Total hip arthroplasty in steroid-induced osteonecrosis: early functional and radiological outcomes

Rahman, Wahida; Garbuz, Donald S.; Masri, Bassam A.

doi:10.1503/cjs.032510

Cited by 29 publications

(15 citation statements)

References 45 publications

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“…It is known to cause significant suffering to patients (5,6). Chlorogenic acid can improve cardiovascular and cerebrovascular blood flow, enhance hematopoietic and immune functions, as well as bone metabolism.…”

Section: Discussionmentioning

confidence: 99%

Mechanism of chlorogenic acid treatment on femoral head necrosis and its protection of osteoblasts

Zhang

2016

Biomedical Reports

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The aim of the present study was to investigate the therapeutic effect of chlorogenic acid on hormonal femoral head necrosis and its protection of osteoblasts. The study established a femoral head necrosis model in Wistar rats using endotoxin and prednisolone acetate. The rats were divided into five groups and were treated with different concentrations of chlorogenic acid (1, 10 and 20 mg/kg). The main detected indicators were the blood rheology, bone mineral density, and the hydroxyproline and hexosamine (HOM) contents. At a cellular level, osteoblasts were cultured and treated by drug-containing serum. Subsequently, cell proliferation and the osteoblast cycle were measured using flow cytometry, and the protein expression levels of Bax and B-cell lymphoma 2 (Bcl-2) were detected using western blotting. Chlorogenic acid at a concentration of 20 mg/kg (high-dose) enhanced the bone mineral density of the femoral head and femoral neck following ischemia. Simultaneously, blood flow following the injection of prednisolone acetate was significantly improved, and the HOM contents of the high-dose chlorogenic acid group were significantly different. The results from the flow cytometry analysis indicated that chlorogenic acid can efficiently ameliorate hormone-induced necrosis. The osteoblasts were isolated and cultured. The MTT colorimetric assay showed that chlorogenic acid at different densities can increase the proliferation capabilities of osteoblasts and accelerate the transition process of G/G phase to S phase, as well as enhance mitosis and the regeneration of osteoblasts. Western blotting detection indicated that chlorogenic acid may prohibit the decrease of Bcl-2 and the increase of Bax during apoptosis, thereby inhibiting osteoblast apoptosis and preventing the deterioration of femoral head necrosis. In conclusion, chlorogenic acid at the density of 20 mg/kg is effective in the treatment of hormonal femoral head necrosis, which may be applicable for future treatment.

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Section: Discussionmentioning

confidence: 99%

Mechanism of chlorogenic acid treatment on femoral head necrosis and its protection of osteoblasts

Zhang

2016

Biomedical Reports

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“…At 12 months, the 1.91% incidence of revision hip arthroplasty among our matched comparison cohort is similar to the 2.03% cumulative incidence of revision reported from a large Medicare database study [3], thus supporting the findings in our comparison cohort and our study's external validity. A prior case series of corticosteroid users undergoing THA showed postoperative complications requiring reoperation included periprosthetic fracture, recurrent hip dislocation, and persistent deep infection [20]. Potential mechanisms for the association between corticosteroids and revision include poor bone formation secondary to suppression of osteoblasts [7], poor bone stock increasing the risk for fracture and prosthesis loosening [7], inhibition of collagen deposition and secretion of growth factors leading to impaired wound healing [27], and weakened immune function leading to infection [1,17].…”

Section: Discussionmentioning

confidence: 99%

Does Chronic Corticosteroid Use Increase Risks of Readmission, Thromboembolism, and Revision After THA?

Boylan

Perfetti

Elmallah

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Systemic corticosteroids are commonly used to treat autoimmune and inflammatory diseases, but they can be associated with various musculoskeletal problems and disorders. There currently is a limited amount of data describing the postoperative complications of THA associated specifically with chronic corticosteroid use. Questions/purposes For chronic corticosteroid users undergoing THA, we asked: (1) What is the risk of hospital readmission at 30 and 90 days after surgery? (2) What is the risk of venous thromboembolism at 30 and 90 days after surgery? (3) What is the risk of revision hip arthroplasty at 12 and 24 months after surgery? Methods We identified patients in the Statewide Planning and Research Cooperative System who underwent primary THA between January 2003 and December 2010. This database provides hospital discharge abstracts for all admissions in the state of New York each year. We used propensity scores to three-to-one match the 402 chronic corticosteroid users with a comparison cohort of 1206 patients according to age, sex, race, comorbidity score, year of surgery, and hip osteonecrosis. The risk of each outcome was compared between chronic corticosteroid users and the matched cohort. Because multiple comparisons were made, we considered p less than 0.008 as statistically significant. Results Readmission was more common for corticosteroid users at 30 days (odds ratio [OR], 1.45; 95% CI, 1.14-1.85; p = 0.003) and 90 days (OR, 1.37; 95% CI, 1.09-1.73; p = 0.007). Venous thromboembolism was not more frequent in corticosteroid users at 30 days (OR, 2.39; 95% CI, 1.08-5.26; p = 0.031) or 90 days (OR, 1.91; 95%

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“…If there are signs of degenerative acetabular changes, total hip arthroplasty is appropriate (Tables I and II, Fig. 5) [126][127][128][129] .…”

Section: Table II Decision-making Hierarchymentioning

confidence: 99%

Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today?

Mont

Cherian

Sierra

et al. 2015

The Journal of Bone and Joint Surgery

439

436

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➤ Although multiple theories have been proposed, no one pathophysiologic mechanism has been identified as the etiology for the development of osteonecrosis of the femoral head. However, the basic mechanism involves impaired circulation to a specific area that ultimately becomes necrotic.➤ A variety of nonoperative treatment regimens have been evaluated for the treatment of precollapse disease, with varying success. Prospective, multicenter, randomized trials are needed to evaluate the efficacy of these regimens in altering the natural history of the disease.➤ Joint-preserving procedures are indicated in the treatment of precollapse disease, with several studies showing successful outcomes at mid-term and long-term follow-up.➤ Studies of total joint arthroplasty, once femoral head collapse is present, have described excellent outcomes at greater than ten years of follow-up, which is a major advance and has led to a paradigm shift in treating these patients.➤ The results of hemiresurfacing and total resurfacing arthroplasty have been suboptimal, and these procedures have restricted indications in patients with osteonecrosis of the femoral head.

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Total hip arthroplasty in steroid-induced osteonecrosis: early functional and radiological outcomes

Cited by 29 publications

References 45 publications

Mechanism of chlorogenic acid treatment on femoral head necrosis and its protection of osteoblasts

Mechanism of chlorogenic acid treatment on femoral head necrosis and its protection of osteoblasts

Does Chronic Corticosteroid Use Increase Risks of Readmission, Thromboembolism, and Revision After THA?

Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today?

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