Non-traumatic avascular necrosis of the femoral head.

Mont, Michael A.; Hungerford, David S.

doi:10.2106/00004623-199503000-00018

Cited by 1,063 publications

(696 citation statements)

References 111 publications

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“…VEGF protein expression also was not different (p = 0.0124, Fig. 6) between the LIPUS group (23 ± 6; 95% CI, [19][20][21][22][23][24][25][26][27] and the control group (22 ± 6; 95% CI, 18-26).…”

Section: Bmp-2 and Vegf Expressionmentioning

confidence: 90%

“…The mineral apposition rate (lm/day) in the LIPUS group (2.3 ± 0.8 lm/day; 95% CI, 1.8 2.8 lm/day) was higher (p = 0.001) than that in the control group (1.6 ± 0.3 lm/day; 95% CL, 1.4-1.8 lm/day). The number of blood vessels in the LIPUS group (7.8 ± 3.6/mm 2 ; 95% CI, 5.5-10.1 mm 2 ) was greater (p = 0.025) than the number in Introduction Approximately 20,000 patients per year are diagnosed with femoral head osteonecrosis in the United States [23]. Steroids, commonly prescribed to patients with systemic lupus erythematosus, nephrotic syndrome, or organ transplantation, are a leading cause of femoral head osteonecrosis; this is known as steroid-associated osteonecrosis [1,35,41].…”

Section: Introductionmentioning

confidence: 99%

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Low-intensity Pulsed Ultrasound Enhances Bone Repair in a Rabbit Model of Steroid-associated Osteonecrosis

Zhu

Cai

Lin

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Steroids are a leading cause of femoral head osteonecrosis. Currently there are no medications available to prevent and/or treat steroid-associated osteonecrosis. Low-intensity pulsed ultrasound (LIPUS) was approved by the FDA for treating delayed union of bone fractures. Some studies have reported that LIPUS can enhance bone formation and local blood flow in an animal model of fracture healing. However, whether the effect of osteogenesis and neovascularization by LIPUS can enhance the repair progress in steroid-associated osteonecrosis is unknown.Questions/purposes We hypothesized that LIPUS may facilitate osteogenesis and neovascularization in the reparative processes of steroid-associated osteonecrosis. Using a rabbit animal model, we asked whether LIPUS affects (1) bone strength and trabecular architecture; (2) blood vessel number and diameter; and (3) BMP-2 and VEGF expression. Methods Bilateral femoral head necrosis was induced by lipopolysaccharide and methylprednisolone in 24 rabbits. The left femoral heads of rabbits received LIPUS therapy (200 mW/cm 2 ) for 20 minutes daily and were classified as the LIPUS group. The right femoral heads of the same rabbits did not receive therapy and were classified as the control group. All rabbits were euthanized 12 weeks after LIPUS therapy. Micro-CT, biomechanical testing, histologic evaluation, immunohistochemistry, quantitative realtime PCR, and Western blot were used for examination of the effects of LIPUS. Results Twelve weeks after LIPUS treatment, the loading strength in the control group was 355 ± 38 N (95% CI, 315-394 N), which was lower (p = 0.028) than that in the LIPUS group (441 ± 78 N; 95% CI, 359-524 N). The bone tissue volume density (bone volume/total volume) in the LIPUS group (49.29% ± 12.37%; 95 % CI, 36.31%-62.27%) was higher (p = 0.022) than that in the control group (37.93% ± 8.37%; 95 % CI, 29.15%-46.72%). The percentage of empty osteocyte lacunae in the LIPUS group (17% ± 4%; 95% CI, 15%-20%) was lower (p = 0.002) than that in the control group (26% ± 9%; 95% CI, 21%-32%). The mineral apposition rate (lm/day) in the LIPUS group (2.3 ± 0.8 lm/day; 95% CI, 1.8 2.8 lm/day) was higher (p = 0.001) than that in the control group (1.6 ± 0.3 lm/day; 95% CL, 1.4-1.8 lm/day). The number of blood vessels in the LIPUS group (7.8 ± 3.6/mm 2 ; 95% CI, 5.5-10.1 mm 2 ) was greater (p = 0.025) than the number in Hanxiao Zhu and Xunzi Cai contributed equally to this work and should be considered as co-first authors.The institution of the authors has received funding from the National Natural Science Foundation of China (Hangzhou, Zhejiang, China) (81101377, 81101345, 81171687, 81371954, 81201414, 81201416, 81401785, 81472113) 123Clin Orthop Relat Res (2015) 473:1830-1839 DOI 10.1007 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® the control group (5.7 ± 2.6/mm 2 ; 95% CI, 4.0-7.3 mm 2 ). Messenger RNA (mRNA) and protein expression of BMP-2 in the LIPUS group (75 ± 7, 95% CI, 70-7...

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Section: Bmp-2 and Vegf Expressionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Low-intensity Pulsed Ultrasound Enhances Bone Repair in a Rabbit Model of Steroid-associated Osteonecrosis

Zhu

Cai

Lin

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…The failure rates of various femoral head-preserving surgical procedures for an extensive ONFH lesion are high [1,10,12,26,32,35,45]. The reported success rate of TRO also is inconsistent and controversial even though some authors including Sugioka et al reported TRO is an effective headpreserving procedure in younger patients [2, 3, 8, 9, 14-16, 21-23, 29, 31, 32, 39-42, 44].…”

Section: Discussionmentioning

confidence: 99%

“…Despite improvements in techniques and materials in total hip arthroplasty (THA), survivorship in young patients is still suboptimal owing to the high rate of complications [7,18,20,33]. Although head-preserving surgeries such as core decompression [10,26] and vascularized and nonvascularized grafting [12,26,32,45] appear to delay the progression of collapse and subsequent arthritic changes, in these studies the indications vary in terms of etiologic factors, radiographic staging, or indications for surgery, and the survival rate of the femoral head decreases with increases in size and stage of the lesion [1,4,10,32].…”

Section: Introductionmentioning

confidence: 99%

Transtrochanteric Rotational Osteotomy for Nontraumatic Osteonecrosis of the Femoral Head in Young Adults

Biswal

Hazra

Yun

et al. 2009

Clin Orthop Relat Res

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Transtrochanteric rotational osteotomy (TRO) is a controversial procedure with reported inconsistent results. We reviewed 50 patients (60 hips) who underwent this procedure for extensive osteonecrosis of the femoral head, focusing on varization to determine its effectiveness as a head-preserving procedure in young adults. The mean age of the patients was 28 years (range, 18-46 years). Using the Ficat-Arlet classification, 40 hips had Stage II and 20 hips had Stage III involvement. According to the classification system of Shimizu et al., the extent of the lesions were Grade C in 54 hips and Grade B in six hips; the location of the lesions were Grade c in 56 hips and Grade b in four hips. Minimum followup was 18 months (mean, 84 months; range, 18-156 months). The mean preoperative Harris hip score was 44.7 points (range, 32-62 points) which improved to an average postoperative score of 80.1 points (range, 44-100 points) at the latest followup. Forty-four hips showed no radiographic evidence of progression of collapse. Ten hips showed progressive collapse, seven hips showed progressive varus deformity, three hips had stress fractures of the femoral neck, and one hip had infection. We believe TRO with varization is worth attempting for extensive osteonecrosis of the femoral head in young adults, although failures and complications are not uncommon.

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“…Similar to a 2014 review [9], a 2013 review of VBGs states that defects greater than 5 to 6 cm require VBGs [44]. However the source, a review article does not mention a centimeter-based rule for bone grafts [28].…”

Section: Introductionmentioning

confidence: 99%

Vascularized versus Nonvascularized Bone Grafts: What Is the Evidence?

Allsopp

Hunter-Smith

Rozen

2016

Clinical Orthopaedics &Amp; Related Research

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Background There is a general perception in practice that a vascular supply should be used when large pieces of bone graft are used, particularly those greater than 6 cm in length for long-bone and large-joint reconstructions. However, the scientific source of this recommendation is not clear. Questions/purposes We wished to perform a systematic review to (1) investigate the origin of evidence for this 6-cm rule, and (2) to identify whether there is strong evidence to support the importance of vascularization for longer grafts and/or the lack of vascularization for shorter grafts. Methods Two systematic reviews were performed using SCOPUS and Medline, one for each research question. For

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Non-traumatic avascular necrosis of the femoral head.

Cited by 1,063 publications

References 111 publications

Low-intensity Pulsed Ultrasound Enhances Bone Repair in a Rabbit Model of Steroid-associated Osteonecrosis

Low-intensity Pulsed Ultrasound Enhances Bone Repair in a Rabbit Model of Steroid-associated Osteonecrosis

Transtrochanteric Rotational Osteotomy for Nontraumatic Osteonecrosis of the Femoral Head in Young Adults

Vascularized versus Nonvascularized Bone Grafts: What Is the Evidence?

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