Aims. The modified Dunn procedure has the potential to restore the anatomy in hips with severe slipped capital femoral epiphyses (SCFE). However, there is a risk of developing
Symptomatic hip osteonecrosis is a disabling
condition with a poorly understood aetiology and pathogenesis. Numerous
treatment options for hip osteonecrosis are described, which include
non-operative management and joint preserving procedures, as well
as total hip replacement (THR). Non-operative or joint preserving
treatment may improve outcomes when an early diagnosis is made before
the lesion has become too large or there is radiographic evidence
of femoral head collapse. The presence of a crescent sign, femoral
head flattening, and acetabular involvement indicate a more advanced-stage
disease in which joint preserving options are less effective than
THR. Since many patients present after disease progression, primary
THR is often the only reliable treatment option available. Prior
to the 1990s, outcomes of THR for osteonecrosis were poor. However,
according to recent reports and systemic reviews, it is encouraging
that with the introduction of newer ceramic and/or highly cross-linked
polyethylene bearings as well as highly-porous fixation interfaces,
THR appears to be a reliable option in the management of end-stage
arthritis following hip osteonecrosis in this historically difficult
to treat patient population. Cite this article:
Aims. The aims of the study were to report for a cohort aged younger than 40 years: 1) indications for HRA; 2) patient-reported outcomes in terms of the modified Harris Hip Score (HHS); 3) dislocation rate; and 4) revision rate. Methods. This retrospective analysis identified 267 hips from 224 patients who underwent an hip resurfacing arthroplasty (HRA) from a single fellowship-trained surgeon using the direct lateral approach between 2007 and 2019. Inclusion criteria was minimum two-year follow-up, and age younger than 40 years. Patients were followed using a prospectively maintained institutional database. Results. A total of 217 hips (81%) were included for follow-up analysis at a mean of 3.8 years. Of the 23 females who underwent HRA, none were revised, and the median head size was 46 mm (compared to 50 mm for males). The most common indication for HRA was femoroacetabular impingement syndrome (n = 133), and
The cause of fracture of the femoral neck after hip resurfacing is poorly understood. In order to evaluate the role of
The use of bisphosphonates in the treatment of
We performed 96 Birmingham resurfacing arthroplasties of the hip in 71 consecutive patients with
This retrospective study describes the long-term results of core decompression and placement of a non-vascularised bone graft in the management of
We describe the results of 76 total arthroplasties of the hip for stage-III or stage-IV
Symptomatic and non-symptomatic hip osteonecrosis related to sickle cell disease (SCD) has a high risk of progression to collapse and total hip arthroplasty (THA) in this disease has a high rate of complications. We asked question about the benefit of performing an IRM to detect and treat with cell therapy an early (stage I or II) contralateral osteonecrosis. 430 consecutive SCD adult (32 years, 18 to 51) patients (225 males) with bilateral osteonecrosis (diagnosed with MRI) were included in this study from 1990 to 2010. One side with collapse was treated with THA and the contralateral without collapse (stage I or II) treated with cell therapy. The volume of osteonecrosis was measured with MRI. For cell therapy, the average total number of mesenchymal stem cells (MSCs) counted as number of colony forming units-fibroblast injected in each hip was 160,000 ± 45,000 cells (range 75,000 to 210,000 cells). At the most recent FU (20 years, range 10 to 30), among the 430 hips treated with cell therapy, 45 hips (10.5%) had collapsed and had required THA at 10 years (range 5 to 14 years) and 380 hips (88%) were without collapse and asymptomatic (or with few symptoms) with a decrease percentage of necrosis on MRI from 45% to 11%. Among the 430 contralateral THA, 96 (22.3%) had required one revision, 28 had a re-revision, and 12 a third re-revision with aseptic loosening (85% of revisions) and/or infection (6% of revisions). Hips undergoing cell therapy were approximately three times less likely to undergo revision or re-revision surgery (p < 0.01) as compared with hips undergoing a primary THA. THA is the usual treatment of collapsed ON in patients with SCD. In this population, it is worth looking with MRI for an early stage on the contralateral hip and performing (when necessary) bone marrow cell implantation during the same anesthesia as for arthroplasty.
Bone marrow stem cells (BMSCs) represent a collection of different cell types exhibiting stem cell characteristics but with notable heterogeneity. Among these, Skeletal Stem Cells (SSCs) represent a distinct matrix subgroup within BMSC and demonstrate a specialized capacity to facilitate bone formation, recruit chondrocytes, and contribute to hematopoiesis. SSCs play a pivotal role in orchestrating the functions of skeletal organs. Local ischemia has a significant impact on cell survival and function. We hypothesize that bone ischemia induces alterations in the differentiation potential of SSCs, consequently influencing changes in bone structure. We mechanically dissected tissue from the necrotic segment in the femoral head and more normal appearing areas from the femoral neck of specimens from 5 patients diagnosed with osteonecrosis of the femoral head (ONFH). These tissues were enzymatically broken down into individual cell suspensions. Utilizing fluorescence-activated cell sorting (FACS) based on specific surface markers indicative of human skeletal stem cells (hSSC), namely CD45- CD235a- CD31- TIE2- Podoplanin (PDPN)+ CD146- CD73+ CD164+, we isolated a distinct cell population. Subsequent in vitro evaluations, focusing on clonogenicity, osteogenesis, and chondrogenesis were conducted to assess the functional prowess of these SSCs. Moreover, we introduced BMP2 at a concentration of 50ng/ml to SSCs extracted from necrotic regions to potentially reinstate their osteogenic capabilities. We effectively isolated SSCs from both Necrotic and Non-necrotic Zones. We observed an augmented clonal formation capacity and chondrogenesis ability of SSCs isolated from the necrotic region, accompanied by a significant decline in osteogenic ability ( Ischemia adversely affects the proliferation and function of SSCs, resulting in a diminished osteogenic capacity and an insensitivity to BMP2, ultimately leading to structural alterations in bone tissue.
Cartilage defects of the hip cause significant
pain and may lead to arthritic changes that necessitate hip replacement.
We propose the use of fresh osteochondral allografts as an option
for the treatment of such defects in young patients. Here we present
the results of fresh osteochondral allografts for cartilage defects
in 17 patients in a prospective study. The underlying diagnoses
for the cartilage defects were osteochondritis dissecans in eight
and
We have compared different types of intertrochanteric osteotomy for avascular of necrosis of the hip and evaluated their performance in the light of improving outcome after total hip arthroplasty (THA). During a period of 14 years we performed 63 flexion osteotomies (partly combined with varus or valgus displacement), 29 rotational osteotomies, 13 varus osteotomies, eight medialising osteotomies and two extension osteotomies. The mean period of follow-up for all 115 operations was 7.3 years (maximum 24.6). At follow-up, 27 of 29 patients with a rotational osteotomy had already undergone a THA, compared with 36 of 63 after flexion osteotomy. A high incidence of complications (55.2%) was seen early after rotational osteotomy, compared with 17.5% after flexion osteotomy. For all osteotomies there was a high correlation between the size of the necrotic area and the incidence of failure, which also correlated with the preoperative Ficat and Steinberg stages. Using Kaplan-Meier survivorship analysis, Sugioka’s rotational osteotomy showed a survival probability after five years of 0.26 (95% confidence interval 0.49 to 0.14), and after ten years of 0.15 (CI 0.36 to 0.06). The survival probability for flexion osteotomy was 0.70 (CI 0.83 to 0.59) after five years and 0.50 (CI 0.65 to 0.38) after ten years. The subgroup of flexion osteotomy with a necrotic sector of less than 180° achieved the best survival probability of 0.90 (CI 1.00 to 0.80) after five years and 0.61 (CI 0.84 to 0.45) after ten years. The indications for intertrochanteric osteotomy for
Surgical treatment for osteonecrosis of the femoral head (ONFH) includes both joint-preserving techniques and joint replacement. Joint preservation is more effective in early-stage ONFH; thus, prompt diagnosis when the femoral head is still salvageable is an important clinical goal. We report a 20-year retrospective study that summarizes the proportion of patients diagnosed with early-stage versus late-stage ONFH at initial presentation to our practice. Our institutional database was reviewed to identify patients 18–65 years of age who were diagnosed with atraumatic ONFH in our clinic between 1998–2018. The Association Research Circulation Osseous (ARCO) system was used to stage ONFH, based on available imaging. Patients with prior surgical treatment for ONFH were excluded.Background
Methods
A staging system has been developed to revise the 1994 ARCO classification for ONFH. The final consensus resulted in the following 4-staged system: stage I—X-ray is normal, but either magnetic resonance imaging or bone scan is positive; stage II—X-ray is abnormal (subtle signs of osteosclerosis, focal osteoporosis, or cystic change in the femoral head) but without any evidence of subchondral fracture, fracture in the necrotic portion, or flattening of the femoral head; stage III—fracture in the subchondral or necrotic zone as seen on X-ray or computed tomography scans. This stage is further divided into stage IIIA (early, femoral head depression ≤2 mm) and stage IIIB (late, femoral head depression >2 mm); and stage IV—X-ray evidence of osteoarthritis with accompanying joint space narrowing, acetabular changes, and/or joint destruction. Radiographs, magnetic resonance imaging (MRI), and computed tomography (CT) scans may all be involved in diagnosing ONFH; however, the optimal diagnostic modality remains unclear. The purpose of this study was to identify: 1) how ONFH is diagnosed at a single academic medical center, and 2) if CT is a necessary modality for diagnosing/staging OFNH. The EMR was queried for the diagnosis of ONFH between 1/1/2008–12/31/2018 at a single academic medical center. CT and MRI scans were reviewed by the senior author and other contributors. The timing and staging quality of the diagnosis of ONFH were compared between MRI and CT to determine if CT was a necessary component of the ONFH work-up.Introduction
Methods
The purpose of this study was to analyze trends in the surgical management of ON in recent years. Specifically, we evaluated the annual prevalences of: 1) joint preserving procedures (osteotomies and core decompression/grafts) and 2) joint non-preserving procedures (total hip arthroplasties [THAs], revision THAs, partial THAs) for the treatment of osteonecrosis of the femoral head (ONFH) between 2009 and 2016. A total of 406,239 ONFH patients who were treated between 2009 and 2016 were identified from a nationwide database. Treatment procedures were extracted using ICD-9-CM and ICD-10-CM procedure codes. Annual rates of each of the above procedures were calculated and the trends in the procedure types were also evaluated. Chi-square tests were performed to compare the annual prevalence of each procedure. The mean annual prevalence over the 8-year study period was calculated for each procedure.Introduction
Background
Without intervention 80% of hips with osteonecrosis (ON) will progress. Core decompression has shown favorable results (60–80% survivorship) in early stage ON, and recently, bone marrow aspirate concentration (BMAC) injection into the decompressed femoral head has been proposed to stimulate healing of the necrotic lesion and improve outcomes and survivorship. We retrospectively reviewed the clinical and radiographic outcomes of 42 hips in 26 patients who underwent core decompression with BMAC for ON with a minimum of 1 year follow up. We evaluated pre-op visual analog pain scores (VAS), Steinberg class based on radiographs, as well as Kerboul angle as measured on MRI. Clinical outcomes were reported as change in VAS at final follow up, advancement in Steinberg classification based on radiographs at final follow up, or decision to proceed with THA.Introduction
Methods
The long-term survival of modern ceramic-ceramic bearings in young active patients with osteonecrosis undergoing total hip arthroplasty (THA) is unknown. A previously published study of this series at 5-year follow-up demonstrated an extremely high activity level. The purpose of this study is to examine whether this very high activity level is associated with ceramic-on-ceramic THA failure at long-term follow-up. This is a retrospective review of a single-surgeon at an academic medical center between years 2003–2010. Inclusion criteria were consecutive series of ceramic-on-ceramic articulations in patients younger than 50 with a diagnosis of osteonecrosis. Median follow-up was 12.4 years (range 10–17). Data was collected via mail, telephone, and e-mail surveys. Exclusion criteria included deceased prior to follow-up. Preoperative and postoperative Western Ontario and McMaster University Arthritis Index (WOMAC) and University of California at Los Angeles Activity scores (UCLA) were collected. Student t-tests were used as appropriate.Introduction
Methods