Vascularized Compared with Nonvascularized Fibular Grafts for Large Osteonecrotic Lesions of the Femoral Head

Kim, Shin‐Yoon; Kim, Yonggoo; Kim, Poong-Taek; Ihn, Joo-Chul; Cho, Byung-Chae; Koo, Kyung‐Hoi

doi:10.2106/jbjs.d.02593

Cited by 109 publications

(58 citation statements)

References 24 publications

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“…This provides an explanation for previous findings indicating that insufficient neovascularization precludes delivery of sufficient levels of oxygen and nutrients or therapeutic agents to the lesion center to facilitate tissue repair (27). In addition, after a significant decrease in the vascularization index at 1 week, the rapidly increased vascularization index, to a high level in DRϪ rabbits as compared with the slow increase in the vascularization index to a low level in DRϩ rabbits, also provides an explanation for the previously reported clinical results showing that, as compared with nonvascularized fibular grafting, vascularized fibular grafting effectively prevents femoral head collapse (30), implying that continuous neovascularization insufficiency might be prognostic of destructive repair of osteonecrotic lesions.…”

Section: Discussionmentioning

confidence: 89%

Continuous occurrence of both insufficient neovascularization and elevated vascular permeability in rabbit proximal femur during inadequate repair of steroid‐associated osteonecrotic lesions

Zhang¹,

Sheng²,

He³

et al. 2009

Arthritis & Rheumatism

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Objective. To examine the features of the intraosseous vasculature, the size of the marrow stem cell pool (MSCP), and expression of vascular endothelial growth factor A (VEGF) during inadequate repair of steroid-associated osteonecrotic lesions in rabbits.Methods. Steroid-associated osteonecrosis was induced in male rabbits. At 0, 1, 2, 4, and 6 weeks postinduction, vascularization and permeability indices were quantified by dynamic magnetic resonance imaging (MRI). In addition, the size of the MSCP in the hematopoietic and mesenchymal compartments was determined, and marrow mononuclear cells expressing specific surface markers for endothelial progenitor cells or periendothelial mural precursor cells were counted. At various time points after the rabbits were killed, the proximal femora were dissected to examine the intraosseous vasculature by angiography, histomorphometry, and ultramorphology. In addition, osteonecrotic lesion repair and marrow VEGF expression were evaluated.Results. Lesion formation without repair was observed at 2 weeks after induction of steroid-associated osteonecrosis. Rabbits displaying destructive repair (DR؉) and those displaying reparative osteogenesis (DR؊) from 4 weeks to 6 weeks postinduction were identified. From week 2 to week 6, the vascularization index was significantly lower in DR؉ rabbits compared with DR؊ rabbits, whereas the permeability index was significantly higher in DR؉ rabbits compared with DR؊ rabbits. The features of the intraosseous vasculature determined by angiography, histomorphometry, and ultramorphology were consistent with those determined by dynamic MRI. The MSCP size and number of marrow mononuclear cells expressing specific surface markers were all significantly lower in DR؉ rabbits than in DR؊ rabbits from week 1 to week 6. The increased VEGF expression at 2 weeks was maintained through week 6 in DR؉ rabbits, whereas VEGF expression decreased in DR؊ rabbits from week 2 to week 6.Conclusion. Continuous occurrence of both insufficient neovascularization and elevated vascular permeability is accompanied by a continuously lowlevel MSCP and uncontrolled VEGF expression during inadequate repair of steroid-associated osteonecrotic lesions.Pulsed steroids are frequently prescribed as lifesaving agents for serious infectious diseases such as severe acute respiratory syndrome and acquired immunodeficiency syndrome, or as disease-modifying agents for chronic autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis. However, pulsed administration of steroids often results in osteonecrosis (also known as avascular necrosis). Orthopedic surgeons face the challenge of managing subchondral

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Section: Discussionmentioning

confidence: 89%

Continuous occurrence of both insufficient neovascularization and elevated vascular permeability in rabbit proximal femur during inadequate repair of steroid‐associated osteonecrotic lesions

Zhang¹,

Sheng²,

He³

et al. 2009

Arthritis & Rheumatism

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“…Of the four articles identified, none presented evidence for a difference between VBGs and NVBGs based on length. The articles, including one comparison of fibular grafts to extremities and three comparisons of fibular grafts to the femoral head [23,34,42,49] did not provide strong evidence that VBGs are superior to NVBGs as graft length increases, nor that they are inferior to NVBGs. The articles provided inconclusive evidence for the existence of a relationship between length and the need for vascularization.…”

Section: Resultsmentioning

confidence: 99%

“…The other three studies examined grafts to the femoral head and showed that VBGs had better radiographic [23,34,49] and functional outcomes [34,49]. Kim [34] studied 100 fibular grafts to the femoral head (Evidence Hierarchy III-2, MINORS score 16 of 24) and did not examine grafts based on length.…”

Section: Resultsmentioning

confidence: 99%

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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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“…Although certain methods such as the patient-specific Ioannina aiming device increase optimal graft placement in the anterosu- perior aspect of the femoral head, vascularized grafting still remains technically challenging [40] . Non-vascularized fibular grafts have also been studied as an alternative, but vascularized grafts appear to have better clinical results for prevention of femoral head collapse [41] . Several osteotomies have been studied for the treatment of pre-collapse and early post-collapse (Steinberg stage Ⅱ to Ⅳ) osteonecrosis, with the goal of transferring weight-bearing forces away from necrotic subchondral bone toward other areas of the articular surface.…”

Section: Current Treatment Optionsmentioning

confidence: 99%

Osteonecrosis of the femoral head: An update in year 2012

Kaushik

Das²,

Cui³

2012

WJO

137

118

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Osteonecrosis is a phenomenon involving disruption to the vascular supply to the femoral head, resulting in articular surface collapse and eventual osteoarthritis. Although alcoholism, steroid use, and hip trauma remain the most common causes, several other etiologies for osteonecrosis have been identified. Basic science research utilizing animal models and stem cell applications continue to further elucidate the pathophysiology of osteonecrosis and promise novel treatment options in the future. Clinical studies evaluating modern joint-sparing procedures have demonstrated significant improvements in outcomes, but hip arthroplasty is still the most common procedure performed in these affected younger adults. Further advances in joint-preserving procedures are required and will be widely studied in the coming decade.

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Vascularized Compared with Nonvascularized Fibular Grafts for Large Osteonecrotic Lesions of the Femoral Head

Cited by 109 publications

References 24 publications

Continuous occurrence of both insufficient neovascularization and elevated vascular permeability in rabbit proximal femur during inadequate repair of steroid‐associated osteonecrotic lesions

Continuous occurrence of both insufficient neovascularization and elevated vascular permeability in rabbit proximal femur during inadequate repair of steroid‐associated osteonecrotic lesions

Vascularized versus Nonvascularized Bone Grafts: What Is the Evidence?

Osteonecrosis of the femoral head: An update in year 2012

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