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Shoji T, Shozen H, Ueki S, Kaneta H, Yaunaga Y, Adachi N. Evaluation of the long-term patient-reported outcomes after hip arthroplasty or joint preserving with Sugioka femoral osteotomy in patients with femoral head osteonecrosis. INTERNATIONAL ORTHOPAEDICS 2024; 48:1201-1208. [PMID: 38376531 PMCID: PMC11001741 DOI: 10.1007/s00264-024-06118-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE This study retrospectively evaluated long-term clinical outcomes and patient-reported outcome measures (PROMs) in patients with osteonecrosis of the femoral head (ONFH) who underwent transtrochanteric rotational osteotomy (TRO), curved varus osteotomy (CVO), and total hip arthroplasty (THA). METHODS We retrospectively reviewed the 109 hips in 96 patients (46 men, 50 women) who underwent CVO, TRO, or THA for ONFH treatment. The mean follow-up period for the TRO, CVO, and THA groups was 14.8, 11.5, and 13.3 years, respectively. RESULTS The THA conversion rate of the TRO patients was significantly higher than that of the patients with CVO, and the final clinical scores in the patients with TRO did not improve compared with preoperative scores. Postoperative PROMs showed that the total and pain scores of the patients with THA were significantly higher than those of patients with TRO and CVO, while the PROM score did not change between patients with TRO and CVO. The analysis further showed that the preoperative type C2, stage 3A, or postoperative type C1 and C2 were significant predictors of decreased final PROM scores. CONCLUSION This study found that CVO and THA are clinically effective treatments for ONFH, with significant improvements compared with preoperative scores. However, THA was associated with significantly higher PROMs and pain scores than those of CVO and TRO in long-term follow-up. Furthermore, our results suggest that postoperative PROMs depend mainly on the preoperative level of collapse and postoperative transposed intact ratio of the articular surface of the femoral head.
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Affiliation(s)
- Takeshi Shoji
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
| | - Hideki Shozen
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Shinichi Ueki
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Hiroki Kaneta
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Yuji Yaunaga
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi, Saijo-Town, Higashi-Hiroshima, 739-0036, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
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Onaga M, Nakasone S, Ishihara M, Igei T, Washizaki F, Kuniyoshi S, Nishida K. Total hip arthroplasty after failed transtrochanteric rotational osteotomy for osteonecrosis of the femoral head: analysis of three-dimensional morphological features. BMC Musculoskelet Disord 2024; 25:194. [PMID: 38439044 PMCID: PMC10910828 DOI: 10.1186/s12891-024-07299-z] [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: 11/18/2023] [Accepted: 02/21/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND In total hip arthroplasty (THA) after failed transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH), deformity of the proximal femur has been reported to affect stem placement. The aims of this study were to evaluate the morphological changes in the proximal femur, muscle atrophy, and soft tissue thickening in THA after TRO and the clinical outcomes. METHODS The TRO group included 17 patients (18 hips) who underwent THA after failed TRO. The control group included 21 patients (28 hips) who underwent primary THA for ONFH. To evaluate the deformity of the proximal femur before THA, we measured the anteroposterior and mediolateral diameters of the femur on computed tomographic slices 5 mm proximal to the lesser trochanter. To evaluate muscle atrophy and soft tissue thickening, we measured the thicknesses of the psoas major, iliac, and gluteus medius muscles and the anterior capsule of the hip joint. RESULTS The ratio of the anteroposterior to mediolateral diameters of the proximal femur was significantly greater in the TRO group (p < 0.01). The thicknesses of the muscles did not differ between the two groups, whereas the anterior capsule was significantly thicker in the TRO group (p < 0.05). Varus or valgus stem alignment (> 3°) was frequent in the TRO group (p < 0.01). CONCLUSIONS The round shape of the proximal femur was deformed after TRO compared with primary THA for ONFH, which may have caused malposition of the stem. In addition, we should pay attention to anterior protrusion of the proximal femur and thickening of the anterior capsule.
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Affiliation(s)
- Masamichi Onaga
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Aza-Uehara, Nishihara Cho, Nakagami-Gun, Okinawa, 9030215, Japan
| | - Satoshi Nakasone
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Aza-Uehara, Nishihara Cho, Nakagami-Gun, Okinawa, 9030215, Japan.
| | - Masato Ishihara
- Department of Orthopedic Surgery, Nakagami Hospital, 610 Noborikawa, Okinawa, Okinawa, 9042195, Japan
| | - Takahiro Igei
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Aza-Uehara, Nishihara Cho, Nakagami-Gun, Okinawa, 9030215, Japan
| | - Fumiyuki Washizaki
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Aza-Uehara, Nishihara Cho, Nakagami-Gun, Okinawa, 9030215, Japan
| | - Sakura Kuniyoshi
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Aza-Uehara, Nishihara Cho, Nakagami-Gun, Okinawa, 9030215, Japan
| | - Kotaro Nishida
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Aza-Uehara, Nishihara Cho, Nakagami-Gun, Okinawa, 9030215, Japan
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Xu Y, Zeng P. A review and meta-analysis of the survival rate of adult with osteonecrosis of the femoral head treated with transtrochanteric rotational osteotomy. Medicine (Baltimore) 2022; 101:e31777. [PMID: 36451500 PMCID: PMC9704880 DOI: 10.1097/md.0000000000031777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Osteonecrosis of the femoral head (ONFH) is a progressive disease, and transtrochanteric rotational osteotomy (TRO) is a promising option to treat hip preservation. Compared with outcomes of non-Asian patients, those of Asian patients are different. Once ONFH has progressed to the stage of collapse, total hip arthroplasty (THA) is an unavoidable surgical procedure. However, patients treated with TRO still have a certain rate of femoral head collapse. A meta-analysis was done to comprehensively understand the outcome of TRO surgery for ONFH, in which conversion to THA was used as an endpoint event or the survival rate of patients with ONFH after TRO surgery as an indicator. METHODS We retrieved electronic databases from the inception of the study until June 2022, using the survival rate after TRO surgery or that after conversion to the endpoint event of THA as the effect indicator. The Risk Difference Independent unmatched samples of counting information with 95% confidence intervals (CI) were used to calculate the outcome. Also, subgroup analysis was carried out for Asian and non-Asian patients. Heterogeneity and publication bias analyses were also done for the included studies. RESULTS We pooled 19 studies, all of which were about applying TRO procedure for ONFH. There were 15 cohort studies, 4 case-control studies, and no randomized controlled studies. Based on the information extracted from the reported above (we extracted the relevant independent effect values separately for the case-control studies), this meta-analysis was performed based on a fixed-effect model, and META analysis was performed for an independent unpaired group of the samples. The total hip survival rate after TRO in ONFH was 0.58(95% CI = 0.45-0.72), The survival rate for Asians was: 0.68 (95% CI = 0.51-0.85) and for non-Asians was: 0.41 (95% CI = 0.17-0.64), respectively. CONCLUSIONS The application of TRO surgery in ONFH can effectively relieve patients' symptoms and they enjoy n a high survival rate, especially for Asian patients. This makes it a promising surgical technique.
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Affiliation(s)
- Yong Xu
- Graduate School of Guangxi University of Chinese Medicine, Nanning, China
- * Correspondence: Yong Xu, Graduate School of Guangxi University of Chinese Medicine, No. 13, Wuhe Avenue, Qingxiu District, Nanning City, Guangxi Zhuang Autonomous Region 530200, China (e-mail: )
| | - Ping Zeng
- Department of Orthopedics, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
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Liu N, Zheng C, Wang Q, Huang Z. Treatment of non‑traumatic avascular necrosis of the femoral head (Review). Exp Ther Med 2022; 23:321. [PMID: 35386618 PMCID: PMC8972838 DOI: 10.3892/etm.2022.11250] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/26/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ning Liu
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | | | - Qinglong Wang
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Zhipeng Huang
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, Shaanxi 710000, P.R. China
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Kaneko K, Chen H, Kaufman M, Sverdlov I, Stein EM, Park‐Min K. Glucocorticoid-induced osteonecrosis in systemic lupus erythematosus patients. Clin Transl Med 2021; 11:e526. [PMID: 34709753 PMCID: PMC8506634 DOI: 10.1002/ctm2.526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 07/21/2021] [Accepted: 07/25/2021] [Indexed: 12/24/2022] Open
Abstract
Osteonecrosis (ON) is a complex and multifactorial complication of systemic lupus erythematosus (SLE). ON is a devastating condition that causes severe pain and compromises the quality of life. The prevalence of ON in SLE patients is variable, ranging from 1.7% to 52%. However, the pathophysiology and risk factors for ON in patients with SLE have not yet been fully determined. Several mechanisms for SLE patients' propensity to develop ON have been proposed. Glucocorticoid is a widely used therapeutic option for SLE patients and high-dose glucocorticoid therapy in SLE patients is strongly associated with the development of ON. Although the hips and knees are the most commonly affected areas, it may be present at multiple anatomical locations. Clinically, ON often remains undetected until patients feel discomfort and pain at specific sites at which point the process of bone death is already advanced. However, strategies for prevention and options for treatment are limited. Here, we review the epidemiology, risk factors, diagnosis, and treatment options for glucocorticoid-induced ON, with a specific focus on patients with SLE.
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Affiliation(s)
- Kaichi Kaneko
- Arthritis and Tissue Degeneration Program, David Z. Rosensweig Genomics Research CenterHospital for Special SurgeryNew YorkNew York10021USA
| | - Hao Chen
- Arthritis and Tissue Degeneration Program, David Z. Rosensweig Genomics Research CenterHospital for Special SurgeryNew YorkNew York10021USA
- Department of OrthopedicsBeijing Friendship HospitalBeijing100050China
| | - Matthew Kaufman
- Arthritis and Tissue Degeneration Program, David Z. Rosensweig Genomics Research CenterHospital for Special SurgeryNew YorkNew York10021USA
- Case Western Reserve School of MedicineClevelandOhio44106USA
| | - Isaak Sverdlov
- Arthritis and Tissue Degeneration Program, David Z. Rosensweig Genomics Research CenterHospital for Special SurgeryNew YorkNew York10021USA
- Tuoro College of Osteopathic Medicine‐New York CampusNew YorkNew York10027USA
| | - Emily M. Stein
- Endocrinology Service, Hospital for Special SurgeryNew YorkNew YorkUSA
- Metabolic Bone Disease Service, Hospital for Special SurgeryNew YorkNew YorkUSA
| | - Kyung‐Hyun Park‐Min
- Arthritis and Tissue Degeneration Program, David Z. Rosensweig Genomics Research CenterHospital for Special SurgeryNew YorkNew York10021USA
- Department of MedicineWeill Cornell Medical CollegeNew YorkNew YorkUSA
- BCMB allied programWeill Cornell Graduate School of Medical SciencesNew YorkNew York10021USA
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He M, Wei Q, Chen Z, Yang F, Chen X, Qin YX, Fang B, He W. Porous tantalum rod implantation is associated with low survival rates in patients with type C2 osteonecrosis of the femoral head but has no effect on the clinical outcome of conversion total hip arthroplasty: a retrospective study with an average 8-year follow-up. BMC Musculoskelet Disord 2020; 21:841. [PMID: 33308229 PMCID: PMC7733268 DOI: 10.1186/s12891-020-03860-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/03/2020] [Indexed: 11/22/2022] Open
Abstract
Background Our study aimed to investigate the clinical outcomes and survival rates following porous tantalum rod surgery (PTRS) and conversion total hip arthroplasty (THA) subsequent to failed PTRS. Methods A total of 38 subjects (40 hips) with osteonecrosis of the femoral head (ONFH) were included in this retrospective study between January 2008 and December 2011. All subjects were evaluated before surgery by using the Association Research Circulation Osseous (ARCO) classification system, the Japan Investigation Committee (JIC) classification and the Harris hip score (HHS). The endpoint of this study was set as final follow-up (including the survival time of PTRS and conversion THA). The rates of radiological progression were also evaluated. Patients who received conversion THA were further followed and compared to a control group of 58 patients with ONFH who underwent primary THA. Results The mean follow-up time was 120.7 ± 9.2 (range, 104–143) months, and the overall survival rate was 75% at 96 months (ARCO stage II: 81.5%; stage III: 38.5%; JIC type C1: 83.3%; C2: 30%). The HHS before surgery was 59 (55–61), in contrast to 94 (91–96) at 96 months follow-up (P < 0.01). HHS in stage III show a significant poorer result compared to stage II at 24 months. HHS in Type C2 group show no significant difference compared to HHS before surgery at 24 and 60 months follow up (P = 0.91, P = 0.30). Twelve hips requiring secondary THA were followed for 66.9 ± 31.7 months, and control hips that underwent primary THA was followed for 75.4 ± 14.9 months. The HHS in the conversion group was 89 (86–93) and that in the primary THA group was 92 (79–95, P = 0.09) at the 5-year follow-up. Conclusion In the mid-term follow-up, porous tantalum implants showed an encouraging survival rate in symptomatic patients in early stages (ARCO stage II) or with limited necrotic lesions (JIC type C1). In addition, our results did not demonstrated any difference between primary THA and conversion THA.
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Affiliation(s)
- Mincong He
- Department of Orthopedic Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China.,Laboratory of Orthopaedics & Traumatology, Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Qiushi Wei
- Institute of Orthopedics of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, NO.12 Jichang Road, Guangzhou, Guangdong, 510405, People's Republic of China
| | - Zhenqiu Chen
- Laboratory of Orthopaedics & Traumatology, Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fan Yang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Xiaojun Chen
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Yi-Xian Qin
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Bin Fang
- Department of Orthopedic Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China. .,Laboratory of Orthopaedics & Traumatology, Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Wei He
- Institute of Orthopedics of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China. .,The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, NO.12 Jichang Road, Guangzhou, Guangdong, 510405, People's Republic of China.
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Hip survival rate in the patients with avascular necrosis of femoral head after transtrochanteric rotational osteotomy: a systematic review and meta-analysis. Chin Med J (Engl) 2020; 132:2960-2971. [PMID: 31855958 PMCID: PMC6964954 DOI: 10.1097/cm9.0000000000000562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Supplemental Digital Content is available in the text Background: The clinical outcome of transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH) remains controversial, and the promising clinical results of several Japanese studies could not be reproduced in American and European studies. Trying to solve controversies on TRO for ONFH rising from apparently conflicting studies, a meta-analysis was conducted to assess the 5- and 10-year hip survival rates (with conversion to artificial joint replacement and radiographic failure as endpoints) after TRO. Methods: All eligible studies were searched in seven comprehensive databases including PubMed, Web of Science, Embase, Cochrane Library, VIP Database, China Knowledge Resource Integrated Database, and Wan Fang Database prior to June 2019. The outcomes evaluated were 5- and 10-year hip survival rates after TRO. The odds ratio and risk difference for the non-comparative binary data with the 95% confidence intervals (CIs) were calculated for each outcome. The included studies were assessed for methodologic bias and potential reasons for heterogeneity were explored. Results: Nineteen studies of TRO for ONFH were eligible for this meta-analysis according to inclusion criteria. Based on the previous report, two calculation methods (Methods 1 and 2) were adopted in this meta-analysis. Furthermore, we performed a sub-group analysis of the 5- and 10-year hip survival rates (Method 1) after TRO for ONFH: Asian sub-population and non-Asian sub-population. Taking conversion to artificial joint replacement as the endpoint, 5- and 10-year hip survival rates (Method 1) after TRO for ONFH in the Asian population were 0.86 (95% CI = 0.82–0.89) and 0.72 (95% CI = 0.65–0.78), respectively, and 5- and 10-year hip survival rates after TRO for ONFH in the non-Asian population were 0.55 (95% CI = 0.43–0.67) and 0.42 (95% CI = 0.28–0.55), respectively. The 5- and 10-year hip survival rates (Method 2) after TRO for ONFH were 0.90 (95% CI = 0.79–0.95) and 0.89 (95% CI = 0.81–0.94), respectively. Taking radiographic failure as the endpoint, 5- and 10-year hip survival rates after TRO for ONFH were 0.70 (95% CI = 0.64–0.76) and 0.53 (95% CI = 0.46–0.61), respectively. Conclusions: The 5- and 10-year hip survival rates after TRO for ONFH were satisfactory in the Asian population, and were acceptable in the non-Asian population despite high early failure rates.
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Shoji T, Yamasaki T, Ota Y, Saka H, Yasunaga Y, Adachi N. Effect of transtrochanteric rotational osteotomy on impingement and contact state of a femoral implant in conversion total hip arthroplasty - Retrospective simulation study. Clin Biomech (Bristol, Avon) 2020; 71:68-72. [PMID: 31704537 DOI: 10.1016/j.clinbiomech.2019.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/10/2019] [Accepted: 10/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The transtrochanteric rotational osteotomy is a common osteotomy for osteonecrosis of the femoral head, although the results of conversion total hip arthroplasty after the osteotomy are controversial. We evaluated how deformities in the proximal femur after the osteotomy affect hip impingement and the contact state of the stem in total hip arthroplasty. METHODS We retrospectively reviewed 35 hips (24 men) that had undergone the transtrochanteric rotational osteotomy for osteonecrosis of the femoral head (TRO-group) and compared them with 31 contralateral, unoperated hips (Primary group). The distance between the anterior and posterior greater trochanter at the cutting point of the femur, defined as the greater trochanter width and the contact area of the femoral implant surface with cortical bone were measured by CT-based three-dimensional templating software. We also calculated the hip range of motion in conversion total hip arthroplasty and analyzed the correlations between the greater trochanter width and the range of motion. FINDINGS The number of bony-impingement cases was significantly greater, and the range of motion in flexion, internal rotation and external rotation was significantly less in TRO-group. There was a significant negative correlation between the greater trochanter width and range of motion of internal rotation. There were no significant differences between two groups in percentages of femoral-implant contact area. INTERPRETATIONS The femoral implant fixation appears to be satisfactorily fixed in all zones in conversion total hip arthroplasty. However, the greater attention should be paid to minimizing bony impingement, especially on the anterior side, in conversion total hip arthroplasty.
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Affiliation(s)
- Takeshi Shoji
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yuki Ota
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Hideki Saka
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yuji Yasunaga
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi, Saijo-town, Higashi-hiroshima 739-0036, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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Kawai T, Shanjani Y, Fazeli S, Behn AW, Okuzu Y, Goodman SB, Yang YP. Customized, degradable, functionally graded scaffold for potential treatment of early stage osteonecrosis of the femoral head. J Orthop Res 2018; 36:1002-1011. [PMID: 28782831 PMCID: PMC5924591 DOI: 10.1002/jor.23673] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/24/2017] [Indexed: 02/04/2023]
Abstract
Osteonecrosis of the femoral head (ONFH) is a debilitating disease that results in progressive collapse of the femoral head and subsequent degenerative arthritis. Few treatments provide both sufficient mechanical support and biological cues for regeneration of bone and vascularity when the femoral head is still round and therefore salvageable. We designed and 3D printed a functionally graded scaffold (FGS) made of polycaprolactone (PCL) and β-tricalcium phosphate (β-TCP) with spatially controlled porosity, degradation, and mechanical strength properties to reconstruct necrotic bone tissue in the femoral head. The FGS was designed to have low porosity segments (15% in proximal and distal segments) and a high porosity segment (60% in middle segment) according to the desired mechanical and osteoconductive properties at each specific site after implantation into the femoral head. The FGS was inserted into a bone tunnel drilled in rabbit femoral neck and head, and at 8 weeks after implantation, the tissue formation as well as scaffold degradation was analyzed. Micro-CT analysis demonstrated that the FGS-filled group had a significantly higher bone ingrowth ratio compared to the empty-tunnel group, and the difference was higher at the distal low porosity segments. The in vivo degradation rate of the scaffold was higher in the proximal and distal segments than in the middle segment. Histological analysis of both non-decalcified and calcified samples clearly indicated new bone ingrowth and bone marrow-containing bone formation across the FGS. A 3D printed PCL-β-TCP FGS appears to be a promising customized resorbable load-bearing implant for treatment of early stage ONFH. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1002-1011, 2018.
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Affiliation(s)
- Toshiyuki Kawai
- Department of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Stanford, 94305, California
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku Kyoto, 606-8507, Japan
| | - Yaser Shanjani
- Department of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Stanford, 94305, California
| | - Saba Fazeli
- Department of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Stanford, 94305, California
- Department of Mechanical Engineering, Stanford University, 440 Escondido Mall, Stanford, 94305, California
| | - Anthony W Behn
- Department of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Stanford, 94305, California
| | - Yaichiro Okuzu
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku Kyoto, 606-8507, Japan
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Stanford, 94305, California
- Department of Bioengineering, Stanford University, 318 Campus Drive, Stanford, 94305, California
| | - Yunzhi P Yang
- Department of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Stanford, 94305, California
- Department of Bioengineering, Stanford University, 318 Campus Drive, Stanford, 94305, California
- Department of Materials Science and Engineering, Stanford University, 496 Lomita Mall, Stanford, 94305, California
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Karasuyama K, Motomura G, Ikemura S, Fukushi JI, Hamai S, Sonoda K, Kubo Y, Yamamoto T, Nakashima Y. Risk factor analysis for postoperative complications requiring revision surgery after transtrochanteric rotational osteotomy for osteonecrosis of the femoral head. J Orthop Surg Res 2018; 13:6. [PMID: 29316952 PMCID: PMC5761186 DOI: 10.1186/s13018-018-0714-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study investigated the risk factors for postoperative complications requiring revision surgery within 3 years after transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH). METHODS We reviewed 127 patients (147 hips) who underwent TRO (anterior or posterior rotational osteotomy) for ONFH between January 2002 and December 2014. Two patients were lost to follow-up, and five patients with progression of femoral head collapse requiring a salvage procedure such as total hip arthroplasty within 3 years after TRO were excluded. The better hip in patients treated bilaterally was also excluded (n = 20) to avoid duplication of patient demographics, leaving 120 hips (120 patients) for the analysis. We reviewed the medical records of each patient to screen for postoperative complications that required revision surgery within 3 years after surgery, recording the patient's age, sex, body mass index, surgical side, condition of the contralateral hip, previous alcohol intake, previous alcohol abuse, previous corticosteroid use, perioperative corticosteroid use, smoking status, preoperative stage and type of ONFH, preoperative activity level, and preoperative and final follow-up Japanese Orthopaedic Association scores. Differences between cases with and without complications were analyzed. RESULTS Eleven (9.2%) cases showed postoperative complications that required revision surgery. The most common complication was deep infection (n = 5), followed by nonunion of the greater trochanter (n = 3), nonunion of the intertrochanteric osteotomy site (n = 2), and femoral head fracture (n = 1). The multivariate analysis showed an independent association between previous alcohol abuse and postoperative complications (odds ratio, 13.5). CONCLUSION A correlation might exist between alcohol abuse and complications following a TRO procedure.
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Affiliation(s)
- Kazuyuki Karasuyama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Jun-Ichi Fukushi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Kazuhiko Sonoda
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Yusuke Kubo
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, 12 Jonan-ku, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
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The Results of Total Hip Arthroplasty After Sugioka Transtrochanteric Anterior Rotational Osteotomy for Osteonecrosis. J Arthroplasty 2017; 32:2768-2773. [PMID: 28529111 DOI: 10.1016/j.arth.2017.04.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/10/2017] [Accepted: 04/18/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Since Sugioka transtrochanteric anterior rotational osteotomy (ARO) for osteonecrosis of the femoral head (ONFH) changes the morphology of the proximal femur, total hip arthroplasty (THA) after previous ARO is considered a technically demanding procedure. The purpose of this study was to compare the clinicoradiologic outcomes of THA after ARO with those of THA without any antecedent surgery for ONFH. METHODS Twenty-four hips in 20 patients who underwent cementless THA after ARO (postosteotomy group) were retrospectively reviewed and compared with patients who underwent cementless THA without any antecedent surgery for ONFH during the same period (primary group). In the postosteotomy group, the mean duration from ARO to THA was 19.7 years. All patients were followed for at least 5 years (mean, 8.3 years; follow-up rate, 78.5%). A clinical assessment was performed preoperatively and at the latest follow-up using the Harris Hip Score. A radiographic examination was performed at 3 months after THA and at the latest follow-up. RESULTS The Harris Hip Score at the latest follow-up in the postosteotomy group was equivalent to that in the primary group, but longer operation time and greater intraoperative blood loss were observed in the postosteotomy group. There were no significant differences in postoperative complications, including dislocation (2 hips in each group). The leg lengthening in the postosteotomy group tended to be longer. No hips showed implant malpositioning, loosening, or required any revision surgery. CONCLUSION The clinicoradiologic outcomes of THA after ARO are considered to be comparable with those of THA without any antecedent surgery for ONFH.
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12
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Kubo Y, Yamamoto T, Motomura G, Karasuyama K, Sonoda K, Iwamoto Y. Patient-reported outcomes of femoral osteotomy and total hip arthroplasty for osteonecrosis of the femoral head: a prospective case series study. SPRINGERPLUS 2016; 5:1880. [PMID: 27833839 PMCID: PMC5081314 DOI: 10.1186/s40064-016-3576-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 10/18/2016] [Indexed: 11/29/2022]
Abstract
Background Patient-reported scoring systems have recently been used after surgical procedures. The purpose of this prospective study was to evaluate the patient-reported outcomes of femoral osteotomy and total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH). Methods Forty-two symptomatic ONFH patients with asymptomatic contralateral hip underwent either transtrochanteric anterior rotational osteotomy (ARO) or THA as a primary operation. Of these, 20 patients whose contralateral hips remained asymptomatic at the final follow-up (more than 1 year postoperatively) were recruited to participate in this study. Nine patients were treated with ARO (ARO group) and 11 patients were treated with THA (THA group). Both the Oxford hip score (OHS) and the short form 36 (SF-36) were evaluated preoperatively and at the final follow-up. Results The preoperative OHS was 29.1 ± 10.9 and 21.9 ± 9.6 points in the ARO and THA groups, which significantly improved to 38.4 ± 9.4 and 40.3 ± 5.1 points at the final follow-up, respectively. The preoperative physical component summary score was 30.8 ± 12.8 and 17.8 ± 14.5 points in the ARO group and THA groups, which significantly improved to 44.5 ± 10.6 and 43.3 ± 10.4 points at the final follow-up, respectively. The preoperative mental component summary score was 48.0 ± 8.5 and 48.6 ± 11.3 points in the ARO and THA groups, both of which remained unchanged at the final follow-up. Conclusions The short-term patient-reported outcomes of this study suggested that both ARO and THA for ONFH resulted in significantly improved postoperative hip joint function.
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Affiliation(s)
- Yusuke Kubo
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Kazuyuki Karasuyama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Kazuhiko Sonoda
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, 1-1 Sonekita-machi, Kokuraminami-ku, Kitakyushu, 800-0296 Japan
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13
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Mont MA, Cherian JJ, Sierra RJ, Jones LC, Lieberman JR. Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today? A Ten-Year Update. J Bone Joint Surg Am 2015; 97:1604-27. [PMID: 26446969 DOI: 10.2106/jbjs.o.00071] [Citation(s) in RCA: 300] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Although multiple theories have been proposed, no one pathophysiologic mechanism has been identified as the etiology for the development of osteonecrosis of the femoral head. However, the basic mechanism involves impaired circulation to a specific area that ultimately becomes necrotic.➤ A variety of nonoperative treatment regimens have been evaluated for the treatment of precollapse disease, with varying success. Prospective, multicenter, randomized trials are needed to evaluate the efficacy of these regimens in altering the natural history of the disease.➤ Joint-preserving procedures are indicated in the treatment of precollapse disease, with several studies showing successful outcomes at mid-term and long-term follow-up.➤ Studies of total joint arthroplasty, once femoral head collapse is present, have described excellent outcomes at greater than ten years of follow-up, which is a major advance and has led to a paradigm shift in treating these patients.➤ The results of hemiresurfacing and total resurfacing arthroplasty have been suboptimal, and these procedures have restricted indications in patients with osteonecrosis of the femoral head.
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Affiliation(s)
- Michael A Mont
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M.A. Mont:
| | - Jeffrey J Cherian
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M.A. Mont:
| | - Rafael J Sierra
- Mayo Clinic, 200 First Street S.W., Gonda 14 South, Rochester, MN 55905
| | - Lynne C Jones
- Department of Orthopaedic Surgery, Johns Hopkins University, 601 North Caroline Street, JHOC 5245, Baltimore, MD 21287
| | - Jay R Lieberman
- Keck Medical Center of University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA 90033
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Ehmke TA, Cherian JJ, Wu ES, Jauregui JJ, Banerjee S, Mont MA. Treatment of Osteonecrosis in Systemic Lupus Erythematosus: A Review. Curr Rheumatol Rep 2014; 16:441. [DOI: 10.1007/s11926-014-0441-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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15
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Shigemura T, Nakamura J, Shimizu K, Iida S, Oinuma K, Kishida S, Ohtori S, Takahashi K. Articular collapse and surgical frequency in corticosteroid-associated osteonecrosis of the femoral head and the knee: an MRI-based prospective study. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s12570-013-0216-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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16
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Shigemura T, Kishida S, Iida S, Oinuma K, Nakamura J, Takahashi K, Harada Y. Cementless total hip arthroplasty for osteonecrosis of the femoral head in systemic lupus erythematosus: a study with 10–16 years of follow-up. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s12570-012-0149-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Osteonecrosis in systemic lupus erythematosus: an early, frequent, and not always symptomatic complication. Autoimmune Dis 2012; 2012:725249. [PMID: 22919470 PMCID: PMC3419396 DOI: 10.1155/2012/725249] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 06/16/2012] [Indexed: 12/23/2022] Open
Abstract
Osteonecrosis may complicate the course of systemic lupus erythematosus and may contemporaneously affect multiple joints. The major risk factor associated with the development of osteonecrosis is the use of glucocorticoid at high doses. Recent studies using serial MRI, which represents the “gold standard” for the early detection of osteonecrosis, yielded some interesting findings about the natural history of this clinical entity. Osteonecrosis in the majority of the cases is asymptomatic and occurs early in the course of the disease. Its later occurrence is associated with lupus flare that requires the increase of corticosteroid dose. The optimal treatment of osteonecrosis is controversial. In case of silent osteonecrosis involving a small area conservative strategy is usually adequate. When lesions are symptomatic surgical treatment as core decompression or free vascularized fibular grafting is required; extracorporeal shockwave treatment may represent an alternative therapeutic approach. When the lesion has a medium-large dimension or involves a weight-bearing area bone collapse is a common complication requiring total joint replacement. Coadministration of bisphosphonate or warfarin with high doses of corticosteroid might be a promising preventive strategy of osteonecrosis.
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