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Tsubosaka M, Maruyama M, Lui E, Kushioka J, Toya M, Gao Q, Shen H, Li X, Chow SKH, Zhang N, Yang YP, Goodman SB. Preclinical models for studying corticosteroid-induced osteonecrosis of the femoral head. J Biomed Mater Res B Appl Biomater 2024; 112:e35360. [PMID: 38247252 DOI: 10.1002/jbm.b.35360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 11/02/2023] [Accepted: 11/27/2023] [Indexed: 01/23/2024]
Abstract
Nontraumatic osteonecrosis of the femoral head (ONFH) is a refractory condition that commonly results in femoral head collapse and degenerative arthritis of the hip. In the early stages, surgical procedures for hip preservation, including core decompression (CD), have been developed to prevent progressive collapse of the femoral head. Optimization of bone regeneration and biological augmentation may further enhance the therapeutic efficacy of CD for ONFH. Thus, combining CD with cell-based therapy has recently been proposed. In fact, patients treated with cell-based therapy using autologous bone marrow concentrate demonstrate improved survivorship of the femoral head, compared with conventional CD alone. Preclinical research studies to investigate adjunctive therapies for CD often utilize the rabbit model of corticosteroid-induced ONFH. Mesenchymal stem cells (MSCs) are known to promote osteogenesis and angiogenesis, and decrease inflammation in bone. Local drug delivery systems have the potential to achieve targeted therapeutic effects by precisely controlling the drug release rate. Scaffolds can provide an osteoconductive structural framework to facilitate the repair of osteonecrotic bone tissue. We focused on the combination of both cell-based and scaffold-based therapies for bone tissue regeneration in ONFH. We hypothesized that combining CD and osteoconductive scaffolds would provide mechanical strength and structural cell guidance; and that combining CD and genetically modified (GM) MSCs to express relevant cytokines, chemokines, and growth factors would promote bone tissue repair. We developed GM MSCs that overexpress the anti-inflammatory, pro-reconstructive cytokines platelet-derived growth factor-BB to provide MSCs with additional benefits and investigated the efficacy of combinations of these GM MSCs and scaffolds for treatment of ONFH in skeletally mature male New Zealand white rabbits. In the future, the long-term safety, efficacy, durability, and cost-effectiveness of these and other biological and mechanical treatments must be demonstrated for the patients affected by ONFH.
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Affiliation(s)
- Masanori Tsubosaka
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Masahiro Maruyama
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Elaine Lui
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
- Department of Mechanical Engineering, Stanford University School of Engineering, Stanford, California, USA
| | - Junichi Kushioka
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Masakazu Toya
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Qi Gao
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Huaishuang Shen
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Xueping Li
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Simon Kwoon-Ho Chow
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Ning Zhang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Yunzhi Peter Yang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
- Department of Material Science and Engineering, Stanford University School of Medicine, Stanford, California, USA
- Department of Bioengineering, Stanford University School of Medicine, Stanford, California, USA
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
- Department of Bioengineering, Stanford University School of Medicine, Stanford, California, USA
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Shinohara I, Tsubosaka M, Toya M, Lee ML, Kushioka J, Murayama M, Gao Q, Li X, Zhang N, Chow SKH, Matsumoto T, Kuroda R, Goodman SB. C-C Motif Chemokine Ligand 2 Enhances Macrophage Chemotaxis, Osteogenesis, and Angiogenesis during the Inflammatory Phase of Bone Regeneration. Biomolecules 2023; 13:1665. [PMID: 38002347 PMCID: PMC10669364 DOI: 10.3390/biom13111665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
Local cell therapy has recently gained attention for the treatment of joint diseases and fractures. Mesenchymal stem cells (MSCs) are not only involved in osteogenesis and angiogenesis, but they also have immunomodulatory functions, such as inducing macrophage migration during bone regeneration via macrophage crosstalk. C-C motif chemokine ligand 2 (CCL2), a known inflammatory mediator, is associated with the migration of macrophages during inflammation. This study examined the utility of CCL2 as a therapeutic target for local cell therapy. Using lentiviral vectors for rabbit MSCs, genetically modified CCL2 overexpressing MSCs were generated. Osteogenic differentiation assays were performed using MSCs with or without macrophages in co-culture, and cell migration assays were also performed. Additionally, co-cultures were performed with endothelial cells (ECs), and angiogenesis was evaluated using a tube formation assay. Overexpression of CCL2 did not affect bone formation under monoculture conditions but promoted chemotaxis and osteogenesis when co-cultured with macrophages. Furthermore, CCL2-overexpression promoted tube formation in co-culture with ECs. These results suggest that CCL2 induces macrophage chemotaxis and osteogenesis by promoting crosstalk between MSCs and macrophages; CCL2 also stimulates ECs to induce angiogenesis. These findings indicate that CCL2 may be a useful therapeutic target for local cell therapy in areas of bone loss.
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Affiliation(s)
- Issei Shinohara
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA 94063, USA; (I.S.); (M.T.); (M.T.); (M.L.L.); (J.K.); (M.M.); (Q.G.); (X.L.); (S.K.-H.C.)
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan; (T.M.); (R.K.)
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA 94063, USA; (I.S.); (M.T.); (M.T.); (M.L.L.); (J.K.); (M.M.); (Q.G.); (X.L.); (S.K.-H.C.)
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan; (T.M.); (R.K.)
| | - Masakazu Toya
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA 94063, USA; (I.S.); (M.T.); (M.T.); (M.L.L.); (J.K.); (M.M.); (Q.G.); (X.L.); (S.K.-H.C.)
| | - Max L. Lee
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA 94063, USA; (I.S.); (M.T.); (M.T.); (M.L.L.); (J.K.); (M.M.); (Q.G.); (X.L.); (S.K.-H.C.)
| | - Junichi Kushioka
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA 94063, USA; (I.S.); (M.T.); (M.T.); (M.L.L.); (J.K.); (M.M.); (Q.G.); (X.L.); (S.K.-H.C.)
| | - Masatoshi Murayama
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA 94063, USA; (I.S.); (M.T.); (M.T.); (M.L.L.); (J.K.); (M.M.); (Q.G.); (X.L.); (S.K.-H.C.)
| | - Qi Gao
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA 94063, USA; (I.S.); (M.T.); (M.T.); (M.L.L.); (J.K.); (M.M.); (Q.G.); (X.L.); (S.K.-H.C.)
| | - Xueping Li
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA 94063, USA; (I.S.); (M.T.); (M.T.); (M.L.L.); (J.K.); (M.M.); (Q.G.); (X.L.); (S.K.-H.C.)
| | - Ning Zhang
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong;
| | - Simon Kwoon-Ho Chow
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA 94063, USA; (I.S.); (M.T.); (M.T.); (M.L.L.); (J.K.); (M.M.); (Q.G.); (X.L.); (S.K.-H.C.)
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan; (T.M.); (R.K.)
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan; (T.M.); (R.K.)
| | - Stuart B. Goodman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA 94063, USA; (I.S.); (M.T.); (M.T.); (M.L.L.); (J.K.); (M.M.); (Q.G.); (X.L.); (S.K.-H.C.)
- Department of Bioengineering, Stanford University School of Medicine, Stanford, CA 94305, USA
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Lu Y, Chen X, Lu X, Sun C, Li M, Chen G, Long Z, Gao Y, Zhang H, Huang M, Ji C, Fan H, Liu D, Hao Y, Wang H, Zhang L, Zhang H, Lu J, Wang Z, Li J. Reconstructing avascular necrotic femoral head through a bioactive β-TCP system: From design to application. Bioact Mater 2023; 28:495-510. [PMID: 37408798 PMCID: PMC10318430 DOI: 10.1016/j.bioactmat.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/09/2023] [Accepted: 06/11/2023] [Indexed: 07/07/2023] Open
Abstract
A variety of techniques have been used for treating avascular necrosis of the femoral head (ANFH), but have frequently failed. In this study, we proposed a β-TCP system for the treatment of ANFH by boosting revascularization and bone regeneration. The angio-conductive properties and concurrent osteogenesis of the highly interconnected porous β-TCP scaffold were revealed and quantified through an in vivo model that simulated the ischemic environment of ANFH. Mechanical test and finite element analysis showed that the mechanical loss caused by tissue necrosis and surgery was immediately partially compensated after implantation, and the strength of the operated femoral head was adaptively increased and eventually returned to normal bone, along with continuous material degradation and bone regeneration. For translational application, we further conducted a multi-center open-label clinical trial to assess the efficacy of the β-TCP system in treating ANFH. Two hundred fourteen patients with 246 hips were enrolled for evaluation, and 82.1% of the operated hips survived at a 42.79-month median follow-up. The imaging results, hip function, and pain scores were dramatically improved compared to preoperative levels. ARCO stage Ⅱ disease outperformed stage Ⅲ in terms of clinical effectiveness. Thus, bio-adaptive reconstruction using the β-TCP system is a promising hip-preserving strategy for the treatment of ANFH.
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Affiliation(s)
- Yajie Lu
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
- Department of Clinical Oncology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
- The State Key Laboratory of Cancer Biology Biotechnology Center, School of Pharmacy, Air Force Medical University, Xi'an, 710032, China
| | - Xiantao Chen
- Department of Osteonecrosis of the Femoral Head, Luoyang Orthopedic-Traumatological Hospital of Henan Province, Luoyang, 471002, China
| | - Xiao Lu
- Shanghai Bio-lu Biomaterials Co., Ltd, Shanghai, 201100, China
- Shanghai Technology Innovation Center of Orthopedic Biomaterials, Shanghai, 201100, China
| | - Changning Sun
- State Key Laboratory for Manufacturing System Engineering, Xi'an Jiaotong University, Xi'an, 710054, China
- National Medical Products Administration (NMPA) Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, 710054, China
| | - Minghui Li
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Guojing Chen
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Zuoyao Long
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, 110000, China
| | - Yuan Gao
- The State Key Laboratory of Cancer Biology Biotechnology Center, School of Pharmacy, Air Force Medical University, Xi'an, 710032, China
| | - Haoqiang Zhang
- Department of Orthopedics, The 940th Hospital of Joint Logistics Support Force of People's Liberation Army, Lanzhou, 730000, China
| | - Mengquan Huang
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Chuanlei Ji
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Hongbin Fan
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Dong Liu
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Yuewen Hao
- Department of Medical Imaging, Xi'an Children's Hospital, Xi'an, 710000, China
| | - Hong Wang
- Department of Medical Imaging, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Leilei Zhang
- Department of Osteonecrosis of the Femoral Head, Luoyang Orthopedic-Traumatological Hospital of Henan Province, Luoyang, 471002, China
| | - Hongmei Zhang
- Department of Clinical Oncology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Jianxi Lu
- Shanghai Bio-lu Biomaterials Co., Ltd, Shanghai, 201100, China
- Shanghai Technology Innovation Center of Orthopedic Biomaterials, Shanghai, 201100, China
| | - Zhen Wang
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Jing Li
- Department of Orthopedics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
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Zhang C, Lin Y, Yang L, Duan X. 3D Printing-Assisted Supramalleolar Osteotomy for Ankle Osteoarthritis. ACS OMEGA 2022; 7:42191-42198. [PMID: 36440128 PMCID: PMC9685747 DOI: 10.1021/acsomega.2c04764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
Ankle osteoarthritis (OA) is an important factor that causes pain and dysfunction after ankle joint movement. In early and mid-term ankle OA, supramalleolar osteotomy can delay the progression of disease and maximize the preservation of ankle joint function. Three-dimensional printing (3DP) technology has brought us new hope, which can improve the accuracy of osteotomy, reduce the number of fluoroscopy, reduce the amount of blood loss, and achieve personalized and accurate treatment. The data of 16 patients with ankle OA in our center from January 2003 to July 2020 were retrospectively analyzed and divided into the 3DP group and the traditional group according to different treatment methods. Seven patients in the 3DP group used the 3DP personalized osteotomy guide; nine patients were treated by traditional osteotomy. All patients were followed up for 13.9 ± 3.1 months after the operation. The operation time in the 3DP group was 126.4 ± 11.1 min, its intraoperative blood loss was 85.7 ± 24.1 mL, and its intraoperative fluoroscopy time was 2.4 ± 0.2, which were all significantly less than 167.3 ± 12.2 min, 158.3 ± 22.8 mL, and 5.8 ± 0.2 times in the traditional group (P < 0.05), respectively. In the 3DP group, its postoperative tibial anterior surface (TAS) angle was 90.6 ± 0.3° and the talar tilt (TT) angle was 2.2 ± 0.6°, which were all significantly different compared with its preoperative data of 83.4 ± 1.7 and 8.0 ± 1.5°, respectively (P < 0.05). Compared with traditional osteotomy, 3DP-assisted supramalleolar osteotomy for varus and valgus ankle OA can significantly shorten the operation time and reduce intraoperative bleeding and the frequency of intraoperative fluoroscopy; personalized 3DP osteotomy guides and models can assist in the accurate correction of varus deformity during operation, restore the lower limb alignment, and improve the biomechanical status of the lower limbs. In addition, the 3DP of porous tantalum has good histocompatibility, and its interface structure and porosity are more conducive to bone ingrowth. For complex bone defects and revision prostheses, matching implants can be printed individually, which could realize the personalized precise treatment.
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Miyahara HDS, Ranzoni LV, Ejnisman L, Vicente JRN, Croci AT, Gurgel HMDC. Osteonecrose da cabeça femoral: Artigo de atualização. Rev Bras Ortop 2022; 57:351-359. [PMID: 35785123 PMCID: PMC9246540 DOI: 10.1055/s-0041-1736308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/18/2021] [Indexed: 11/19/2022] Open
Abstract
Among the pathologies that affect the hip joint, osteonecrosis of the femoral head (ONFH) is probably the most intriguing and challenging. It consists of a multifactorial disease with a highly-variable spectrum in its clinical presentation. It has a devastating effect, due to disabling painful conditions, both for usual activities and sports. Given the huge range of risk factors, such as prolonged use of corticosteroids (especially in cases of rheumatologic diseases), trauma sequelae, sickle cell anemia, HIV, alcoholism, smoking, blood dyscrasias, and several other diseases that compromise the blood supply to the femoral head, ONFH has a varied clinical presentation and prognosis, which makes it difficult to determine a specific treatment, especially in cases in which chondral involvement has not yet occurred and the hip joint is still preserved. These are the main factors found in the literature that determine the classifications of this pathology. The range of treatments includes several options for cases in which an attempt is made to save the joint: conservative treatment, traditional decompression and/or combined with some type of adjuvant treatment (homologous grafting, synthetic grafting, vascularized grafts, tantalum screws, and bone marrow aspirate injection), and, for cases in which there is already a subchondral fracture and/or collapse of the femoral head and/or a reduction in the joint space, femoral osteotomies or total hip arthroplasty are commonly performed.
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Affiliation(s)
- Helder de Souza Miyahara
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
| | - Lucas Verissimo Ranzoni
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
| | - Leandro Ejnisman
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
| | - José Ricardo Negreiros Vicente
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
| | - Alberto Tesconi Croci
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
| | - Henrique Melo de Campos Gurgel
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
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Wei QS, He MC, He XM, Lin TY, Yang P, Chen ZQ, Zhang QW, He W. Combining frog-leg lateral view may serve as a more sensitive X-ray position in monitoring collapse in osteonecrosis of the femoral head. J Hip Preserv Surg 2022; 9:10-17. [PMID: 35651706 PMCID: PMC9142202 DOI: 10.1093/jhps/hnac006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/22/2021] [Accepted: 02/15/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Load-bearing capacity of the bone structures of anterolateral weight-bearing area plays an important role in the progressive collapse in osteonecrosis of the femoral head (ONFH). The purpose of this study is to assess the efficacy of combined evaluation of anteroposterior (AP) and frog-leg lateral (FLL) view in diagnosing collapse. Between December 2016 and August 2018, a total of 478 hips from 372 patients with ONFH (268 male, 104 female; mean age 37.9 ± 11.4 years) were retrospectively evaluated. All patients received standard AP and FLL views of hip joints. Japanese Investigation Committee (JIC) classification system was used to classify necrotic lesion in AP view. Anterior necrotic lesion was evaluated by FLL view. All patients with pre-collapse ONFH underwent non-operative hip-preserving therapy. The collapse rates were calculated and compared with Kaplan–Meier survival analysis with radiological collapse as endpoints. Forty-four (44/478, 9.2%) hips were classified as type A, 65 (65/478, 13.6%) as type B, 232 (232/478, 48.5%) as type C1 and 137 (137/478, 28.7%) as type C2. Three hundred cases (300/478, 62.5%) were collapsed at the initial time point. Two hundred and twenty six (226/300, 75.3%) hips and 298 (298/300, 99.3%) hips collapse were identified with AP view and FLL view, respectively. An average follow-up of 37.0 ± 32.0 months was conducted to evaluate the occurrence of collapse in 178 pre-collapse hips. Collapses occurred in 89 hips (50.0%). Seventy-seven (77/89, 86.5%) hips were determined with AP view alone and 85 (85/89, 95.5%) hips were determined with the combination of AP and FLL views. The collapse rates at five years were reported as 0% and 0%, 16.2% and 24.3%, 58.3% and 68.1% and 100% and 100% according to AP view alone or combination of AP and FLL views for types A, B, C1 and C2, respectively. The collapse can be diagnosed more accurately by combination of AP and FLL views. Besides, JIC type A and type B ONFH can be treated with conservative hip preservation, but pre-collapse type C2 ONFH should be treated with joint-preserving surgery. Type C1 needs further study to determine which subtype has potential risk of collapse.
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Affiliation(s)
- Qiu-Shi Wei
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
| | - Min-Cong He
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
| | - Xiao-Ming He
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
| | - Tian-Ye Lin
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
| | - Peng Yang
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
| | - Zhen-Qiu Chen
- No. 3 Orthopaedic Region, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 16, Jichang Road, Baiyun District, Guangzhou 510407, P.R. China
| | - Qing-Wen Zhang
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
| | - Wei He
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
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Yuan P, Liu X, Du B, Sun GQ, Wang X, Lin XY. Mid- to long-term results of modified avascular fibular grafting for ONFH. J Hip Preserv Surg 2021; 8:274-281. [PMID: 35414946 PMCID: PMC8994109 DOI: 10.1093/jhps/hnab046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/22/2021] [Accepted: 05/02/2021] [Indexed: 11/23/2022] Open
Abstract
Free vascularized fibular grafting was reported a favorable method to prevent the collapse of the femoral head. This study analyzed the mid- to long-term outcomes of avascular fibular grafting (AVFG) for osteonecrosis of the femoral head (ONFH) with 6- to 8-year follow-up. From March 2009 to March 2012, 34 patients (48 hips) were diagnosed with ONFH operated with AVFG in Jiangsu Province Hospital of traditional Chinese Medicine. We retrospectively reviewed the clinic outcomes of these patients and evaluated the differences in outcomes by diverse stages [Association Research Circulation Osseous (ARCO)] and types [China–Japan Friendship Hospital (CJFH) classification] annually. The hip survival rate, Harris hip score (HHS), activity level and imaging stability were calculated. The average follow-up time was 6.7 years. At the last follow-up, 34 of 48 hips survived totally. According to the ARCO stage, the overall clinical success rate for hip preserving were 76.0% (19/25) in II stage, 85.7% (12/14) in IIIA stage and 33.3% (3/9) in IIIB stage. Referring to the CJFH classification system, the hip survival rate were 100% (2/2) in M type, 90.9% (10/11) in C type, 77.8% (14/18) in L1 type, 57.1% (8/14) in L2 type and 0% (0/3) in L3 type. The mean visual analog scale (VAS) score, HHS and Western Ontario McMaster Osteoarthritis index (WOMAC) were significantly improved at the final follow-up compared with pre-operative values (P < 0.001). The AVFG operation can increase the hip function and improve patients’ lives quality. The mid- to long-term efficacy can satisfy fundamental life requirements, especially for those early-stage and small-scale patients who suffer ONFH to avoid or put off the time of total hip arthroplasty surgery.
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Affiliation(s)
- Peng Yuan
- Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210000, China
| | - Xin Liu
- Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing Jiangsu 210000, China
| | - Bin Du
- Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing Jiangsu 210000, China
| | - Guang-Quan Sun
- Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing Jiangsu 210000, China
| | - Xu Wang
- Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210000, China
| | - Xuan-Ye Lin
- Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210000, China
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Hussaini M, Balakumar J, Slattery D. Efficacy of tantalum rod insertion for preventing femoral head collapse in osteonecrosis in a paediatric population: a pilot study. J Hip Preserv Surg 2021; 8:343-347. [PMID: 35505803 PMCID: PMC9052407 DOI: 10.1093/jhps/hnab065] [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: 01/17/2021] [Revised: 05/05/2021] [Accepted: 08/22/2021] [Indexed: 12/03/2022] Open
Abstract
Femoral head osteonecrosis in the paediatric population is difficult to treat, with the primary goals of management being prevention of subchondral collapse and the avoidance of early total hip replacement. This study aims to describe the use of a porous tantalum rod implant to provide mechanical support in preventing femoral head collapse in a paediatric population. A retrospective chart-based analysis of patients with osteonecrosis of the hip was performed at our institution to identify those who had undergone tantalum rod insertion. A total of 10 patients (fives males and five females, median age 12.5 years, 9–18) had tantalum rods implanted between December 2013 and February 2018. One patient was excluded due to follow-up at a different institution. The radiographic degree of osteonecrosis was characterized according to the Ficat classification and the Kerboul angle. Radiographic assessment of pre- and post-operative plain films was performed. The outcome measures were Tonnis grade and percentage collapse of the femoral head. Nine patients with a mean follow-up time of 18.4 months were included in the analysis. There was no significant increase in the femoral head collapse percentage post tantalum rod insertion compared to pre-operatively (P = 0.63). There was a significant increase in the Tonnis grade post-operatively (P < 0.05), with sub-group analysis showing minimal increase in Ficat Stage 1 patients. This study is the first to examine the role of tantalum rod insertion in preventing femoral head collapse in a paediatric population, with results suggesting potential benefit in a subset of patients.
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Affiliation(s)
- Muqtasid Hussaini
- Department of Orthopaedics, Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, VIC 3052, Australia
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Lin T, Li K, Chen W, Yang P, Zhuang Z, Zhang Y, He W, Zhang Q, Wei Q. Relationship between hip joint medial space ratio and collapse of femoral head in non-traumatic osteonecrosis: a retrospective study. J Hip Preserv Surg 2021; 8:311-317. [PMID: 35505807 PMCID: PMC9052403 DOI: 10.1093/jhps/hnab049] [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: 02/25/2021] [Revised: 05/03/2021] [Accepted: 05/13/2021] [Indexed: 11/15/2022] Open
Abstract
ABSTRACT
To retrospectively analyze the medial space ratio (MSR) of the hip joint to evaluate its efficacy in predicting osteonecrosis of femoral head (ONFH)-induced collapse and its impacts on the mechanical environment of necrotic femoral head. In this retrospective analysis of traditional Chinese medicine, non-traumatic ONFH (NONFH) patients from January 2008 to December 2013 were selected. The patients were divided into collapse group and non-collapse group based on whether the femoral head collapsed. The anatomical parameters including center–edge (CE) angle, sharp angle, acetabular depth ratio and MSR were evaluated. Receiver operating characteristic curves were estimated to evaluate the sensitivity and specificity of MSR and CE angle in collapse prediction. The results showed that 135 patients (151 hips) were included in this study. The differences in CE angle and MSR between collapse group and non-collapse group were statistically significant. The mean survival time of the hips of patients with MSR <20.35 was greater (P < 0.001) than that of patients with MSR >20.35. The ONFH patients with MSR >20.35 were prone to stress concentration. We could conclude that the hip joint MSR and CE angle strongly correlated with the collapse of NONFH. The specificity of MSR is higher than that of CE angle. When MSR is >20.35, the collapse rate of ONFH will increase significantly.
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Affiliation(s)
- Tianye Lin
- Department of Joint Orthopaedic, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, 261 Longxi Avenue, Liwan, Guangzhou, Guangdong 510405, China
- Institute of Orthopedics, Guangzhou University of Chinese Medicine, 261 Longxi Avenue, Liwan, Guangzhou, Guangdong 510405, China
| | - Keda Li
- Liaoning University of Chinese Medicine, No. 79, Chongshan East Road, Huanggu, Shengyang, Liaoning 110033, China
| | - Weijian Chen
- Guangzhou Orthopedic Hospital, Guangzhou University of Chinese Medicine, 449 Dongfeng Middle Road, Yuexiu, Guangzhou, Guangdong 510405, China
| | - Peng Yang
- Department of Joint Orthopaedic, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, 261 Longxi Avenue, Liwan, Guangzhou, Guangdong 510405, China
- Institute of Orthopedics, Guangzhou University of Chinese Medicine, 261 Longxi Avenue, Liwan, Guangzhou, Guangdong 510405, China
| | - Zhikun Zhuang
- Quanzhou Osteopathic Hospital Affiliated to Fujian University of Traditional Chinese Medicine, No. 61, South Section of Citong West Road, Quanzhou, Fujian 362000, China
| | - Ying Zhang
- Luoyang Orthopedic-Traumatological Hospital, 82 Qiming South Road, Luoyang, Henan 471000, China
| | - Wei He
- Department of Joint Orthopaedic, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, 261 Longxi Avenue, Liwan, Guangzhou, Guangdong 510405, China
- Institute of Orthopedics, Guangzhou University of Chinese Medicine, 261 Longxi Avenue, Liwan, Guangzhou, Guangdong 510405, China
| | - Qingwen Zhang
- Department of Joint Orthopaedic, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, 261 Longxi Avenue, Liwan, Guangzhou, Guangdong 510405, China
- Institute of Orthopedics, Guangzhou University of Chinese Medicine, 261 Longxi Avenue, Liwan, Guangzhou, Guangdong 510405, China
| | - Qiushi Wei
- Department of Joint Orthopaedic, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, 261 Longxi Avenue, Liwan, Guangzhou, Guangdong 510405, China
- Institute of Orthopedics, Guangzhou University of Chinese Medicine, 261 Longxi Avenue, Liwan, Guangzhou, Guangdong 510405, China
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Yang F, Zhuang Z, Tu Y, Hong Z, Pang F, He W, Wei Q, Li Z. Pathological progress of traumatic femur head necrosis after femoral neck fracture in children and adolescents: a case series study. J Hip Preserv Surg 2021; 7:696-704. [PMID: 34377512 PMCID: PMC8349579 DOI: 10.1093/jhps/hnab025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/15/2021] [Indexed: 11/14/2022] Open
Abstract
The pathological progression and prognosis of traumatic femur head necrosis (TFHN) after femoral neck fracture (FNF) in children and adolescent is relatively unknown and has never been specifically characterized. As we speculated, the prognosis in such population would be poor and characterized as the high risk of femoral head collapse, hip deformity and degeneration in a short term. This retrospective case series enrolled 64 children and adolescent with TFHN who treated with observational treatment from 2000.1 to 2018.1. The primary outcomes, the progression of femoral head collapse, hip deformity (Stulberg classification) and hip degeneration (Tönnis grade), and their prognostic factors were analysed. Sixty-four patients with a mean age of 13 years (6-16 years) were included. A total of 28 hips (44%) showed unsatisfactory outcome and 25 (39%) hips collapsed progressively during a mean follow-up of 48 months (24-203 months). Finally, 38 hips (59%) experienced hip deformity, 20 of them were Class IV/V. Thirty-four hips (53%) generally progressed to osteoarthritis, 14 of them were classified as Grades II/III. The location of the lesion and the presence of subluxation were found to be related to progression of collapse; however, the presence of subluxation was the only independent risk factor of severe hip deformity and degeneration. TFHN in children and adolescent is a rapidly progressing disease with a poor prognosis characterized by a high risk of femoral head collapse progression. If the subluxation emerged, collapsed cases showed increasingly tendency towards hip deformity and degeneration.
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Affiliation(s)
- Fan Yang
- Department of Orthopaedics & Traumatology, Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, No.12, airport road, Baiyun distinct, Guangzhou city, Guangdong province, 510000, China
| | - Zhikun Zhuang
- Department of Orthopaedics & Traumatology, Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, No.12, airport road, Baiyun distinct, Guangzhou city, Guangdong province, 510000, China
- Department of Joint Diseases, Quanzhou Orthopedic-traumatological Hospital of Fujian Traditional Chinese Medicine University, No.61, Citong western road, Quanzhou city, Fujian province, 362000, China
| | - Yonggang Tu
- Department of Orthopaedics & Traumatology, Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, No.12, airport road, Baiyun distinct, Guangzhou city, Guangdong province, 510000, China
- Department of Orthopaedics, Dongguan Eastern Central Hospital, No. 88, Changdong Road, Changping Town, Dongguan city, Guangdong province, 510000, China
| | - Zhinan Hong
- Department of Orthopaedics & Traumatology, Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, No.12, airport road, Baiyun distinct, Guangzhou city, Guangdong province, 510000, China
- Department of Joint Diseases, Traumatology & Orthopedics Institute of Guangzhou University of Chinese Medicine, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou city, Guangdong province, 510000, China
| | - Fengxiang Pang
- Department of Orthopaedics & Traumatology, Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, No.12, airport road, Baiyun distinct, Guangzhou city, Guangdong province, 510000, China
| | - Wei He
- Department of Orthopaedics & Traumatology, Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, No.12, airport road, Baiyun distinct, Guangzhou city, Guangdong province, 510000, China
- Department of Joint Diseases, Traumatology & Orthopedics Institute of Guangzhou University of Chinese Medicine, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou city, Guangdong province, 510000, China
| | - Qiushi Wei
- Department of Orthopaedics & Traumatology, Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, No.12, airport road, Baiyun distinct, Guangzhou city, Guangdong province, 510000, China
- Department of Joint Diseases, Traumatology & Orthopedics Institute of Guangzhou University of Chinese Medicine, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou city, Guangdong province, 510000, China
| | - Ziqi Li
- Department of Orthopaedics & Traumatology, Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, No.12, airport road, Baiyun distinct, Guangzhou city, Guangdong province, 510000, China
- Department of Joint Diseases, Traumatology & Orthopedics Institute of Guangzhou University of Chinese Medicine, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou city, Guangdong province, 510000, China
- Correspondence to: Z. Li. E-mail:
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Wu ZS, Hong G, Yang P, Yang F, Chen ZQ, He W, Wei QS. The survival of non-traumatic osteonecrosis of femoral head at ARCO II with ring-shaped sclerotic zone: a mid-term follow-up retrospective study. J Hip Preserv Surg 2020; 7:705-712. [PMID: 34377513 PMCID: PMC8349575 DOI: 10.1093/jhps/hnab013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/27/2020] [Accepted: 02/11/2021] [Indexed: 11/13/2022] Open
Abstract
The sclerotic zone in the osteonecrosis of femoral head (ONFH), containing condensed trabecular bone and abundant neovascularization, is the transition area between osteonecrosis and normal tissue. Due to the prominent feature in ONFH, the characteristics of the sclerotic zone might indicate the femoral head survival of the disease. Thirty ONFH patients (41 hips) with ring-shaped sclerotic zone at Association Research Circulation Osseous-II were recruited during 1996 to 2019, and the corresponding radiographic images in their follow-up are reviewed retrospectively. Two subtypes (type A and B) are defined to discriminate different locations of ring-shaped sclerotic zone in the femoral head (center or subchondral bone plate) in accordance with the radiographic images. The natural history of the enrolled subjects was followed up for average 9 years to record and compare their collapse incidences as well as the progress of hip symptoms. Chi-square test shows that the occurrence rates of symptomatic hip of type A are significantly lower than that of type B and differences between these two groups were significant (P < 0.05). Kaplan Meier survival curve analysis shows that the mean survival time of type A is 247.600 M (95% CI: 203.072 ∼ 292.128 M) and type B is 88.795 M (95% CI: 72.607 ∼ 104.984 M). The survival rate of femoral head of type A is significantly higher than that of type B (P < 0.005). This study demonstrates that type A shows a more satisfactory clinical outcomes and lower femoral head collapse rate in a mid-term follow-up.
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Affiliation(s)
- Zhong-Shu Wu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Guoju Hong
- Division of Orthopaedic Surgery, The University of Alberta, 116 Street, 85 Avenue, Edmonton, AB T6G 2R3, Canada
| | - Peng Yang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Fan Yang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Zhen-Qiu Chen
- No. 3 Orthopaedic Region, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Wei He
- Department of Orthopaedics, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 261 Longxi Road, Liwan District, Guangzhou 510378, China
- Traumatology and Orthopedics Institute of Guangzhou University of Chinese Medicine, No. 261 Longxi Road, Liwan District, Guangzhou 510378, China
| | - Qiu-Shi Wei
- Department of Orthopaedics, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 261 Longxi Road, Liwan District, Guangzhou 510378, China
- Traumatology and Orthopedics Institute of Guangzhou University of Chinese Medicine, No. 261 Longxi Road, Liwan District, Guangzhou 510378, China
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