Treatment of Early Stage Osteonecrosis of the Femoral Head

Marker, David R.; Seyler, Thorsten M.; McGrath, Mike; Delanois, Ronald E.; Ulrich, Slif D.; Mont, Michael A.

doi:10.2106/jbjs.h.00671

Cited by 119 publications

(99 citation statements)

References 94 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the clinic, although patients are diagnosed, 70-80 % of untreated patients experience femoral head collapse and have to undergo total hip arthroplasty (THA) [1]. Thus, research over the past decade has focused on identifying a minimally invasive regenerative therapy that can help prevent femoral head collapse [2,3].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, non-cellular therapeutic strategies that use growth factors have also been proposed [2,3,7,8]. In an animal study using adult rabbits, we reported that a single local administration of gelatin hydrogel impregnated with recombinant human fibroblast growth factor (rhFGF)-2 not only promoted the regeneration of the necrotic bone but also suppressed the progression of ONFH [9].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A pilot study of regenerative therapy using controlled release of recombinant human fibroblast growth factor for patients with pre-collapse osteonecrosis of the femoral head

Kuroda

Asada

et al. 2015

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Purpose We evaluated the safety and clinical outcomes of a single local administration of gelatin hydrogel impregnated with recombinant human fibroblast growth factor (rhFGF)-2 for the treatment of the precollapse stage of osteonecrosis of the femoral head (ONFH). Methods Patients with ONFH (precollapse stage ≤2) received a single local administration of 800 μg of rhFGF-2-impregnated gelatin hydrogel and were followed up for one year. The surgery was performed using a minimally invasive technique involving a 1-cm skin incision, and walking was allowed from day one postoperatively. The primary outcomes included occurrence of adverse events and complications. The secondary outcomes included changes in the Harris hip scores, visual analog scale for pain scores, University of California, Los Angeles (UCLA) activity scores, and radiological images. Results We included ten patients, of which five experienced 14 adverse events, including one complication from spinal anesthesia. However, patients completely recovered from all adverse events. The mean clinical scores significantly improved by one year postoperatively compared with the pre-operative scores (before vs. after: visual analog score for pain, 21.2 vs. 5.3 mm; UCLA activity score, 5.5 vs. 6.6; Harris hip score, 81.0 vs. 96.9 points). There was only one case of femoral head collapse; however, this occurred in a hip with extensive necrosis. Stage progression and collapse did not occur in the other nine cases. Computed tomography confirmed bone regeneration in the femoral heads. Conclusions Clinical application of rhFGF-2-impregnated gelatin hydrogel for patients with precollapse ONFH was feasible and safe.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A pilot study of regenerative therapy using controlled release of recombinant human fibroblast growth factor for patients with pre-collapse osteonecrosis of the femoral head

Kuroda

Asada

et al. 2015

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

show abstract

“…The primary therapeutic strategy for ONFH in our institute is aimed at preserving the femoral head. In most cases of ONFH that are less than stage III of the Association Research Circulation Osseous (ARCO) [1,3] classification, surgical interventions consist of osteotomy operations, such as transtrochanteric rotational osteotomy [4] and varus femoral osteotomy [5]. However, bipolar hemiarthroplasty (BHA) has been performed in cases with a wide necrotic area and in which collapse of the femoral head is expected.…”

Section: Introductionmentioning

confidence: 99%

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

Moriya

Uchiyama

Takahira

et al. 2012

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Purpose Bipolar hemiarthroplasty (BHA) for idiopathic osteonecrosis of the femoral head (ONFH) is performed at our institution. The purpose of this study was to evaluate the clinical and radiographic findings after BHA for the treatment of steroid -induced ONFH. Methods Thirty-seven hips in 27 patients were assessed (seven men, 11 hips; 20 women, 26 hips), average patient age at the time of surgery of 42.6 (range 20-83) years, with steroid-induced ONFH treated with BHA between 1995 and 2005. The mean follow-up duration was approximately ten (range five to15) years. Patients were evaluated according to the Japan Orthopaedic Association (JOA) hip score. Kaplan-Meier survivorship was calculated to examine revision arthroplasty failure rate. Radiographic analysis of loosening included radiolucent lines and osteolysis of the acetabulum or femur. Causes of loosening were analysed using multiple logistic regression. Result JOA hip score increased from 53 points (preoperative) to 87 points (final follow-up). Survival rates were 96.8 % and 78.6 % at ten and 15 years, respectively. Prosthesis loosening occurred on the acetabular side in five hips (13.5 %). No femoral-component loosening was observed. BHA had poor results in patients with Association Research Circulation Osseous (ARCO) stage IV ONFH and in patients under 40 years of age. Conclusion BHA, with strict surgical indications, may be a good option for treating ONFH. Based on these results, total hip arthroplasty is recommended for patients with ARCO stage IV ONFH or for patients under 40 years of age.

show abstract

“…The goal of core decompression is to decrease the intraosseous pressure and allow the regrowth of healthy bone tissue. Although this procedure has been used for more than 3 decades, its efficacy remains controversial [Marker et al, 2008]. Once ONFH progresses to the final stage (i.e.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Osteonecrosis of the Femoral Head with VEGF<sub>165</sub> Transgenic Bone Marrow Mesenchymal Stem Cells in Mongrel Dogs

Hang

Wang

Guo

et al. 2011

Cells Tissues Organs

View full text Add to dashboard Cite

We evaluated the efficacy of vascular endothelial growth factor 165 (VEGF₁₆₅) transgenic bone marrow mesenchymal stem cells (BMSCs) for the repair of early-stage osteonecrosis of the femoral head (ONFH) in mature mongrel dogs. This animal model was surgically established by femoral neck osteotomy and subsequent repinning. Twenty-seven dogs (54 hips) were divided into 3 equal-sized groups: a pCI-neo-VEGF₁₆₅ BMSC group, a pCI-neo BMSC group and a core decompression-alone group. The lipofectamine was used to introduce the VEGF₁₆₅ gene into the BMSCs. After core decompression, transgenic and non-transgenic autologous BMSCs were implanted. Therapeutic efficacy, including new bone formation and neovascularization in the femoral head, was examined by computed radiography, single-photon emission computed tomography, histological and histomorphometric analysis and immunofluorescent staining for von Willebrand factor in pathological sections. The femoral osteotomy site healed completely by the 4th week after the osteotomy surgery and regions of histologically evident osteonecrosis were found 12 weeks later. A regular arrangement of trabeculae and obvious bone regeneration were observed in the animals receiving implanted VEGF-transgenic BMSCs. The quantity of newly generated capillaries was significantly increased in the pCI-neo-VEGF₁₆₅ BMSC group, but there was no significant difference between the pCI-neo BMSC group and the core decompression-alone group. These results demonstrated that VEGF₁₆₅ transgenic autologous BMSCs enhanced bone reconstruction and blood vessel regeneration in the ONFH model. Compared with non-transgenic BMSCs, this approach could provide advanced benefits in the treatment of ONFH.

show abstract

Treatment of Early Stage Osteonecrosis of the Femoral Head

Cited by 119 publications

References 94 publications

A pilot study of regenerative therapy using controlled release of recombinant human fibroblast growth factor for patients with pre-collapse osteonecrosis of the femoral head

A pilot study of regenerative therapy using controlled release of recombinant human fibroblast growth factor for patients with pre-collapse osteonecrosis of the femoral head

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

Treatment of Osteonecrosis of the Femoral Head with VEGF<sub>165</sub> Transgenic Bone Marrow Mesenchymal Stem Cells in Mongrel Dogs

Contact Info

Product

Resources

About