Avascular necrosis of the hip

Lamb, Jonathan; Holton, Colin; O'Connor, Philip A.; Giannoudis, Peter V.

doi:10.1136/bmj.l2178

Cited by 56 publications

(63 citation statements)

References 9 publications

(14 reference statements)

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“…Glucocorticoid (GC) usage is one of the main risk factors [ 1 ]. GC-induced NONFH is assumed to cause thrombosis to occur in bone blood vessels, leading to a sequential process of blood flow obstruction, venous high pressure, arterial ischemic, osseous hypoxia, loss of bone integrity, and collapse of the subchondral bone [ 2 , 3 ]. Plasminogen activator inhibitor 1 (PAI-1) can suppress the conversion of plasminogen to plasmin and reduce the levels of fibrinolysis in blood vessels, leading to the formation of thrombus [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Bone marrow mesenchymal stem cell-derived exosomes promote plasminogen activator inhibitor 1 expression in vascular cells in the local microenvironment during rabbit osteonecrosis of the femoral head

Wang

et al. 2020

Stem Cell Res Ther

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Background Nontraumatic osteonecrosis of the femoral head (NONFH) is a highly disabling orthopedic disease in young individuals. Plasminogen activator inhibitor 1 (PAI-1) has been reported to be positively associated with NONFH. We aimed to investigate the dysregulating PAI-1 in bone marrow mesenchymal stem cells (BMMSCs) and vascular cells in rabbit steroid-induced NONFH. Methods To verify the hypothesis that BMMSCs could promote thrombus formation in a paracrine manner, we collected exosomes from glucocorticoid-treated BMMSCs (GB-Exo) to determine their regulatory effects on vascular cells. microRNA sequencing was conducted to find potential regulators in GB-Exo. Utilizing gain-of-function and knockdown approaches, we testified the regulatory effect of microRNA in exosomes. Results The expression of PAI-1 was significantly increased in the local microenvironment of the femoral head in the ONFH model. GB-Exo promoted PAI-1 expression in vascular smooth muscle cells and vascular endothelial cells. We also revealed that miR-451-5p in GB-Exo plays a crucial role for the elevated PAI-1. Moreover, we identified miR-133b-3p and tested its role as a potential inhibitor of PAI-1. Conclusions This study provided considerable evidence for BMMSC exosomal miR-mediated upregulation of the fibrinolytic regulator PAI-1 in vascular cells. The disruption of coagulation and low fibrinolysis in the femoral head will eventually lead to a disturbance in the microcirculation of NONFH. We believe that our findings could be of great significance for guiding clinical trials in the future.

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Section: Introductionmentioning

confidence: 99%

Bone marrow mesenchymal stem cell-derived exosomes promote plasminogen activator inhibitor 1 expression in vascular cells in the local microenvironment during rabbit osteonecrosis of the femoral head

Wang

et al. 2020

Stem Cell Res Ther

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“…8 La ON de cadera suele ser bilateral y el riesgo de la bilateralidad es mayor dentro de los dos años posteriores al diagnóstico unilateral. 9 La ON atraumática de cadera con frecuencia es asintomática, siendo difícil establecer el inicio del proceso. Al presentarse con sintomatología, esta se caracteriza por dolor en la articulación de la cadera, pudiendo irradiarse hacia la ingle, región anterior del muslo o hasta la rodilla.8…”

Section: Causas De Osteonecrosisunclassified

No dejemos morir al hueso: interiorizándonos con los procesos óseos avasculares

Mena

Mendoza

Galván

et al. 2020

Revista Argentina de Radiología / Argentinian Journal of Radiol

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ResumenEl objetivo de este artículo es realizar una revisión de las localizaciones, causas y hallazgos radiológicos específicos de los procesos avasculares óseos.Se define como isquemia ósea a las alteraciones ocasionadas por déficit de irrigación, llevando a la destrucción del hueso. Existen diferencias entre necrosis isquémica e infarto óseo, en base al sitio óseo de afectación. La etiología traumática es la más frecuente y suele ser unilateral. Los sitios de presentación más frecuentes son: cabeza femoral y humeral, rodilla y semilunar.La resonancia magnética (RM) es considerada la modalidad de imagen más sensible y específica, tanto para el diagnóstico temprano como estadificación y control.El conocimiento de las causas, características radiológicas y sus diferentes fases evitan el diagnóstico erróneo de otras etiologías, como las primarias o infecciosas, facilitando un correcto algoritmo terapéutico.

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“…It is the final common pathway of a complex interplay of genetic anomalies and stimulus factors that results in the loss of blood supply to the femoral head of the femur 1 . The underlying pathogenesis is unclear 2 . As a daunting orthopaedic intractable disease, ONFH can even gradually lead to lifelong disability in patients; it primarily affects young to middle-aged adults 3 .…”

Section: Introductionmentioning

confidence: 99%

Exploring the Risk Factors for the Misdiagnosis of Osteonecrosis of Femoral Head: A Case‐Control Study

Tan

Jia

et al. 2020

Orthopaedic Surgery

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The purpose of the present study was to evaluate the present situation and risk factors for the misdiagnosis of osteonecrosis of femoral head (ONFH), providing the basis for accurate diagnosis of ONFH. Methods: For this retrospective study, 1471 patients with ONFH were selected from the China Osteonecrosis of Femoral Head Database (CONFHD). These patients had been recruited between July 2016 and December 2018. According to whether or not they were misdiagnosed, the patients were divided into two groups, with 1168 cases (22-84 years old) included in the diagnosis group and 303 cases (21-80 years old) in the misdiagnosis group. Misdiagnosis was measured using the following criteria: (i) the patient had the same symptoms and signs, and the second diagnosis was not consistent with the initial diagnosis within 6 months; and (ii) the patient was admitted to a hospital participating in CONFHD and the previous diagnosis was inconsistent with the diagnosis given by the expert group. Comparisons of age, visual analogue scale for pain, and body mass index between the two groups were performed using a t-test. Gender, causes of ONFH, primary diseases requiring corticosteroids, methods of corticosteroid use, corticosteroid species, type of trauma, onset side of the disease, pain side, whether symptoms are hidden, and type of imaging examination at the initial visit were compared using the χ 2-test. Years of alcohol consumption, weekly alcohol consumption, and physician title at the initial visit were compared using a Mann-Whitney U-test. Furthermore, the statistically significant factors were evaluated using multiple regression analysis to investigate the risk factors of misdiagnosis. Results: A total of 303 patients (20.6%) were misdiagnosed: 118 cases were misdiagnosed as lumbar disc herniation, 86 cases as hip synovitis, 48 cases as hip osteoarthritis, 32 cases as rheumatoid arthritis, 11 cases as piriformis syndrome, 5 cases as sciatica, and 3 cases as soft-tissue injury. Whether symptoms are hidden

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Avascular necrosis of the hip

Cited by 56 publications

References 9 publications

Bone marrow mesenchymal stem cell-derived exosomes promote plasminogen activator inhibitor 1 expression in vascular cells in the local microenvironment during rabbit osteonecrosis of the femoral head

Bone marrow mesenchymal stem cell-derived exosomes promote plasminogen activator inhibitor 1 expression in vascular cells in the local microenvironment during rabbit osteonecrosis of the femoral head

No dejemos morir al hueso: interiorizándonos con los procesos óseos avasculares

Exploring the Risk Factors for the Misdiagnosis of Osteonecrosis of Femoral Head: A Case‐Control Study

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