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Yang TJ, Li Y, Wen PP, Wu ZX, Ye X, Zhang C, Sun SY, Zhang GY, Sun YF, Zhou CK, Ye R, He HJ. Clinical evaluation of blood flow in femoral head necrosis using color doppler ultrasound. Sci Rep 2025; 15:13260. [PMID: 40247092 PMCID: PMC12006462 DOI: 10.1038/s41598-025-98198-3] [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: 06/11/2024] [Accepted: 04/10/2025] [Indexed: 04/19/2025] Open
Abstract
This study aims to utilize Color Doppler Ultrasound to collect blood flow parameters of the medial circumflex femoral artery and explore the changes in blood flow in osteonecrosis of the femoral head, providing objective indicators for clinical assessment and prognosis. Color Doppler Ultrasound was used to examine the medial circumflex femoral artery in 30 patients with osteonecrosis of the femoral head (52 hips: ARCO Stage I-2 hips, Stage II-24 hips, Stage III-24 hips, Stage IV-2 hips) and 30 healthy controls (57 hips). Arterial diameter and blood flow parameters [peak systolic velocity, resistance index, pulsatility index] were collected and analyzed for vascular and blood flow characteristics in osteonecrosis of the femoral head. (1) Compared with the healthy group, the osteonecrosis group showed significantly lower peak systolic velocity and resistance index, while no significant differences were observed in arterial diameter and pulsatility index. (2) Arterial diameter in Stage I was significantly larger than in Stages II, III, and IV, with no significant differences observed among Stages II, III, and IV. Peak systolic velocity, resistance index, and pulsatility index all significantly decreased with disease progression from Stage I to Stage IV, but no significant difference in pulsatility index was found between Stages II and III. (3) There was no significant difference in arterial diameter between the non-collapsed and collapsed groups; however, peak systolic velocity, resistance index, and pulsatility index were all significantly lower in the collapsed group compared to the non-collapsed group. (1) The alterations in blood supply in femoral head necrosis primarily manifest as changes in blood flow parameters. (2) Vascular morphology and blood flow parameters could potentially be useful indicators for assessing the progression of femoral head necrosis. (3) Changes in blood flow parameters may provide valuable insights into the risk of femoral head collapse.
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Affiliation(s)
- Tong-Jie Yang
- Wangjing Hospital, China Academy of Chinese Medical Sciences, 6 South Middle Ring Road, Chaoyang District, Beijing, 100102, China
| | - Yan Li
- Wangjing Hospital, China Academy of Chinese Medical Sciences, 6 South Middle Ring Road, Chaoyang District, Beijing, 100102, China
| | - Peng-Peng Wen
- First Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Ouhai District, Wenzhou, 325000, Zhejiang Province, China
| | - Zi-Xuan Wu
- Wangjing Hospital, China Academy of Chinese Medical Sciences, 6 South Middle Ring Road, Chaoyang District, Beijing, 100102, China
- Beijing University of Chinese Medicine, No. 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Xin Ye
- The Third Affiliated Hospital of Zhejiang, Chinese Medical University, No. 219 Moganshan Road, Xihu District, Hangzhou, 310009, Zhejiang, China
- Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China
| | - Cheng Zhang
- Wangjing Hospital, China Academy of Chinese Medical Sciences, 6 South Middle Ring Road, Chaoyang District, Beijing, 100102, China
| | - Shi-Yi Sun
- Wangjing Hospital, China Academy of Chinese Medical Sciences, 6 South Middle Ring Road, Chaoyang District, Beijing, 100102, China
| | - Guang-Yi Zhang
- Wangjing Hospital, China Academy of Chinese Medical Sciences, 6 South Middle Ring Road, Chaoyang District, Beijing, 100102, China
- Beijing University of Chinese Medicine, No. 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Yi-Fei Sun
- Wangjing Hospital, China Academy of Chinese Medical Sciences, 6 South Middle Ring Road, Chaoyang District, Beijing, 100102, China
- Beijing University of Chinese Medicine, No. 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Cheng-Kun Zhou
- Wangjing Hospital, China Academy of Chinese Medical Sciences, 6 South Middle Ring Road, Chaoyang District, Beijing, 100102, China
| | - Ren Ye
- First Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Ouhai District, Wenzhou, 325000, Zhejiang Province, China
| | - Hai-Jun He
- Wangjing Hospital, China Academy of Chinese Medical Sciences, 6 South Middle Ring Road, Chaoyang District, Beijing, 100102, China.
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Özdemir E, Özdeş AA, Topsakal FE, Altay N, Özdeş HU, Demirel E. The Relationship Between Femoral Head Avascular Necrosis and Erectile Dysfunction: A Retrospective Case-Control Study Conducted in Türkiye. J Clin Med 2025; 14:2674. [PMID: 40283505 PMCID: PMC12027669 DOI: 10.3390/jcm14082674] [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: 03/02/2025] [Revised: 04/10/2025] [Accepted: 04/12/2025] [Indexed: 04/29/2025] Open
Abstract
Background/Objectives: Femoral head avascular necrosis (FAN) is a serious orthopedic disorder that causes the death of bone tissue as the outcome of the occlusion or insufficiency of the vessels supplying blood to the femoral head. It is especially common in middle-aged men. Factors such as alcohol consumption, corticosteroid use, trauma, and systemic diseases have influential roles in the development of FAN, and the ensuing vascular disruptions can also negatively affect the patient's broader systemic vascular health. Erectile dysfunction (ED) is a condition caused by an impairment in penile blood flow, which reduces quality of life in men and has psychosocial effects. This study examined the potential relationship between FAN and ED in consideration of the similar pathophysiological mechanisms of these conditions. Methods: The research was planned as a retrospective case-control study and conducted between January 2020 and December 2023. FAN was diagnosed based on the Ficat-Arlet classification using plain radiography and magnetic resonance imaging, and staging was performed with expert clinical evaluations. The International Index of Erectile Function (IIEF) scale was administered to evaluate ED. Data from 50 patients with FAN and 50 healthy men were evaluated using appropriate statistical methods, including univariate comparisons and correlation analysis. Results: The analysis demonstrated a significant association between increasing FAN stages and greater severity of erectile dysfunction (ED). ED was identified in 35 out of 50 patients in the FAN group (70%), compared to 15 out of 50 individuals in the control group (30%). This difference was statistically significant (p < 0.05), indicating a substantially higher prevalence of ED in patients with FAN. A significant negative correlation was also observed between the FAN stage and International Index of Erectile Function (IIEF) scores (Spearman's rho = -0.631; p = 0.001). The mean IIEF score was 23.4 in patients with FAN stage 1, which declined to 9.6 in those with stage 4, reflecting a marked deterioration in erectile function with advancing FAN stages. No statistically significant difference was found in the age distribution between the FAN and control groups (p > 0.05). Conclusions: This study demonstrates that, with the progression of FAN, systemic vascular deterioration affects penile blood flow, increasing the severity of ED. This finding highlights the common pathophysiological mechanisms of FAN and ED and reveals the importance of early diagnosis and multidisciplinary treatment approaches. This relationship should be examined in detail with larger samples and prospective designs in future studies.
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Affiliation(s)
- Ekrem Özdemir
- Department of Orthopedics and Traumatology, Erzurum City Hospital, 25240 Erzurum, Türkiye; (F.E.T.); (N.A.); (E.D.)
| | - Ahmet Alper Özdeş
- Department of Urology, Karakoçan State Hospital, 23600 Elazığ, Türkiye;
| | - Fatih Emre Topsakal
- Department of Orthopedics and Traumatology, Erzurum City Hospital, 25240 Erzurum, Türkiye; (F.E.T.); (N.A.); (E.D.)
| | - Nasuhi Altay
- Department of Orthopedics and Traumatology, Erzurum City Hospital, 25240 Erzurum, Türkiye; (F.E.T.); (N.A.); (E.D.)
| | - Hüseyin Utku Özdeş
- Department of Orthopedics and Traumatology, İnönü University Faculty of Medicine, 44280 Malatya, Türkiye;
| | - Esra Demirel
- Department of Orthopedics and Traumatology, Erzurum City Hospital, 25240 Erzurum, Türkiye; (F.E.T.); (N.A.); (E.D.)
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Chen T, Luo L, Li J, Li J, Lin T, Liu M, Sang H, Hong X, Pu J, Huang W. Advancements in 3D printing technologies for personalized treatment of osteonecrosis of the femoral head. Mater Today Bio 2025; 31:101531. [PMID: 40026627 PMCID: PMC11869124 DOI: 10.1016/j.mtbio.2025.101531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Revised: 01/25/2025] [Accepted: 01/28/2025] [Indexed: 03/05/2025] Open
Abstract
Three-dimensional (3D) printing technology has shown significant promise in the medical field, particularly in orthopedics, prosthetics, tissue engineering, and pharmaceutical preparations. This review focuses on the innovative application of 3D printing in addressing the challenges of osteonecrosis of the femoral head (ONFH). Unlike traditional hip replacement surgery, which is often suboptimal for younger patients, 3D printing offers precise localization of necrotic areas and the ability to create personalized implants. By integrating advanced biomaterials, this technology offers a promising strategy approach for early hip-preserving treatments. Additionally, 3D-printed bone tissue engineering scaffolds can mimic the natural bone environment, promoting bone regeneration and vascularization. In the future, the potential of 3D printing extends to combining with artificial intelligence for optimizing treatment plans, developing materials with enhanced bioactivity and compatibility, and translating these innovations from the laboratory to clinical practice. This review demonstrates how 3D printing technology uniquely addresses critical challenges in ONFH treatment, including insufficient vascularization, poor mechanical stability, and limited long-term success of conventional therapies. By introducing gradient porous scaffolds, bioactive material coatings, and AI-assisted design, this work outlines novel strategies to improve bone regeneration and personalized hip-preserving interventions. These advancements not only enhance treatment efficacy but also pave the way for translating laboratory findings into clinical applications.
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Affiliation(s)
- Tingting Chen
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian , 350108, China
| | - Lincong Luo
- Yue Bei People's Hospital Postdoctoral Innovation Practice Base, Southern Medical University, Guangzhou, 510515, China
| | - Jiaying Li
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong , 510515, China
| | - Jiamin Li
- School of Basic Medical Sciences, Guangdong Medical University, Dongguan, 523808, China
| | - Tao Lin
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong , 510515, China
| | - Mingrui Liu
- School of Basic Medicine, Dali University, Dali, Yunnan, 671003, China
| | - Hang Sang
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong , 510515, China
| | - Xinyu Hong
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian , 350108, China
| | - Jiahao Pu
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian , 350108, China
| | - Wenhua Huang
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian , 350108, China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong , 510515, China
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Cheng EY, Mirzaei A. Differential risk of autoimmune disorders in non-traumatic osteonecrosis: clue to pathogenesis. Expert Rev Clin Immunol 2025; 21:413-424. [PMID: 40035487 DOI: 10.1080/1744666x.2025.2475982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 02/11/2025] [Accepted: 03/03/2025] [Indexed: 03/05/2025]
Abstract
INTRODUCTION Non-traumatic osteonecrosis is a frequent complication in patients with autoimmune disorders, though its prevalence varies markedly depending upon the type of disorder. Understanding the causes of this difference can help uncover the underlying pathophysiology of osteonecrosis and guide the development of effective preventive and therapeutic strategies. AREAS COVERED In this perspective study, we reviewed available databases, including PubMed, Cochrane Library, Scopus, and Web of Science, to explore why the risk of osteonecrosis varies among different autoimmune disorders. Is this variation primarily due to the disease's pathophysiology, the use of medications such as corticosteroids, or a combination of both? If both factors are involved, what is the extent of each contribution in this context? EXPERT OPINION Non-traumatic osteonecrosis is often induced by an interaction between disease pathophysiology and corticosteroid use. In patients with different autoimmune disorders but an identical history of corticosteroid use, the risk of osteonecrosis is influenced by how the underlying pathophysiology compromises bone health. In autoimmune disorders with multiple adverse effects on bone, such as SLE (systemic lupus erythematosus), there is a much higher risk of osteonecrosis compared to disorders with minimal impact on bone health, such as celiac disease and MS (multiple sclerosis).
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Affiliation(s)
- Edward Y Cheng
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Alireza Mirzaei
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
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Qi T, Yan Y, Qi W, Chen W, Yang H. Hip joint-preserving strategies for treating osteonecrosis of the femoral head: From nonoperative to operative procedures. J Orthop Translat 2025; 51:256-277. [PMID: 40190345 PMCID: PMC11968294 DOI: 10.1016/j.jot.2025.02.001] [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: 07/18/2024] [Revised: 01/08/2025] [Accepted: 02/05/2025] [Indexed: 04/09/2025] Open
Abstract
Osteonecrosis of the femoral head (ONFH) has an exceedingly high prevalence and disability rate, causing a tremendous socioeconomic burden. The prevalence of ONFH is increasing, while the population of the patients with ONFH is becoming younger. Once the femoral head collapses, treatment becomes difficult and often requires a hip joint replacement, which is not favorable for young patients. Therefore, hip joint-preserving treatments at an early stage of ONFH are particularly important. This study provides a comprehensive review on hip-preserving strategies for treating ONFH, including nonoperative treatments (e.g., protective weight bearing, hyperbaric oxygen, pulsed electromagnetic, extracorporeal shockwave, bisphosphonate, anticoagulants, hypolipidemics, vasodilators, and traditional Chinese medicine) and operative treatments (e.g., core decompression, osteotomy, bone grafting, mesenchymal stem cell transplantation, tantalum rods, and tissue engineering). Nonoperative treatments aim to slow down the progression of the disease and delay the need for joint replacement; however, they usually cannot effectively prevent the progression of the disease, except in cases of small necrosis areas (<10 %). Additionally, nonoperative treatments have unclear mechanisms that require further investigation. In contrast, operative treatments may stop the negative outcomes of necrosis and therefore appear to be more promising. Currently, an emerging area in operative treatments is regenerative medicine, which could promote the generation of bone tissues and blood vessels and restore hip joint function to pre-necrotic levels as much as possible. This review seeks to not only provide an important reference for clinicians when choosing appropriate strategies for treating ONFH but also offer certain guidance for future basic research in developing ONFH treatments. The translational potential of this article The incidence of ONFH is increasing, and patients are becoming younger on average. Therefore, the development of hip joint-preserving strategies to treat ONFH at earlier stages is urgently needed, particularly for young patients. However, a comprehensive review is lacking regarding the currently-available hip joint-preserving strategies and their effectiveness. This study is motivated to fill this gap and serve as an important reference for clinicians in choosing appropriate strategies to treat ONFH.
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Affiliation(s)
- Tanqiu Qi
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
| | - Yan Yan
- Department of Orthopaedics, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
- Engineering Research Center of Chinese Orthopaedic and Sports Rehabilitation Artificial Intelligent, Ministry of Education, Beijing, China
| | - William Qi
- School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, United States
| | - Weiheng Chen
- Department of Orthopaedics, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
- Engineering Research Center of Chinese Orthopaedic and Sports Rehabilitation Artificial Intelligent, Ministry of Education, Beijing, China
| | - Haisheng Yang
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
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Tang H, Lai Y, Zhao E, Zhou K, Chen G, Zhou Z. Efficacy of small-diameter core decompression with platelet-rich plasma in early osteonecrosis of the femoral head: a retrospective study. BMC Musculoskelet Disord 2025; 26:9. [PMID: 39754197 PMCID: PMC11697860 DOI: 10.1186/s12891-024-08243-x] [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: 10/27/2024] [Accepted: 12/23/2024] [Indexed: 01/07/2025] Open
Abstract
BACKGROUND Osteonecrosis of the femoral head (ONFH) is a challenging condition, primarily affecting young and middle-aged individuals, which results in hip dysfunction and, ultimately, femoral head collapse. However, the comparative effectiveness of joint-preserving procedures, particularly in the early stages of ONFH (ARCO stage I or II), remains inconclusive. This study aims to evaluate the efficacy of a novel technique called small-diameter core decompression (CD) combined with platelet-rich plasma (PRP), for the treatment of early-stage ONFH. METHODS Clinical data of 40 patients (51 hips) with pre-collapse stage ONFH were retrospectively analyzed. Nineteen patients (23 hips) underwent small-diameter CD + PRP (group A) and 21 patients (28 hips) received conventional CD (group B) and follow-up was conducted every 3 months. Hip radiographs (X-rays and MRI) were evaluated using various ONFH staging systems (Preserved Angles, ARCO, JIC, and CHFJ stages). X-rays were performed at each follow-up to assess femoral head collapse and the rate of total hip arthroplasty (THA). Additionally, the Visual Analogue Scale (VAS), Harris Hip Score (HHS), Charnley score, SF-36, Athens Insomnia Scale (AIS), and State-Trait Anxiety Inventory (STAI) were used to evaluate hip pain, function, quality of life, and psychological status. These assessments were conducted both preoperatively and at each follow-up visit. RESULTS The mean follow-up duration in Group A was 11.57 months, with a femoral head survivorship of 82.61%. One hip underwent THA 14 months after the novel procedure. In Group B, with an average follow-up period of 11.32 months, femoral head survivorship was 60.71% (p = 0.111), and 2 hips required THA (p = 0.999). At the final follow-up, the VAS, stiffness, HHS and Charnley scores of Group A showed significant improvements compared to those in Group B. Quality of life, anxiety and insomnia were also significantly improved in the Group A compared to Group B. CONCLUSION The application of PRP following CD results in significant pain relief, improved short-term functional outcomes, and enhanced quality of life compared to CD alone. However, whether it hinders disease progression in early ONFH and reduces the conversion rate to THA and femoral head collapse remains uncertain. Further research with larger sample sizes and extended follow-up is needed to validate these preliminary findings.
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Affiliation(s)
- Haiwei Tang
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yahao Lai
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Enze Zhao
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Kai Zhou
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Gang Chen
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
| | - Zongke Zhou
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
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Cheng EY, Mirzaei A. Potential molecular targets for the pharmacologic management of non-traumatic osteonecrosis. Expert Opin Ther Targets 2024; 28:991-1000. [PMID: 39469902 DOI: 10.1080/14728222.2024.2421755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Accepted: 10/23/2024] [Indexed: 10/30/2024]
Abstract
INTRODUCTION Non-traumatic osteonecrosis is a debilitating condition marked by bone death, primarily due to reduced blood supply. Currently, no effective pharmacologic intervention is available to manage this condition effectively. AREAS COVERED Lipid metabolic disorders, chronic inflammation, vascular dysfunction, coagulopathy, and impaired bone homeostasis are suggested as the key pathogenic mechanisms involved in the development of non-traumatic osteonecrosis. Targeting any of these dysfunctions offers a potential avenue for pharmacologic intervention. However, the potential molecular targets for pharmacologic treatment of non-traumatic osteonecrosis remain underexplored. In this study, we reviewed available databases to compile a comprehensive set of pathogenic mechanisms and corresponding therapeutic targets for non-traumatic osteonecrosis. EXPERT OPINION Evidence suggests that a single pathogenic mechanism cannot fully explain the development of osteonecrosis, supporting the adoption of a multi-pathogenic theory. This theory implies that effective management of non-traumatic osteonecrosis requires targeting multiple pathogenic mechanisms simultaneously. Moreover, the same pathogenic mechanisms are unlikely to explain osteonecrosis development in patients with different etiologies. Consequently, a one-size-fits-all approach to medication is unlikely to be effective across all types of non-traumatic osteonecrosis. Future research should, therefore, focus on developing multi-target pharmacologic treatments tailored to the specific etiology of non-traumatic osteonecrosis.
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Affiliation(s)
- Edward Y Cheng
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Alireza Mirzaei
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
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Li C, Liu J, Sheng Y, Wang Y, Jia L, Zhang Y, Li J, Di S, Nie H, Han Y. In situ metabolomic analysis of osteonecrosis of the femoral head (ONFH) using MALDI MSI. Anal Bioanal Chem 2024; 416:5155-5164. [PMID: 39090265 DOI: 10.1007/s00216-024-05453-z] [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: 05/08/2024] [Revised: 06/25/2024] [Accepted: 07/15/2024] [Indexed: 08/04/2024]
Abstract
Osteonecrosis of the femoral head (ONFH) is a common orthopedic disease characterized by disability and deformity. To better understand ONFH at molecular level and to explore the possibility of early diagnosis, instead of diagnosis based on macroscopic spatial characteristics, a matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI MSI) method was developed for ONFH disease for the first time. The most challenging step for ONFH MSI is to deal with human bone tissues which are much harder than the other biological samples studied by the reported MSI studies. In this work, the MSI sectioning method of hard bone tissues was established using tender acids and a series of test criteria. Small-molecule metabolites, such as lipids and amino acids, were detected in bone sections, realizing the in situ detection of spatial distribution of biometabolites. By comparing the distribution of metabolites from different regions of normal femoral head, ONFH bone tissue (ONBT), and adjacent ONFH bone tissue (ANBT), the whole process of femoral head from normal stage to necrosis was monitored and visualized at molecular level. Moreover, this developed MSI method was used for metabolomics study of ONFH. 72 differential metabolites were identified, suggesting that disturbances in energy metabolism and lipid metabolism affected the normal life activities of osteoblasts and osteoclasts. This study provides new perspectives for future pathological studies of ONFH.
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Affiliation(s)
- Chen Li
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, 300211, China
| | - Jikun Liu
- State Key Laboratory of Heavy Oil Processing, China University of Petroleum, Beijing, 102200, China
| | - Yiqi Sheng
- State Key Laboratory of Heavy Oil Processing, China University of Petroleum, Beijing, 102200, China
| | - Yinghao Wang
- State Key Laboratory of Heavy Oil Processing, China University of Petroleum, Beijing, 102200, China
| | - Lan Jia
- Department of Kidney Disease and Blood Purification, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Yinguang Zhang
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, 300211, China
| | - Jiantao Li
- Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, 100048, China
| | - Shuangshuang Di
- Beijing National Laboratory for Molecular Sciences, College of Chemistry and Molecular Engineering, Peking University, Beijing, 100871, China
| | - Honggang Nie
- Beijing National Laboratory for Molecular Sciences, College of Chemistry and Molecular Engineering, Peking University, Beijing, 100871, China.
| | - Yehua Han
- State Key Laboratory of Heavy Oil Processing, China University of Petroleum, Beijing, 102200, China.
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Sato H, Kondo N, Kurosawa Y, Hasegawa E, Wakamatsu A, Nozawa Y, Kobayashi D, Nakatsue T, Wada Y, Kazama JJ, Kuroda T, Nakano M, Endo N, Narita I. Incidence and clinical course of femoral localized periosteal thickening and atypical femoral fracture over a 10-year period in patients with autoimmune inflammatory rheumatic disease. JBMR Plus 2024; 8:ziae090. [PMID: 39119540 PMCID: PMC11307327 DOI: 10.1093/jbmrpl/ziae090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 08/10/2024] Open
Abstract
Atypical femoral fracture (AFF) is generally a rare complication of long-term use of bisphosphonate (BP); glucocorticoid (GC) use and Asian race are also risk factors. Femoral localized periosteal thickening (LPT, also termed "beaking") of the lateral cortex often precedes AFF. This cohort study investigated the incidence of LPT and AFF and their clinical courses over 10 yr in patients with autoimmune inflammatory rheumatic diseases (AIRDs) treated with BP and GC. The study population consisted of 121 patients with AIRDs taking BP and GC. LPT was screened by X-ray, and the LPT shape was evaluated. Prednisolone (PSL) dose was 10 (8-12) mg/d at enrollment and 9 (6-10) mg/d at the last observation. LPT was evident in 10 patients at enrollment and increased linearly to 31 patients (26%) at the last observation. AFF occurred in 9 femurs of 5 patients with LPT. All patients with AFF had bilateral LPT, and the prevalence of pointed type and LPT height were higher in the AFF-positive group than in the AFF-negative group. AFF occurred before BP discontinuation in 2 patients, 1 yr after BP discontinuation in 1, after BP discontinuation followed by 7 yr of alfacalcidol use in 1, and after switching from alfacalcidol to denosumab in 1. The prevalence rates of AFF and LPT associated with long-term BP use with concomitant use of GC (mostly PSL ≥ 6 mg/d) in Japanese patients with AIRD increased over time. The selection of long-term osteoporosis treatment for LPT-positive patients is difficult in some cases.
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Affiliation(s)
- Hiroe Sato
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City 951-8510, Niigata, Japan
- Health Administration Center, Niigata University, 2-8050 Ikarashi, Nishi-ku, Niigata City 950-2181, Niigata, Japan
| | - Naoki Kondo
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City 951-8510, Niigata, Japan
| | - Yoichi Kurosawa
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City 951-8510, Niigata, Japan
| | - Eriko Hasegawa
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City 951-8510, Niigata, Japan
| | - Ayako Wakamatsu
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City 951-8510, Niigata, Japan
| | - Yukiko Nozawa
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City 951-8510, Niigata, Japan
- Health Administration Center, Niigata University, 2-8050 Ikarashi, Nishi-ku, Niigata City 950-2181, Niigata, Japan
| | - Daisuke Kobayashi
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City 951-8510, Niigata, Japan
| | - Takeshi Nakatsue
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City 951-8510, Niigata, Japan
| | - Yoko Wada
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City 951-8510, Niigata, Japan
| | - Junichiro James Kazama
- Department of Nephrology and Hypertension, Fukushima Medical University, 1 Hikariga-oka, Fukushima City 960-1295, Fukushima, Japan
| | - Takeshi Kuroda
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City 951-8510, Niigata, Japan
- Health Administration Center, Niigata University, 2-8050 Ikarashi, Nishi-ku, Niigata City 950-2181, Niigata, Japan
| | - Masaaki Nakano
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City 951-8510, Niigata, Japan
| | - Naoto Endo
- Division of Orthopedic Surgery, Tsubame Rosai Hospital, 633, Sawatari, Tsubame City 959-1228, Niigata, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City 951-8510, Niigata, Japan
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Dong S, Ge J, Meng Q, Yuan T, Wang Y, Li Y, Lu Q, Song W, Li Z, Sun S. Crebanine mitigates glucocorticoid-induced osteonecrosis of the femoral head by restoring bone remodelling homeostasis via attenuating oxidative stress. J Cell Mol Med 2024; 28:e70044. [PMID: 39205463 PMCID: PMC11358393 DOI: 10.1111/jcmm.70044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 07/24/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024] Open
Abstract
The onset of osteonecrosis of the femoral head (ONFH) is intimately associated with the extensive administration of glucocorticoids (GCs). Long-term stimulation of GCs can induce oxidative stress in both osteoclasts (OCs) and osteoblasts (OBs), resulting in the disturbance of bone remodelling. An alkaloid named crebanine (CN) demonstrates pharmacological properties including anti-inflammation and reactive oxygen species (ROS) modulation. Our objective is to assess the therapeutic potential of CN in treating ONFH and elucidate the associated underlying mechanisms. The network pharmacology analysis uncovered that CN played a role in regulating ROS metabolism. In vitro, CN demonstrated its ability to reduce the dexamethasone (DEX)-stimulated generation of OCs and suppress their resorptive function by downregulating the level of osteoclast marker genes. Concurrently, CN also mitigated DEX-induced damage to OBs, facilitating the restoration of osteoblast marker gene expression, cellular differentiation and function. These effects were achieved by CN augmenting the antioxidant system to reduce intracellular ROS levels. Furthermore, in vitro results were corroborated by micro-CT and histological data, which also showed that CN attenuated MPS-induced ONFH in mice. This study highlights the therapeutic potential of CN in counteracting GCs-induced ONFH.
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Affiliation(s)
- Shankun Dong
- Department of Joint SurgeryShandong Provincial Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
| | - Jianxun Ge
- Department of Joint SurgeryShandong Provincial Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
| | - Qi Meng
- Department of Joint SurgeryShandong Provincial Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
| | - Tao Yuan
- Department of Joint SurgeryShandong Provincial Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
| | - Yi Wang
- Department of Joint SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
- Orthopaedic Research Laboratory, Medical Science and Technology Innovation CenterShandong First Medical University and Shandong Academy of Medical SciencesJinanShandongChina
| | - Yi Li
- Department of Joint SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
- Orthopaedic Research Laboratory, Medical Science and Technology Innovation CenterShandong First Medical University and Shandong Academy of Medical SciencesJinanShandongChina
| | - Qizhen Lu
- Department of Joint SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
- Orthopaedic Research Laboratory, Medical Science and Technology Innovation CenterShandong First Medical University and Shandong Academy of Medical SciencesJinanShandongChina
| | - Wenao Song
- Department of Clinical LaboratoryShandong Provincial Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
| | - Ziqing Li
- Department of Joint SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
- Orthopaedic Research Laboratory, Medical Science and Technology Innovation CenterShandong First Medical University and Shandong Academy of Medical SciencesJinanShandongChina
| | - Shui Sun
- Department of Joint SurgeryShandong Provincial Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
- Department of Joint SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
- Orthopaedic Research Laboratory, Medical Science and Technology Innovation CenterShandong First Medical University and Shandong Academy of Medical SciencesJinanShandongChina
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11
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Meng Q, Wang Y, Yuan T, Su Y, Li Z, Sun S. Osteoclast: The novel whistleblower in osteonecrosis of the femoral head. GENE REPORTS 2023; 33:101833. [DOI: 10.1016/j.genrep.2023.101833] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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12
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Ko YS, Ha JH, Park JW, Lee YK, Kim TY, Koo KH. Updating Osteonecrosis of the Femoral Head. Hip Pelvis 2023; 35:147-156. [PMID: 37727298 PMCID: PMC10505838 DOI: 10.5371/hp.2023.35.3.147] [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: 01/27/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 09/21/2023] Open
Abstract
Osteonecrosis of the femoral head (ONFH), a condition characterized by the presence of a necrotic bone lesion in the femoral head, is caused by a disruption in the blood supply. Its occurrence is more common in young and middle-aged adults and it is the main reason for performance of total hip arthroplasty in this age group. Its incidence is increasing along with increased use of glucocorticoids for management of adjuvant therapy for treatment of leukemia as well as organ transplantation and other myelogenous diseases. Current information on etiology and pathogenesis, as well as natural history, stage system, and treatments is provided in this review. A description of the Association Research Circulation Osseous (ARCO) criteria for classification of glucocorticoids- and alcohol-associated ONFH, 2019 ARCO staging system, and 2021 ARCO classification using computed tomography for the early stages of ONFH is also provided.
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Affiliation(s)
- Young-Seung Ko
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joo Hyung Ha
- Department of Orthopaedic Surgery, Gumdan Top General Hospital, Incheon, Korea
| | - Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae-Young Kim
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Kay Joint Center at Cheil Orthopaedic Hospital, Seoul, Korea
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13
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孙 亚, 王 岩, 周 丽, 李 奕, 申 佳, 董 本, 杨 培, 李 岩, 马 剑, 马 信. [Research progress on the design of bone scaffolds with different single cell structures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:1037-1041. [PMID: 37586807 PMCID: PMC10435337 DOI: 10.7507/1002-1892.202303130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/27/2023] [Indexed: 08/18/2023]
Abstract
Objective To review the research progress of design of bone scaffolds with different single cell structures. Methods The related literature on the study of bone scaffolds with different single cell structures at home and abroad in recent years was extensively reviewed, and the research progress was summarized. Results The single cell structure of bone scaffold can be divided into regular cell structure, irregular cell structure, cell structure designed based on topology optimization theory, and cell structure designed based on triply periodic minimal surface. Different single cell structures have different structural morphology and geometric characteristics, and the selection of single cell structure directly determines the mechanical properties and biological properties of bone scaffold. It is very important to choose a reasonable cell structure for bone scaffold to replace the original bone tissue. Conclusion Bone scaffolds have been widely studied, but there are many kinds of bone scaffolds at present, and the optimization of single cell structure should be considered comprehensively, which is helpful to develop bone scaffolds with excellent performance and provide effective support for bone tissue.
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Affiliation(s)
- 亚迪 孙
- 天津大学天津医院(天津市天津医院)骨科研究所(天津 300211)Institute of Orthopaedics, Tianjin Hospital, Tianjin University (Tianjin Hospital), Tianjin, 300211, P. R. China
- 天津市骨科研究所(天津 300050)Tianjin Orthopedic Institute, Tianjin, 300050, P. R. China
- 天津市骨科生物力学与医学工程重点实验室(天津 300050)Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, P. R. China
| | - 岩 王
- 天津大学天津医院(天津市天津医院)骨科研究所(天津 300211)Institute of Orthopaedics, Tianjin Hospital, Tianjin University (Tianjin Hospital), Tianjin, 300211, P. R. China
- 天津市骨科研究所(天津 300050)Tianjin Orthopedic Institute, Tianjin, 300050, P. R. China
- 天津市骨科生物力学与医学工程重点实验室(天津 300050)Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, P. R. China
| | - 丽芸 周
- 天津大学天津医院(天津市天津医院)骨科研究所(天津 300211)Institute of Orthopaedics, Tianjin Hospital, Tianjin University (Tianjin Hospital), Tianjin, 300211, P. R. China
- 天津市骨科研究所(天津 300050)Tianjin Orthopedic Institute, Tianjin, 300050, P. R. China
- 天津市骨科生物力学与医学工程重点实验室(天津 300050)Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, P. R. China
| | - 奕扬 李
- 天津大学天津医院(天津市天津医院)骨科研究所(天津 300211)Institute of Orthopaedics, Tianjin Hospital, Tianjin University (Tianjin Hospital), Tianjin, 300211, P. R. China
- 天津市骨科研究所(天津 300050)Tianjin Orthopedic Institute, Tianjin, 300050, P. R. China
- 天津市骨科生物力学与医学工程重点实验室(天津 300050)Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, P. R. China
| | - 佳慧 申
- 天津大学天津医院(天津市天津医院)骨科研究所(天津 300211)Institute of Orthopaedics, Tianjin Hospital, Tianjin University (Tianjin Hospital), Tianjin, 300211, P. R. China
- 天津市骨科研究所(天津 300050)Tianjin Orthopedic Institute, Tianjin, 300050, P. R. China
- 天津市骨科生物力学与医学工程重点实验室(天津 300050)Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, P. R. China
| | - 本超 董
- 天津大学天津医院(天津市天津医院)骨科研究所(天津 300211)Institute of Orthopaedics, Tianjin Hospital, Tianjin University (Tianjin Hospital), Tianjin, 300211, P. R. China
- 天津市骨科研究所(天津 300050)Tianjin Orthopedic Institute, Tianjin, 300050, P. R. China
- 天津市骨科生物力学与医学工程重点实验室(天津 300050)Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, P. R. China
| | - 培川 杨
- 天津大学天津医院(天津市天津医院)骨科研究所(天津 300211)Institute of Orthopaedics, Tianjin Hospital, Tianjin University (Tianjin Hospital), Tianjin, 300211, P. R. China
- 天津市骨科研究所(天津 300050)Tianjin Orthopedic Institute, Tianjin, 300050, P. R. China
- 天津市骨科生物力学与医学工程重点实验室(天津 300050)Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, P. R. China
| | - 岩 李
- 天津大学天津医院(天津市天津医院)骨科研究所(天津 300211)Institute of Orthopaedics, Tianjin Hospital, Tianjin University (Tianjin Hospital), Tianjin, 300211, P. R. China
- 天津市骨科研究所(天津 300050)Tianjin Orthopedic Institute, Tianjin, 300050, P. R. China
- 天津市骨科生物力学与医学工程重点实验室(天津 300050)Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, P. R. China
| | - 剑雄 马
- 天津大学天津医院(天津市天津医院)骨科研究所(天津 300211)Institute of Orthopaedics, Tianjin Hospital, Tianjin University (Tianjin Hospital), Tianjin, 300211, P. R. China
- 天津市骨科研究所(天津 300050)Tianjin Orthopedic Institute, Tianjin, 300050, P. R. China
- 天津市骨科生物力学与医学工程重点实验室(天津 300050)Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, P. R. China
| | - 信龙 马
- 天津大学天津医院(天津市天津医院)骨科研究所(天津 300211)Institute of Orthopaedics, Tianjin Hospital, Tianjin University (Tianjin Hospital), Tianjin, 300211, P. R. China
- 天津市骨科研究所(天津 300050)Tianjin Orthopedic Institute, Tianjin, 300050, P. R. China
- 天津市骨科生物力学与医学工程重点实验室(天津 300050)Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, P. R. China
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Quan H, Ren C, He Y, Wang F, Dong S, Jiang H. Application of Biomaterials in Treating Early Osteonecrosis of the Femoral Head: Research Progress and Future Perspectives. Acta Biomater 2023; 164:15-73. [PMID: 37080444 DOI: 10.1016/j.actbio.2023.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/24/2023] [Accepted: 04/05/2023] [Indexed: 04/22/2023]
Abstract
Osteonecrosis of the femoral head (ONFH), a progressive pathological process of femoral head ischemia and osteocyte necrosis, is a refractory orthopedic disease caused by multiple etiologies and there is no complete cure at present. With the extension of ONFH duration, osteocyte apoptosis and trabecular bone loss can decrease the load-bearing capacity of the femoral head, which leads to the collapse of the articular cartilage and subchondral bone. Therefore, an urgent clinical need exists to develop effective treatment strategies of early-stage ONFH for maintaining the hip joint function and preventing femoral head collapse. In recent years, extensive attention has been paid to the application of diverse biomaterials in treating early ONFH for sustaining the normal morphology and function of the autologous femoral head, and slowing disease progression. Herein, we review the research progress of bone grafts, metallic materials, bioceramics, bioglasses and polymer materials for early ONFH treatment, and discuss the biological mechanisms of bone repair and regeneration in the femoral-head necrotic area. We propose suggestions for future research directions, from a special perspective of improving the local microenvironment in femoral head by facilitating vessel-associated osteoclasts (VAOs) generation and coupling of bone-specific angiogenesis and osteogenesis, as well as inhibiting bone-associated osteoclasts (BAOs) and BAO-mediated bone resorption. This review can provide ideas for the research, development, and clinical application of biomaterials for treating early ONFH. STATEMENT OF SIGNIFICANCE: We believe that at least three aspects of this manuscript make it interesting to readers of the Acta Biomaterialia. First, we briefly summarize the incidence, pathogenesis, risk factors, classification criteria and treatment of early osteonecrosis of the femoral head (ONFH). Second, we review the research progress in biomaterials for early ONFH treatment and the biological mechanisms of bone repair and regeneration in femoral-head necrotic area. Third, we propose future research progress on improving the local microenvironment in femoral head by facilitating vessel-associated osteoclasts generation and coupling of bone-specific angiogenesis and osteogenesis, as well as inhibiting bone-associated osteoclasts and bone resorption. We hope this review can provide ideas for the research, development, and clinical application of biomaterials for treating early ONFH.
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Affiliation(s)
- Hongyu Quan
- Department of Biomedical Materials Science, School of Biomedical Engineering, Third Military Medical University, Chongqing, 400038, China; College of Bioengineering, Chongqing University, Chongqing, 400044, China
| | - Chencan Ren
- Department of Biomedical Materials Science, School of Biomedical Engineering, Third Military Medical University, Chongqing, 400038, China; College of Bioengineering, Chongqing University, Chongqing, 400044, China
| | - Yuwei He
- Department of Biomedical Materials Science, School of Biomedical Engineering, Third Military Medical University, Chongqing, 400038, China
| | - Fuyou Wang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
| | - Shiwu Dong
- Department of Biomedical Materials Science, School of Biomedical Engineering, Third Military Medical University, Chongqing, 400038, China; State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing 400038, China.
| | - Hong Jiang
- Department of Biomedical Materials Science, School of Biomedical Engineering, Third Military Medical University, Chongqing, 400038, China.
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Téllez Arévalo AM, Quaye A, Rojas-Rodríguez LC, Poole BD, Baracaldo-Santamaría D, Tellez Freitas CM. Synthetic Pharmacotherapy for Systemic Lupus Erythematosus: Potential Mechanisms of Action, Efficacy, and Safety. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:56. [PMID: 36676680 PMCID: PMC9866503 DOI: 10.3390/medicina59010056] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
The pharmacological treatment of systemic lupus erythematosus (SLE) aims to decrease disease activity, progression, systemic compromise, and mortality. Among the pharmacological alternatives, there are chemically synthesized drugs whose efficacy has been evaluated, but which have the potential to generate adverse events that may compromise adherence and response to treatment. Therapy selection and monitoring will depend on patient characteristics and the safety profile of each drug. The aim of this review is to provide a comprehensive understanding of the most important synthetic drugs used in the treatment of SLE, including the current treatment options (mycophenolate mofetil, azathioprine, and cyclophosphamide), review their mechanism of action, efficacy, safety, and, most importantly, provide monitoring parameters that should be considered while the patient is receiving the pharmacotherapy.
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Affiliation(s)
- Angélica María Téllez Arévalo
- Department of Physiological Sciences, School of Medicine, Pontificia Universidad Javeriana, Carrera 7 No. 40–62, Bogotá 110231, Colombia
| | - Abraham Quaye
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, UT 84602, USA
| | - Luis Carlos Rojas-Rodríguez
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia
| | - Brian D. Poole
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, UT 84602, USA
| | - Daniela Baracaldo-Santamaría
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia
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16
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Jia Y, Sun J, Jia Z, Xue Z, Wang R, He H, Chen W. Tongue Manifestation in Patients with Osteonecrosis of the Femoral Head: A Cross-sectional Study. Orthop Surg 2022; 14:2023-2030. [PMID: 35894147 PMCID: PMC9483080 DOI: 10.1111/os.13388] [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: 12/10/2021] [Revised: 06/08/2022] [Accepted: 06/11/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Although tongue manifestation is a vital component of Traditional Chinese Medicine (TCM), relevant research on patients with osteonecrosis of the femoral head (ONFH) is still lacking. This study will explore the characteristic tongue manifestation of ONFH patients to inform future research and clinical practice. METHODS This is a cross-sectional study. All ONFH patients meeting criteria and their clinical data were collected from the online China osteonecrosis of the femoral head database (CONFHD) since it was created. Organized tongue manifestations of eligible patients through the tongue manifestation acquisition instrument, including tongue shape, tongue color, tongue coating thickness, tongue coating color and tongue coating moisture. We used descriptive analysis for the general information while systematic clustering analysis for the better summary of tongue characteristics. RESULTS A total of 375 ONFH patients were included with an average age of 46.3 years. Most patients appeared with enlarged tongue body (54.4%), and the proportions of pale and red tongue (62.4%) were higher than others. Tongue coating were mainly showed as thick (64.5%), white (57.6%) and moist (79.7%). Comparison of tongue shape between different causes of ONFH had a significant statistically difference (P = 0.000). Tongue manifestations could be cluster analyzed into three categories which were matched into four TCM syndromes. CONCLUSIONS The tongue manifestation of ONFH patients has a significant change both in tongue body and coating, and different features may be related to the ONFH pathology. This study provides new and valuable tongue informations for a preliminary screening of ONFH patients.
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Affiliation(s)
- Yan Jia
- Department of Minimally Invasive Arthrology, The Third Affiliated Hospital of Beijing University of Chinese medicine, Beijing, China
| | - Jigao Sun
- Department of Minimally Invasive Arthrology, The Third Affiliated Hospital of Beijing University of Chinese medicine, Beijing, China.,Department of Orthopedics, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Zhaoxu Jia
- Department of Minimally Invasive Arthrology, The Third Affiliated Hospital of Beijing University of Chinese medicine, Beijing, China.,Department of Orthopedics, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Zhipeng Xue
- Department of Minimally Invasive Arthrology, The Third Affiliated Hospital of Beijing University of Chinese medicine, Beijing, China
| | - Rongtian Wang
- Department of Minimally Invasive Arthrology, The Third Affiliated Hospital of Beijing University of Chinese medicine, Beijing, China
| | - Haijun He
- Third Department of Orthopedics, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Weiheng Chen
- Department of Minimally Invasive Arthrology, The Third Affiliated Hospital of Beijing University of Chinese medicine, Beijing, China
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17
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Network-Based Pharmacology and Bioinformatics Study on the Mechanism of Action of Gujiansan in the Treatment of Steroid-Induced Avascular Necrosis of the Femoral Head. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8080679. [PMID: 35915795 PMCID: PMC9338865 DOI: 10.1155/2022/8080679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/17/2022] [Indexed: 11/18/2022]
Abstract
Objective To investigate the main pharmacological basis and mechanism of action of Gujiansan in the treatment of steroid-induced avascular necrosis of the femoral head (SANFH). Methods The active constituents and targets of Gujiansan were screened by using TCMSP and other databases, and relevant disease targets were obtained by analyzing the microarray of SANFH in the GEO database. The intersection of the two was taken to obtain the potential targets of Gujiansan for the treatment of SANFH, and key active constituents were screened with the “active constituent-target” network constructed by the Cytoscape software; then, the STRING database was used to construct the protein interaction network to screen the key targets. The Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses of key targets were performed by the DAVID database, and the relationship between the “key active constituent-key target-key signaling pathway” was explored. Finally, the molecular docking between key active constituents and key targets was verified. In addition, qPCR detection technology was used to evaluate the preventive and therapeutic effects of key active constituents of Gujiansan in a rat osteoblast model of SANFH to verify the possible mechanism of the effect of Gujiansan in the treatment of SANFH. Results (1) 106 active constituents and 55 targets were obtained for the treatment of SANFH. (2) Quercetin, luteolin, kaempferol, cryptotanshinone, and naringenin were the key active constituents for the treatment of SANFH. (3) IL1B, STAT3, CAT, PTGS2, and MAPK3 were the key targets for the treatment of SANFH. (4) IL1B, STAT3, CAT, PTGS2, MAPK3, and HMOX1 are key targets in the protein interaction network. (5) DAVID enrichment analysis mainly covers the regulation of DNA-binding transcription factor activity, positive regulation of cytokine production, and response to oxidative stress and other biological processes, involving IL-17, AGE-RAGE, C-type lectin receptor, and other signaling pathways. (6) Gujiansan is a multitarget and multisignaling pathway for the treatment of SANFH. (7) Good binding activity exists between key active constituents and key targets. Conclusion This study analyzes the potential mechanism of action of Gujiansan in the treatment of SANFH with network pharmacology, which can provide a reference for the further study of its pharmacological basis and targets.
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18
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Koo KH, Mont MA, Cui Q, Hines JT, Yoon BH, Novicoff WM, Lee YJ, Cheng EY, Drescher W, Hernigou P, Kim SY, Sugano N, Zhao DW, Ha YC, Goodman SB, Sakai T, Jones LC, Lee MS, Yamamoto T, Lee YK, Kang Y, Burgess J, Chen D, Quinlan N, Xu JZ, Park JW, Kim HS. The 2021 Association Research Circulation Osseous Classification for Early-Stage Osteonecrosis of the Femoral Head to Computed Tomography-Based Study. J Arthroplasty 2022; 37:1074-1082. [PMID: 35151809 DOI: 10.1016/j.arth.2022.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/24/2022] [Accepted: 02/03/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The Association Research Circulation Osseous developed a novel classification for early-stage (precollapse) osteonecrosis of the femoral head (ONFH). We hypothesized that the novel classification is more reliable and valid when compared to previous 3 classifications: Steinberg, modified Kerboul, and Japanese Investigation Committee classifications. METHODS In the novel classification, necrotic lesions were classified into 3 types: type 1 is a small lesion, where the lateral necrotic margin is medial to the femoral head apex; type 2 is a medium-sized lesion, with the lateral necrotic margin being between the femoral head apex and the lateral acetabular edge; and type 3 is a large lesion, which extends outside the lateral acetabular edge. In a derivation cohort of 40 early-stage osteonecrotic hips based on computed tomography imaging, reliabilities were evaluated using kappa coefficients, and validities to predict future femoral head collapse by chi-squared tests and receiver operating characteristic curve analyses. The predictability for future collapse was also evaluated in a validation cohort of 104 early-stage ONFH. RESULTS In the derivation cohort, interobserver reliability (k = 0.545) and intraobserver agreement (63%-100%) of the novel method were higher than the other 3 classifications. The novel classification system was best able to predict future collapse (P < .05) and had the best discrimination between non-progressors and progressors in both the derivation cohort (area under the curve = 0.692 [0.522-0.863], P < .05) and the validation cohort (area under the curve = 0.742 [0.644-0.841], P = 2.46 × 10-5). CONCLUSION This novel classification is a highly reliable and valid method of those examined. Association Research Circulation Osseous recommends using this method as a unified classification for early-stage ONFH. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Kyung-Hoi Koo
- Department of Orthopaedic surgery, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, South Korea
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Jeremy T Hines
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Byung-Ho Yoon
- Department of Orthopaedic Surgery, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Wendy M Novicoff
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Yun Jong Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, South Korea
| | - Edward Y Cheng
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN
| | - Wolf Drescher
- Department of Orthopaedic and Trauma Surgery, RWTH Aachen University, Aachen, Germany
| | | | - Shin-Yoon Kim
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - De-Wei Zhao
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Lynne C Jones
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mel S Lee
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Young-Kyun Lee
- Department of Orthopaedic surgery, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, South Korea
| | - Yusuhn Kang
- Department of Diagnostic Radiology, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, South Korea
| | - James Burgess
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Dennis Chen
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Nicole Quinlan
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Jian Zhong Xu
- Department of Orthopaedic Surgery, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Jung-Wee Park
- Department of Orthopaedic surgery, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, South Korea
| | - Hong-Seok Kim
- Department of Orthopaedic surgery, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, South Korea
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19
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Li W, Huang Z, Tan B, Chen G, Li X, Xiong K, Zhu R, Li R, Li S, Ye H, Liang Z, Dong X, Zhou S, Chen S, Xi H, Cheng H, Xu R, Tu S, Chen Z, Qi L, Song J, Xiao R, Liu H, Nan Q, Yu H, Cui H, Shen Y, Wang C, Lin N, Zhang Y, Chen W. General recommendation for assessment and management on the risk of glucocorticoid-induced osteonecrosis in patients with COVID-19. J Orthop Translat 2021; 31:1-9. [PMID: 34692412 PMCID: PMC8526281 DOI: 10.1016/j.jot.2021.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/02/2021] [Accepted: 09/14/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/OBJECTIVE Coronavirus disease 2019 (COVID-19) is a disaster in human medical history and glucocorticoids remain the most promising therapy. Osteonecrosis is a disease caused by reduced intraosseous blood flow to bones in the joints, which will rapidly induce joint destruction. Approximately one-third patients with severe acute respiratory syndrome (SARS) who received high cumulative doses and long treatment durations of glucocorticoids occurred osteonecrosis. Considering the similarity of SARS and COVID-19 on their pathogen, clinical characteristics, and therapeutic strategies, it is particularly desirable to investigate whether osteonecrosis will become a common sequela among convalescent COVID-19 patients. METHODS This multi-strategy study was designed by integrating different research methods, such as meta-analysis, systematic review, and cross-sectional investigations to address above study objectives. At first, two meta-analyses were performed on the osteonecrosis incidence among SARS patients and the clinical data of glucocorticoid exposure among COVID-19 patients. Then, a systematic review of low-dosage glucocorticoid associated osteonecrosis and a cross-sectional investigation of glucocorticoid exposure of COVID-19 patients in Wuhan city of China were also conducted. Moreover, the pathogenesis, diagnosis, prevention, and treatment options for osteonecrosis patients with COVID-19 infection were further presented and discussed. RESULTS Our meta-analysis showed that 32% of SARS patients had developed osteonecrosis after receiving glucocorticoid treatment with high dose, and our system review supported that low level glucocorticoid exposure might also lead to the occurrence of osteonecrosis. Similarly, 40% of COVID-19 patients had undergone glucocorticoid treatment according to our meta-analysis. The cross-sectional investigation in Wuhan city of China found that the average of cumulative glucocorticoid exposure level was 504 mg calculated by the dosage of methylprednisolone. Notably, a confirmed osteonecrosis case was identified from 1406 patients with COVID-19 during our cross-sectional investigation, implying that preventive management of osteonecrosis should be better started with regular clinical follow-up observation. CONCLUSION Growing evidence of the glucocorticoid therapy for COVID-19 patients prompts us to establish risk-classification-based early screening and to introduce early prevention protocol of its associated osteonecrosis that will be of clinical significance in favor of improved prognosis of this disease. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE To establish risk-classification-based early screening and to introduce early prevention protocol of glucocorticoid-induced osteonecrosis will be of clinical significance in favor of improved prognosis of COVID-19.
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Affiliation(s)
- Wenlong Li
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Zeqing Huang
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, PR China
| | - Biao Tan
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, PR China
| | - Gang Chen
- Hubei College of Chinese Medicine, Jingzhou, 434020, PR China
- Hubei University of Chinese Medicine, Wuhan, 430065, PR China
| | - Xugui Li
- Hubei 672 Orthopaedics Hospital of Integrated Chinese and Western Medicine, Wuhan, 430079, PR China
| | - Kan Xiong
- Wuhan Jiangxia District Hospital of Traditional Chinese Medicine, Wuhan, 430200, PR China
| | - Ruizheng Zhu
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Ruihan Li
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Shuwen Li
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Hengli Ye
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
- Guizhou University of Traditional Chinese Medicine, Guiyang, 550025, PR China
| | - Zhi Liang
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Xiaojun Dong
- Wuhan Hospital of Traditional Chinese Medicine, Wuhan, 430014, PR China
| | - Shijing Zhou
- Hubei 672 Orthopaedics Hospital of Integrated Chinese and Western Medicine, Wuhan, 430079, PR China
| | - Song Chen
- Hubei University of Chinese Medicine, Wuhan, 430065, PR China
| | - Haixiang Xi
- Wuhan Hospital of Traditional Chinese Medicine, Wuhan, 430014, PR China
| | - Hao Cheng
- Hubei 672 Orthopaedics Hospital of Integrated Chinese and Western Medicine, Wuhan, 430079, PR China
| | - Rongpeng Xu
- Hubei College of Chinese Medicine, Jingzhou, 434020, PR China
| | - Shenghao Tu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Zhe Chen
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Lihua Qi
- Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, 430061, PR China
| | - Jiandong Song
- Hubei Integrated Traditional Chinese and Western Medicine Hospital, Wuhan, 430015, PR China
| | - Ruoran Xiao
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Huilan Liu
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Qian Nan
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Huiyong Yu
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Hongsheng Cui
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Yanguang Shen
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Chengxiang Wang
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Na Lin
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, PR China
| | - Yanqiong Zhang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, PR China
| | - Weiheng Chen
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
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20
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Finch ER, Payton MA, Jenkins DA, Cai X, Li L, Karol SE, Relling MV, Janke LJ. Fenofibrate reduces osteonecrosis without affecting antileukemic efficacy in dexamethasone-treated mice. Haematologica 2021; 106:2095-2101. [PMID: 32675219 PMCID: PMC8327737 DOI: 10.3324/haematol.2020.252767] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Indexed: 01/19/2023] Open
Abstract
Recent clinical trials in children with acute lymphoblastic leukemia (ALL) indicate that severe hypertriglyceridemia (>1000 mg/dL) during therapy is associated with an increased frequency of symptomatic osteonecrosis. Interventions to lower triglycerides have been considered, but there have been no preclinical studies investigating the impact of lowering triglycerides on osteonecrosis risk, nor whether such interventions interfere with the antileukemic efficacy of ALL treatment. We utilized our clinically relevant mouse model of dexamethasoneinduced osteonecrosis to determine whether fenofibrate decreased osteonecrosis. To test whether fenofibrate affected the antileukemic efficacy of dexamethasone, we utilized a BCR-ABL+ model of ALL. Serum triglycerides were reduced by fenofibrate throughout the period of treatment, with the most pronounced, 4.5-fold, decrease at week 3 (P<1x10-6). Both frequency (33% vs. 74%, P=0.006) and severity (median necrosis score of 0 vs. 75; P=6x10-5) of osteonecrosis were reduced with fenofibrate. Fenofibrate had no impact on BCR-ABL+ ALL survival (P=0.65) nor on the antileukemic properties of dexamethasone (P=0.49). These data suggest that lowering triglycerides with fenofibrate reduces dexamethasone- induced osteonecrosis while maintaining antileukemic efficacy, and thus may be considered for clinical trials.
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Affiliation(s)
- Emily R Finch
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Monique A Payton
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - David A Jenkins
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Xiangjun Cai
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lie Li
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Seth E Karol
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Mary V Relling
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Laura J Janke
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
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21
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Hines JT, Jo WL, Cui Q, Mont MA, Koo KH, Cheng EY, Goodman SB, Ha YC, Hernigou P, Jones LC, Kim SY, Sakai T, Sugano N, Yamamoto T, Lee MS, Zhao D, Drescher W, Kim TY, Lee YK, Yoon BH, Baek SH, Ando W, Kim HS, Park JW. Osteonecrosis of the Femoral Head: an Updated Review of ARCO on Pathogenesis, Staging and Treatment. J Korean Med Sci 2021; 36:e177. [PMID: 34155839 PMCID: PMC8216992 DOI: 10.3346/jkms.2021.36.e177] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 11/22/2022] Open
Abstract
Non-traumatic osteonecrosis of the femoral head (ONFH) usually affects adults younger than 50 years and frequently leads to femoral head collapse and subsequent arthritis of the hip. It is becoming more prevalent along with increasing use of corticosteroids for the adjuvant therapy of leukemia and other myelogenous diseases as well as management of organ transplantation. This review updated knowledge on the pathogenesis, classification criteria, staging system, and treatment of ONFH.
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Affiliation(s)
- Jeremy T Hines
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Woo Lam Jo
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Kyung Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
| | - Edward Y Cheng
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA
| | - Yong Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | | | - Lynne C Jones
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shin Yoon Kim
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Mel S Lee
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Dewei Zhao
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Wolf Drescher
- Department of Orthopedic Surgery, RWTH University Hospital, Aachen, Germany
| | - Tae Young Kim
- Department of Orthopaedic Surgery, Konkuk University College of Medicine, Seoul, Korea
| | - Young Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Byung Ho Yoon
- Department of Orthopaedic Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Seung Hoon Baek
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Wataru Ando
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hong Seok Kim
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jung Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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22
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Long Y, Zhang S, Zhao J, You H, Zhang L, Li J, Leng X, Wang Q, Tian X, Li M, Zeng X. Risk of osteonecrosis in systemic lupus erythematosus: An 11-year Chinese single-center cohort study. Lupus 2021; 30:1459-1468. [PMID: 34082592 DOI: 10.1177/09612033211021166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Osteonecrosis (ON), which can lead to physical disability, is a common complication of systemic lupus erythematosus (SLE). The purpose of this study was to determine the prevalence of ON and identify possible risk factors in Chinese SLE patients. METHODS SLE patients who fulfilled the 1997 American College of Rheumatology SLE classification criteria were recruited from the Peking Union Medical College Hospital. The chi-square test (χ2 test) and multivariate regression analyses were used to evaluate risk factors. The Cox proportional-hazards model was used to construct the survival curves and estimate the simultaneous effects of prognostic factors on survival. RESULTS We consecutively enrolled 1,158 patients, of which 88 patients (7.6%) developed ON. Among ON patients, 57.1% of patients had isolated femoral head necrosis and 42.9% had multiple joint involvement. The mean age of ON patients (24.62 ± 8.89 years) was significantly younger than SLE patients without ON (27.23 ± 10.16 years, p = 0.09). The ON group presented with a much longer disease course (10.68 ± 5.97 years, p < 0.001) and increased incidence of arthritis, kidney, and central nervous system (CNS) involvement (65.9% [p < 0.05], 57.6% [p < 0.05], and 16.5% [p < 0.05], respectively, in the ON group). ON patients were more likely to be treated with glucocorticoid (GC) and to receive a high dose of prednisolone at the initial stage of SLE (p < 0.05). The percentage of patients who received hydroxychloroquine was much higher in the control group (p < 0.001). Cox regression analysis suggested that CNS involvement and GC therapy were two independent risk factors for ON in SLE patients. The presence of anti-phospholipid antibodies (aPLs) was a risk factor for multiple joint necrosis (odds ratio: 6.28, p = 0.009). CONCLUSIONS ON remains a serious and irreversible complication in SLE. In addition to glucocorticoid therapy, we found that CNS system involvement was a risk factor for ON, while the administration of hydroxychloroquine was a protective factor. The clinical characteristics of multiple site ON patients were distinct from isolated femoral head necrosis patients. The presence of aPLs was a risk factor for multiple site osteonecrosis.
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Affiliation(s)
- Yin Long
- Department of Rheumatology and Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shangzhu Zhang
- Department of Rheumatology and Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China.,Ministry of Education, Key Laboratory of Rheumatology and Clinical Immunology, Beijing, China
| | - Jiuliang Zhao
- Department of Rheumatology and Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China.,Ministry of Education, Key Laboratory of Rheumatology and Clinical Immunology, Beijing, China.,Chinese Rheumatism Data Center (CRDC), Chinese SLE Treatment and Research Group (CSTAR), Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hanxiao You
- Department of Rheumatology and Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Zhang
- Department of Rheumatology and Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China.,Ministry of Education, Key Laboratory of Rheumatology and Clinical Immunology, Beijing, China
| | - Jing Li
- Department of Rheumatology and Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China.,Ministry of Education, Key Laboratory of Rheumatology and Clinical Immunology, Beijing, China
| | - Xiaomei Leng
- Department of Rheumatology and Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China.,Ministry of Education, Key Laboratory of Rheumatology and Clinical Immunology, Beijing, China
| | - Qian Wang
- Department of Rheumatology and Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China.,Ministry of Education, Key Laboratory of Rheumatology and Clinical Immunology, Beijing, China.,Chinese Rheumatism Data Center (CRDC), Chinese SLE Treatment and Research Group (CSTAR), Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xinping Tian
- Department of Rheumatology and Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China.,Ministry of Education, Key Laboratory of Rheumatology and Clinical Immunology, Beijing, China.,Chinese Rheumatism Data Center (CRDC), Chinese SLE Treatment and Research Group (CSTAR), Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Mengtao Li
- Department of Rheumatology and Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China.,Ministry of Education, Key Laboratory of Rheumatology and Clinical Immunology, Beijing, China.,Chinese Rheumatism Data Center (CRDC), Chinese SLE Treatment and Research Group (CSTAR), Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China.,Ministry of Education, Key Laboratory of Rheumatology and Clinical Immunology, Beijing, China.,Chinese Rheumatism Data Center (CRDC), Chinese SLE Treatment and Research Group (CSTAR), Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Wang G, Xin H, Tian G, Sheng K, Zhang N, Sun S. Core decompression combined with implantation of β-tricalcium phosphate modified by a BMSC affinity cyclic peptide for the treatment of early osteonecrosis of the femoral head. Am J Transl Res 2021; 13:967-978. [PMID: 33841633 PMCID: PMC8014422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 01/23/2021] [Indexed: 06/12/2023]
Abstract
Early intervention of osteonecrosis of the femoral head (ONFH) is very important. At present, the therapeutic effect on early ONFH is not completely satisfactory. D7 peptide has special affinity towards bone marrow mesenchymal stem cell (BMSC). Taking advantage of the adsorption/freeze-drying strategy, we constructed D7 cyclic peptide-modified β-tricalcium phosphate (β-TCP) scaffolds. The functional β-TCP scaffolds can enhance adhesion, spreading and proliferation of BMSCs compared with unmodified β-TCP scaffolds, which was comfired in cytological experiments. In rabbit model of early ONFH, functional β-TCP scaffolds were stuffed into the cavities after core decompression (CD). Radiographic and histological examination confirmed that CD followed by filling of functional β-TCP scaffolds can obviously improve the therapeutic effect of early ONFH. Our study provides a new option for curing early ONFH.
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Affiliation(s)
- Guozong Wang
- Department of Joint Surgery, People’s Hospital of RizhaoRizhao 276800, Shandong, China
| | - Hua Xin
- Department of Neurology, People’s Hospital of RizhaoRizhao 276800, Shandong, China
| | - Guanghao Tian
- Department of Internal Medicine, Lixia People’s HospitalJinan 250014, Shandong, China
| | - Kuisheng Sheng
- Department of Orthopedics, Rizhao City Traditional Chinese Medicine HospitalRizhao 276800, Shandong, China
| | - Nianping Zhang
- The Teaching and Research Section of Surgery, The First Clinical College of Shandong University of Traditional Chinese MedicineJinan 250355, Shandong, China
| | - Shui Sun
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan 250021, Shandong, China
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Cui Q, Jo WL, Koo KH, Cheng EY, Drescher W, Goodman SB, Ha YC, Hernigou P, Jones LC, Kim SY, Lee KS, Lee MS, Lee YJ, Mont MA, Sugano N, Taliaferro J, Yamamoto T, Zhao D. ARCO Consensus on the Pathogenesis of Non-traumatic Osteonecrosis of the Femoral Head. J Korean Med Sci 2021; 36:e65. [PMID: 33724736 PMCID: PMC7961868 DOI: 10.3346/jkms.2021.36.e65] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/08/2021] [Indexed: 02/04/2023] Open
Abstract
Osteonecrosis of the femoral head (ONFH) is a devastating disease frequently leading to femoral head collapse and hip arthritis. Specifically, non-traumatic ONFH primarily affects young and middle-aged adults. Although compromised local circulation of the femoral head seems to be pathognomonic for the disease, the pathogenesis is perplexing and continues to be an area of scrutiny and research. Comprehension of the pathogenesis is of crucial importance for developing and guiding treatments for the disease. Therefore, we provide an up-to-date consensus on the pathogenesis of non-traumatic ONFH.
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Affiliation(s)
- Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Woo Lam Jo
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Kyung Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital and Medical College of Seoul National University, Seongnam, Korea
| | - Edward Y Cheng
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Wolf Drescher
- Department of orthopedic surgery, RWTH University Hospital, Aachen, Germany
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA
| | - Yong Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | | | - Lynne C Jones
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shin Yoon Kim
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyu Sang Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mel S Lee
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yun Jong Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital and Medical College of Seoul National University, Seongnam, Korea
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Nobuhiko Sugano
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - John Taliaferro
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Dewei Zhao
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
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Goodman SB, Maruyama M. Inflammation, Bone Healing and Osteonecrosis: From Bedside to Bench. J Inflamm Res 2020; 13:913-923. [PMID: 33223846 PMCID: PMC7671464 DOI: 10.2147/jir.s281941] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/22/2020] [Indexed: 12/15/2022] Open
Abstract
Osteonecrosis of the epiphyseal and metaphyseal regions of major weight-bearing bones of the extremities is a condition that is associated with local death of bone cells and marrow in the afflicted compartment. Chronic inflammation is a prominent feature of osteonecrosis. If the persistent inflammation is not resolved, this process will result in progressive collapse and subsequent degenerative arthritis. In the pre-collapse stage of osteonecrosis, attempt at joint preservation rather than joint replacement in this younger population with osteonecrosis is a major clinical objective. In this regard, core decompression, with/without local injection of bone marrow aspirate concentrate (BMAC), is an accepted and evidence-based method to help arrest the progression and improve the outcome of early-stage osteonecrosis. However, some patients do not respond favorably to this treatment. Thus, it is prudent to consider strategies to mitigate chronic inflammation concurrent with addressing the deficiencies in osteogenesis and vasculogenesis in order to save the affected joint. Interestingly, the processes of inflammation, osteonecrosis, and bone healing are highly inter-related. Therefore, modulating the biological processes and crosstalk among cells of the innate immune system, the mesenchymal stem cell-osteoblast lineage and others are important to providing the local microenvironment for resolution of inflammation and subsequent repair. This review summarizes the clinical and biologic principles associated with osteonecrosis and provides potential cutting-end strategies for modulating chronic inflammation and facilitating osteogenesis and vasculogenesis using local interventions. Although these studies are still in the preclinical stages, it is hoped that safe, efficacious, and cost-effective interventions will be developed to save the host’s natural joint.
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Affiliation(s)
- Stuart B Goodman
- Departments of Orthopaedic Surgery, Stanford University, Stanford, CA, USA.,Departments of Bioengineering, Stanford University, Stanford, CA, USA
| | - Masahiro Maruyama
- Departments of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
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Huang ZQ, Fu FY, Li WL, Tan B, He HJ, Liu WG, Chen WH. Current Treatment Modalities for Osteonecrosis of Femoral Head in Mainland China: A Cross-Sectional Study. Orthop Surg 2020; 12:1776-1783. [PMID: 33063459 PMCID: PMC7767781 DOI: 10.1111/os.12810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/22/2020] [Accepted: 08/23/2020] [Indexed: 01/22/2023] Open
Abstract
Objective To investigate the application of treatment modalities for patients with osteonecrosis of the femoral head (ONFH) in mainland China. Methods This cross‐sectional study was based on the online application of China Osteonecrosis of the Femoral Head Database (CONFHD). Between July 2016 to December 2018, the CONFHD program planned to recruit ONFH patients from 12 administrative areas across mainland China. Real‐world medical records of treatment regimens for these patients, including surgeries and prescriptions, were approved to upload to the CONFHD application for further analysis. The surgeries performed on these patients were classified into total hip arthroplasty and hip‐preserving procedures, and the latter was further classified into core decompression, bone grafting, and tantalum rod implantation. Prescription medications were classified into chemical medicine and Chinese herbal medicine (CHM); chemical medicine was further classified according to their chemical compounds, and CHM was classified according to therapeutic functions based on traditional Chinese medicine theory. Descriptive analysis was performed to summarize the application of different treatment regimens on the overall sample. Results A total of 1491 patients (2381 hips) who fulfilled the protocol criteria were included. There were 1039 males and 452 females with a mean age of 47.29 ± 12.69 years. The causes of ONFH were alcoholism in 642 patients (43%), corticosteroid in 439 patients (29%), trauma in 239 patients (16%), and idiopathic ONFH in 171 patients (11%). Operative treatments (including total hip arthroplasty and hip‐preserving procedures) were performed on 49% of patients (43% of hips), chemical medicine therapy (including bisphosphonate, statins, and prostacyclin) was given to 37% of patients (37% of hips), and CHM was administrated to 72% of patients (75% of hips). The aforementioned interventions were not always used alone, since 47% of patients (52% of hips) received combined regimens with multiple interventions. Among hips treated by surgery, all hips with ARCO stage IV ONFH received THA (305 hips), and THA was also performed on 63 hips with stage II ONFH. Over half of hips with stage I (81%), II (91%), and III (92%) ONFH had received pharmacological treatments. Prostacyclin and bisphosphonate were the top two most prescribed medicines used alone. CHM therapies with multiple CHM functions were more commonly prescribed. Conclusion Current treatment modalities for ONFH patients in mainland China include operative treatment, chemical medicine, and CHM. Combined regimens with different treatment modalities are common in real‐world clinical practices.
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Affiliation(s)
- Ze-Qing Huang
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Fan-Yu Fu
- Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Wen-Long Li
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Biao Tan
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hai-Jun He
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wen-Gang Liu
- The Second Hospital of Traditional Chinese Medicine of Guangdong Province, Guangdong, China
| | - Wei-Heng Chen
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
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Bar M, Ott SM, Lewiecki EM, Sarafoglou K, Wu JY, Thompson MJ, Vaux JJ, Dean DR, Saag KG, Hashmi SK, Inamoto Y, Dholaria BR, Kharfan-Dabaja MA, Nagler A, Rodriguez C, Hamilton BK, Shah N, Flowers MED, Savani BN, Carpenter PA. Bone Health Management After Hematopoietic Cell Transplantation: An Expert Panel Opinion from the American Society for Transplantation and Cellular Therapy. Biol Blood Marrow Transplant 2020; 26:1784-1802. [PMID: 32653624 DOI: 10.1016/j.bbmt.2020.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/05/2020] [Indexed: 12/14/2022]
Abstract
Bone health disturbances commonly occur after hematopoietic cell transplantation (HCT) with loss of bone mineral density (BMD) and avascular necrosis (AVN) foremost among them. BMD loss is related to pretransplantation chemotherapy and radiation exposure and immunosuppressive therapy for graft-versus-host-disease (GVHD) and results from deficiencies in growth or gonadal hormones, disturbances in calcium and vitamin D homeostasis, as well as osteoblast and osteoclast dysfunction. Although the pathophysiology of AVN remains unclear, high-dose glucocorticoid exposure is the most frequent association. Various societal treatment guidelines for osteoporosis exist, but the focus is mainly on menopausal-associated osteoporosis. HCT survivors comprise a distinct population with unique comorbidities, making general approaches to bone health management inappropriate in some cases. To address a core set of 16 frequently asked questions (FAQs) relevant to bone health in HCT, the American Society of Transplant and Cellular Therapy Committee on Practice Guidelines convened a panel of experts in HCT, adult and pediatric endocrinology, orthopedics, and oral medicine. Owing to a lack of relevant prospective controlled clinical trials that specifically address bone health in HCT, the answers to the FAQs rely on evidence derived from retrospective HCT studies, results extrapolated from prospective studies in non-HCT settings, relevant societal guidelines, and expert panel opinion. Given the heterogenous comorbidities and needs of individual HCT recipients, answers to FAQs in this article should be considered general recommendations, with good medical practice and judgment ultimately dictating care of individual patients. Readers are referred to the Supplementary Material for answers to additional FAQs that did not make the core set.
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Affiliation(s)
- Merav Bar
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
| | - Susan M Ott
- Department of Medicine, University of Washington, Seattle, Washington
| | - E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, New Mexico; Bone Health TeleECHO, UNM Health Sciences Center, Albuquerque, New Mexico
| | - Kyriakie Sarafoglou
- Department of Pediatrics, Divisions of Endocrinology and Genetics & Metabolism, University of Minnesota Medical School, Minneapolis, Minnesota; Department of Experimental & Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, Minnesota
| | - Joy Y Wu
- Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Matthew J Thompson
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Jonathan J Vaux
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, Washington
| | - David R Dean
- Department of Oral Medicine, University of Washington School of Dentistry, Seattle, Washington
| | - Kenneth G Saag
- Department of Medicine, Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Shahrukh K Hashmi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Yoshihiro Inamoto
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Bhagirathbhai R Dholaria
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida
| | - Arnon Nagler
- Bone Marrow Transplantation Department, Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Cesar Rodriguez
- Department of Internal Medicine Hematology and Oncology, Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Betty K Hamilton
- Blood and Marrow Transplant Program, Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Nina Shah
- Division of Hematology-Oncology, University of California, San Francisco, California
| | - Mary E D Flowers
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Bipin N Savani
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paul A Carpenter
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
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Tosun HB, Uludağ A, Demir S, Serbest S, Yasar MM, Öznam K. Effectiveness of Iloprost in the Treatment of Bone Marrow Edema. Cureus 2020; 12:e10547. [PMID: 33101795 PMCID: PMC7575317 DOI: 10.7759/cureus.10547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background and objective Bone marrow edema (BME) is a rare condition caused by insufficient osseous blood supply and may result in severe pain that has adverse effects on patients’ life. To date, various conservative treatments have been recommended for the treatment of BME, including analgesics, immobilization of the affected extremity, and iloprost infusion. The aim of this retrospective study was to investigate the effectiveness of parenteral iloprost therapy in the treatment of BME detected in different skeletal locations. Materials and methods This retrospective study included 23 patients (17 men and six women) with BME who were classified as stage I-III according to the Association Research Circulation Osseous (ARCO) classification. BME was localized to the proximal femur in 13 (56.5%), the distal femur in four (17.4%), tarsal bone in four (17.4%), and tibial plateau in two (8.7%) patients. The mean age of the patients was 46.7 years and all the patients were evaluated with the Visual Analog scale (VAS), Functional Mobility Scale (FMS), and MRI. Results A significant improvement was observed in the post-treatment VAS and FMS scores of all patients compared to their pre-treatment scores. Moreover, the edema regressed completely in 60.9% of the patients at three months of MRI control. No serious side effects were observed during the treatment in any of the patients. However, transient side effects including headache, arrhythmia, and flushing were observed in five patients. Conclusion The present study indicated that iloprost therapy is an effective and safe option in the treatment of BME patients, particularly in the reduction of severe pain that has adverse effects on patients’ social life, regardless of ARCO staging. Moreover, this therapy could be particularly useful in reducing pain, improving functional recovery, and achieving complete regression of the edema on MRI in ARCO stage I-II patients.
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Affiliation(s)
| | - Abuzer Uludağ
- Orthopaedics, Adiyaman University Faculty of Medicine, Adiyaman, TUR
| | - Sukru Demir
- Orthopaedics and Traumatology, Fırat University, Elazıg, TUR
| | - Sancar Serbest
- Orthopaedics and Traumatology, Kırıkkale University Faculty of Medicine, Kirikkale, TUR
| | - Mehmet Mete Yasar
- Orthopaedics and Traumatology, Adıyaman University Faculty of Medicine, Adıyaman, TUR
| | - Kadir Öznam
- Orthopaedics and Traumatology, Medipol University School of Medicine, Istanbul, TUR
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Mechanisms and Molecular Targets of the Tao-Hong-Si-Wu-Tang Formula for Treatment of Osteonecrosis of Femoral Head: A Network Pharmacology Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:7130105. [PMID: 32963569 PMCID: PMC7499271 DOI: 10.1155/2020/7130105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 08/19/2020] [Accepted: 08/27/2020] [Indexed: 01/11/2023]
Abstract
The Tao-Hong-Si-Wu-Tang (THSWT) formula, a classic prescription of traditional Chinese medicine, has long been used for the treatment of osteonecrosis of femoral head (ONFH). However, its mechanisms of action and molecular targets are not comprehensively clear. In the present study, the Traditional Chinese Medicine System Pharmacology (TCMSP) database was employed to retrieve the active compounds of each herb included in the THSWT formula. After identifying the drug targets of active compounds and disease targets of ONFH, intersection analysis was conducted to screen out the shared targets. The protein-protein network of the shared targets was built for further topological analysis. Gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway analysis were then carried out. A gene pathway network was constructed to screen the core target genes. We identified 61 active compounds, 155 drug targets, and 5443 disease targets. However, intersection analysis only screened out 37 shared targets. Kaempferol, luteolin, and baicalein regulated the greatest number of targets associated with ONFH. The THSWT formula may regulate osteocyte function through specific biological processes, including responses to toxic substances and oxidative stress. The regulated pathways included the relaxin, focal adhesion, nuclear factor-κB, toll-like receptor, and AGE/RAGE signaling pathways. RELA, VEGFA, and STAT1 were the important target genes in the gene network associated with the THSWT formula for the treatment of ONFH. Therefore, the present study suggested that the THSWT formula has an action mechanism involving multiple compounds and network targets for the treatment of ONFH.
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Zhu W, Guo M, Yang W, Tang M, Chen T, Gan D, Zhang D, Ding X, Zhao A, Zhao P, Yan W, Zhang J. CD41-deficient exosomes from non-traumatic femoral head necrosis tissues impair osteogenic differentiation and migration of mesenchymal stem cells. Cell Death Dis 2020; 11:293. [PMID: 32341357 PMCID: PMC7184624 DOI: 10.1038/s41419-020-2496-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 02/06/2023]
Abstract
Non-traumatic osteonecrosis of the femoral head (ONFH) is clinically a devastating and progressive disease without an effective treatment. Mesenchymal stem cells (MSCs) transplantation has been used to treat ONFH in early stage, but the failure rate of this therapy is high due to the reduced osteogenic differentiation and migration of the transplanted MSCs related with pathological bone tissues. However, the mechanism responsible for this decrease is still unclear. Therefore, we assume that the implanted MSCs might be influenced by signals delivered from pathological bone tissue, where the exosomes might play a critical role in this delivery. This study showed that exosomes from ONFH bone tissues (ONFH-exos) were able to induce GC-induced ONFH-like damage, in vivo and impair osteogenic differentiation and migration of MSCs, in vitro. Then, we analyzed the differentially expressed proteins (DEPs) in ONFH-exos using proteomic technology and identified 842 differentially expressed proteins (DEPs). On the basis of gene ontology (GO) enrichment analysis of DEPs, fold-changes and previous report, cell adhesion-related CD41 (integrin α2b) was selected for further investigation. Our study showed that the CD41 (integrin α2b) was distinctly decreased in ONFH-exos, compared to NOR-exos, and downregulation of CD41 could impair osteogenic differentiation and migration of the MSCs, where CD41-integrin β3-FAK-Akt-Runx2 pathway was involved. Finally, our study further suggested that CD41-affluent NOR-exos could restore the glucocorticoid-induced decline of osteogenic differentiation and migration in MSCs, and prevent GC-induced ONFH-like damage in rat models. Taken together, our study results revealed that in the progress of ONFH, exosomes from the pathological bone brought about the failure of MSCs repairing the necrotic bone for lack of some critical proteins, like integrin CD41, and prompted the progression of experimentally induced ONFH-like status in the rat. CD41 could be considered as the target of early diagnosis and therapy in ONFH.
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Affiliation(s)
- Weiwen Zhu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - MinKang Guo
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wu Yang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Min Tang
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Chongqing Medical University, Chongqing, 400016, China
| | - Tingmei Chen
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Chongqing Medical University, Chongqing, 400016, China
| | - Delu Gan
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Chongqing Medical University, Chongqing, 400016, China
| | - Dian Zhang
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Chongqing Medical University, Chongqing, 400016, China
| | - Xiaojuan Ding
- Department of Laboratory, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Anping Zhao
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Pei Zhao
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wenlong Yan
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jian Zhang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Chinese herbal Huo-Gu formula for the treatment of steroid-associated osteonecrosis of femoral head: A 14-year follow-up of convalescent SARS patients. J Orthop Translat 2020; 23:122-131. [PMID: 32292697 PMCID: PMC7129775 DOI: 10.1016/j.jot.2020.03.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 02/06/2023] Open
Abstract
Purpose The coronavirus disease 2019 (COVID-19) reminds us of the severe acute respiratory syndrome (SARS) outbreak in 2003, and up to date, corticosteroid is commonly administrated to severe patients with COVID-19. Osteonecrosis of the femoral head (ONFH) is a common disabling complication among convalescent SARS patients who received corticosteroid therapy. In China, a considerable number of convalescent SARS patients with steroid-associated ONFH had undergone conservative treatment by traditional Chinese medicine, and this study aims to evaluate the long-term results of a spleen-invigorating Huo-Gu formula (HGF) therapy in these patients. Participants and methods A total of 33 convalescent SARS patients (9 males and 24 females) with bilateral steroid-associated ONFH (66 hips) were enrolled in this study. All patients received oral HGF therapy for 6 months when they were confirmed the diagnosis of steroid-associated ONFH. They had been regularly followed up at an interval of 1 year. Harris hip score and medical imaging modalities, including plain radiography, computed tomography and magnetic resonance imaging, were performed to evaluate the outcomes. Results Based on average 14 years of follow-up of HGF therapy (ranging from 6 to 16 years), 38 hips (57%) among the 66 hips developed definite osteoarthritis, and 14 hips (26%) in 53 precollapse hips (Association Research Circulation Osseous [ARCO] Stage I or II) progressed to femoral head collapse (ARCO Stage III or IV). Only five patients (also 5 hips) underwent total hip arthroplasty, and the mean hip survival time was over 15 years by the Kaplan-Meier analysis. We observed a mean Harris hip score of 63 points, which represented the reserve of 55% in pain score and 70% in physical function score. The severity of groin pain was not correlated to the severity of osteoarthritis. Conclusion Chinese herbal HGF therapy demonstrates beneficial effects on preventing femoral head collapse, delaying total hip arthroplasty, and maintaining physical function in the treatment of steroid-associated ONFH. HGF therapy might be therefore a good alternative for the treatment of steroid-associated ONFH secondary to rheumatologic and infection diseases. Translational potential of the article HGF therapy might be a good alternative for the treatment of steroid-associated ONFH secondary to rheumatologic and infectious diseases.
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Li TX, Huang ZQ, Li Y, Xue ZP, Sun JG, Gao HH, He HJ, Chen WH. Prediction of Collapse Using Patient-Specific Finite Element Analysis of Osteonecrosis of the Femoral Head. Orthop Surg 2020; 11:794-800. [PMID: 31663283 PMCID: PMC6819171 DOI: 10.1111/os.12520] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/11/2019] [Accepted: 07/28/2019] [Indexed: 01/12/2023] Open
Abstract
Objective To develop a prediction method for femoral head collapse by using patient‐specific finite element analysis of osteonecrosis of the femoral head (ONFH). Methods The retrospective study recruited 40 patients with ARCO stage‐II ONFH (40 pre‐collapse hips). Patients were divided into two groups according to the 1‐year follow‐up outcomes: patient group without femoral head collapse (noncollapse group, n = 20) and patient group with collapse (collapse group, n = 20). CT scans of the hip were performed for all patients once they joined the study. Patient‐specific finite element models were generated based on these original CT images following the same procedures: segmenting the necrotic lesion and viable proximal femur, meshing the computational models, assigning different material properties according to the Hounsfield unit distribution, simulating the stress loading of the slow walking gait, and measuring the distribution of the von Mises stress. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive performance of the maximum level of the von Mises stress. The optimal cut‐off value was selected based on the Youden index and the corresponding predictive accuracy was reported as well. Results The mean level of the maximum von Mises stress in the collapse group was 2.955 ± 0.539 MPa, whereas the mean stress level in the noncollapse group was 1.923 ± 0.793 MPa (P < 0.01). ROC analysis of the maximum von Mises stress found that the area under the ROC curve was 0.842 (95% CI: 0.717–0.968, P < 0.01). The maximum Youden index was 0.60, which corresponded to two optimal cut‐off values: 2.7801 MPa (sensitivity: 0.70; specificity: 0.90; predictive accuracy: 80.00%; LR+: 7), and 2.7027 MPa (sensitivity: 0.75; specificity: 0.85; predictive accuracy: 77.50%; LR+: 5). Conclusion Finite element analysis is a potential method for femoral head collapse prediction among pre‐collapse ONFH patients. The maximum level of the von Mises stress on the weight‐bearing surface of the femoral head could be a good biomechanical marker to classify the collapse risk. The collapse prediction method based on patient‐specific finite element analysis is, thus, suitable to apply to clinical practice, but further testing on a larger dataset is desirable.
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Affiliation(s)
- Tai-Xian Li
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ze-Qing Huang
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yan Li
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhi-Peng Xue
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ji-Gao Sun
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Huan-Huan Gao
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hai-Jun He
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wei-Heng Chen
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Sun W, Li Z. [Extracorporeal shockwave therapy for osteonecrosis of femoral head: traps and challenges]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:659-661. [PMID: 31197988 DOI: 10.7507/1002-1892.201905059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Extracorporeal shock wave (ESW), as a noninvasive, safe, and effective treatment, was applied to the treatment in osteonecrosis of femoral head (ONFH) since the end of last century. Although this therapy is more and more widely used, there are many traps and challenges. We recommend using the high-energy focus ESW to treat ONFH, rather than using the low energy radial pressure wave. Furthermore, for different types ONFH, scientific personalized treatment planning should be made first. There are demands of multicenter united researches for this unknown field of ONFH treated with ESW, and so to provide high-level evidence-based medicine evidence.
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Affiliation(s)
- Wei Sun
- Department of Orthopedics, China-Japan Friendship Hospital, Beijing, 100029, P.R.China;Shock Wave Medicine Center, Dornier Academy, China-Japan Friendship Hospital, Beijing, 100085, P.R.China
| | - Zirong Li
- Department of Orthopedics, China-Japan Friendship Hospital, Beijing, 100029,
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