Osteonecrosis of the femoral head (ONFH) is a debilitating, painful, progressive, and refractory disease that has multiple etiologic risk factors. It is caused by bone cell death, which itself has various causes, leading to femoral head collapse and subsequent osteoarthritis. ONFH primarily influences patients aged from 20 to 50 years; in addition, bilateral hip joints are involved in 75% of patients. Causes include use of corticosteroids, alcohol abuse, previous trauma, hemoglobinopathy, Gaucher disease, coagulopathies, and other diseases. No pharmacologic treatment has been shown to be effective for early ONFH. Outcomes of total hip arthroplasty (THA) for these young and active patients have some drawbacks, primarily due to the young age of these patients, limited lifetime and durability of the implants and their fixation, and the skeletal manifestations of osteonecrosis. As a result of these concerns, there has been an increased focus on early interventions for ONFH aimed at preservation of the native articulation.
Introduction. Collapse of femoral head associated with end-stage arthritis form hallmark of osteonecrosis of femoral head. Purpose was to assess efficacy of platelet rich plasma following
Post-traumatic osteonecrosis of the femoral head (ONFH) is a major complication of femoral neck fractures that require numerous solutions. The purpose of the current study is to investigate the effects of platelet-rich plasma (PRP) incorporated autologous granular bones graft for the treatment of pre-collapse stages (ARCO stage II-III) of post-traumatic ONFH. A total of 46 patients were eligible and enrolled into the study. 24 patients were treated with
Management of symptomatic osteonecrosis of the hip includes either some type of head preservation procedure or a total hip arthroplasty (THA). In general, once there is collapse of the femoral head, femoral head preservation procedures have limited success. There are a number of different femoral head preservation procedures that are presently performed and there is no consensus regarding which one is most effective. These procedures involve a
Background.
Introduction.
Osteonecrosis (ON) is a debilitating condition that can progress to severe arthritis of the hip. While its exact pathogenesis remains poorly understood, ON is known to be associated with risk factors such as corticosteroid use, alcoholism, and autoimmune disease. Initial radiographic evaluation can reveal sclerotic and cystic changes in the femoral head, which are usually the first clues in diagnosis. Despite these indicators, plain radiographs generally are not sufficient for diagnosis, therefore requiring subsequent magnetic resonance imaging (MRI) studies. Moreover, performing an appropriate assessment of these imaging modalities can help guide the course of treatment. Treatment options are aimed at slowing or stopping the onset of femoral head collapse and include non-operative management, joint preservation procedures, and total joint arthroplasty. Patients at risk of developing ON may benefit from early diagnosis because the characteristic small or medium-sized pre-collapse lesions that are associated with this stage can often be treated with a non-operative or joint preservation approach. However, patients typically present with advanced disease progression and sometimes an unsalvageable joint, thereby necessitating more invasive operative intervention. Surgical modalities include the use of osteotomy,
The mean age of patients with osteonecrosis reported in series in our literature is 38 to 53. Thus, performing a total hip replacement on a patient who would need a procedure to last 40–45 years is a concern. Patients with osteonecrosis of the hip require some type of surgical treatment. Without treatment, a large majority of femoral heads in patients even with Ficat stage I osteonecrosis will collapse or become symptomatic. A common scenario is a patient who first presents to the orthopaedic surgeon with severe arthritis secondary to osteonecrosis in one hip and a normal appearing radiograph on the asymptomatic contralateral side. Performing a total hip on the severe arthritic hip is usually not debated. A MRI will commonly show Ficat stage I osteonecrosis on the asymptomatic contralateral hip. Some method of
The mean age of patients with osteonecrosis reported in series in our literature is 38 to 53. Thus, performing a total hip replacement on a patient who would need a procedure to last 40–45 years is a concern. Patients with osteonecrosis of the hip require some type of surgical treatment. Without treatment, a large majority of femoral heads in patients even with Ficat stage I osteonecrosis will collapse or become symptomatic. A common scenario is a patient who first presents to the orthopaedic surgeon with severe arthritis secondary to osteonecrosis in one hip and a normal appearing radiograph on the asymptomatic contralateral side. Performing a total hip on the severe arthritic hip is usually not debated. A MRI will commonly show Ficat stage I osteonecrosis on the asymptomatic contralateral hip. Some method of
Introduction:. One method of femoral head preservation following avascular necrosis (AVN) is
Introduction. The natural history of osteonecrosis of the femoral head (ONFH) is not cleanly understood, but most of them progresse to the joint destruction and requires total hip replacement arthroplasty. There are several head preserving procedure, but no single therapeutic method proved to be effective in preventing progression of the disease. The possibility has been raised that implantation of bone marrow containing osteogenic precursors may be effective in the treatment of this disease. However, there are no long-term follow-up results of cell therapy for ONFH. AS far as we know, there are no reports about bone graft and cell therapy for ONFH. Therefore, we performed a prospective clinical and radiological evaluation on ONFH treated with
INTRODUCTION. Total hip arthroplasty (THA) is not commonly performed in young patients. However, markedly advanced hip disease can cause disabling end-stage arthritis, and THA may be the only available option for pain relief and restoration of function. We report our experience with modern alternative bearing THA in patients younger than 21 years. METHODS. Twenty-one consecutive primary THAs were performed in 18 patients. Pre- and post-operative Harris Hip Scores (HHS) and any postoperative complications were recorded. Radiographs were reviewed for evidence of premature component loosening. Mean patient age at operation was 18 years (range, 13-20). There were 14 females (78%) and 4 males (22%). Nine patients (50%) were Caucasian, 8 (44%) were African-American, and 1 (6%) was Asian. Average follow-up was 45 months (range, 16-85). All patients failed conservative treatment; 15 patients had prior
Fresh-frozen allograft bone is frequently used
in orthopaedic surgery. We investigated the incidence of allograft-related
infection and analysed the outcomes of recipients of bacterial culture-positive
allografts from our single-institute bone bank during bone transplantation.
The fresh-frozen allografts were harvested in a strict sterile environment
during total joint arthroplasty surgery and immediately stored in
a freezer at -78º to -68º C after packing. Between January 2007
and December 2012, 2024 patients received 2083 allografts with a
minimum of 12 months of follow-up. The overall allograft-associated
infection rate was 1.2% (24/2024). Swab cultures of 2083 allografts
taken before implantation revealed 21 (1.0%) positive findings.
The 21 recipients were given various antibiotics at the individual
orthopaedic surgeon’s discretion. At the latest follow-up, none
of these 21 recipients displayed clinical signs of infection following
treatment. Based on these findings, we conclude that an incidental positive
culture finding for allografts does not correlate with subsequent
surgical site infection. Additional prolonged post-operative antibiotic
therapy may not be necessary for recipients of fresh-frozen bone
allograft with positive culture findings. Cite this article:
Bone-marrow oedema can occur both in isolation and in association with necrosis of bone, but it has not been shown whether each respond to the same methods of treatment. We treated 16 patients with isolated oedema and 17, in which it was associated with necrosis of the proximal femur, with the prostacyclin derivative iloprost, which has been shown to be effective in the idiopathic form. The Harris hip score, the range of movement, the extent of the oedema as measured by MRI, pain on a visual analogue scale and patient satisfaction were recorded before and subsequent to treatment. In both groups, we were able to show a significant improvement (p <
0.001) in these observations during the period of follow-up indicating that iloprost will produce clinical improvement in both circumstances.