BackgroundNontraumatic osteonecrosis of the femoral head (ONFH) is treated with a series of methods. High-energy extracorporeal shock wave therapy (ESWT) is an option with promising mid-term outcomes. The objective of this study was to determine the long-term outcomes of ESWT for ONFH.MethodsFifty-three hips in 39 consecutive patients were treated with ESWT in our hospital between January 2005 and July 2006. Forty-four hips in 31 patients with stage I–III nontraumatic ONFH, according to the Association Research Circulation Osseous (ARCO) system, were reviewed in the current retrospective study. The visual analog pain scale (VAS), Harris hip score, radiography, and magnetic resonance imaging were used to estimate treatment results. The progression of ONFH was evaluated by imaging examination and clinical outcomes. The results were classified as clinical success (no progression of hip symptoms) and imaging success (no progression of stage or substage on radiography and MRI).ResultsThe mean follow-up duration was 130.6 months (range, 121 to 138 months). The mean VAS decreased from 3.8 before ESWT to 2.2 points at the 10-year follow-up (p < 0.001). The mean Harris hip score improved from 77.4 before ESWT to 86.9 points at the 10-year follow-up. The clinical success rates were 87.5% in ARCO stage I patients, 71.4% in ARCO stage II patients, and 75.0% in ARCO stage III patients. Imaging success was observed in all stage I hips, 64.3% of stage II hips, and 12.5% of stage III hips. Seventeen hips showed progression of the ARCO stage/substage on imaging examination. Eight hips showed femoral head collapse at the 10-year follow-up. Four hips in ARCO stage III and one hip in ARCO stage II were treated with total hip arthroplasty during the follow-up. Three were performed 1 year after ESWT, one at 2 years, and one at 5 years.ConclusionsThe results of the current study indicated that ESWT is an effective treatment method for nontraumatic ONFH, resulting in pain relief and function restoration, especially for patients with ARCO stage I–II ONFH.

Background: The occurrence of oscillating saw malfunction, power shortage, or contamination occurs frequently when implementing femoral neck osteotomy during total hip arthroplasty (THA). This study aimed to introduce the fretsaw as a novel substitute osteotomy tool with various advantages.Methods: Twenty patients (20 hips) who underwent primary THA were included. Ten patients underwent femoral neck osteotomy using a fretsaw, while the other 10 patients underwent the procedure using an oscillating saw. Intraoperative evaluation and radiographic data were obtained for all patients during and after surgery.Results: The mean osteotomy time was 20.60 ± 1.08s (range 16–27) and 22.10 ± 1.49s (range 16–31) in the oscillating saw and fretsaw groups, respectively. The mean osteotomy height was 1.21 ± 0.16 (range 1.01–1.43) cm and 1.14 ± 0.08 (range 1.02–1.28) cm in the oscillating saw and fretsaw groups, respectively. The use of fretsaw did not result in bone notch or blood splashes.Conclusion: The fretsaw can be a substitute femoral neck osteotomy tool with various advantages in THA while oscillating saw malfunction.

Background: Mechanical failure, power shortage, and unexpected contamination of oscillating saw occasionally happened in actualizing femoral neck osteotomy during total hip arthroplasty, while no appropriate alternative solution be available presently. This study aimed to introduce a novel osteotomy instrumentation (fretsaw, jig, cable passer hook) as a substitute tool while oscillating saw was unavailable in THA.Methods: This study included 40 patients (40 hips) who underwent femoral neck osteotomy during primary THA using the new osteotomy instrumentation (n=20) and oscillating saw (n=20). Clinical data and intraoperative findings of all patients were evaluated.Results: The mean osteotomy time was 22.3 ± 3.1 s (range, 17–30 s) and 29.4 ± 3.7 s (range, 25–39 s) in the oscillating saw group and the new osteotomy instrumentation group, respectively (P<0.001). The Harris Hip Score (HHS) improved in both groups; the mean HSS was 82.3 ± 2.5 and 83.3 ± 3.5 in the oscillating saw group and new osteotomy instrumentation group at 6 months after surgery, respectively (P=0.297).Conclusion: The original osteotomy instrumentation can be an ideal substitute tool for femoral neck osteotomy in THA, especially when the oscillating saw is unavailable or malfunctional.

ObjectiveThe aim of this study was to compare the clinical efficacy of percutaneous vertebroplasty with a side-hole push rod (modified PVP) and conventional PVP in treating osteoporotic vertebral compression fractures (OVCFs).Materials and methodsThis study included 69 patients with 1-level OVCFs. Perioperative indicators, including the operative time, cement injection volume, cement leakage rate, and distribution of cement in the fractured area, were analysed. The visual analogue scale (VAS) and Oswestry disability index (ODI) were administered pre- and postoperatively.ResultsNo significant differences were observed in the operative time or cement injection volume between the two groups (p > 0.05). The total diffusion score of bone cement in the PVP group was significantly lower than that in the modified PVP group (p < 0.05). Compared with the conventional PVP group, the modified PVP group had a significantly lower VAS score at 3 days postoperatively (p < 0.05). There were no differences in the VAS or ODI scores between the two groups at the last follow-up (p > 0.05). Bone cement leakage was observed in 15 cases in the conventional PVP group (15/32) and in 9 cases in the modified PVP group (9/37).ConclusionThe modified version of PVP provides sufficient cement to fill the fractured area and is associated with a lower incidence of cement leakage and undesired postoperative results than is conventional PVP, indicating that modified PVP is a safe and effective new technique for the treatment of OVCFs.