Femoral Head and Neck Fenestration Through a Direct Anterior Approach Combined With Compacted Autograft for the Treatment of Early Stage Nontraumatic Osteonecrosis of the Femoral Head: A Retrospective Study

Wang, Qiuru; Li, Donghai; Yang, Zhouyuan; Kang, Pengde

doi:10.1016/j.arth.2019.10.043

Cited by 18 publications

(20 citation statements)

References 35 publications

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“…In this study, we used a modified surgery named femoral head and neck fenestration, which provides an easier approach for the drill bit to the femoral head and reduces surgical trauma. [ 48 ] The experimental results showed that the drilling approach used here in this surgery accurately reached 4–5 mm under the internal cartilage of the femoral head. The bone defect was in the center of the femoral head, approximately one‐third of the transverse diameter of the femoral head, which would cause femoral head fracture and could not be repaired by itself.…”

Section: Discussionmentioning

confidence: 95%

Delivery of MiR335‐5p‐Pendant Tetrahedron DNA Nanostructures Using an Injectable Heparin Lithium Hydrogel for Challenging Bone Defects in Steroid‐Associated Osteonecrosis

Yang

Luo

et al. 2021

Adv Healthcare Materials

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Corticosteroids-induced Dickkopf-1 (DKK1) upregulation and Wnt signaling inhibition result in bone metabolism disorder and steroid-associated osteonecrosis (SAON). Implanting biomaterials to regulate the Wnt pathway is a promising method to repair challenging bone defects associated with SAON. Here, tetrahedral DNA nanostructures (TDNs) are fabricated as gene carriers to deliver MiR335-5p, which targets DKK1 translation. Heparin lithium hydrogel (Li-hep-gel) is synthesized to act as a lithium and MiR@TDNs delivery agent. Finally, the repair effects on challenging bone defect in SAON using a MiR@TDNs/Li-hep-gel composite are assessed in vivo. The results reveal that MiR@TDNs are absorbed by bone mesenchymal stem cells (BMSCs) and increase cell viability and reduce apoptosis. Moreover, MiR@TDNs promote alkaline phosphatase expression and calcium nodular deposition, decrease lipid droplet expression of BMSCs, and improve vascular endothelial growth factor secretion and vascular-like structure formation in vitro. After MiR@TDNs/Li-hep-gel is implanted into the SAON model, the internal bone defect of osteonecrosis is repaired with a large area of new bone accompanied with neovascularization and reduced empty lacunae. In conclusion, MiR@TDNs/Li-hep-gel can provide dual delivery of lithium and MiR@TDNs, which synergistically upregulate the Wnt signaling pathway, enhancing bone regeneration in challenging bone defects, and can be potentially used in SAON repair.

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Section: Discussionmentioning

confidence: 95%

Delivery of MiR335‐5p‐Pendant Tetrahedron DNA Nanostructures Using an Injectable Heparin Lithium Hydrogel for Challenging Bone Defects in Steroid‐Associated Osteonecrosis

Yang

Luo

et al. 2021

Adv Healthcare Materials

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“…Subsequently, through the review of the full text, 23 articles were included in the study. Among them, the comparison between CD and BG includes 11 articles ( Yang et al, 2010 ; Zhao et al, 2013 ; Li et al, 2016 ; Cao et al, 2017 ; Mohanty et al, 2017 ; Sallam et al, 2017 ; Hu et al, 2018 ; Nally et al, 2018 ; Lakshminarayana et al, 2019 ; Wang et al, 2020a ; Shiravani Brojeni et al, 2020 ), and the comparison between CD and CD + BM includes 13 articles ( Gangji et al, 2011 ; Sen et al, 2012 ; Zhao et al, 2012 ; Liu et al, 2013 ; Ma et al, 2014 ; Tabatabaee et al, 2015 ; Pepke et al, 2016 ; Hernigou et al, 2018a ; Hauzeur et al, 2018 ; Kang et al, 2018 ; Nally et al, 2018 ; Martinot et al, 2020b ; Li et al, 2020 ). The flow chart of article selection is shown in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

“…We believe that although BG provides bone support, the clearance of necrotic bone and the amount of filled bone will affect the postoperative effect. In addition, BG has the disadvantages of long operation time and large amount of bleeding, which is described in Wang’s experiment ( Wang et al, 2020a ). In particular, vascularized BG is more difficult to achieve technically and has more postoperative complications ( Gonzalez Della Valle et al, 2005 ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of current treatment strategy for osteonecrosis of the femoral head from the perspective of cell therapy

Wang

Zhang

2023

Front. Cell Dev. Biol.

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Aims: The purpose of our study is to compare the effects of core decompression (CD) and bone grafting (BG) on osteonecrosis of the femoral head (ONFH). And evaluate the efficacy of CD based on cell therapy to provide guidance for the dose and number of cells.Methods: We searched PubMed, Embase, and the Cochrane Library between 2012 and 2022, with keywords including “osteonecrosis of the femoral head”, “core decompression” and “bone grafting”. We selected comparative studies of CD and BG, and the comparison of CD combined with bone marrow (BM) transplantation and CD alone. Changes in hip pain were assessed by VAS, hip function were assessed by HHS and WOMAC, and THA conversion rate was used as an evaluation tool for femoral head collapse. From these three aspects, the dose of bone marrow and the number of cells transplantation were subgroup analyzed.Results: Eleven studies were used to compare the efficacy of CD and BG. There was no significant difference in HHS, and the THA conversion rate of BG was significantly lower than that of CD. Thirteen CD studies based on cell therapy were included in the meta-analysis. Bone marrow aspiration concentrate (BMAC) can significantly improve VAS (mean difference (MD), 10.15; 95% confidence intervals (CI) 7.35 to 12.96, p < 0.00001) and reduce THA conversion rate (odds ratio (OR), 2.38; 95% CI 1.26 to 4.47, p = 0.007). Medium dose bone marrow fluid has a lower p-value in THA conversion rate. The p values of bone marrow mononuclear cells (BMMC) of 109 magnitude in VAS score were lower.Conclusion: In general, there is no consensus on the use of BG in the treatment of ONFH. The enhancement of cell-based CD procedure shows promising results. Using 20 mL BMAC and 109 magnitude BMMC is likely to achieve better results.

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“…Reason Why We Chose Core Compression Several surgical treatments have been described for patients with pre-collapsed ONFH, including various types of osteotomy, vascularized or non-vascularized bone grafting, and core decompression 14,24,25 . At present, there is no gold standard for surgical treatment of asymptomatic ONFH.…”

Section: Main Findings Of This Studymentioning

confidence: 99%

Core Decompression Prevents Progression of Asymptomatic Type C Osteonecrosis of Femoral Head According to the Japanese Investigation Committee Classification: A Retrospective Study

Wang

Zhang

et al. 2022

Orthopaedic Surgery

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Objective To evaluate whether core decompression could prevent progression of asymptomatic type C osteonecrosis of the femoral head (ONFH) according to the Japanese Investigation Committee (JIC) classification. Methods This retrospective cohort study included 124 hips (117 patients) with asymptomatic type C ONFH. Seventy‐one hips (67 patients) received core decompression (core decompression group) and 53 hips (50 patients) received no surgical treatment (control group). Clinical and radiological follow‐up was conducted at 6 and 12 months, then annually until 5 years. Clinical outcomes were evaluated in terms of the Oxford hip score and UCLA Activity Level rating. Radiological outcomes were evaluated using X‐ray and magnetic resonance imaging. Survival analysis was performed based on collapse of the femoral head as the first endpoint and total hip arthroplasty (THA) as the second endpoint. Results There were no significant differences in clinical outcomes between the core decompression group and the control group within 2 years after surgery. Patients in the core decompression group had significantly better Oxford hip score and UCLA Activity Level from year 3 to the end of follow‐up (P < 0.05). In year 5, the absolute difference in Oxford hip score (5.3 points) exceeded the reported minimal clinically important difference (MCID, 5.2 points). In years 3–5, the absolute difference in UCLA Activity Level rating (0.95 points, 0.95 points, and 0.99 points, respectively) exceeded the reported MCID (0.92 points). By 5‐year follow‐up, significantly fewer patients in the core decompression group had experienced femoral head collapse (40.8% vs 62.3%, P = 0.011) or received THA (26.8% vs 45.3%, p = 0.022). Conclusions Core decompression can prevent progression of asymptomatic type C ONFH according to the JIC classification, leading to better medium‐term hip function and activity levels than no surgical treatment. Core decompression is recommended for early intervention against asymptomatic type C ONFH.

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Femoral Head and Neck Fenestration Through a Direct Anterior Approach Combined With Compacted Autograft for the Treatment of Early Stage Nontraumatic Osteonecrosis of the Femoral Head: A Retrospective Study

Cited by 18 publications

References 35 publications

Delivery of MiR335‐5p‐Pendant Tetrahedron DNA Nanostructures Using an Injectable Heparin Lithium Hydrogel for Challenging Bone Defects in Steroid‐Associated Osteonecrosis

Delivery of MiR335‐5p‐Pendant Tetrahedron DNA Nanostructures Using an Injectable Heparin Lithium Hydrogel for Challenging Bone Defects in Steroid‐Associated Osteonecrosis

Comparison of current treatment strategy for osteonecrosis of the femoral head from the perspective of cell therapy

Core Decompression Prevents Progression of Asymptomatic Type C Osteonecrosis of Femoral Head According to the Japanese Investigation Committee Classification: A Retrospective Study

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