Correlation between continuation of glucocorticoid treatment and risk of femoral head collapse

Zhu, Zhongxin; Li, Shaoguang; Yu, Huan; Huang, Jiaxin; Tong, Peijian

doi:10.1007/s00132-019-03851-1

Cited by 5 publications

(6 citation statements)

References 29 publications

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“…Roger [ 33 ] found that eliminating risk factors significantly improved the survival rate for conservative treatment of ONFH. Zhu [ 8 ] proved that patients with glucocorticoid-induced osteonecrosis of the femoral head (GA-ONFH) who continued glucocorticoids treatment postoperatively had a significantly increased risk of femoral head collapse (≥ 3 mm). Consistent with these results, our study also found that continued postoperative exposure to risk factors was statistically different in both univariate and multivariate analyses ( P < 0.05) and was an independent prognostic factor affecting hip preservation outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Osteonecrosis of the femoral head (ONFH) is a rapidly progressive and debilitating disease [ 1 ] with an increasing annual incidence worldwide [ 2 – 5 ], affecting over 20 million people [ 6 ]. Despite identification of several risk factors, including trauma [ 7 ], corticosteroid use [ 8 ], excessive alcohol consumption [ 9 ], and smoking [ 10 ], the etiology and pathogenesis of ONFH remain unclear, leading to a lack of effective prevention initiatives. Total hip arthroplasty (THA) is the exclusive reliable option for end-stage osteoarthritis resulting from ONFH [ 7 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Predicting efficacy and guiding procedure choice in non-vascularized bone grafting: a CT Radiomics and clinical predictor approach

Chen,

Xue,

et al. 2023

BMC Musculoskelet Disord

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Objectives There is no practical approach for accurately predicting the efficacy of non-vascularized bone grafting (NVBG) and guiding its optimal procedure. Materials and methods This study enrolled 153 patients with 182 hips that underwent NVBG procedures. The patients were randomly divided into a training cohort (n = 130) and a validation cohort (n = 52). In the training cohort, radiomics model, clinical model, and combined radiomics-clinical (C-R) model were constructed using Rad-scores and clinical predictors to predict the efficacy of NVBG. The optimal model was visualized by a nomogram and assessed by decision curve analysis (DCA). 128 hips that underwent successful NVBG were then randomized into a new training cohort (n = 92) and a new validation cohort (n = 36), and three models were constructed and validated to predict the choice of NVBG procedure. Results Japanese Investigation Committee (JIC) classification, exposure to risk factors postoperative, and Rad-scores consisting of four radiomics features were independent predictors for the efficacy of NVBG (P < 0.05). The C-R model provided better performance in both the training cohort (AUC: 0.818) and validation cohort (AUC: 0.747). To predict the choice of NVBG procedure, the C-R model built by JIC classification and Rad-scores consisting of five radiomics features showed the finest performance in both cohorts (AUC: 0.860 and 0.800, respectively). DCA showed great benefit using the C-R model for the choice of NVBG procedure. Conclusion The approach integrated by CT radiomics and clinical predictors can be visually and quantitatively applied to predict the efficacy and guide the choice of NVBG procedure with great predictive accuracy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predicting efficacy and guiding procedure choice in non-vascularized bone grafting: a CT Radiomics and clinical predictor approach

Chen,

Xue,

et al. 2023

BMC Musculoskelet Disord

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“…15,16 Therefore, the key to early treatment of FH necrosis is to preserve the FH and prevent FHC. 17 In recent years, porous tantalum rods have become a new method for the treatment of ANFH, which can effectively relieve the blood circulation obstruction caused by trauma and other factors, increase the blood supply to the FH, reduce the patient's pain level, and provide effective biomechanical support for the patient, and have achieved better efficacy in the treatment of early ANFH. 18,19 Tantalum has been used as a biomaterial for many years.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Factors Influencing Postoperative Femoral Head Collapse in Patients With Ficat I, II, and III Stages of Aseptic Necrosis of the Femoral Head

Zhang

Cao

et al. 2022

J Am Acad Orthop Surg

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Objective: To investigate the factors influencing postoperative femoral head collapse (FHC) in patients with Ficat I, II, and III stages of aseptic necrosis of the femoral head (ANFH). Methods: Retrospective analysis of 178 patients with ANFH admitted to our hospital from October 2018 to October 2021 was studied, and patients were categorized into the FHC group and no FHC group according to whether FHC occurred after surgery. The influencing factors causing postoperative FHC were analyzed by univariate and multifactor logistic regression. Results: In the collapsed group, there were statistically significant differences in etiology, extent of necrosis, mechanism of injury, preoperative waiting time, Japanese Femoral Necrosis Research Society staging, distance from the tip of the tantalum rod to the center of necrosis, and Harris score after treatment (P , 0.05). The etiology, extent of necrosis, mechanism of injury, preoperative waiting time, Japanese Femoral Osteonecrosis Research Society classification, distance between the tantalum rod tip and the center of necrosis, and Harris score after treatment were set as independent variables, and postoperative FHC in patients with Ficat I, II, and III stages of ANFH was used as the dependent variable in the univariate logistic regression analysis. Discussion: Hormonal osteonecrosis of the femur, extent of necrosis, type C1 and type C2 in the Japanese Society for the Study of Femoral Osteonecrosis staging, and distance of the tip of the tantalum rod from the center of necrosis are risk factors for postoperative FHC in patients with Ficat I, II, and III stages of ANFH. Femoral head (FH) necrosis is a frequent and hard-to-treat orthopaedic disease among young and elderly. [1][2][3] It is mostly caused by poorly repositioned femoral neck fractures and bone tissue self-lesions, and

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“…(6) The necrotic area was filled with cancellous bone taken from the iliac bone and compressed with an impaction rod to prop up the collapsed femoral head. (7) The cancellous bone surface of the musculocutaneous bone flap with rich blood supply was oriented towards the femoral head to further fill the necrotic area, the anterolateral column was proheld up, and the iliac bone flap was transferred to the fenestration of the femoral head. (8) The iliac bone flap was temporarily fixed with Kirschner wire, and the titanium nail with the appropriate length was selected after the depth sounder measurement.…”

Section: Surgical Methodsmentioning

confidence: 99%

Comparison of SHD-IBG and PVIBGT in ONFH including mechanical and pathological analysis of failure cases

Sun,

Ma,

Chen

et al. 2024

Sci Rep

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Currently, there is a lack of relevant research on the efficacy difference between SHD combined with IBG and PVIBGT in the treatment of osteonecrosis of the femoral head(ONFH). Firstly, this study intends to compare the effectiveness of surgical hip dislocation combined with impacting bone grafts (SHD-IBG) and pedicled vascularised iliac bone graft transfer (PVIBGT) in treating ONFH. And the study investigates patients who suffered from hip preservation failures from both groups to better comprehend failure reasons. 30 patients (34 hips) with ARCO stage IIIA femoral head necrosis were selected between January 2012 and July 2022. They were divided into group A(SHD-IBG) and group B (PVIBGT) according to different surgical methods. Firstly, compared the 1-year effect between SHD-IBG and PVIBGT at 1 year postoperatively; Secondly, assessed the medium and long-term efficacy of SHD-IBG hip preservation treatment; Lastly, based on study of the femoral head removed from patients with hip preservation failure in the two groups, the reasons for the failure of hip preservation were comprehensively analyzed in the two groups. Group A: 11 males (13 hips), 4 females (4 hips);Group B: 9 males (11 hips), 6 females (6 hips).Firstly, the average Harris scores of the two groups at 1 year after surgery: preoperative: 70.7, 1 year after surgery: 78.9 in group A; preoperative: 69.5, 1 year after surgery: 81.5 in group B. The differences were statistically significant (P < 0.05).Compared to the preoperative period, quantitative analysis by DCE-MRI showed an increase in perfusion in the necroticarea and an improvement in hyperperfusion in the repair-responsive area one year after the surgery. Secondly, in group A, the hip preservation rate was 88.2% at 2.5–11 (average of 77 months) years of follow-up, and the mean Harris score at the last follow-up was 73.2.Semi-quantitative analysis of postoperative DCE-MRI showed that the perfusion curves of necrotic and repaired areas were similar to those of the normal area. This suggests the instability within the femoral head had been effectively improved, and the perfusion had partially recovered. Thirdly, according to Micro-CT and pathologica studies of patients with hip preservation failure in these two groups, all these patients' femoral head was significantly collapsed and deformed. Their trabeculae was thin and partially disorganized, with fractures in the subchondral bone and separation of the cartilage from the subchondral bone. The necrotic areas had sparse trabeculae, disorganized arrangement, loss of continuity, and disappearance of cells in the trabecular traps. The necrotic area was covered with fibrous tissue, and partial restoration was observed in the repair area. Mechanical finite element analysis showed that the maximum equivalent force was observed in the weight- bearing area and the cortical bone surrounding the shaft of femurand. The result of DCE-MRI showed that the repair reaction area exhibited abnormal hyperperfusion. In this study, the efficacy of SHD-IBG and PVIBGT was compared at 1 year after operation, and the long-term follow-up of SHD-IBG was 2.5–11 (mean 77 months) years, combined with DCE-MRI results, we found that the short-term effect of PVIBGT was more significant than that of SHD-IBG. SHD-IBG can achieve satisfactory hip preservation in the medium and long term follow-up.

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Correlation between continuation of glucocorticoid treatment and risk of femoral head collapse

Cited by 5 publications

References 29 publications

Predicting efficacy and guiding procedure choice in non-vascularized bone grafting: a CT Radiomics and clinical predictor approach

Predicting efficacy and guiding procedure choice in non-vascularized bone grafting: a CT Radiomics and clinical predictor approach

Analysis of Factors Influencing Postoperative Femoral Head Collapse in Patients With Ficat I, II, and III Stages of Aseptic Necrosis of the Femoral Head

Comparison of SHD-IBG and PVIBGT in ONFH including mechanical and pathological analysis of failure cases

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