARCO stage IV patients in the study cohorts appeared to suffer more one-year complications, no significant difference was observed at long-term follow-up. Enhanced clinical guidance on preventing early prosthesis dislocation may help improve the prognosis of final-stage ONFH patients.
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Affiliation(s)
- Tianyu Wang
- Department of Orthopaedic Surgery, The 3r, Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Dongwei Wu
- Department of Orthopaedic Surgery, The 3r, Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Chengsi Li
- Department of Orthopaedic Surgery, The 3r, Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Xinqun Cheng
- Department of Orthopaedic Surgery, The 3r, Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Zhenbang Yang
- Department of Orthopaedic Surgery, The 3r, Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The 3r, Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, The 3r, Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
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15
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Peng P, Wang X, Qiu C, Zheng W, Zhang H. Extracellular vesicles from human umbilical cord mesenchymal stem cells prevent steroid-induced avascular necrosis of the femoral head via the PI3K/AKT pathway. Food Chem Toxicol 2023; 180:114004. [PMID: 37634611 DOI: 10.1016/j.fct.2023.114004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 08/29/2023]
Abstract
Extracellular vesicles (EVs) secreted by human umbilical cord mesenchymal stem cells (hucMSC) have excellent therapeutic potential for many diseases. The aim of this study was to define the role of hucMSC-EVs in the prevention and treatment of steroid-induced avascular necrosis of the femoral head (SANFH). After establishing the SANFH rat model, the effects of hucMSC-EVs were assessed by measuring the microstructure of the femoral head using HE staining, micro-computed tomography (micro-CT), and TUNEL staining. The administration of hucMSC-EVs caused a significant reduction to glucocorticoids (GCs)-induced osteoblast apoptosis and empty lacuna of the femoral head, while effectively improving the microstructure. HucMSC-EVs rescued the deactivation of the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway induced by GCs, and reversed the proliferation and migration of osteoblasts inhibited by GCs. In addition, hucMSC-EVs attenuated the inhibitory effects of GCs on rat osteoblast osteogenesis, angiogenesis of endothelial cells, and prevented osteoblast apoptosis. However, the promoting effects of hucMSC-EVs were abolished following the blockade of PI3K/AKT on osteoblasts. hucMSC-EVs were found to prevent glucocorticoid-induced femoral head necrosis in rats through the PI3K/AKT pathway.
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Affiliation(s)
- Puji Peng
- Department of Orthopedics, Henan Provincial People's Hospital, Zhengzhou, 450003, China; Department of Orthopedics, Zhengzhou University People's Hospital, Zhengzhou, 450003, China
| | - XueZhong Wang
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Chen Qiu
- Department of Orthopedics, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, 430000, China
| | - Wendi Zheng
- Department of Orthopedics, Henan Provincial People's Hospital, Zhengzhou, 450003, China; Department of Orthopedics, Zhengzhou University People's Hospital, Zhengzhou, 450003, China.
| | - Hongjun Zhang
- Department of Orthopedics, Henan Provincial People's Hospital, Zhengzhou, 450003, China; Department of Orthopedics, Zhengzhou University People's Hospital, Zhengzhou, 450003, China.
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16
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Iwasa M, Ando W, Uemura K, Hamada H, Takao M, Sugano N. Association between magnitude of femoral head collapse and quality of life in patients with osteonecrosis of the femoral head. Mod Rheumatol 2023; 33:416-421. [PMID: 35260881 DOI: 10.1093/mr/roac023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/12/2022] [Accepted: 03/04/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The magnitude of femoral head collapse (MFHC) is one of the criteria for staging osteonecrosis of the femoral head (ONFH). The present study aimed to clarify the relationship between MFHC and hip pain or functional quality of life (QOL) scores in patients with ONFH. METHODS Seventy patients with ONFH who had femoral head collapse without osteoarthritic changes were divided into four groups based on MFHC by 1 mm. Pain was assessed using the visual analogue scale (VAS). QOL was evaluated using patient-reported outcome measures such as the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ), Oxford Hip Score (OHS), and Short Form-12 Health Survey, version 2 (SF-12v2). We also explored the relationship between MFHC and QOL. RESULTS Pain score and satisfaction score in the VAS, JHEQ pain subscale, JHEQ movement subscale, and JHEQ total score were significantly associated with MFHC, and no significant differences were found between groups in any subscale or total score for OHS and SF-12v2. CONCLUSION In patients with ONFH, differences in MFHC by 1 mm were associated with deterioration of some pain VAS and QOL outcomes.
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Affiliation(s)
- Makoto Iwasa
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keisuke Uemura
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaki Takao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
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17
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Kong N, Yang H, Tian R, Liu G, Li Y, Guan H, Wei Q, Du X, Lei Y, Li Z, Cao R, Zhao Y, Wang X, Wang K, Yang P. An injectable self-adaptive polymer as a drug carrier for the treatment of nontraumatic early-stage osteonecrosis of the femoral head. Bone Res 2022; 10:28. [PMID: 35279673 PMCID: PMC8918325 DOI: 10.1038/s41413-022-00196-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/16/2021] [Accepted: 12/22/2021] [Indexed: 11/09/2022] Open
Abstract
Core decompression (CD) with the elimination of osteonecrotic bone is the most common strategy for treating early-stage nontraumatic osteonecrosis of the femoral head (ONFH). Adjuvant treatments are widely used in combination with CD as suitable methods of therapy. Existing augmentations have to be fabricated in advance. Here, we report a novel injectable glycerin-modified polycaprolactone (GPCL) that can adapt to the shape of the CD cavity. GPCL shows great flowability at 52.6 °C. After solidification, its compressive modulus was 120 kPa at body temperature (37 °C). This excellent characteristic enables the polymer to provide mechanical support in vivo. In addition, GPCL acts as a carrier of the therapeutic agent zoledronic acid (ZA), demonstrating sustained release into the CD region. ZA-loaded GPCL was injected into ONFH lesions to treat early-stage nontraumatic cases. Compared to that in the CD group, CD+ZA-loaded GPCL injection preserved bone density and increased the collagen level in the femoral head. At the interface between the GPCL and CD tunnel wall, osteogenesis was significantly promoted. In addition, morphological evaluations revealed that the femoral heads in the CD+ZA-GPCL group exhibited improved pressure resistance. These results suggest a strategy effective to preserve the bone density of the femoral head, thus decreasing the possibility of femoral head collapse. This novel injectable polymer has, therefore, considerable potential in clinical applications.
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Affiliation(s)
- Ning Kong
- Department of Bone and Joint Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, 710004, China
| | - Hang Yang
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
| | - Run Tian
- Department of Bone and Joint Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, 710004, China
| | - Guanzhi Liu
- Department of Bone and Joint Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, 710004, China
| | - Yiyang Li
- Department of Bone and Joint Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, 710004, China
| | - Huanshuai Guan
- Department of Bone and Joint Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, 710004, China
| | - Qilu Wei
- Department of Bone and Joint Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, 710004, China
| | - Xueshan Du
- Department of Dermatology, Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, 710004, China
| | - Yutian Lei
- Department of Bone and Joint Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, 710004, China
| | - Zhe Li
- Department of Bone and Joint Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, 710004, China
| | - Ruomu Cao
- Department of Bone and Joint Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, 710004, China
| | - Yiwei Zhao
- Department of Bone and Joint Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, 710004, China
| | - Xiaohui Wang
- Department of Spine Surgery, Honghui Hospital of Xi'an Jiaotong University, No. 555 Youyi East Road, Xi'an, 710000, China
| | - Kunzheng Wang
- Department of Bone and Joint Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, 710004, China.
| | - Pei Yang
- Department of Bone and Joint Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, 710004, China.
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Tani T, Ando W, Fukushima W, Hamada H, Takao M, Ito K, Sakai T, Sugano N. Geographic distribution of the incidence of osteonecrosis of the femoral head in Japan and its relation to smoking prevalence. Mod Rheumatol 2022; 32:186-192. [PMID: 33719872 DOI: 10.1080/14397595.2021.1899452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Alcohol intake and smoking are modifiable lifestyle-related risk factors for osteonecrosis of the femoral head (ONFH). We investigated geographic differences in ONFH incidence in Japan and the correlation with alcohol intake and smoking to develop prevention strategies for ONFH in Japan. METHODS This ecological study was conducted in Japan primarily using the following data sources: nationwide epidemiological survey and national survey. We estimated the annual ONFH incidence and the prevalence of alcohol drinking and smoking in each prefecture. Prefectural incidence and prevalence were calculated by sex and age-standardization. RESULTS The mean annual ONFH incidence per 100,000 population was 3.08 in men and 1.63 in women, respectively. There was no significant correlation between ONFH incidence and the prevalence of any levels of alcohol intake, while smoking ≥20 cigarettes/day showed a significant and moderate correlation in men (r = 0.47, p = .01). This correlation remained significant after adjustment for the prevalence of any levels of alcohol intake (standardized partial regression coefficient = 0.47-0.49, p = .009-.01). CONCLUSION ONFH incidence is geographically variable in Japan, and this may be partly explained by the distribution of smoking prevalence. Smoking cessation may contribute to an effective decline in the overall ONFH incidence in Japan.
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Affiliation(s)
- Tetsuro Tani
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Wakaba Fukushima
- Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaki Takao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Ito
- Department of Healthcare Management, College of Healthcare Management, Fukuoka, Japan
| | - Takashi Sakai
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
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Ando W, Takao M, Tani T, Uemura K, Hamada H, Sugano N. Geographical distribution of the associated factors of osteonecrosis of the femoral head, using the designated intractable disease database in Japan. Mod Rheumatol 2021; 32:1006-1012. [PMID: 34918124 DOI: 10.1093/mr/roab065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/11/2021] [Accepted: 08/12/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Osteonecrosis of the femoral head (ONFH) is a designated intractable disease (DID) in Japan. The Ministry of Health, Labour, and Welfare launched an online registry system for DIDs. We aimed to investigate the epidemiological characteristics of patients with ONFH using the DID database. METHODS Data of patients with ONFH registered in the DID database between January 2004 and December 2013 were extracted. The incidence of new cases and distributions of sex, age, and associated risk factors were investigated. The prevalence of the two categories, 'steroid-associated' and 'alcohol-associated' risk factors, was estimated for each prefecture. RESULTS New 15,049 cases of ONFH were investigated. The mean registration rate-corrected annual ONFH incidence per 100,000 individuals was 1.77. The male-to-female ratio was 1.33. Age distribution peaked in the 40s and 50s for male and 60s for female. The prevalence of steroid-associated ONFH was lower in males (28.6%) than in females (49.8%), while that of alcohol-associated ONFH was higher in males (47.2%) than in females (9.3%). No clear region was identified for the steroids. The incidence of alcohol-associated ONFH was significantly higher in Tokyo and Okinawa, regardless of sex. CONCLUSIONS Alcohol-associated ONFH incidence varies geographically across Japan, suggesting that it has regional characteristics.
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Affiliation(s)
- Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaki Takao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tetsuro Tani
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keisuke Uemura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
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Sato R, Ando W, Fukushima W, Sakai T, Hamada H, Takao M, Ito K, Sugano N. Epidemiological study of osteonecrosis of the femoral head using the national registry of designated intractable diseases in Japan. Mod Rheumatol 2021; 32:808-814. [PMID: 34910162 DOI: 10.1093/mr/roab047] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/18/2021] [Accepted: 07/19/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVES We aimed to investigate the epidemiological characteristics of osteonecrosis of the femoral head (ONFH) using the designated intractable diseases (DID) database in Japan. METHODS Data on patients who had received public subsidies for medical costs due to ONFH from 2012 to 2013 were extracted from the DID database. The incidence and prevalence of ONFH, distribution of gender, age, and the prevalence of associated risk factors were assessed. These epidemiological characteristics were compared with those of another nationwide ONFH survey conducted during a similar period. RESULTS Data on 3264 newly diagnosed patients (incident cases) and 20,042 patients registered until 2013 (prevalent cases) were evaluated. The corrected annual incidence and prevalence of ONFH per 100,000 were 3.0 and 18.2-19.2, respectively. The ratio of males to females was 1.4 in 2012 and 1.2 in 2013, respectively. Peak distribution was observed at ages 40s and 60s in males and females, respectively. The prevalence of the risk factors were steroid-associated: 39%, alcohol-associated: 30%, both: 4%, and none: 27%. CONCLUSIONS The DID database data showed a similar distribution of gender and age to that in other nationwide surveys but lower incidence and prevalence of ONFH. Sampling bias may affect the epidemiological characteristics of ONFH.
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Affiliation(s)
- Ryuichi Sato
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Wakaba Fukushima
- Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takashi Sakai
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaki Takao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Ito
- Department of Healthcare Management, College of Healthcare Management, Fukuoka, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
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Yin BH, Chen HC, Zhang W, Li TZ, Gao QM, Liu JW. Effects of hypoxia environment on osteonecrosis of the femoral head in Sprague-Dawley rats. J Bone Miner Metab 2020; 38:780-793. [PMID: 32533328 DOI: 10.1007/s00774-020-01114-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 05/11/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Osteonecrosis of the femoral head (ONFH) is a disease in which the blood supply of the femoral head is interrupted or damaged, resulting in joint dysfunction. Hypoxic environments increase the expression of EPO, VEGF, and HIF causes vascular proliferation and increases the blood supply. It also causes the organism to be in a state of hypercoagulability and increases thrombosis. Therefore, the purpose of this study was to explore the occurrence of ONFH after the use of glucocorticoids (GCs) under conditions of hypoxia tolerance for a long time. MATERIALS AND METHODS Sprague-Dawley rats were fed in a hypobaric hypoxic chamber at an altitude of 4000 m, the whole blood viscosity, and plasma viscosity were determined to analyze the blood flow and hemagglutination. Western blotting, polymerase chain reaction, and immunohistochemistry were used to detect EPO, VEGF, CD31, and osteogenesis related proteins. Femoral head angiography was used to examine the local blood supply and micro-CT scanning was used to detect the structure of the bone trabecula. RESULTS Under hypoxic environments, the expression of EPO and VEGF increased, which increased the local blood supply of the femoral head, but due to more severe thrombosis, the local blood supply of the femoral head decreased. CONCLUSIONS Hypoxic environments can aggravate ONFH in SD rats; this aggravation may be related to the hypercoagulable state of the blood. We suggest that long-term hypoxia should be regarded as one of the risk factors of ONFH and we need to conduct a more extensive epidemiological investigation on the occurrence of ONFH in hypoxic populations.
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Affiliation(s)
- Bo-Hao Yin
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Hong-Chi Chen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Wei Zhang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China.
| | - Tan-Zhu Li
- Department of Orthopedic Surgery, Xigaze People's Hospital, 5 Shanghai Road, Xigazê, Tibet Autonomous Region, People's Republic of China
| | - Qiu-Ming Gao
- Department of Orthopedic Surgery, The 940th Hospital of Joint Logistics Support Force of PLA, Lanzhou, Gansu, People's Republic of China
| | - Jing-Wen Liu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China
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Kaneko S, Takegami Y, Seki T, Fukushima W, Sakai T, Ando W, Ishiguro N, Sugano N. Surgery trends for osteonecrosis of the femoral head: a fifteen-year multi-centre study in Japan. INTERNATIONAL ORTHOPAEDICS 2020; 44:761-769. [PMID: 31974641 DOI: 10.1007/s00264-020-04480-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/15/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE The most appropriate procedure and at what type and stage of osteonecrosis of the femoral head (ONFH) these procedures had been argued. We attempted to clarify the trend in surgical operations with respect to the age of patients, type classification, and stage of ONFH over a period of 15 years by using the multi-center sentinel monitoring system in Japan. METHODS We evaluated the hips of 3844 patients using this system in three phases of every five years from 2003 to 2017. We classified the surgical procedures as osteotomy (OT), hemiarthroplasty (Hemi), and total hip arthroplasty (THA). We assessed the trend in age, type classification, and stage of ONFH over three time periods; "early," and the "late." We calculated the proportion of surgeries for ONFH in each period. We used the Cochran-Armitage test to evaluate trends in proportion of two levels of characteristics across three time periods. RESULTS The proportion of younger patients significantly decreased. The proportion of OT and Hemi decreased over time, while the proportion of THA increased. The proportion of patients with types C1 and C2 who underwent OT and Hemi decreased over time. In contrast, that of THA increased. The proportion of patients who underwent OT and Hemi significantly decreased; the proportion of patients who underwent THA significantly increased over time at all stages. CONCLUSIONS In Japan, the younger patients underwent surgery for ONFH decreased. The patients who underwent OT and Hemi for ONFH decreased, while that of THA increased over time.
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Affiliation(s)
- Shinya Kaneko
- Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Yasuhiko Takegami
- Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Taisuke Seki
- Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Wakaba Fukushima
- Graduate School of Medicine, Osaka City University, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Takashi Sakai
- Graduate School of Medicine, Yamaguchi University, 1-1-1, Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Wataru Ando
- School of Medicine, Osaka University Graduate, 2-2, Yamadaoka, Suita, Osaka, 565-0870, Japan
| | - Naoki Ishiguro
- Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Nobuhiko Sugano
- School of Medicine, Osaka University Graduate, 2-2, Yamadaoka, Suita, Osaka, 565-0870, Japan
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Kosukegawa I, Okazaki S, Yamamoto M, Nagoya S, Suzuki C, Shimizu J, Takahashi H, Yamashita T. The proton pump inhibitor, lansoprazole, prevents the development of non-traumatic osteonecrosis of the femoral head: an experimental and prospective clinical trial. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:713-721. [PMID: 31938894 PMCID: PMC7181448 DOI: 10.1007/s00590-020-02622-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 01/08/2020] [Indexed: 12/02/2022]
Abstract
Background An effective prevention strategy for osteonecrosis of the femoral head (ONFH) has yet to be established. We previously reported that the innate immune system via the toll-like receptor (TLR) response induced by corticosteroids leads to the development of ONFH and that repression of IRF7 activity by an inhibitor could interfere with the development of ONFH while maintaining the therapeutic effect of the corticosteroids. Objective In the present study, we hypothesize that lansoprazole has the potential to suppress IRF7 activity and prevent corticosteroid-induced ONFH in rats. Furthermore, we conducted a preliminary clinical trial to prevent corticosteroid-induced ONFH in autoimmune disease patients. Methods Male Wistar rats were randomly divided into four groups. On Day 1, each rat was injected with TLR4 ligand (LPS) or TLR7 ligand (imiquimod), followed by methylprednisolone with or without lansoprazole on Day 2. They were killed at 1 or 14 days after the last injection.We prospectively recruited 30 patients requiring primary high-dose corticosteroid treatment for immune diseases. All patients were administered lansoprazole, starting the night before corticosteroid treatment began. MRI was performed before corticosteroid treatment, and at 4, 12 and 24 weeks afterward. Results In rats, co-treatment of lansoprazole with corticosteroids significantly repressed both IRF7 activity and the development of ONFH. Moreover, in the human patients, the incidence of ONFH was significantly decreased from 53.4 to 13.3%. Conclusions Although the present study is preliminary, the results show that co-treatment of lansoprazole with corticosteroids prevents ONFH development. Lansoprazole may be both safe and effective in preventing osteonecrosis of the femoral head in patients needing corticosteroid treatment.
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Affiliation(s)
- Ima Kosukegawa
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo, 060-8543, Japan.
| | - Shunichiro Okazaki
- Department of Orthopedic Surgery, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
| | - Motohisa Yamamoto
- Department of Rheumatology and Allergy, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Satoshi Nagoya
- Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Chisako Suzuki
- Department of Rheumatology and Clinical Immunology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Junya Shimizu
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Hiroki Takahashi
- Department of Rheumatology and Clinical Immunology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo, 060-8543, Japan
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Gadinsky NE, Klinger CE, Sculco PK, Helfet DL, Lorich DG, Lazaro LE. Femoral Head Vascularity: Implications Following Trauma and Surgery About the Hip. Orthopedics 2019; 42:250-257. [PMID: 31355905 DOI: 10.3928/01477447-20190723-03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/28/2019] [Indexed: 02/03/2023]
Abstract
Traumatic injury and surgical intervention about the hip joint place the arterial supply to the femoral head (FH) at risk. Compromised perfusion may lead to FH ischemia, cell death, and osteonecrosis. Progression to FH collapse may lead to pain, functional impairment, and decreased quality of life, especially in younger patients. This review describes the arterial supply to the FH, analyzes the impact of femoral neck fractures on FH vascularity, and explores the vascular implications of various surgical interventions about the hip, offering specific techniques to minimize iatrogenic damage to the vessels supplying the FH. [Orthopedics. 2019; 42(5):250-257.].
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Hernigou P, Rigoulot G, Auregan JC, Housset V, Bastard C, Dubory A, Lachaniette CHF. Unusual indication of Cell therapy for hip osteonecrosis after pregnancy. SICOT J 2018; 4:46. [PMID: 30394283 PMCID: PMC6216759 DOI: 10.1051/sicotj/2018044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 09/05/2018] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Osteonecrosis is a rare event during or after pregnancy. Due to the low number of cases, there is no report of long-term results after conservative surgery in this population. METHOD From 1992 to 2010, 145 consecutive female patients with unilateral symptomatic (94 stage I and 51 stage II) left hip osteonecrosis (ON) related to pregnancy were treated between 4 and 16 months after delivery with percutaneous mesenchymal stem cell (MSC) injection obtained from bone marrow concentration. The average total number of MSCs (counted as number of colonies forming units-fibroblast) injected in the hip was 185 000 ± 65 000 cells (range 95 000-240 000 cells). RESULTS At the most recent follow-up (average 15 years after hip surgery, range 8-25 years), among the 145 hips included in the study, 4 hips (2.7%) had collapsed and were treated with total hip arthroplasty (THA). Thirty-two of the 94 stage I had progressed to stage II; and 4 of the 51 stage II had progressed to stage III and collapse. The other 141 hips (97.3%) were without collapse and pain free. On MRI, as percentage of the volume of the femoral head, the osteonecrosis had decreased from 34.5% pre-operatively to 6% at the most recent follow-up. For women who had other children after treatment, a subsequent pregnancy was not associated with osteonecrosis. CONCLUSION Patients with hip osteonecrosis following pregnancy had a low conversion rate to THA when treated early with cell therapy.
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Affiliation(s)
- Philippe Hernigou
- Hôpital Henri Mondor, 51 avenue du Maréchal de Tassigny, 94000 Creteil, France
| | - Guillaume Rigoulot
- Hôpital Henri Mondor, 51 avenue du Maréchal de Tassigny, 94000 Creteil, France
| | - Jean Charles Auregan
- Auregan Jean Charles, Hopital Antoine Beclere, 157 Rue de la Porte de Trivaux, 92140 Clamart, France
| | - Victor Housset
- Hôpital Henri Mondor, 51 avenue du Maréchal de Tassigny, 94000 Creteil, France
| | - Claire Bastard
- Hôpital Henri Mondor, 51 avenue du Maréchal de Tassigny, 94000 Creteil, France
| | - Arnaud Dubory
- Hôpital Henri Mondor, 51 avenue du Maréchal de Tassigny, 94000 Creteil, France
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Hip osteonecrosis: stem cells for life or behead and arthroplasty? INTERNATIONAL ORTHOPAEDICS 2018; 42:1425-1428. [PMID: 29934715 DOI: 10.1007/s00264-018-4026-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 06/04/2018] [Indexed: 12/15/2022]
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Kobayashi S, Kubo T, Iwamoto Y, Fukushima W, Sugano N. Nationwide multicenter follow-up cohort study of hip arthroplasties performed for osteonecrosis of the femoral head. INTERNATIONAL ORTHOPAEDICS 2018; 42:1661-1668. [PMID: 29754187 DOI: 10.1007/s00264-018-3980-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 05/04/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify modifiable factors related to post-operative dislocation and reoperation in patients with osteonecrosis of the femoral head (ONFH) in a large cohort. METHODS We studied 4995 hip arthroplasties: total hip arthroplasty (THA) was performed in 79% of patients; bipolar hemiarthroplasty (BP), 17%; total resurfacing arthroplasty (tRS), 3%; and hemi-resurfacing arthroplasty (hRS), 1%. A new type of BP (accounting for 49% of BPs) comprised a femoral component with a polished or smooth, small-diameter (approximately 10 mm) neck with a round or oval axial cut surface and no sharp corners. RESULTS The infection rate was relatively low (0.56%) even though 58% of cases of ONFH were associated with systemic steroid use, a known risk factor for infection. Post-operative dislocation occurred in 4.3% of cases, with re-operation needed in 3.9%. The dislocation rate was related to surgery type: 5.2% in THA, 0.9% in BP, and 0% in tRS and hRS. Among total arthroplasties with six month or longer follow-up (3670 THAs and 159 tRSs), the risk factors for post-operative dislocation were younger (≤ 40 years) or older (≥ 62 years) age, higher body weight, posterolateral approach, and smaller prosthetic head diameter. Regarding the need for re-operation, higher body weight and surgery type were identified as risk factors. CONCLUSIONS The relatively high dislocation rate of 5.2% in THA is a cause for concern. The identified risk factors for dislocation should be considered when selecting THA for treatment. Prosthesis survivorship in hRSs was inferior to that in BPs or THAs. Body weight also affected the survivorship of hip arthroplasties.
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Affiliation(s)
- Seneki Kobayashi
- The Japanese Investigation Committee on Osteonecrosis of the Femoral Head under the Ministry of Health, Labour and Welfare of Japan, Chiyoda, Tokyo, Japan.,Department of Orthopaedic Surgery, Suwa Red Cross Hospital, Suwa-city, Nagano-prefecture, Japan
| | - Toshikazu Kubo
- The Japanese Investigation Committee on Osteonecrosis of the Femoral Head under the Ministry of Health, Labour and Welfare of Japan, Chiyoda, Tokyo, Japan.,Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto-city, Kyoto-prefecture, Japan
| | - Yukihide Iwamoto
- The Japanese Investigation Committee on Osteonecrosis of the Femoral Head under the Ministry of Health, Labour and Welfare of Japan, Chiyoda, Tokyo, Japan.,Department of Orthopaedic Surgery, Graduate School of Medical Science, Kyushu University, Fukuoka-city, Fukuoka-prefecture, Japan
| | - Wakaba Fukushima
- The Japanese Investigation Committee on Osteonecrosis of the Femoral Head under the Ministry of Health, Labour and Welfare of Japan, Chiyoda, Tokyo, Japan.,Department of Public Health, Osaka City University Graduate School of Medicine, Osaka-city, Osaka-prefecture, Japan
| | - Nobuhiko Sugano
- The Japanese Investigation Committee on Osteonecrosis of the Femoral Head under the Ministry of Health, Labour and Welfare of Japan, Chiyoda, Tokyo, Japan. .,Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-city, Osaka-prefecture, 565-0871, Japan.
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Hernigou P, Dubory A, Homma Y, Guissou I, Flouzat Lachaniette CH, Chevallier N, Rouard H. Cell therapy versus simultaneous contralateral decompression in symptomatic corticosteroid osteonecrosis: a thirty year follow-up prospective randomized study of one hundred and twenty five adult patients. INTERNATIONAL ORTHOPAEDICS 2018; 42:1639-1649. [PMID: 29744647 DOI: 10.1007/s00264-018-3941-8] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/05/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Symptomatic osteonecrosis related to corticosteroids has a high risk of progression to collapse in absence of treatment. The purposes of this study were to evaluate the results of autologous bone marrow grafting of the symptomatic hip in adult patients with osteonecrosis and to compare the results with core decompression alone in the contralateral symptomatic hip. MATERIALS AND METHODS A total of 125 consecutive patients (78 males and 47 females) with bilateral osteonecrosis (ON) and who had both hips symptomatic and at the same stage on each side (stage I or II) were included in this study from 1988 to 1998. The volume of osteonecrosis was measured with MRI in both hips; the smaller size ON was treated with core decompression, and the contralateral hip with the larger ON was treated with percutaneous mesenchymal cell (MSC) injection obtained from bone marrow concentration. The average total number of MSCs (counted as number of colony forming units-fibroblast) injected in each hip was 90,000 ± 25,000 cells (range 45,000 to 180,000 cells). RESULTS At the most recent FU (average 25 years after the first surgery, range 20 to 30 years), among the 250 hips included in the study, 35 hips (28%) had collapsed at the most recent follow-up after bone marrow grafting, and 90 (72%) after core decompression (CD). Ninety-five hips (76%) in the CD group underwent total hip replacement and 30 hips (24%) in the bone marrow graft group (p < 0.0001). Hips undergoing only CD were approximately three times more likely to undergo a primary THA (odds ratio: 10.0278; 95% CI: 5.6117 to 17.9190; p < 0.0001) as compared with hips undergoing an initial bone marrow grafting. For the 90 hips treated with bone marrow injection and without collapse, the mean volume of repair evaluated by MRI at the most recent follow-up was 16.4 cm3 (range 12 to 21 cm3) corresponding to a decrease of the pre-operative average volume from 22.4 cm3 (range 35-15 cm3) to 6 cm3 (range 12-0 cm3); as percentage of the volume of the femoral head, the decrease moved from 44.8 to 12%. CONCLUSION Core decompression with bone marrow injection improved the outcome of the disease as compared with core decompression alone in the same patient.
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Hernigou P, Thiebaut B, Housset V, Bastard C, Homma Y, Chaib Y, Flouzat Lachaniette CH. Stem cell therapy in bilateral osteonecrosis: computer-assisted surgery versus conventional fluoroscopic technique on the contralateral side. INTERNATIONAL ORTHOPAEDICS 2018; 42:1593-1598. [PMID: 29696307 DOI: 10.1007/s00264-018-3953-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 04/16/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Surgical management of osteonecrosis with core decompression with stem cell therapy is a new procedure. The technique is performed with fluoroscopic guidance. This study attempts to determine if computer-navigated technique can improve the procedure. METHODS Thirty consecutive patients with bilateral symptomatic osteonecrosis without collapse were included in this study during the year 2011. A prospective, randomized, and controlled study was conducted on 60 hips (bilateral osteonecrosis) using conventional fluoroscopy technique on one side and computer-based navigation on the contralateral side. Bone marrow aspirated from the two iliac crests was mixed before concentration. Each side received the same volume of concentrated bone marrow and the same number of cells 110,000 ± 27,000 cells (counted as CFU-F). RESULTS Computer navigation achieved better parallelism to the ideal position of the trocar, with better trocar placement as regards to tip-to-subchondral distance and ideal centre position within the osteonecrosis for injection of stem cells. Using computer navigation took fewer attempts to position the trocar, used less fluoroscopy time, and decreased the radiation exposure as compared with surgery performed with conventional fluoroscopy. At the most recent follow-up (6 years), increasing the precision with computer navigation resulted in less collapse (7 versus 1) and better volume of repair (13.4 versus 8.2 cm3) for hips treated with the computer-assisted technique. CONCLUSIONS The findings of this study suggest that computer navigation may be safely used in a basic procedure for injection of stem cells.
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