Introduction and Objective.
Summary Statement.
The pathophysiological basis of alterations in trabecular bone of patients with osteonecrosis of the femoral head (ONFH) remains unclear. ONFH has classically been considered a vascular disease with secondary changes in the subchondral bone. However, there is increasing evidence suggesting that ONFH could be a bone disease, since alterations in the functionality of bone tissue distant from the necrotic lesion have been observed. We comparatively studied the transcriptomic profile of trabecular bone obtained from the intertrochanteric region of patients with ONFH without an obvious aetiological factor, and patients with osteoarthritis (OA) undergoing total hip replacement in our Institution. To explore the biological processes that could be affected by ONFH, we compared the transcriptomic profile of trabecular bone from the intertrochanteric region and the femoral head of patients affected by this condition. Differential gene expression was studied using an Affymetrix microarray platform. Transcriptome analysis showed a differential signature in trabecular bone from the intertrochanteric region between patients with ONFH and those with OA. The gene ontology analyses of the genes overexpressed in bone tissue of patients with ONFH revealed a range of enriched biological processes related to cell adhesion and migration and angiogenesis. In contrast, most downregulated transcripts were involved in cell division. Trabecular bone in the intertrochanteric region and in the femoral head also exhibited a differential expression profile. Among the genes differentially expressed, we highlighted those related with cytokine production and immune response. This study identified a set of differently expressed genes in trabecular bone of patients with idiopathic ONFH, which might underlie the pathophysiology of this condition.
Background: Traditionally, it is believed that structural failure of the ischemic epiphysis as well as changes in radiodensity seen in Legg-Calve-Perthes disease are due to repair. Little is known if bone material properties are altered following
Introduction:
Introduction. The mechanism for development of corticosteroid-induced osteonecrosis of the femoral head remains to be understood. Elucidation of the mechanism and the establishment of preventive methods have been critical issues. To establish a clinical method for prevention of corticosteroid-induced osteonecrosis, we have examined the suppressive effect of reduced glutathione (GSH) in a corticosteroid-induced rabbit model. Methods. Female Japanese white rabbits were separated into five groups: Group S4, a single intramuscular 4 mg/kg methyl prednisolone acetate (MPSL) administration in the gluteus; Group G4, administration of a 5 mg/kg regular dose GSH for 5 consecutive days starting on the day of a single 4 mg/kg MPSL administration; Group S20, a single intramuscular administration of 20 mg/kg MPSL in the gluteus; Group G20, administrations of 5 mg/kg GSH for 5 consecutive days starting on the day of a single 20 mg/kg MPSL administration; and Group N, control group with no treatment. All rabbits were sacrificed 14 days after MPSL administration. Histopathological analyses were performed by hematoxylin-eosin staining. Immunohistological analyses were performed using anti-lectinlike oxidized LDL reseptor-1 antibody (anti-LOX-1 antibody). Results.
Introduction.
Secondary osteonecrosis of the knee affects young population and causes bilateral extensive lesions. Arthroplasty is the last resort in younger population and joint preserving options questionable in pathological bone. Conservative measures have shown failure in multiple studies and hence no gold standard treatment advocated. We aimed at identifying and analysing various treatment options for secondary osteonecrosis with respect to the outcomes and studying features of symptomatic secondary osteonecrosis with regards to demographic pattern, radiological features and causative factors. A systematic review of literature was performed in accordance with the Cochrane handbook for systematic reviews and reported according to the PRISMA guidelines.Abstract
Introduction
Methods
Introduction:
Total hip arthroplasty (THA) outcome in patients with osteonecrosis of the femoral head ONFH) are excellent, however, there is controversy when compared with those in patients with osteoarthritis (OA). Reduced mineralization capacity of osteoblasts of the proximal femur in patients with ONFH could affect implant fixation. We asked if THA fixation in patients with ONFH is worse than in those with OA. We carried out a prospective comparative case (OA)-control (ONFH) study of patients undergoing THA at our hospital between 2017 and 2019. The minimum follow-up was 2 years. Inclusion criteria were patients with uncemented THA, younger than 70 years old, a Dorr femoral type C and idiopathic ONFH. We compared the clinical (Merlé D'Aubigné-Postel score) and radiological results related with implant positioning and fixation. Engh criteria and subsidence were assessed at the immediate postoperative, 12 weeks, 6 months, 12 months and yearly. Osteoblastic activity was determined by mineralization assay on primary cultures of osteoblasts isolated from trabecular bone samples collected from the intertrochanteric area obtained during surgery. Group 1 (ONFH) included 18 patients and group 2 (OA), 22. Average age was 55.9 years old in group 1 and 61.3 in group 2. (p=0.08). There were no differences related with sex, Dorr femoral type or femoral filling. The mean clinical outcome score was 17.1 in group 1 and 16.5 in group 2 (p=0.03). There were no cases of dislocation, infection, or revision surgery in this series. There were 5 cases (28%) of femoral stem subsidence greater than 3mm within 6 first months in group 1 and 1 case (4.5%) in group 2 (p=0.05). Although there were no significant differences related to clinical results, bone fixation was slower, and a greater subsidence was observed in patients with ONFH. Greater femoral stem subsidence was associated with a lower capacity for mineral nodule formation in cultured osteoblasts. The surgical technique could influence THA outcome in patients with reduced mineralization capacity of osteoblasts.
Introduction.
Purpose. To determine (i) the relationship between osteonecrosis and hip function, physical function and quality of life in adolescents and young adults treated for DDH; and (ii) how affected children change over 10 years. Methods. We included 109 patients (mean age 19.2 ± 3.8 years) with osteonecrosis and 30 age-matched patients without osteonecrosis following DDH treatment between 1992–2005. All completed valid patient-reported outcome measures to quantify their hip function (maximum score 100); physical function (maximum score 100); and quality of life (maximum score 1). Of these, 39 patients had been followed prospectively since 2006, allowing quantification of within-person changes over time. We graded all radiographs for severity of osteonecrosis, residual dysplasia, subluxation and osteoarthritis. We determined the association between patient-reported outcomes and radiographic severity of osteonecrosis using mixed-effects regression analysis; and repeated-measures analysis of variance to quantify person changes over time. We adjusted for age, prior operations and acetabular dysplasia. Results. In 135 patients (168 hips) with and without osteonecrosis, mean differences (95%
confidence interval) in hip function, physical function and quality of life were 0.75 (−6.67, 8.17), −1.97 (−17.58, 13.60) and −0.05 (−0.91, 0.36), respectively. Adjusted analysis showed no difference in these outcomes based on radiographic severity of osteonecrosis (p>
0.05). Of 39 patients followed over 10 years, 4 had undergone hip arthroplasty. For the remainder, mean changes (95%
confidence interval) in hip function, physical function and quality of life from baseline to current assessment were 7.18 (−2.11, 12.26), −2.11 (−15.47, 11.25), −0.03 (−0.11, 0.05), respectively. Radiographic severity of osteonecrosis was not correlated with changes in patient-reported outcomes over time. Conclusion.
Introduction.