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Yang TJ, Wen PP, Ye X, Wu XF, Zhang C, Sun SY, Wu ZX, Zhang GY, Sun YF, Ye R, Zhou CK, He HJ. CT Hounsfield units in assessing bone and soft tissue quality in the proximal femur: A systematic review focusing on osteonecrosis and total hip arthroplasty. PLoS One 2025; 20:e0319907. [PMID: 40138288 PMCID: PMC11940759 DOI: 10.1371/journal.pone.0319907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 02/10/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND Computed tomography (CT) Hounsfield Units (HU) offer valuable insights into the changes in bone and soft tissue densities, playing a crucial role in the diagnosis and management of various proximal femur conditions. This systematic review aims to consolidate the application of HU in assessing tissue quality in the proximal femur, with a special focus on osteonecrosis of the femoral head (ONFH) and implications for total hip arthroplasty (THA), thereby addressing unresolved issues in these areas. METHODS We conducted a comprehensive literature search on MEDLINE/PubMed, EMBASE, Google Scholar, SpringerLink, Scops, Web of Science, and Bentham Science Publishers from inception to January 2024, following the PRISMA guidelines, to retrieve all studies relevant to the application of HU in assessing both bone and soft tissue quality of the proximal femur, particularly in the context of ONFH and THA. We systematically evaluated the key findings extracted from the included articles. RESULTS This systematic review included a total of 58 studies, involving 15,668 patients. The sample sizes ranged from 50 to 685, with the CT slice thickness varying from 0.5 mm to 10 mm. The results mainly focused on three areas: (1) the relationship between HU and the density of proximal femoral tissues (n = 33); (2) the assessment of HU in predicting the risk of femoral head collapse (n = 10); (3) the application of HU during the perioperative period of THA (n = 15). CONCLUSION (1) HU can effectively contribute to the evaluation of bone and soft tissue densities in the proximal femur, and reflect local stress changes. (2) In ONFH patients, bone density does not decrease in the necrotic area of the femoral head before collapse. However, abnormally elevated HU at the outer boundary of the necrotic lesion are significant in assessing collapse risk. (3) HU can be used to preoperatively assess hip bone quality for THA, guide surgical approaches, predict intraoperative fractures, monitor postoperative bone ingrowth or absorption, identify and quantitatively evaluate periprosthetic loosening, and guide postoperative rehabilitation.
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Affiliation(s)
- Tong-jie Yang
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Chaoyang District, Beijing, China
| | - Peng-peng Wen
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Xin Ye
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Xiao-feng Wu
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Cheng Zhang
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Chaoyang District, Beijing, China
| | - Shi-yi Sun
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Chaoyang District, Beijing, China
| | - Zi-xuan Wu
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Chaoyang District, Beijing, China
- Beijing University of Chinese Medicine, Chaoyang District, Beijing, China
| | - Guang-yi Zhang
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Chaoyang District, Beijing, China
- Beijing University of Chinese Medicine, Chaoyang District, Beijing, China
| | - Yi-fei Sun
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Chaoyang District, Beijing, China
- Beijing University of Chinese Medicine, Chaoyang District, Beijing, China
| | - Ren Ye
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Cheng-kun Zhou
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Chaoyang District, Beijing, China
| | - Hai-jun He
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Chaoyang District, Beijing, China
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Dong Y, Yan Y, Zhou J, Tang K, Wang X, Quan R, Lin J, Jia Y, Zheng Z, Mi B, Chen W. Relationship between anterior or posterior femoral head necrosis and collapse based on MRI-defined key necrotic layer sets. J Orthop Surg Res 2025; 20:251. [PMID: 40050989 PMCID: PMC11887068 DOI: 10.1186/s13018-025-05633-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Accepted: 02/20/2025] [Indexed: 03/09/2025] Open
Abstract
BACKGROUND Current clinical studies on femoral head necrotic lesions primarily focus on the medial and lateral regions, while detailed MRI-based methods to evaluate the relationship between anterior or posterior necrosis and collapse remain lacking. OBJECTIVE By defining the anterior and posterior positions of the femoral head in MRI, a method was proposed for rapid clinical prognosis assessment of femoral head necrosis based on necrotic location. METOHD A retrospective analysis was conducted on TSE sequence T1W1 coronal plane images from 200 cases of femoral head necrosis. The frequency of necrotic lesions appearing on each MRI layer was statistically analyzed to construct a high-frequency necrotic layer set. Among these cases, 100 hips were randomly selected, and the relationship between femoral head collapse at one-year follow-up and different high-frequency necrotic layer sets was analyzed to identify the key necrotic layer set. Based on this, the anterior and posterior regions of the femoral head were defined on MRI. The remaining 100 hips were used as a validation set to assess the impact of anterior or posterior necrosis of the femoral head, as defined by this method, on collapse. RESULTS In this study, a total of eight high-frequency necrotic lesion layer sets (S1-S8) were constructed based on MRI data. Among them, S3 (L1 + L2 + L0 + L3) showed the strongest correlation with femoral head collapse, with an AUC of 0.662. Therefore, S3 was defined as the anterior side of the femoral head. Analysis of the validation set revealed that, using this method, the probability of femoral head collapse was 11.4 times higher when necrotic lesions appeared on the anterior side compared to the absence of necrosis on the anterior side. CONCLUSION In MRI, the anterior side of the femoral head corresponds to the S3 region, where necrosis increases the risk of collapse by 11.4 times.
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Affiliation(s)
- Yawei Dong
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, NO.51, Xiaoguan Street, Chaoyang District, Beijing, China
- Engineering Research Center of Chinese Orthopaedics and Sports Rehabilitation Artificial Intelligent, Ministry of Education, Beijing, China
| | - Yan Yan
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, NO.51, Xiaoguan Street, Chaoyang District, Beijing, China
- Engineering Research Center of Chinese Orthopaedics and Sports Rehabilitation Artificial Intelligent, Ministry of Education, Beijing, China
| | - Jun Zhou
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, NO.51, Xiaoguan Street, Chaoyang District, Beijing, China
- Engineering Research Center of Chinese Orthopaedics and Sports Rehabilitation Artificial Intelligent, Ministry of Education, Beijing, China
| | - Kaiqiang Tang
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, NO.51, Xiaoguan Street, Chaoyang District, Beijing, China
- Engineering Research Center of Chinese Orthopaedics and Sports Rehabilitation Artificial Intelligent, Ministry of Education, Beijing, China
| | - Xiaohan Wang
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, NO.51, Xiaoguan Street, Chaoyang District, Beijing, China
- Engineering Research Center of Chinese Orthopaedics and Sports Rehabilitation Artificial Intelligent, Ministry of Education, Beijing, China
| | - Rui Quan
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, NO.51, Xiaoguan Street, Chaoyang District, Beijing, China
- Engineering Research Center of Chinese Orthopaedics and Sports Rehabilitation Artificial Intelligent, Ministry of Education, Beijing, China
| | - Jiaming Lin
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, NO.51, Xiaoguan Street, Chaoyang District, Beijing, China
- Engineering Research Center of Chinese Orthopaedics and Sports Rehabilitation Artificial Intelligent, Ministry of Education, Beijing, China
| | - Yan Jia
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, NO.51, Xiaoguan Street, Chaoyang District, Beijing, China
- Engineering Research Center of Chinese Orthopaedics and Sports Rehabilitation Artificial Intelligent, Ministry of Education, Beijing, China
| | - Zelu Zheng
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, NO.51, Xiaoguan Street, Chaoyang District, Beijing, China
- Engineering Research Center of Chinese Orthopaedics and Sports Rehabilitation Artificial Intelligent, Ministry of Education, Beijing, China
| | - Baohong Mi
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, NO.51, Xiaoguan Street, Chaoyang District, Beijing, China.
- Engineering Research Center of Chinese Orthopaedics and Sports Rehabilitation Artificial Intelligent, Ministry of Education, Beijing, China.
| | - Weiheng Chen
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, NO.51, Xiaoguan Street, Chaoyang District, Beijing, China.
- Engineering Research Center of Chinese Orthopaedics and Sports Rehabilitation Artificial Intelligent, Ministry of Education, Beijing, China.
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Li X, Zhou X, Yang J, Böker KO, Schilling AF, Lehmann W. Evaluating femoral head collapse risk post-fixation removal: a finite element analysis. Front Bioeng Biotechnol 2025; 13:1441026. [PMID: 40114849 PMCID: PMC11922834 DOI: 10.3389/fbioe.2025.1441026] [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: 05/30/2024] [Accepted: 02/03/2025] [Indexed: 03/22/2025] Open
Abstract
Background Femoral neck fractures are prevalent in orthopedic injuries, often leading to complications such as nonunion and osteonecrosis of the femoral head (ONFH). Studies indicate that after healing and removal of internal fixation devices, some patients develop ONFH, while others experience osteosclerosis around the screw holes due to prolonged fixation, increasing ONFH risk. Despite such observations, biomechanical studies on this phenomenon are limited. This study assesses the risk of femoral head collapse post-internal fixation device removal and investigates the biomechanical effects of bone grafting at screw removal sites. Methods Using CT data, femoral anatomy was reconstructed. For control, the femoral head's collapse area was identified. Experimental models, divided into those with and without bone grafts in screw holes, incorporated three fixation techniques, namely, triple cannulated screws (3CS), dynamic hip screws with cannulated screws (DHS+CS), and the femoral neck system (FNS), further subclassified into normal and sclerotic screw-hole models. Stress distribution, stress values, stress index, and strain range were assessed. Results In both models, DHS+CS showed the highest stress in the overall model, while 3CS had the highest stress in the collapse area. The 3CS configuration also resulted in the largest strain range, which was observed in the central pillar of normal screw-hole models and the lateral pillar of sclerotic screw-hole models. The bone graft models exhibited lower peak, average stress, and strain values than the normal and sclerotic screw-hole models. Conclusion The FNS screw hole demonstrates a relatively lower mechanical risk of femoral head collapse. In contrast, sclerotic screw holes increase this risk, while bone grafting may improve the biomechanical behavior after fixation removal, potentially reducing the likelihood of femoral head collapse.
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Affiliation(s)
- Xishan Li
- Department of Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Xiang Zhou
- Department of Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
- Department of Articular and Traumatic Orthopedic Surgery, Fourth People's Hospital of Guiyang, Guiyang, Guizhou, China
| | - Jie Yang
- Department of Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Kai Oliver Böker
- Department of Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Arndt F Schilling
- Department of Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Wolfgang Lehmann
- Department of Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
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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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Güvercin Y, Yaylacı M, Dizdar A, Özdemir ME, Ay S, Yaylacı EU, Karahasanoğlu U, Uygun H, Peker G. Biomechanical Analysis and Solution Suggestions of Screw Replacement Scenarios in Femoral Neck Fracture Surgeries: Finite Element Method. Orthop Surg 2025; 17:614-623. [PMID: 39762119 PMCID: PMC11787977 DOI: 10.1111/os.14337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 12/02/2024] [Accepted: 12/10/2024] [Indexed: 02/04/2025] Open
Abstract
OBJECTIVE Despite several surgical options, there has yet to be a consensus on the best treatment for femoral neck fracture (FNF) due to higher complication rates compared to other bone fractures. This study aims to examine the possible consequences and solution suggestions of changing screws during surgery for various reasons in FNF surgical treatment from a biomechanical perspective. METHOD FNF and treatment materials were analyzed biomechanically using a package program based on the finite element method (FEM). This study created a solid model with images of femur bone tomography. Dynamic hip screws (DHS), cannulated screws (CCS), and medial buttress plates (MBP) were obtained by making three-dimensional designs. The required elements for the models were assigned, and the material properties of the elements were defined. The solutions were obtained as crack distance and deformation results after defining the boundary conditions and applying the necessary loading. RESULTS The strain and crack distance values created by six models on the fracture line under different parameters were obtained, and the numerical results were evaluated. The DHS and CCS models produced the highest crack distance and deformation values when all screws were loose. The lowest values were obtained in the intact-85 model when all CCS were tight. When the results are evaluated, it is seen that the MBP has a decreasing effect on the results. Mechanical evaluation of six different options used in femoral neck fractures was performed. 85 mm CCS applied to our standard model gave the best results, while the use of 80 mm CCS in the same model showed promising results compared to other models. It is understood that CCS have the best stability even in loosening models with the medial support plate. Different models are from intact-85 mm DHS+1CS+MBP to DHS+1CS, which was worked with LSR+USR-2, according to decreasing stability. CONCLUSION This study offers various biomechanical solutions to possible intraoperative problems in FNF treatment. The following results were obtained from the study data. When the CCS needs to be lengthened or replaced, it is appropriate to use the CCS with the MBP. A single anti-rotation screw is sufficient for lag screw extensions of the DHS plate, and the MBP may be a savior procedure in surgery.
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Affiliation(s)
- Yılmaz Güvercin
- Department of Orthopaedic and TraumatologyTrabzon Kanuni Training and Research HospitalTrabzonTurkey
| | - Murat Yaylacı
- Biomedical Engineering MSc ProgramRecep Tayyip Erdogan UniversityRizeTurkey
- Department of Civil EngineeringRecep Tayyip Erdogan UniversityRizeTurkey
- Turgut Kıran Maritime FacultyRecep Tayyip Erdogan UniversityRizeTurkey
| | - Ayberk Dizdar
- Department of Biomedical EngineeringKocaeli UniversityKocaeliTurkey
| | | | - Sevil Ay
- Department of Civil EngineeringArtvin Coruh UniversityArtvinTurkey
| | | | - Umitcan Karahasanoğlu
- Department of Orthopaedic and TraumatologyTrabzon Kanuni Training and Research HospitalTrabzonTurkey
| | - Hüseyin Uygun
- Department of Orthopaedic and TraumatologyTrabzon Kanuni Training and Research HospitalTrabzonTurkey
| | - Gökhan Peker
- Department of Orthopaedic and TraumatologyTrabzon Kanuni Training and Research HospitalTrabzonTurkey
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Lu S, Lin T, Han L, Li Z, He M, Wei Q. Location or size? A finite element analysis study of necrotic lesion impact on femoral head collapse. J Orthop Surg Res 2025; 20:48. [PMID: 39815308 PMCID: PMC11734371 DOI: 10.1186/s13018-025-05453-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Accepted: 01/02/2025] [Indexed: 01/18/2025] Open
Abstract
BACKGROUND The location and size of necrotic lesions are important factors for collapse, The preserved angles (PAs) are divided into anterior preserved angle (APA) and lateral preserved angle (LPA), which could accurately measure the location of necrosis lesion. We used them to evaluate the effect of the location and size of necrotic lesions on collapse by finite element analysis, to offer a framework for evaluating the prognosis of osteonecrosis of the femoral head (ONFH) in clinical settings. METHODS 3 left hip models were constructed based on CT data. Within each hip model, three necrosis lesion models were modeled, with necrotic tissue volumes of 30%, 50%, and 70% repectively. The ONFH models with LPA of 45.5°, 50.5°, 55.5°, 60.5°, 65.5°, 70.5°, and 75.5° when APA was 60.5°, and ONFH models with APAs of 45.5°, 50.5°, 55.5°, 60.5°, 65.5°, 70.5°, and 75.5° when LPA was 60.5° were Constructed. The maximum von Mises stess of the femoral head and necrotic lesion, as well as the femoral head displacement, were calculated to evaluate the biomechanical effects of these models. RESULTS (1) In models with the same necrotic volume, when APA was 60.5°, the indexes of the LPA < 60.5° models were significantly higher than those of the LPA ≥ 60.5° models (P < 0.05); the differences of the indexes among the LPA ≥ 60.5° models were not statistically significant (P > 0.05). (2) When LPA was 60.5°, the indexes of models with APA < 60.5 ° and APA ≥ 60.5 ° show the same trend as the former. (3) In the models with the same PAs, there was no statistically significant difference in the indexes (P > 0.05). CONCLUSION The location of the necrotic lesion exerts a greater impact on femoral head collapse compared with the size of the lesion. The location of the necrosis may deserve more consideration when assessing the risk of collapse in patients with early onset ONFH.
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Affiliation(s)
- Shun Lu
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, P. R. China
| | - Tianye Lin
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510378, P. R. China
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, 510378, P. R. China
| | - Longfei Han
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, P. R. China
| | - Ziqi Li
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510378, P. R. China
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, 510378, P. R. China
| | - Mingcong He
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510378, P. R. China.
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, 510378, P. R. China.
| | - Qiushi Wei
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510378, P. R. China.
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, 510378, P. R. China.
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Yixuan H, Xinwei Y, Feifei G, Jianbin M, Mingbin G, Hongzhong X, Wei S, Xin L, Bin D. Effect of Sclerosis Bands in Femoral Head Necrosis on Non-Vascularized Fibular Grafting-A Finite Element Study. Orthop Surg 2024; 16:2526-2538. [PMID: 39223447 PMCID: PMC11456725 DOI: 10.1111/os.14199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 07/25/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE Femoral head necrosis is a challenging condition in orthopaedics, and the occurrence of collapse is an important factor affecting the prognosis of femoral head necrosis. Sclerosis bands are known to influence the collapse of the femoral head, yet there is a lack of research on the biomechanical role of sclerosis bands in non-vascularized fibular grafting surgery. This study aims to evaluate the biomechanical impact of sclerosis bands in femoral head necrosis and their role in non-vascularized fibular grafting surgery (NVFG) using finite element analysis. METHODS We constructed 11 finite element models based on CT scan data of a normal hip joint, simulating different sclerosis band thicknesses and defect scenarios. The models were analyzed for changes in femoral head displacement and von Mises stress. We constructed a hip joint model based on CT data from a normal hip joint, and after reconstruction, assembly, and optimization using 3-matic. We created five groups consisting of 11 finite element analysis models of the hip joint. Mesh partitioning and mechanical parameter settings were performed in ANSYS. The changes and differences in femoral head displacement and von Mises stress of these models were analyzed. RESULTS Increasing sclerosis band thickness led to reduced peak displacement of the femoral head by 28.6%, 42.9%, and 47.6%, and increased surface von Mises stress by 28.3%, 13.8%, and 13.0%, respectively. Post-surgery, peak displacement decreased in all groups compared to pre-surgery levels. Increasing sclerosis band thickness post-surgery resulted in decreased maximum von Mises stress of the femoral head by 13.9%, 3.0%, and 8.1%. Defect volume in the defect groups correlated with increased peak displacement of the femoral head by 10.0%, 30.0%, and 100.0%, and increased surface maximum von Mises stress of the femoral head by 9.3%, 14.0%, and 15.1%. CONCLUSION Sclerosis band formation exacerbates von Mises stress concentration on the femoral head surface. However, thicker sclerosis bands improve post-NVFG stability and mechanical performance. Larger anterior lateral sclerosis band defects significantly compromise postoperative stability, increasing the risk of collapse. Protecting the anterior lateral sclerosis band during NVFG surgery is crucial.
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Affiliation(s)
- Huang Yixuan
- Department of OrthopedicsThe Affiliated Hospital of Nanjing University of Chinese MedicineNanjingChina
- Department of OrthopedicsJiangsu Province Hospital of Chinese MedicineNanjingChina
| | - Yuan Xinwei
- Spinal SurgerySichuan Science City HospitalMianyangChina
| | - Gao Feifei
- Department of OrthopedicsJiangyin Hospital of Traditional Chinese MedicineWuxiChina
| | - Mai Jianbin
- Department of OrthopedicsNanjing Jiangbei HospitalNanjingChina
| | - Guo Mingbin
- Department of OrthopedicsThe Affiliated Hospital of Nanjing University of Chinese MedicineNanjingChina
- Department of OrthopedicsJiangsu Province Hospital of Chinese MedicineNanjingChina
| | - Xi Hongzhong
- Department of OrthopedicsThe Affiliated Hospital of Nanjing University of Chinese MedicineNanjingChina
- Department of OrthopedicsJiangsu Province Hospital of Chinese MedicineNanjingChina
| | - Song Wei
- Department of OrthopedicsThe Affiliated Hospital of Nanjing University of Chinese MedicineNanjingChina
- Department of OrthopedicsJiangsu Province Hospital of Chinese MedicineNanjingChina
| | - Liu Xin
- Department of OrthopedicsThe Affiliated Hospital of Nanjing University of Chinese MedicineNanjingChina
- Department of OrthopedicsJiangsu Province Hospital of Chinese MedicineNanjingChina
| | - Du Bin
- Department of OrthopedicsThe Affiliated Hospital of Nanjing University of Chinese MedicineNanjingChina
- Department of OrthopedicsJiangsu Province Hospital of Chinese MedicineNanjingChina
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Khanchandani P, Narayanan A, Naik AA, Kannan V, Pradhan SS, Srimadh Bhagavataham SK, Pulukool SK, Sivaramakrishnan V. Clinical Characteristics, Current Treatment Options, Potential Mechanisms, Biomarkers, and Therapeutic Targets in Avascular Necrosis of Femoral Head. Med Princ Pract 2024; 33:519-536. [PMID: 39168116 PMCID: PMC11631174 DOI: 10.1159/000541044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 07/17/2024] [Indexed: 08/23/2024] Open
Abstract
Avascular necrosis of femoral head (AVNFH) is a debilitating disease of the young, affecting the quality of life significantly and eventually leading to total hip replacement surgery. The disease is diagnosed clinico-radiologically and MRI is the investigation of choice to diagnose the early stages of the disease. There is neither an early biomarker for detection nor is there a permanent cure for the disease and most of the patients are managed with various combinations of surgical and medical management protocols. In this review, we comprehensively address the etiopathogenesis, clinical characteristics, therapeutic procedures, bone characteristics, histopathology, multi-omic studies, finite element modeling, and systems analysis that has been performed in AVNFH. The etiology includes various factors that compromise the blood supply to the femoral head which also includes contributions by environmental and genetic factors. Multi-omic analysis has shown an association of deregulated pathways with the disease. The cell types involved include mesenchymal stem cells, osteoblasts, osteoclasts, endothelial and immune cells. Biochemical, hematological, histopathology, IHC, and other bone remodeling and degradation marker studies have been performed. A systems analysis using multi-omic data sets from published literature was carried out, the relevance of which is discussed to delineate potential mechanisms in etiopathogenesis, diagnosis, and effective management of this debilitating disease.
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Affiliation(s)
- Prakash Khanchandani
- Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences, Prasanthigram, India
| | - Aswath Narayanan
- Disease Biology Lab, Department of Biosciences, Sri Sathya Sai Institute of Higher Learning, Prasanthigram, India
| | - Ashwin A. Naik
- Disease Biology Lab, Department of Biosciences, Sri Sathya Sai Institute of Higher Learning, Prasanthigram, India
| | - Vishnu Kannan
- Disease Biology Lab, Department of Biosciences, Sri Sathya Sai Institute of Higher Learning, Prasanthigram, India
| | - Sai Sanwid Pradhan
- Disease Biology Lab, Department of Biosciences, Sri Sathya Sai Institute of Higher Learning, Prasanthigram, India
| | | | - Sujith Kumar Pulukool
- Disease Biology Lab, Department of Biosciences, Sri Sathya Sai Institute of Higher Learning, Prasanthigram, India
| | - Venketesh Sivaramakrishnan
- Disease Biology Lab, Department of Biosciences, Sri Sathya Sai Institute of Higher Learning, Prasanthigram, India
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Yu X, Dou S, Lu L, Wang M, Li Z, Wang D. Relationship between lipid metabolism, coagulation and other blood indices and etiology and staging of non-traumatic femoral head necrosis: a multivariate logistic regression-based analysis. J Orthop Surg Res 2024; 19:251. [PMID: 38643101 PMCID: PMC11031896 DOI: 10.1186/s13018-024-04715-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/05/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND To analyze the relationship between lipid metabolism, coagulation function, and bone metabolism and the contributing factor and staging of non-traumatic femoral head necrosis, and to further investigate the factors influencing the blood indicators related to the staging of non-traumatic femoral head necrosis. METHODS The medical records of patients with femoral head necrosis were retrieved from the inpatient medical record management system, and the lipid metabolism, bone metabolism, and coagulation indices of non-traumatic femoral head necrosis (including alcoholic, hormonal, and idiopathic group) were obtained according to the inclusion and exclusion criteria, including Low-Density Lipoprotein Cholesterol, Triglycerides, Non-High-Density Lipoprotein Cholesterol, Apolipoprotein A1, Apolipoprotein (B), Apolipoprotein (E), Uric Acid, Alkaline Phosphatase, Bone-specific Alkaline Phosphatase, Activated Partial Thromboplastin Time, Prothrombin Time, D-dimer, Platelet count. The relationship between these blood indices and the different stages under different causative factors was compared, and the factors influencing the stages of non-traumatic femoral head necrosis were analyzed using multivariate logistic regression. RESULTS (i) Gender, Age and BMI stratification, Low-density Lipoprotein Cholesterol, Triglycerides, Non-High-density Lipoprotein Cholesterol, Apolipoprotein (B), Apolipoprotein (E), Uric Acid, Bone-specific Alkaline Phosphatase, Activated Partial Thromboplastin Time, Plasminogen Time, D-dimer, and Platelet count of the alcohol group were statistically different when compared among the different ARCO staging groups; (ii) The differences in Age and BMI stratification, Triglycerides, Non-High-density Lipoprotein Cholesterol, Apolipoprotein A1, Apolipoprotein B, Apolipoprotein E, Uric Acid, Bone-specific Alkaline Phosphatase, Activated Partial Thromboplastin Time, Plasminogen Time, D-dimer, and Platelet count were statistically significant when compared among the different phases in the hormone group (P < 0.05); (iii) The differences in Age and BMI stratification, Non-High-Density Lipoprotein Cholesterol, Apolipoprotein A1, Apolipoprotein (B), Apolipoprotein (E), Uric Acid, Activated Partial Thromboplastin Time, D-dimer, and Platelet count were statistically significant when compared among the different stages in the idiopathic group (P < 0.05); (v) Statistically significant indicators were included in the multivariate logistic regression analysis, excluding the highly correlated bone-specific alkaline phosphatase, and the results showed that Low-density lipoprotein was negatively correlated with changes in the course of ARCO, and Non-High-Density Lipoprotein cholesterol, Apo B, Activated Partial Thromboplastin Time, and Platelet count were significantly and positively correlated with disease progression. CONCLUSION An abnormal hypercoagulable state as well as an abnormal hyperlipidemic state are risk factors for the progression of non-traumatic femoral head necrosis under various exposure factors, as indicated by Non-High-Density Lipoprotein Cholesterol, Apolipoprotein B, Activated Fractional Thromboplastin Time, and Platelet Counts.
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Affiliation(s)
- Ximing Yu
- The First Clinical College of Shandong University of Traditional Chinese Medicine, Jinan, 252000, China
- Department of Orthopedics, Liaocheng City Hospital of Traditional Chinese Medicine, Liaocheng, 252000, China
| | - Shilu Dou
- Department of Orthopedics, Liaocheng City Hospital of Traditional Chinese Medicine, Liaocheng, 252000, China
| | - Liaodong Lu
- Department of Orthopedics, Liaocheng City Hospital of Traditional Chinese Medicine, Liaocheng, 252000, China
| | - Meng Wang
- Department of Orthopedics, Liaocheng City Hospital of Traditional Chinese Medicine, Liaocheng, 252000, China
| | - Zhongfeng Li
- Department of Orthopedics, Liaocheng City Hospital of Traditional Chinese Medicine, Liaocheng, 252000, China
| | - Dongwei Wang
- The First Clinical College of Shandong University of Traditional Chinese Medicine, Jinan, 252000, China.
- Department of Orthopedics, Liaocheng City Hospital of Traditional Chinese Medicine, Liaocheng, 252000, China.
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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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11
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Ma J, Ge J, Cheng L, Wang B, Yue D, Wang W. Subchondral Bone Plate Classification: A New and More Sensitive Approach for Predicting the Prognosis of Osteonecrosis of the Femoral Head. Cartilage 2023; 14:269-277. [PMID: 37211723 PMCID: PMC10601559 DOI: 10.1177/19476035231173096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 01/27/2023] [Accepted: 04/15/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND This study explores the impact of subchondral bone plate necrosis on the development of the osteonecrosis of femoral head (ONFH) and its joint collapse. METHODS This retrospective study included 76 ONFH patients (89 consecutive hips) with Association for Research on Osseous Circulation stage II who received conservative treatment without surgical intervention. The mean follow-up time was 15.60 ± 12.29 months. ONFH was divided into 2 types (I and II): Type I with a necrotic lesion involving subchondral bone plate and Type II with a necrotic lesion not involving subchondral bone plate. The radiological evaluations were based on plain x-rays. The data were analyzed using SPSS 26.0 statistical software. RESULTS The collapse rate in Type I ONFH was significantly higher than that in Type II ONFH (P < 0.001). The survival time of hips with Type I ONFH was significantly shorter than those with Type II ONFH and with the endpoint of the femoral head collapse (P < 0.001). The collapse rate of Type I in the new classification (80.95%) was higher compared with that of the China-Japan Friendship Hospital (CJFH) classification (63.64%), and the difference was statistically significant (χ2 = 1.776, P = 0.024). CONCLUSION Subchondral bone plate necrosis is an important factor that affects ONFH collapse and prognosis. Current classification using subchondral bone plate necrosis is more sensitive for predicting collapse compared with the CJFH classification. Effective treatments should be taken to prevent collapse if ONFH necrotic lesions involve the subchondral bone plate.
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Affiliation(s)
- Jinhui Ma
- Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, Beijing, China
| | - Juncheng Ge
- Department of Orthopaedic Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Liming Cheng
- Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, Beijing, China
| | - Bailiang Wang
- Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, Beijing, China
| | - Debo Yue
- Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, Beijing, China
| | - Weiguo Wang
- Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, Beijing, China
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12
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Öztürk Y, Ayazoğlu M, Öztürk Ç, Arabacı A, Solak N, Özsoy S. A new patient-specific overformed anatomical implant design method to reconstruct dysplastic femur trochlea. Sci Rep 2023; 13:3204. [PMID: 36828989 PMCID: PMC9958018 DOI: 10.1038/s41598-023-30341-4] [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: 11/26/2022] [Accepted: 02/21/2023] [Indexed: 02/26/2023] Open
Abstract
Patellar luxation with condylar defect is a challenging situation for reconstruction in humans. Patella reluxation, cartilage damage and pain are the most common complications. This study aims to present a new patient specific method of overformed implant design and clinical implantation that prevents luxation of patella without damaging the cartilage in a dog. Design processes are Computer Tomography, Computer Assisted Design, rapid prototyping of the bone replica, creation of the implant with surgeon's haptic knowledge on the bone replica, 3D printing of the implant and clinical application. The implant was fully seated on the bone. Patella reluxation or implant-related bone problem was not observed 80 days after the operation. However, before the implant application, there were soft tissue problems due to previous surgeries. Three-point bending test and finite element analysis were performed to determine the biomechanical safety of the implant. The stress acting on the implant was below the biomechanical limits of the implant. More cases with long-term follow-up are needed to confirm the success of this method in patellar luxation. Compared with trochlear sulcoplasty and total knee replacement, there was no cartilage damage done by surgeons with this method, and the implant keeps the patella functionally in sulcus. This is a promising multidisciplinary method that can be applied to any part of the bone and can solve some orthopaedic problems with surgeon's haptic knowledge.
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Affiliation(s)
- Yetkin Öztürk
- Molecular Biology and Genetics Department, Science and Literature Faculty, Istanbul Technical University, Maslak, 34469, Istanbul, Turkey.
| | - Murat Ayazoğlu
- grid.10516.330000 0001 2174 543XFaculty of Manufacturing Engineering, Istanbul Technical University, Gumussuyu, 34437 Istanbul, Turkey
| | - Çağrı Öztürk
- grid.10516.330000 0001 2174 543XMetallurgical and Materials Engineering Department, Chemical, and Metallurgical Engineering Faculty, Istanbul Technical University, Maslak, 34469 Istanbul, Turkey
| | - Atakan Arabacı
- grid.10516.330000 0001 2174 543XMetallurgical and Materials Engineering Department, Chemical, and Metallurgical Engineering Faculty, Istanbul Technical University, Maslak, 34469 Istanbul, Turkey
| | - Nuri Solak
- grid.10516.330000 0001 2174 543XMetallurgical and Materials Engineering Department, Chemical, and Metallurgical Engineering Faculty, Istanbul Technical University, Maslak, 34469 Istanbul, Turkey
| | - Serhat Özsoy
- grid.506076.20000 0004 1797 5496Surgery Department, Veterinary Faculty, Istanbul University-Cerrahpasa, Buyukcekmece, 34500 Istanbul, Turkey
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13
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Chen WH, Guo WX, Li JX, Wei QS, Li ZQ, He W. Application of protective weight-bearing in osteonecrosis of the femoral head: A systematic review and meta-analysis of randomized controlled trials and observational studies. Front Surg 2022; 9:1000073. [PMID: 36406362 PMCID: PMC9667948 DOI: 10.3389/fsurg.2022.1000073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/06/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The aim of this systematic review and meta-analysis was to estimate the efficacy and prognostic value of protective weight-bearing for ONFH. METHODS The authors searched the PubMed, EMBASE and Cochrane Library databases, up to February 25, 2022. RCTs and observational studies on conservative treatment, including the use of crutches, for skeletally mature patients with ONFH and written in English were included. Outcomes were the total hip arthroplasty (THA) rate, collapse rate, Hip Harris score (HHS) and visual analog scale (VAS) score. Cochrane Review Manager Software 5.4 and Stata 15.1 were used to perform the statistical analyses. RESULTS A total of 14 studies involving 813 patients (1,025 hips) were included in this meta-analysis. The results showed that the THA rate, collapse rate, HHS and VAS scores in the protective weight-bearing group were not significantly different from those in the surgical group. In the protective weight-bearing group, the results showed that the THA rate was 40%, 8% in ARCO stage II, 37% in ARCO stage III, and the collapse rate was 46%. The mean HHS and VAS score was 80.86 and 1.00, respectively. The HHS score at the 3-, 6-, 12-, and 24-month follow-up was 79.93, 83.94, 85.94, and 96.09 points, respectively, whereas the VAS score at the 6- and 12-month follow-up was 2.20 and 1.29, respectively. CONCLUSION Protective weight bearing could achieve satisfactory results in terms of THA rate, collapse rate, HHS and VAS scores. Protective weight-bearing allows most precollapse patients to preserve the hip but also allows postcollapse patients to delay THA or hip-preserving surgery. The effects and prognosis of protective weight-bearing in the short or mid-term are noninferior to surgical hip preservation and are a viable alternative option for osteonecrosis of the femoral head.
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Affiliation(s)
- Wen-huan Chen
- The Third Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wen-xuan Guo
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jian-xiong Li
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiu-shi Wei
- Department of Joint Surgery, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zi-qi Li
- Department of Joint Surgery, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei He
- Department of Joint Surgery, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China,Correspondence: Wei He
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14
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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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15
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Wang P, Wang C, Meng H, Liu G, Li H, Gao J, Tian H, Peng J. The Role of Structural Deterioration and Biomechanical Changes of the Necrotic Lesion in Collapse Mechanism of Osteonecrosis of the Femoral Head. Orthop Surg 2022; 14:831-839. [PMID: 35445585 PMCID: PMC9087473 DOI: 10.1111/os.13277] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/21/2022] [Accepted: 03/21/2022] [Indexed: 11/26/2022] Open
Abstract
Osteonecrosis of the femoral head (ONFH) is a crippling disease which is due to a lack of effective therapeutic measures. Its natural progression is rapid, the internal bone structure of the femoral head changes dramatically, and the subsequent fractures and collapse cause severe hip pain and loss of hip function. Femoral head collapse is a critical turning point in the development of ONFH and is related to the prognosis of patients. Early prevention and intervention help to preserve the hip joint and delay femoral head collapse. However, the mechanism of collapse still needs to be further studied because it is affected by different complex factors. This review discusses the underlying causes of femoral head collapse from two aspects: structural degradation and regional changes of biomechanical properties in the necrotic femoral head.
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Affiliation(s)
- Peng Wang
- Department of Bone and Joint Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Cheng Wang
- Department of Orthopedics,Engineering Research Center of Bone and Joint Precision Medicine,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Haoye Meng
- Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Guangbo Liu
- Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Huo Li
- Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Jianming Gao
- Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Hua Tian
- Department of Orthopedics,Engineering Research Center of Bone and Joint Precision Medicine,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Jiang Peng
- Department of Bone and Joint Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Institute of Orthopaedics,Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
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16
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Zhou H, Liu B, Liu Y, Huang Q, Yan W. Ultrasonic Intelligent Diagnosis of Papillary Thyroid Carcinoma Based on Machine Learning. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:6428796. [PMID: 35047154 PMCID: PMC8763541 DOI: 10.1155/2022/6428796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/03/2021] [Accepted: 12/11/2021] [Indexed: 11/17/2022]
Abstract
Thyroid diseases are divided into papillary carcinoma and nodular diseases, which are very harmful to the human body. Ultrasound is a common diagnostic method for thyroid diseases. In the process of diagnosis, doctors need to observe the characteristics of ultrasound images, combined with professional knowledge and clinical experience, to give the disease situation of patients. However, different doctors have different clinical experience and professional backgrounds, and the diagnosis results lack objectivity and consistency, so an intelligent diagnosis technology for thyroid diseases based on the ultrasound image is needed in clinic, which can give objective and reliable diagnosis opinions on thyroid diseases by extracting the texture, shape, and other information of the image and assist doctors in clinical diagnosis. This paper mainly studies the intelligent ultrasonic diagnosis of papillary thyroid cancer based on machine learning, compares the ultrasonic characteristics of PTMC diagnosed by using the new ultrasound technology (CEUS and UE), and summarizes the differential diagnosis effect and clinical application value of the two technology methods for PTMC. In this paper, machine learning, diffuse thyroid image features, and RBM learning methods are used to study the ultrasonic intelligent diagnosis of papillary thyroid cancer based on machine learning. At the same time, the new contrast-enhanced ultrasound (CEUS) technology and ultrasound elastography (UE) technology are used to obtain the experimental phenomena in the experiment of ultrasonic intelligent diagnosis of papillary thyroid cancer. The results showed that 90% of the cases were diagnosed by contrast-enhanced ultrasound and confirmed by postoperative pathology. CEUS and UE have reliable practical value in the diagnosis of PTMC, and the combined application of CEUS and UE can improve the sensitivity and accuracy of PTMC diagnosis.
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Affiliation(s)
- Heng Zhou
- Ultrasound Department, Hubei Provincial Hospital of TCM, Wuhan 430061, China
| | - Bin Liu
- Network and Computing Center, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Yang Liu
- Ultrasound Department, Hubei Provincial Hospital of TCM, Wuhan 430061, China
| | - Qunan Huang
- Department of Ultrasound Diagnosis, Central Theater General Hospital of the Chinese People's Liberation Army, Wuhan 430000, China
| | - Wei Yan
- Ultrasound Department, Hubei Provincial Hospital of TCM, Wuhan 430061, China
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Yao B, Wang H, Shao M, Chen J, Wei G. Evaluation System of Smart Logistics Comprehensive Management Based on Hospital Data Fusion Technology. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1490874. [PMID: 35035810 PMCID: PMC8759850 DOI: 10.1155/2022/1490874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/14/2021] [Accepted: 11/18/2021] [Indexed: 12/18/2022]
Abstract
With the acceleration of the informatization process, but because of the late start of the informatization construction of logistics management, the current digital system construction of logistics management has not been popularized, and the intelligent logistics integrated management evaluation system is also extremely lacking. In order to solve the lack of existing intelligent logistics comprehensive management evaluation system, this paper introduces the research of intelligent logistics comprehensive management evaluation system based on hospital data fusion technology. This paper analyzes and utilizes the Kalman filter and adaptive weighted data fusion technology in data fusion technology and then analyzes the evaluation index and system design principles of the intelligent logistics comprehensive management evaluation system and then designs the application layer from the application layer. Design the application layer from the application layer. Then design the framework of the intelligent logistics comprehensive management evaluation system at the network layer and the data layer. The system is finally tested, and the test results show that the evaluation accuracy of the system reaches 80%.
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Affiliation(s)
- Biwen Yao
- Stomatological Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Huiming Wang
- Stomatological Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Mingliang Shao
- Stomatological Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Jian Chen
- Stomatological Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Guo Wei
- Stomatological Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310006, China
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18
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Shang Y, Xu J, Zhang T, Dong Z, Li J, Bi W, Xie Z. Prediction of the Collapse of Necrotic Femoral Head by CT and X-Ray Examinations before Hip Replacement Based on Intelligent Medical Big Data. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:9971236. [PMID: 34976333 PMCID: PMC8716235 DOI: 10.1155/2021/9971236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022]
Abstract
It was to explore the effect of the CT and X-ray examinations before the hip replacement to predict the collapse of the necrotic femoral head under the classification of medical big data based on the decision tree algorithm of the difference grey wolf optimization (GWO) and provide a more effective examination basis for the treatment of patients with the osteonecrosis of the femoral head (ONFH). From January 2019 to January 2021, a total of 152,000 patients with ONFH and hip replacement in the tertiary hospitals were enrolled in this study. They were randomly divided into two groups, the study sample-X group (X-ray examination results) and based-CT group (CT examination results)-76,000 cases in each group. The actual measurement results of the femoral head form the gold standard to evaluate the effect of the two groups of detection methods. The measurement results of X-ray and CT before hip replacement are highly consistent with the detection results of the physical femoral head specimens, which can effectively predict the collapse of ONFH and carry out accurate staging. It is worthy of clinical promotion.
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Affiliation(s)
- Yongwei Shang
- The Second Department of Orthopedics, The People Hospital of Shijiazhuang, Shijiazhuang 050000, China
| | - Jianjie Xu
- The Second Department of Orthopedics, The People Hospital of Shijiazhuang, Shijiazhuang 050000, China
| | - Ting Zhang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Zhihui Dong
- The Second Department of Orthopedics, The People Hospital of Shijiazhuang, Shijiazhuang 050000, China
| | - Jiebing Li
- The Second Department of Orthopedics, The People Hospital of Shijiazhuang, Shijiazhuang 050000, China
| | - Weidong Bi
- The Second Department of Orthopedics, The People Hospital of Shijiazhuang, Shijiazhuang 050000, China
| | - Zhe Xie
- The Second Department of Orthopedics, The People Hospital of Shijiazhuang, Shijiazhuang 050000, China
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19
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Bahk JH, Jo WL, Kim SC, Kwon SY, Lim YW. Lateral pillar is the key in supporting pre-collapse osteonecrosis of the femoral head: a finite element model analysis of propensity-score matched cohorts. J Orthop Surg Res 2021; 16:728. [PMID: 34930357 PMCID: PMC8686362 DOI: 10.1186/s13018-021-02875-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/05/2021] [Indexed: 12/05/2022] Open
Abstract
Background This study was designed as a cohort study using propensity-score matching to age, gender, and body mass index (BMI) for finite element model (FEM) analysis from pre-collapse CT images of collapsed and non-collapsed hips. Through FEM analysis, a global graphical output around the hip joint can provide simple impression of stress distribution: concentration or dispersion. Methods A total of 32 hips with ARCO stage 2 or 3 ONFH who were on follow up for over a one-year period were retrospectively reviewed. 16 hips with no interval progression of collapse were set as the study group, then 16 hips with progression of collapse which required arthroplasty were set as the control group using propensity-score matching. FEM was generated through Mechanical Finder for each patient, then 4500 N of load was applied to 1000 mm2 area at the top of iliac crest to analyze the models in terms of equivalents for yield stress. Results Age, sex, and BMI had no significant differences between the two groups, while location (p = 0.015) was lateral, and size (p = 0.015) was significantly greater in the collapsed group. Non-collapsed hips mostly exhibited stress dispersion allocated to medial and lateral pillars, while collapsed hips exhibited stress concentration focused on the lateral pillar and the primary compression trabecula. (p = 0.001). Conclusion Through FEM analysis, stress concentration to the lateral pillar and the primary compression trabeculae can be used to predict future collapse in ONFH with high probability. Results provide a simple and intuitive, yet valuable information to aid surgeons. Therefore, especially for young patients, holding out the lateral pillar through joint preserving procedures might be the key in preventing further collapse.
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Affiliation(s)
- Ji Hoon Bahk
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, 222, Banpodae-ro, Seocho-gu, Seoul, 06591, South Korea
| | - Woo-Lam Jo
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, 222, Banpodae-ro, Seocho-gu, Seoul, 06591, South Korea
| | - Seung-Chan Kim
- Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Soon-Yong Kwon
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, 222, Banpodae-ro, Seocho-gu, Seoul, 06591, South Korea
| | - Young Wook Lim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, 222, Banpodae-ro, Seocho-gu, Seoul, 06591, South Korea.
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20
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Qiu H, Du W. Evaluation of the Effect of PDCA in Hospital Health Management. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6778045. [PMID: 34966526 PMCID: PMC8712153 DOI: 10.1155/2021/6778045] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 12/11/2022]
Abstract
PDCA plays a very important role in the hygienic management of hospital operating rooms. Before the PDCA management from February 2018 to February 2019, routine hygiene management in the operating room was adopted; after the PDCA management from February 2018 to February 2019, PDCA cycle management was adopted. 500 surgical patients were randomly selected from both groups. We compare the quality control checklist scores of hand hygiene management, environmental hygiene management, medical waste management, and disinfection and isolation management in the routine group and the PDCA group. We also compared the detection rate of pathogenic bacteria in surgical incisions of the routine group and the PDCA group and the infection rate of various surgical incisions, air samples, surface samples, disinfectants, and sterilization rates of sterile items. The PDCA group's hand hygiene management score, environmental hygiene management score, medical waste management score, and disinfection and isolation management score were higher than those in the conventional group (P < 0.05). The detection rate of pathogenic bacteria in the PDCA group, the infection rate of type I, type II, and type III incisions, and the total infection rate of surgical incisions were lower than those in the conventional group, and the difference was statistically significant (P < 0.05). The qualified rate of air samples and surface samples in the PDCA group was higher than that in the conventional group (P < 0.05), and the difference in the qualified rate of disinfectants and sterile items between the two groups was not statistically significant (P > 0.05). The hygiene management of the operating room adopts PDCA sustainable improvement management measures to effectively increase the qualification rate of disinfection and sterilization, reduce the detection rate of pathogenic bacteria and infection rate of surgical incisions, and strengthen the management quality of hand hygiene, environmental hygiene, medical waste, and disinfection and isolation.
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Affiliation(s)
- Huanmin Qiu
- Party Committee Office, The First Affiliated Hospital of Suchow University, Suzhou 215006, China
| | - Weiwei Du
- Propaganda Department of Party Committee, Renmin Hospital of Wuhan University, Wuhan 430060, China
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21
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Guo L. Diagnostic Value of SonoVue Contrast-Enhanced Ultrasonography in Nipple Discharge Based on Artificial Intelligence. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:2961697. [PMID: 34956565 PMCID: PMC8702308 DOI: 10.1155/2021/2961697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/22/2021] [Accepted: 10/29/2021] [Indexed: 11/17/2022]
Abstract
This paper aims to explore the application value of SonoVue contrast-enhanced ultrasonography based on deep unsupervised learning (DNS) in the diagnosis of nipple discharge. In this paper, a new model (ODNS) is proposed based on the unsupervised learning model and stack self-coding network. The ultrasonic images of 1,725 patients with breast lesions in the shared database are used as the test data of the model. The differences in accuracy (Acc), recall (RE), sensitivity (Sen), and running time between the two models before and after optimization and other algorithms are compared. A total of 48 female patients with nipple discharge are enrolled. The differences in SE, specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) of conventional ultrasound and contrast-enhanced ultrasonography are analyzed based on pathological examination results. The results showed that when the number of network layers is 5, the classification accuracies of DNS and ODNS model data reached the highest values, which were 91.45% and 98.64%, respectively.
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Affiliation(s)
- Ling Guo
- Pingxiang People's Hospital, Pingxiang 337000, China
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22
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Wang Y, Yamako G, Okada T, Arakawa H, Nakamura Y, Chosa E. Biomechanical effect of intertrochanteric curved varus osteotomy on stress reduction in femoral head osteonecrosis: a finite element analysis. J Orthop Surg Res 2021; 16:465. [PMID: 34301290 PMCID: PMC8299639 DOI: 10.1186/s13018-021-02614-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background Intertrochanteric curved varus osteotomy (CVO) has been widely used to remove the necrotic bone away from the weight-bearing portion in the treatment of osteonecrosis of the femoral head (ONFH). However, whether all types of necrosis will benefit from CVO, in terms of the stress level, the effect of different center-edge (CE) angles of acetabulum on stress distribution of necrosis after CVO, and the relationship between the intact ratio and the stress of necrosis, has never been addressed. The purpose of the study was to evaluate the influence of CVO on the stress reduction in necrotic bone using a finite element analysis (FEA) with different CE angles. Methods CVO finite element models of the hip joint were simulated with a lesion of 60°. The osteotomy angles were divided into four configurations (15°, 20°, 25°, and 30°), and three types (A, B, and C1) of lesions were established based on the Japanese Investigation Committee (JIC) classification. In addition, two CE angles (18° and 33°) of acetabulum were considered. The maximum and mean von Mises stress were analyzed in terms of the necrotic bone by a physiological loading condition. Moreover, the correlation of the intact ratio measured in 3D and the stress distribution after CVO was analyzed. Results Stress reduction was obtained after CVO. For type B, the CVO angle was 20° (0.61 MPa), and for type C1, the CVO angle was 30° (0.77 MPa), if the mean stress level was close to type A (0.61 MPa), as a standard. The maximum and mean von Mises stress were higher in the CE angle of 18°models, respectively. The intact ratio measured in 3D had a good negative correlation with stress after CVO and had more influence on stress distribution in comparison to other geometric parameters. Conclusions For making decisions about the biomechanics of CVO, a CVO angle of > 20° was recommended for type B and > 30° was safe for type C1. The risk of progressive collapse was increased in the insufficient situation of the weight-bearing portion after CVO. The intact ratio could provide information about clinical outcomes and stress distribution after CVO.
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Affiliation(s)
- Yuzhu Wang
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Go Yamako
- Department of Mechanical Engineering, Faculty of Engineering, University of Miyazaki, Miyazaki, Miyazaki, Japan.
| | - Takato Okada
- Graduate school of Engineering, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Hideki Arakawa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Yoshihiro Nakamura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Etsuo Chosa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
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