Evaluation of bipolar hemiarthroplasty for the treatment of steroid-induced osteonecrosis of the femoral head

Moriya, M.; Uchiyama, Katsufumi; Takahira, Naonobu; Fukushima, Kazuhiko; Yamamoto, Takanobu; Hoshi, Keika; Itoman, Moritoshi; Takaso, Masashi

doi:10.1007/s00264-012-1612-8

Cited by 33 publications

(27 citation statements)

References 28 publications

(38 reference statements)

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“…[4,5]. The technical improvement of total hip arthroplasty (THA) seems to give hope of complete recovery from the degenerate diseases [6,7]. But for those young and middle-aged patients, it seems too early and patients may face the risk of more than one revision surgery and other complications [8,9].…”

Section: Introductionmentioning

confidence: 99%

Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head

Zeng

He²,

Feng³

et al. 2013

International Orthopaedics (SICOT)

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Purpose To investigate the curative efficacy of osteonecrosis of the femoral head (ONFH) in a hip-preserving operative approach, by grafting a vascularized greater trochanter flap combined with a free iliac flap, in an attempt to seek an innovative approach for patients who suffered middle to late stage ONFH without total hip arthroplasty (THA) surgery. Method Our research included a total of 60 patients (66 hips) who accepted hip-preserving surgery by grafting a vascularized greater trochanter flap combined with a free iliac flap which was tightly filled by hammering because of ONFH (most were Association Research Circulation Osseous (ARCO) stage III patients) from January, 2006 to December, 2010. A Harris Hip Score was obtained during follow-ups, evaluating the clinical efficacy, X-rays were taken regularly for image assessing, and the SF-36 scale was used for estimating quality of life. Terminal observation time was considered when patients had symptom-dependant indications for performing another hip-preserving surgery or THA surgery. Results Fifty-eight patients (64 hips) were eventually contacted by telephone for an out-patient clinic return visit, with a mean follow-up time of 35.8 months (varied from 12 months to 60 months), but two patients lost contact for various reasons. The demographic data were as follows: there were 16 ARCO IIIA cases, 22 ARCO IIIB cases, and 26 ARCO IIIC cases, respectively. Postoperative X-rays revealed a well-repaired necrotic area of the femoral head and improvement of femoral-acetabulum coverage. The last follow-up mean Harris Hip Score was 86.56±7.38 (excellent results reached 87.50 %), which were greatly improved compared to 50.95±6.86 pre-operatively. Also the postoperative mean scores of all dimensions of the SF-36 scale were improved to some extent. Additionally the physical component summary (PSC) scores were enhanced from 42± 13 pre-operatively to 78±11, while the postoperative mental component summary (MCS) scores (76±11) largely increased in contrast to pre-operative scores (51±10), with both target indices having statistical significance (p=0.005, p=0.01), signifying hugely improvement of the quality of life of the patients. A correlation was found between Harris Hip Score and all dimensions of SF-36 scale (r=0.32-0.72), especially closely correlated with physical functioning (PF), role-physical (RP) and bodily pain (BP) in PCS aspect (r= 0.72, p < 0.01; r = 0.58, p < 0.01; r = 0.65, p < 0.01, respectively). Conclusion There is definite curative efficacy for the treatment of ONFH with an hip-preserving operative approach by grafting a vascularized greater trochanter flap combined with a free iliac flap which was tightly filled by hammering. This kind of operative approach reconstructs the biological stability of femoral head, which promotes repair of necrotic areas and indirectly preserves the femoral head of patients and a majority of hip function. It possesses vast clinical as well as practical significance, because the long-term efficacy can satisfy fundam...

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Section: Introductionmentioning

confidence: 99%

Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head

Zeng

He²,

Feng³

et al. 2013

International Orthopaedics (SICOT)

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“…Steroid-related osteonecrosis of the femoral head (SONFH) usually occurs after high-dose steroid treatment for several diseases, such as severe acute respiratory syndrome (SARS), and systemic lupus erythematosus (SLE) [1][2][3]. As a degenerative and refractory bone disease, it ultimately leads to the collapse of subchondral bone and total hip joint replacement [4,5]. Subchondral collapse of femoral head is strongly associated with changes in osteoclast and osteoblast activities [6][7][8], ie, a dominate bone resorption of necrotic bone without adequate repair of bone formation [9,10].…”

Section: Introductionmentioning

confidence: 99%

Bushenhuoxue formula inhibits osteoclastogenesis and bone resorption on rabbit steroid-related osteonecrosis of the femoral head by suppressing NF-κB/NFATc1 pathway

Zhang

et al. 2020

Preprint

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Background: To investigate the effect and underlying mechanism of Bushenhuoxue formula (BSHXF) on steroid-related osteonecrosis of the femoral head (SONFH). Methods：Seventy-five male New Zealand white rabbits were divided into three groups: control group, model group and BSHXF group. Rabbit SONFH was induced by methylprednisolone (MPS) combined with lipopolysaccharide (LPS). At week 2 and 6 post induction, the corresponding number of rabbits were sacrificed, and the femoral heads were harvested for tissue analyses, including histopathology, mechanical test of femoral heads, micro-CT, tartrate-resistant acid phosphatase (TRAP) staining, immunohistochemistry for p-P65 and co-staining of TRAP and alkaline phosphatase (ALP). Additionally, the serum TRACP5b level was measured using enzyme-linked immunosorbent assay (ELISA). Meanwhile, we also evaluated the effect of BSHXF treatment on osteoclastogenesis in vitro. The protein level of cathepsin K (CTSK), P65, p-P65 and NFATc1 in rabbit femoral heads and RAW264.7 cells were detected, respectively.Results: At weeks 2 and 6 post induction, the elevated TRAP, p-P65 expression and reduced ALP expression were observed in the model group, with decreases in weight-bearing capacity of femoral heads and bone mass. After BSHXF treatment, the ratio of empty lacuna and the incidence of osteonecrosis in BSHXF group were markedly lower than that in model group. Micro-CT evaluation indicated that BSHXF has a preventive effect on bone loss in rabbit SONFH. In addition, BSHXF treatment increased weight-bearing capacity of femoral heads and reduced TRAP+ osteoclasts and serum TRACP5b level. Interestingly, CTSK, p-P65 and NFATc1 upregulation in necrotic femoral head could be reversed by BSHXF treatment, which also effectively inhibited RANKL-induced osteoclast differentiation and down-regulated CTSK, p-P65 and NFATc1 expression in vitro.Conclusions: BSHXF could inhibit osteoclastogenesis and bone resorption on rabbit steroid-related osteonecrosis of the femoral head by suppressing NF-κB/NFATc1 pathway.

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“…The steroid‐induced necrosis of the femoral head (SINFH) is a devastating, irreversible, and disabling disease developing following steroid therapy. The functions of the hip joint are markedly impaired when the femoral head collapses.…”

Section: Introductionmentioning

confidence: 99%

Relationship of α2‐Macroglobulin with Steroid‐Induced Femoral Head Necrosis: A Chinese Population‐Based Association Study in Southeast China

Fang

Jiang³

et al. 2019

Orthopaedic Surgery

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Objective The present study aimed to identify the relationship of α‐2‐macroglobulin and microvascular vessel pathology with steroid‐induced femoral head necrosis in the Southeast Chinese population. Methods This study enrolled 40 patients diagnosed with steroid‐induced necrosis of the femoral head. Patients had various stages of femoral head necrosis. The differential expression of serum proteins and mRNA from patients with steroid‐induced necrosis of the femoral head (SINFH) and healthy volunteers was analyzed by western blot and quantitative polymerase chain reaction (QT‐PCR). The pathological change in osteocyte necrosis was indicated by hematoxylin and eosin stain and immunohistochemistry. Results Hematoxylin and eosin stain showed histopathology changes in the necrotic area of patients with steroid‐induced INFH: bone trabeculae were fewer and thinner, became broken, fragmented and structurally disordered; intraosseous adipose cells became enlarged; the arrangement of the osteoblasts became irregular; and vacant bone lacunae increased. QT‐PCR showed significantly lower levels of α‐2‐macroglobulin in the serum of patients with SINFH than in controls (P < 0.05). Immunohistochemical staining and western blotting demonstrated that the expression of α‐2‐macroglobulin was significantly decreased in the necrotic area of SINFH patients (P < 0.05). Conclusion The α‐2‐macroglobulin may be associated with the pathology of SINFH. The multiple pathological reactions occur in SINFH and α‐2‐macroglobulin may serve as a potential biomarker for the diagnosis of SINFH or a promising therapeutic target.

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Evaluation of bipolar hemiarthroplasty for the treatment of steroid-induced osteonecrosis of the femoral head

Cited by 33 publications

References 28 publications

Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head

Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head

Bushenhuoxue formula inhibits osteoclastogenesis and bone resorption on rabbit steroid-related osteonecrosis of the femoral head by suppressing NF-κB/NFATc1 pathway

Relationship of α2‐Macroglobulin with Steroid‐Induced Femoral Head Necrosis: A Chinese Population‐Based Association Study in Southeast China

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