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Wu YM, Xiong YL, Liu WJ, Tang H, Xiao YF, Gao SG. Computer-Assisted and Hip Arthroscopy for Avascular Necrosis of the Femoral Head With Femoroacetabular Impingement. Arthrosc Tech 2023; 12:e557-e562. [PMID: 37138690 PMCID: PMC10150157 DOI: 10.1016/j.eats.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/09/2022] [Indexed: 05/05/2023] Open
Abstract
Avascular necrosis of the femoral head with femoroacetabular impingement is a disabling disease. Without early treatment and intervention, its further development will even lead to hip osteoarthritis and hip dysfunction. This technical note aims to introduce a computer-assisted precise core decompression of the femoral head, followed by injection of platelet-rich plasma and bone marrow aspirate concentrate. Then, the autologous ipsilateral iliac bone is transplanted to the core decompression area. Thereafter, under hip arthroscopy, the injured glenoid lip of the hip joint is repaired, and the cam deformity of the femoral head/neck junction is polished and formed. The advantages of this technique include accurately locating the core decompression area, combined with autologous cells and bone transplantation, being able to delay the process of avascular necrosis of the femoral head, and evaluating articular cartilage injury, subchondral collapse, and guidance during reaming and curettage.
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Affiliation(s)
- Yu-Mei Wu
- Department of Orthopaedics, Xiangyaa Hospital, Central South University, Changsha, Hunan, China
| | - Yi-Lin Xiong
- Department of Orthopaedics, Xiangyaa Hospital, Central South University, Changsha, Hunan, China
| | - Wei-Jie Liu
- Department of Orthopaedics, Xiangyaa Hospital, Central South University, Changsha, Hunan, China
| | - Hang Tang
- Department of Orthopaedics, Xiangyaa Hospital, Central South University, Changsha, Hunan, China
| | - Yi-Fan Xiao
- Department of Orthopaedics, Xiangyaa Hospital, Central South University, Changsha, Hunan, China
| | - Shu-Guang Gao
- Department of Orthopaedics, Xiangyaa Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Address correspondence to Shu-Guang Gao, Department of Orthopaedics, Xiangya Hospital, Central South University, no. 87 Xiangya Rd., Changsha, Hunan, China 410008.
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Wei C, Yang M, Chu K, Huo J, Chen X, Liu B, Li H. The indications for core decompression surgery in patients with ARCO stage I-II osteonecrosis of the femoral head: a new, comprehensive prediction system. BMC Musculoskelet Disord 2023; 24:242. [PMID: 36997998 PMCID: PMC10061868 DOI: 10.1186/s12891-023-06321-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/14/2023] [Indexed: 04/01/2023] Open
Abstract
Background Core decompression (CD) is considered the most popular treatment method for patients with Association Research Circulation Osseous (ARCO) stage I-II osteonecrosis of the femoral head (ONFH). However, the definitive indication for CD is currently not well established. Methods This was a retrospective cohort study. Patients who were diagnosed with ARCO stage I-II ONFH and who underwent CD were included. According to the prognosis, the patients were divided into two groups: collapse of the femoral head after CD and noncollapse of the femoral head. Independent risk factors for the failure of CD treatment were identified. Subsequently, a new scoring system that included all these risk factors was built to help estimate the individual risk of CD failure in patients who were planning to undergo CD. Results The study included 1537 hips after decompression surgery. The overall failure rate of CD surgery was 52.44%. Seven independent prognostic factors for failed CD surgery were identified, such as male sex (HR = 75.449; 95% confidence interval (CI), 42.863-132.807), Aetiology (Idiopathic HR = 2.762; 95% CI, 2.016–3.788, Steroid-induced HR = 2.543; 95% CI, 1.852–3.685), if the patient had a seated occupation (HR = 3.937; 95% CI, 2.712–5.716), age (HR = 1.045; 95% CI, 1.032–1.058), haemoglobin level (HR = 0.909; 95% CI, 0.897–0.922), disease duration (HR = 1.217; 95% CI, 1.169–1.267) and the combined necrosis angle (HR = 1.025; 95% CI, 1.022–1.028). The final scoring system included these seven risk factors, and the area under the curve of this scoring system was 0.935 (95% confidential interval = 0.922–0.948). Conclusion This new scoring system might provide evidence-based medical proof for determining whether a patient with ARCO stage I - II ONFH might benefit from CD surgery. This scoring system is crucial for making clinical decisions. Consequently, this scoring system is recommended before CD surgery, which could help determine the potential prognosis of patients.
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Affiliation(s)
- Congcong Wei
- Department of Joint Surgery, No. 215 Hospital of Shaanxi Nuclear Industry, No.35, West Weiyang Road, Xianyang, Shaanxi Province China
| | - Meng Yang
- grid.452209.80000 0004 1799 0194Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province P.R. China
| | - Kun Chu
- grid.452209.80000 0004 1799 0194Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province P.R. China
| | - Jia Huo
- grid.452209.80000 0004 1799 0194Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province P.R. China
| | - Xiao Chen
- grid.452209.80000 0004 1799 0194Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province P.R. China
| | - Bo Liu
- grid.452209.80000 0004 1799 0194Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province P.R. China
| | - Huijie Li
- grid.452209.80000 0004 1799 0194Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province P.R. China
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Jäger M, Busch A, Sowislok A. Bioactivation of scaffolds in osteonecrosis. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:808-814. [PMID: 36074165 DOI: 10.1007/s00132-022-04303-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
Avascular osteonecrosis (AVN) due to local ischemia leads to an inhomogeneous osseous defect, which can be treated by resection and with bone substitute materials in a joint-preserving treatment. Due to the underlying risk profile of AVN, the mostly subchondral localization and the size of the local bone defect, bone regeneration is impaired. Therefore, bioactivation of the applied bone substitute materials prior to application is highly desirable. Apart from the use of growth factors and other soluble substances, the autologous application of location-typical cells and tissue is a useful alternative to support the bone healing properties of scaffolds. This article presents various methods to activate scaffolds for bone stimulation and discusses these techniques with respect to recent data from the literature.
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Affiliation(s)
- M Jäger
- Chair of Orthopaedics and Trauma Surgery, University of Duisburg-Essen, Essen, Germany.
- Department of Orthopaedics, Trauma and Reconstructive Surgery, St. Marien Hospital Mülheim a. d. Ruhr, Kaiserstr. 50, 45468, Mülheim a. d. Ruhr, Germany.
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Katholisches Klinikum Essen Philippus, Essen, Germany.
| | - A Busch
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Katholisches Klinikum Essen Philippus, Essen, Germany
| | - A Sowislok
- Chair of Orthopaedics and Trauma Surgery, University of Duisburg-Essen, Essen, Germany
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[Osteonecrosis]. DER ORTHOPADE 2021; 50:798-801. [PMID: 34498128 DOI: 10.1007/s00132-021-04147-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
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Liu Z, Yang X, Li Y, Zeng WN, Zhao E, Zhou Z. Multiple drilling is not effective in reducing the rate of conversion to Total hip Arthroplasty in early-stage nontraumatic osteonecrosis of the femoral head: a case-control comparative study with a natural course. BMC Musculoskelet Disord 2021; 22:535. [PMID: 34118907 PMCID: PMC8199416 DOI: 10.1186/s12891-021-04418-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/31/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To determine whether multiple drilling is effective in postponing the need for total hip arthroplasty (THA) in early-stage nontraumatic osteonecrosis of the femoral head (ONFH). METHODS We identified 514 patients who were diagnosed with early-stage ONFH between January 2008 and December 2018. One hundred ninety-six patients underwent multiple drilling, and 318 patients had a natural course of progression. One hundred fifty-nine patients were selected for each group after case-control matching for preoperative demographics and modified Ficat and Arlet stage. The rates of THA conversion were compared. We also performed Cox regression to identify risk factors associated with THA conversion in patients who underwent multiple drilling. RESULTS Kaplan-Meier survivorship with an endpoint of THA for nontraumatic reasons were not significantly different between the multiple drilling group (75.6, 95% confidence interval 67.8-83.4%) and the natural course group (72.2, 95% confidence interval 64.8-79.6%) at 5 years (log-rank, P = .191). In the Cox regression model, a larger extent of necrotic lesion, bone marrow edema (BME), and higher postoperative work intensity significantly increased the risk of THA conversion (P < .05). Among patients treated with autogenous bone grafting, there was a lower risk of failure in patients with necrotic lesion less than 15% (P < .05). CONCLUSIONS Multiple drilling is not effective in reducing the rate of THA conversion in early-stage nontraumatic ONFH. The risk of conversion to THA after multiple drilling is increased by a larger extent of necrotic lesion, presence of BME, and higher postoperative work intensity in patients with early-stage ONFH. TRIAL REGISTRATION The trial was registered in the Chinese Clinical Trial Registry ( ChiCTR2000035180 ) dated 2 August 2020.
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Affiliation(s)
- Zunhan Liu
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Xuetao Yang
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Yuhan Li
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Wei-Nan Zeng
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Enze Zhao
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Zongke Zhou
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China.
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Busato TS, Baggio M, Morozowski MG, Filho GRM, Godoi LD, Capriotti JRV. Increased prevalence of femoroacetabular impingement on the elderly with fractures of the proximal femur. SICOT J 2021; 7:37. [PMID: 34014165 PMCID: PMC8136236 DOI: 10.1051/sicotj/2021033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/13/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives: Femoroacetabular impingement (FAI) has been recently related to several pathologies, besides chondral injury and hip arthritis. We aim to investigate the prevalence of FAI morphology in an elderly cohort hospitalized due to a proximal femur fracture and compare these findings to a control group. We hypothesize that limited medial rotation due to FAI’s morphology could increase stresses to the proximal femur, acting as a facilitating mechanism for fractures in this region. Therefore, a higher prevalence of FAI morphology would be present in the study group. Methods: A retrospective cross-sectional study was performed based on the analysis of radiographic images in AP and lateral views of the fractured hip. Firstly, we have set to measure FAI prevalence in an elderly cohort victimized by fractures of the proximal by measures of the alpha, Tönnis, and lateral center edge angles of a hundred consecutive patients hospitalized for proximal femur fractures. Secondly, we have analyzed the possible relationship between the FAI subtypes and the type of fracture. Finally, we have compared this sample’s data with that of a similar control cohort not affected by fracture. Results: The cohort in this study displayed a higher prevalence of pathological changes in the Tönnis, center-edge, and alpha angles with odds ratios of 3.41, 2.56, and 4.80, respectively (with statistical significance). There was also a significant relationship between cam-type FAI and intertrochanteric fractures, corroborating our initial hypotheses. Conclusions: This study demonstrated that a cohort of older patients affected by fractures of the proximal femur had an increased prevalence of radiographic signs of femoroacetabular impingement. Furthermore, this is the first study demonstrating a statistically significant relationship of cam-type FAI with intertrochanteric fractures, suggesting a possible cause and effect relationship.
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Affiliation(s)
- Thiago Sampaio Busato
- Director of the Adult Hip Surgery Fellowship, CRIAr - Centro de Reconstrução e Instituto de Pesquisa Articular, Curitiba, 80540-220 PR, Brazil
| | - Marcelo Baggio
- Fellow of the Adult Hip Surgery Fellowship, CRIAr - Centro de Reconstrução e Instituto de Pesquisa Articular, Curitiba, 80540-220 PR, Brazil
| | - Marcelo Gavazzoni Morozowski
- Staff of the Adult Hip Surgery Group, CRIAr - Centro de Reconstrução e Instituto de Pesquisa Articular, Curitiba, 80540-220 PR, Brazil
| | - Gladyston Roberto Matioski Filho
- Staff of the Adult Hip Surgery Group, CRIAr - Centro de Reconstrução e Instituto de Pesquisa Articular, Curitiba, 80540-220 PR, Brazil
| | - Lucas Dias Godoi
- Staff of the Adult Hip Surgery Group, CRIAr - Centro de Reconstrução e Instituto de Pesquisa Articular, Curitiba, 80540-220 PR, Brazil
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Serong S, Haubold J, Theysohn J, Landgraeber S. Arthroscopic assessment of concomitant intraarticular pathologies in patients with osteonecrosis of the femoral head. J Hip Preserv Surg 2020; 7:458-465. [PMID: 33948201 PMCID: PMC8081419 DOI: 10.1093/jhps/hnaa059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/11/2020] [Accepted: 11/17/2020] [Indexed: 11/12/2022] Open
Abstract
This study's purpose is to arthroscopically assess the occurrence of intraarticular pathologies in patients with osteonecrosis of the femoral head (OFNH) and to compare arthroscopic with radiologic findings. In a retrospective cohort analysis of ONFH patients undergoing combined core decompression (CD) and hip arthroscopy, concomitant intraarticular pathologies were qualitatively and quantitatively assessed by means of arthroscopy. Intraoperative findings were compared with preoperative radiodiagnostics. Descriptive statistics were performed with results displaying type, degree and prevalence of co-pathologies. Based on a cohort of 27 hips with ONFH at ARCO stages II and III, 26 (96.3%) presented with concomitant intraarticular findings. Cam-deformity (n = 22; 81.5%), labral defects (n = 23; 85.2%) and chondral defects (n = 20; 74.1%) were the most frequent. Four hips (14.8%) had foveal ligament anomalies. Intraoperative detection of cam-deformity positively correlated with radiologically assessed pathologic α angles (p = 0.09). Radiologic evaluation of the acetabular labrum distinctly differed from arthroscopic findings. Reliable statements concerning the cartilage status were not possible due to the great difference in quality of the magnetic resonance imaging (MRIs). The results of this study revealed an arthroscopically proven prevalence of co-pathologies in >95% of patients with ONFH. Cam-type deformity, labral anomalies and chondral defects were the most frequent. Comparison of arthroscopic and radiologic findings showed coherent results regarding cam-deformity but revealed distinct difficulties in the assessment of the labral and chondral status emphasizing the need for standardization of preoperative radiodiagnostics. Moreover, it still has to be evaluated whether combined CD and arthroscopy can improve on the overall outcomes achieved by performance of CD only.
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Affiliation(s)
- Sebastian Serong
- Department of Orthopaedics & Orthopaedic Surgery, Saarland University, Kirrberger Strasse 100, Homburg 66421, Germany.,Sportklinik Duisburg, Dr. Alfred-Herrhausen-Allee 21, Duisburg 47228, Germany
| | - Johannes Haubold
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, Essen 45147, Germany
| | - Jens Theysohn
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, Essen 45147, Germany
| | - Stefan Landgraeber
- Department of Orthopaedics & Orthopaedic Surgery, Saarland University, Kirrberger Strasse 100, Homburg 66421, Germany
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Serong S, Haversath M, Tassemeier T, Dittrich F, Landgraeber S. Results of advanced core decompression in patients with osteonecrosis of the femoral head depending on age and sex-a prospective cohort study. J Orthop Surg Res 2020; 15:124. [PMID: 32238184 PMCID: PMC7110716 DOI: 10.1186/s13018-020-01643-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/20/2020] [Indexed: 12/30/2022] Open
Abstract
Background Core decompression is a common surgical technique to treat osteonecrosis of the femoral head. The aim of this study is to evaluate the effect of the parameters “age” and “sex” on the outcome of this type of treatment. Methods A prospective cohort study was performed. Eighty-six osteonecrotic hips with a mean follow-up of 32.5 months (± 24.8) after advanced core decompression were analysed regarding age- and sex-dependent treatment failure. Additionally, the modified Harris Hip Score and Numeric Rating Scale were compared regarding the parameters age and sex. Results The mean hip survival of the male participants was 51.3 months (39.4% treatment failure), whereas females presented a longer, thus not significant, mean survival of 61.4 months (30% therapy failure; p = 0.48). The further evaluation revealed significantly better survival in the patients aged < 40 years (mean survival 66.09 months, 16% treatment failure) in comparison to those aged ≥ 40 years (mean survival 50.14 months, 46% therapy failure; p = 0.03). The modified Harris Hip Score and Numeric Rating Scale results of patients whose treatment did not fail during the study period were similar, irrespective of the patient’s sex or age. Conclusions The study shows that the number of therapy failures is significantly higher in older patients, with 40 years of age marking the borderline. Patients’ sex does not seem to affect the outcome of treatment, and postoperative clinical scores appear to be identical with individuals not affected by therapy failure. Since age and sex are unalterable parameters, the study helps to provide valuable predictions regarding the chances of long-term hip survival after treatment of osteonecrosis.
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Affiliation(s)
- Sebastian Serong
- Department of Orthopaedics & Orthopaedic Surgery, Saarland University, Kirrberger Strasse 100, 66421, Homburg, Germany.
| | - Marcel Haversath
- Department of Orthopaedics & Traumatology, University of Duisburg-Essen, Essen, Germany
| | - Tjark Tassemeier
- Department of Orthopaedics & Traumatology, University of Duisburg-Essen, Essen, Germany
| | - Florian Dittrich
- Department of Orthopaedics & Orthopaedic Surgery, Saarland University, Kirrberger Strasse 100, 66421, Homburg, Germany
| | - Stefan Landgraeber
- Department of Orthopaedics & Orthopaedic Surgery, Saarland University, Kirrberger Strasse 100, 66421, Homburg, Germany
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