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Sample records for femoral head avascular

  1. Femoral head avascular necrosis

    International Nuclear Information System (INIS)

    Chrysikopoulos, H.; Sartoris, D.J.; Resnick, D.L.; Ashburn, W.; Pretorius, T.

    1988-01-01

    MR imaging has been shown to be more sensitive and specific than planar scintigraphy for avascular necrosis (AVN) of the femoral head. However, experience with single photon emission CT (SPECT) is limited. The authors retrospectively compared 1.5-T MR imaging with SPECT in 14 patients with suspected femoral head AVN. Agreement between MR imaging and SPECT was present in 24 femurs, 14 normal and ten with AVN. MR imaging showed changes of AVN in the remaining four femoral heads. Of these, one was normal and the other three inconclusive for AVN by SPECT. The authors conclude that MR imaging is superior to SPECT for the evaluation of AVN of the hip

  2. [Avascular necrosis of the femoral head].

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    Porubský, Peter; Trč, Tomáš; Havlas, Vojtěch; Smetana, Pavel

    Avascular necrosis of the femoral head in adults is not common, but not too rare diseases. In orthopedic practice, it is one of the diseases that are causing implantation of hip replacement at a relatively early age. In the early detection and initiation of therapy can delay the implantation of prosthesis for several years, which is certainly more convenient for the patient and beneficial. This article is intended to acquaint the reader with the basic diagnostic procedures and therapy.

  3. Avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Kokubo, Takeshi; Takatori, Yoshio; Kamogawa, Morihide; Nakamura, Toshitaka; Ninomiya, Setsuo; Yoshikawa, Kohki; Itai, Yuji; Iio, Masahiro; Mitamura, Tadayuki

    1990-01-01

    T1-weighted MR images of thirty-six hips in 25 patients with avascular necrosis of the femoral head were obtained two to five times during the course of 2 to 26 months. We investigated these MR images in the light of the chronological change and compared them with plain radiographs. MR images changes in 16 femoral head; in general, the abnormal low intensity area in the femoral head reduced in extent and the internal high intensity area became smaller of disappeared. Thirteen femoral heads among them became more flattened on plain radiographs in the same period. It is noted that four different zones are defined in the femoral head after bone necrosis takes place: the dead bone marrow, the dead marrow which still contains fat, the reactive interface and the hyperemic bone marrow. In T1-weighted MR images, the dead bone marrow, the reactive interface and the hyperemic bone marrow are demonstrated as low intensity area, while the dead marrow containing fat may remain high in intensity. On the basis of this knowledge of histopathology and MR images of this disease, we suggest that reduction of the abnormal low intensity area and disappearance of the internal high intensity area on MR images can be regarded as diminution of hyperemia in the living bone marrow and loss of fat in the dead bone marrow, respectively. (author)

  4. CT study of avascular necrosis of femoral head in adults

    International Nuclear Information System (INIS)

    Liu Jihua; Du Yuqing; Xu Aide

    2000-01-01

    Objective: To study the early and new CT signs of avascular necrosis of femoral head in adults. Methods: The CT scans of 127 cases with this condition were analyzed. Results: There were 90 hip joints with femoral head normal in shape, including 67 femoral heads with only high-density sclerosis and 23 ones with high-density and low-density areas. In 111 hip joints, the femoral head was depressed and manifested purely high-density sclerosis in 25 and mixed-density areas in 86. Air-filled cysts appeared in 43 femoral heads. In follow-up cases, the changes in shape and density of femoral head followed some rules. Conclusion: Purely high-density sclerosis is an early sign and is of great diagnostic value combined with its special shape. Air in femoral heads is also a sign of the disease

  5. Avascular necrosis of the femoral head presenting as trochanteric bursitis.

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    Mandell, B F

    1990-01-01

    Five patients are described with avascular necrosis of the femoral head who presented with ipsilateral trochanteric bursitis, in the absence of clearcut hip joint disease. Avascular necrosis was indicated by magnetic resonance imaging. It is suggested that clinical trochanteric bursitis, especially when refractory to local corticosteroid treatment, may be the initial sign of hip disease. In the patient with risk factor(s) for avascular necrosis that diagnosis should be considered and evaluated with appropriate studies, such as magnetic resonance imaging, to prevent weight bearing at an early stage and permit possible surgical decompression in the hope of postponing or obviating the need for total hip replacement. PMID:2241294

  6. Angiographic analysis of avascular necrosis of a femoral head -selective angiography of medial femoral circumflex artery-

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    Ryu, Kyung Nam; Yoon, Yup; Lee, Sun Wha; Lim, Jae Hoon [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1991-07-15

    The degree of anatomical revascularization of a necrotic femoral head and traumatic hip would provide information about treatment and prognosis. The authors analyzed the vascular changes of femoral head among unilateral avascular necrosis, bilateral avascular necrosis, and traumatic hips. Forty - four patients with avascular necrosis and 19 patients with traumatic hips were examined by selective angiography of the medial femoral circumflex artery. In the traumatic hip cases, 12 (63%) showed occlusion, 2 (11%) hypertrophy of the capsular branches, and 5 ( 26 % ) were normal . In the avascular necrosis cases, 15 (25%) showed occlusion, 39 (67%) had hypertrophy of the capsular branches, and 4 (7%) had normal findings. Hypertrophy of the superior capsular branch of the medial femoral circumflex artery is more frequently observed in avascular necrosis than in traumatic hip. Bilateral avascular necrosis reveals more frequent incidences than unilateral cases. Selective angiography could help in the therapy plan and also provide information about the contralateral side.

  7. Angiographic analysis of avascular necrosis of a femoral head -selective angiography of medial femoral circumflex artery-

    International Nuclear Information System (INIS)

    Ryu, Kyung Nam; Yoon, Yup; Lee, Sun Wha; Lim, Jae Hoon

    1991-01-01

    The degree of anatomical revascularization of a necrotic femoral head and traumatic hip would provide information about treatment and prognosis. The authors analyzed the vascular changes of femoral head among unilateral avascular necrosis, bilateral avascular necrosis, and traumatic hips. Forty - four patients with avascular necrosis and 19 patients with traumatic hips were examined by selective angiography of the medial femoral circumflex artery. In the traumatic hip cases, 12 (63%) showed occlusion, 2 (11%) hypertrophy of the capsular branches, and 5 ( 26 % ) were normal . In the avascular necrosis cases, 15 (25%) showed occlusion, 39 (67%) had hypertrophy of the capsular branches, and 4 (7%) had normal findings. Hypertrophy of the superior capsular branch of the medial femoral circumflex artery is more frequently observed in avascular necrosis than in traumatic hip. Bilateral avascular necrosis reveals more frequent incidences than unilateral cases. Selective angiography could help in the therapy plan and also provide information about the contralateral side

  8. Morphometric findings in avascular necrosis of the femoral head.

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    Kamal, Diana; Trăistaru, Rodica; Alexandru, D O; Kamal, C K; Pirici, D; Pop, O T; Mălăescu, D Gh

    2012-01-01

    Avascular necrosis of the femoral head is an illness with a controversial etiology, the trigger event being the suppression of blood flow to the femoral head. The disease affects mostly young adults within their third and fifth decade, the majority of the patients being men. The main risk factors are trauma, chronic alcohol consumption, smoking, corticotherapy. The main goal of our study is to describe the morphometric changes found in the bone tissue of patients diagnosed with avascular necrosis of the femoral head, with different risk factors, by comparing the area of bone trabeculae inside the area of necrosis with that from the adjacent viable tissue. The morphometric study used biological material from 16 patients with ages between 29 and 57 years, who underwent surgery for avascular necrosis of the femoral head. They were admitted in the Orthopedics Department at the Emergency County Hospital in Craiova between 2010 and 2011 and were split into four groups. Group I presented trauma as the main risk factor, Group II had corticotherapy as the defining risk factor, Group III presented chronic alcohol consumption and Group IV was represented by the patients who smoked and exhibited chronic alcohol consumption. There was not a significant statistical difference between the areas of bone trabeculae of the four groups when we compared viable bone tissue to the necrotized one. Knowing the risk factors of the avascular necrosis of the femoral head is critical to the management of the disease, because diagnosing it in an early stage is a necessity for obtaining a good result for conservative treatment.

  9. Avascular necrosis of the femoral head in HIV infected patients

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    Marcos Almeida Matos

    Full Text Available Avascular necrosis (AVN of the femoral head is an emerging complication in HIV infected patients. It has been suggested that the increased incidence of AVN in this population may be caused by an increased prevalence of predisposing factors for osteonecrosis, including protease inhibitors, hyperlipidemia, corticosteroid use, alcohol and intravenous drug abuse. The aim of this study was to assess the risk factors for avascular necrosis developing in the femoral head of HIV infected individuals. This study consisted of meta-analysis of the secondary data extracted from current literature. The selected articles allowed two study groups to be drawn up for comparison. Group 1 comprised 324 individuals infected by the HIV virus, who did not present femoral head AVN. Group 2 comprised 32 HIV positive patients, who presented femoral head AVN. The parameters used for analysis were as follows: age, gender, sexual preference, use of intravenous drugs, time of diagnosis, CD4+ cell count, use of antiretroviral agents and duration, serum cholesterol and serum triglycerides. The present study found a statistically significant association between hypertriglyceridemia, hypercholesterolemia, sexual preference and intravenous drug abuse. The authors concluded that femoral head osteonecrosis is associated with hyperlipidemia (hypercholesterolemia and hypertriglyceridemia and intravenous drug abuse. This study supports the hypothesis that protease inhibitors play a role in the development of osteonecrosis through a tendency to cause hyperlipidemia.

  10. Pravastatin Protects Against Avascular Necrosis of Femoral Head via Autophagy.

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    Liao, Yun; Zhang, Ping; Yuan, Bo; Li, Ling; Bao, Shisan

    2018-01-01

    Autophagy serves as a stress response and may contribute to the pathogenesis of avascular necrosis of the femoral head induced by steroids. Statins promote angiogenesis and ameliorate endothelial functions through apoptosis inhibition and necrosis of endothelial progenitor cells, however the process used by statins to modulate autophagy in avascular necrosis of the femoral head remains unclear. This manuscript determines whether pravastatin protects against dexamethasone-induced avascular necrosis of the femoral head by activating endothelial progenitor cell autophagy. Pravastatin was observed to enhance the autophagy activity in endothelial progenitor cells, specifically by upregulating LC3-II/Beclin-1 (autophagy related proteins), and autophagosome formation in vivo and in vitro . An autophagy inhibitor, 3-MA, reduced pravastatin protection in endothelial progenitor cells exposed to dexamethasone by attenuating pravastatin-induced autophagy. Adenosine monophosphate-activated protein kinase (AMPK) is a key autophagy regulator by sensing cellular energy changes, and indirectly suppressing activation of the mammalian target of rapamycin (mTOR). We found that phosphorylation of AMPK was upregulated however phosphorylation of mTOR was downregulated in pravastatin-treated endothelial progenitor cells, which was attenuated by AMPK inhibitor compound C. Furthermore, liver kinase B1 (a phosphorylase of AMPK) knockdown eliminated pravastatin regulated autophagy protein LC3-II in endothelial progenitor cells in vitro . We therefore demonstrated pravastatin rescued endothelial progenitor cells from dexamethasone-induced autophagy dysfunction through the AMPK-mTOR signaling pathway in a liver kinase B1-dependent manner. Our results provide useful information for the development of novel therapeutics for management of glucocorticoids-induced avascular necrosis of the femoral head.

  11. Avascular Necrosis of the Femoral Head: Are Any Genes Involved?

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    Pouya, Farzaneh; Kerachian, Mohammad Amin

    2015-01-01

    Avascular necrosis of the femoral head (ANFH) is a pathologic process that results from interruption of blood supply to the femur bone resulting in the death of bone cells and collapse of the femoral head. Nontraumatic ANFH continues to be a significant challenge to orthopedic surgeons. While the exact mechanisms remain elusive, many new insights have emerged from research in the last decade that has given us a clearer picture of the pathogenesis of nontraumatic ANFH. Progression to the end stage of ANFH appears to be related to five main mechanisms: hypercoagulable conditions, angiogenesis suppressions, hyperadipogenesis, heritable states, and switching the bone remodelling into bone resorption. Researchers have been examining the pathogenic mechanisms of ANFH but none of these theories have been firmly confirmed although some appear more plausible than the others. All of these factors can switch bone remodelling into bone resorption, which can further lead to ANFH progression ending up to femoral head collapse. PMID:26213697

  12. Avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Kokubo, Takashi; Takatori, Yoshio; Ninomiya, Setsuo; Sasaki, Yasuhito

    1993-01-01

    Magnetic resonance (MR) images and conventional radiographs were compared in 142 hips with avascular necrosis, and a staging system for the disease based on MR imaging was developed. MR images were classified into three patterns: a band of low signal intensity (class I); an area of low signal intensity with internal spot(s) of high signal (class II); and an area of low signal intensity without internal spots of high signal (class III). Most MR class I lesions were in radiographic stage I (normal) or II (sclerotic or cystic changes without collapse). Most MR class II lesions were in radiographic stage III (segmental collapse), and most MR class III lesions were in stage III or IV (secondary degenerative changes). The MR image classification was closely correlated with radiographic staging (p<0.01, using χ square test). We considered that this classification closely reflected the different stages of the disease according to the histopathology of the bone marrow. (author)

  13. MR imaging of avascular necrosis of the femoral head

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    Choi, Eun Wan; Cho, Won Soo; Hong, Hyun Sook; Lee, Hae Kyung; Choi, Deuk Lin; Kim, Ki Jung [Soonchunhyang University Hospital, Seoul (Korea, Republic of)

    1993-09-15

    We evaluated the magnetic resonance imaging (MRI) findings of femoral heads in 20 normal and 45 abnormal patients. The bone marrow in the healthy adults consisted of a combination of hematopoietic and fatty marrow, which showed age-related dirtribation, that is the component of fatty marrow was increased and the marrow vascularity was decreased with age. Avascular necrosis (AVN) showed a decreased bone marrow signal within an normal appearing femoral head on T1 and T2 -weighted images. In addition, we could see inhomogeneous low signal intensive (31 cases), a ring of low intensive with central normal signal intensity (25 cases), focal low signal intensity (12 case), or a band of low signal intensity (4 cases). MRI findings were abnormal in 10 cases with normal radiographic findings as well as in all the cases with abnormal ones. In conclusion, MRI should be the choice of the imaging modality for the evaluation of early bone marrow changes of AVN.

  14. MR imaging of avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Choi, Eun Wan; Cho, Won Soo; Hong, Hyun Sook; Lee, Hae Kyung; Choi, Deuk Lin; Kim, Ki Jung

    1993-01-01

    We evaluated the magnetic resonance imaging (MRI) findings of femoral heads in 20 normal and 45 abnormal patients. The bone marrow in the healthy adults consisted of a combination of hematopoietic and fatty marrow, which showed age-related dirtribation, that is the component of fatty marrow was increased and the marrow vascularity was decreased with age. Avascular necrosis (AVN) showed a decreased bone marrow signal within an normal appearing femoral head on T1 and T2 -weighted images. In addition, we could see inhomogeneous low signal intensive (31 cases), a ring of low intensive with central normal signal intensity (25 cases), focal low signal intensity (12 case), or a band of low signal intensity (4 cases). MRI findings were abnormal in 10 cases with normal radiographic findings as well as in all the cases with abnormal ones. In conclusion, MRI should be the choice of the imaging modality for the evaluation of early bone marrow changes of AVN

  15. Magnetic resonance imaging of avascular necrosis of the femoral head

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    Ozono, Kenji; Takaoka, Kunio [Osaka Univ. (Japan). Faculty of Medicine

    1989-07-01

    To evaluate the diagnostic value and limitation of magnetic resonance imaging (MRI) in avascular necrosis of the femoral head (ANF), clinical stages and types were examined on MRI scans of 68 femoral heads of 46 ANF patients. Stage 1 patients fell into two groups: (1) stage 1-A group of real ANF in which abnormal findings were observed on both MRI and bone scanning and (2) stage 1-B group of asymptomatic ANF in which MRI detected abnormality that was missed by bone scanning. In these groups, MRI showed inhomogeneous, band, and spotty patterns. Stage 2 or 3 patients tended to have homogeneous or ring-pattern hypointensities on MRI. Histological examination showed that repair reaction at the marginal site of hypointensity was partly responsible for the occurrence of hypointensities. In Stage 4 patients, not only femoral head but also acetabular site was visible as homogeneous hypointensity, which was similar to that in osteoarthritis. Because repair areas, as well as necrotic areas, were frequently visualized as hypointensities in Stages 2 or more, MRI might overestimate necrotic areas. (N.K.).

  16. Femoral Head Avascular Necrosis Is Not Caused by Arthroscopic Posterolateral Femoroplasty.

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    Rupp, Robert E; Rupp, Sasha N

    2016-05-01

    This study was conducted to identify the risk of avascular necrosis of the femoral head after arthroscopic femoroplasty extending to the posterolateral femoral neck, the source of the primary blood supply to the femoral head. Cam lesions of femoroacetabular impingement are typically anterior along the junction of the femoral head and neck. However, anatomic variations can involve the posterolateral vascular region of the femoral head and neck. Femoroplasty involving this vascular region can lead to injury to the blood supply to the femoral head, with subsequent avascular necrosis. If the posterolateral portion of the cam lesion is preserved, persistent femoroacetabular impingement may occur. A retrospective review identified 112 patients who underwent arthroscopic femoroplasty for femoroacetabular impingement over a 2-year period. Of these patients, 14 had femoroplasty that extended to the posterolateral femoral head. Of this group, 5 had undergone magnetic resonance imaging (MRI) after femoroplasty and the other 9 were contacted to undergo MRI of the hip to evaluate for avascular necrosis. A radiologist and the senior author evaluated all MRI scans specifically for avascular necrosis of the femoral head. All procedures were performed by the senior author. Mean age of the 14 patients (8 women and 6 men) with femoroplasty that extended into the posterolateral vascular region of the femoral head was 44 years (range, 23-69 years). All 14 patients underwent MRI evaluation of the affected hip a mean of 25 months (range, 7-44 months) after femoroplasty. No MRI scans showed evidence of avascular necrosis of the femoral head. Femoroplasty of the posterolateral vascular region of the femoral head is not associated with avascular necrosis. Patients with femoroacetabular impingement and a cam lesion extending to the posterolateral femoral head can undergo femoroplasty of this region without the development of avascular necrosis. [Orthopedics. 2016; 39(3):177-180.]. Copyright

  17. Research and advancement of treating avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Wang Kaibing; Bai Bin; Wang Honghui; Sui Hong

    2006-01-01

    To undertake retrospective analysis of the research and advancement of treating avascular necrosis of the femoral head. After comparing the superiority and inferiority of different treatments and the present therapeutic status many therapeutic methods for avascular necrosis of the femoral head have been performed, commonly according to the staging of necrosis. Conservative therapy is suitable for stage 0-I, interventional therapy is suitable for stage II-III, operation is adapted for stage II-III and femoral head collapse or degenerative changes. Avascular necrosis of the femoral head is a chronic and dysfunctional illness. Comprehensive treatment according to different stage is now the most popular. Interventional therapy is the study focus of the avascular necrosis of the femoral head meanwhile. (authors)

  18. Avascular necrosis of the femoral head after osteosynthesis of femoral neck fracture.

    Science.gov (United States)

    Min, Byung-Woo; Kim, Sung-Jin

    2011-05-18

    The reported incidence of avascular necrosis after femoral neck fracture fixation varies widely, and there is no consensus regarding its risk factors. We evaluated the incidence of avascular necrosis of the femoral head with the use of contemporary techniques for femoral neck fracture fixation. We then sought to determine what potential risk factors influenced the development of avascular necrosis.Between 1990 and 2005, one hundred sixty-three intracapsular femoral neck fractures in 163 patients were treated with internal fixation at our level-I trauma center. All patients were monitored until conversion to total hip arthroplasty or for a minimum of 2 years postoperatively. Ten patients (10 hips) died and 7 patients (7 hips) were lost to follow-up. The remaining 146 patients (146 hips) had a mean 5.2 years of follow-up (range, 3 months to 17 years). The incidence of avascular necrosis was 25.3% (37 hips). The average time to diagnosis of avascular necrosis was 18.8 months (range, 3-47 months). Patient sex, age, interval from injury to surgery, and mechanism of injury were statistically not associated with the development of avascular necrosis. The quality of fracture reduction, adequacy of fixation, degree of displacement, and comminution of the posterior cortex were significantly associated. After we controlled for patient and radiographic characteristics, multivariate analyses indicated that the important predictors for avascular necrosis are poor reduction (odds ratio=13.889) and initial displacement of the fracture (odds ratio=4.693). Copyright 2011, SLACK Incorporated.

  19. Selective angiography of the avascular necrosis of the femoral head

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    Choi, Joong Chan; Park, Cheong Hee; Rho, Tae Jin; Yune, Seung Ho; Rhee, Byung Chull [Chung Nam National University College of Medicine, Deajeon (Korea, Republic of)

    1988-10-15

    The diagnosis of the avascular of the femoral head (AVN) has advanced. RI scan, intraosseous pressure monitoring, intramedullary venography, CT, MRI, and selective femoral angiography are used in diagnosis. Among these methods, selective or superselective angiography is necessary to study the change of the vessels of the hip, because the vascular insufficiency could be a major etiology of AVN. Selective femoral angiography was performed for 23 hips of 22 patients who were suspected as AVN by simple rediographs and RI scans in order to estimate the change of vascularity of the femoral head. The results were as follow. 1. The alteration of vasculature appeared in 21 cases among all 23 cases (91%), which included 100% in the traumatic group (4/4 cases) and 90% in nontraumatic group (17/19 cases). 2. The affected vessles in nontraumatic group were the proximal portion of the posterior branch of the medical circumflex artery in 2 cases, the modportion of posterior branch in 2 cases, the distal portion of the posterior branch in 11 cases, and superior capsular branch in 2 cases. 3. The affected vessels in traumatic group were proximal portion in 1 cases, midportion in 1 case, and superior capsular artrey in 2 cases. 4. The obstruction of inferior casular artery was noted in 6 cases of nontraumatic group. 5. The retrograde filling of the posterior branch of medial circumflex artery were noted in 1 case from superior gluteal artery, in 1 case from inferior gluteal artery, in 1 case form superior and inferior gluteal artery and retrograde filling of inferior gluteal artery from medial circumflex artery was in 6 cases.

  20. Selective angiography of the avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Choi, Joong Chan; Park, Cheong Hee; Rho, Tae Jin; Yune, Seung Ho; Rhee, Byung Chull

    1988-01-01

    The diagnosis of the avascular of the femoral head (AVN) has advanced. RI scan, intraosseous pressure monitoring, intramedullary venography, CT, MRI, and selective femoral angiography are used in diagnosis. Among these methods, selective or superselective angiography is necessary to study the change of the vessels of the hip, because the vascular insufficiency could be a major etiology of AVN. Selective femoral angiography was performed for 23 hips of 22 patients who were suspected as AVN by simple rediographs and RI scans in order to estimate the change of vascularity of the femoral head. The results were as follow. 1. The alteration of vasculature appeared in 21 cases among all 23 cases (91%), which included 100% in the traumatic group (4/4 cases) and 90% in nontraumatic group (17/19 cases). 2. The affected vessles in nontraumatic group were the proximal portion of the posterior branch of the medical circumflex artery in 2 cases, the modportion of posterior branch in 2 cases, the distal portion of the posterior branch in 11 cases, and superior capsular branch in 2 cases. 3. The affected vessels in traumatic group were proximal portion in 1 cases, midportion in 1 case, and superior capsular artrey in 2 cases. 4. The obstruction of inferior casular artery was noted in 6 cases of nontraumatic group. 5. The retrograde filling of the posterior branch of medial circumflex artery were noted in 1 case from superior gluteal artery, in 1 case from inferior gluteal artery, in 1 case form superior and inferior gluteal artery and retrograde filling of inferior gluteal artery from medial circumflex artery was in 6 cases.

  1. Avascular necrosis of the femoral head after renal transplantation

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    Jeong, Hae Woong; Yoon, Jeong Hee; Kim, Chang Soo [Maryknoll Hospital, Pusan (Korea, Republic of)

    1999-08-01

    To determine the incidence of avascular necrosis (AVN) of the femoral head after renal transplantation, evaluate plain radiographic and MR findings, and compare known predisposing factors between the AVN group and the control group. Between August 1990 and June 1998, 256 renal transplantations were carried out at the Maryknoll hospital. The incidence of AVN was determined clinically, and in the AVN group, plain radiographic and MR findings were evaluated. A control group of 29 cases was randomly selected from among the remaining 241 patients, and acute rejection, mean daily steroid dose and osteopenia were compared between the AVN group and the control group. The incidence of AVN of the femoral head was 5.9%(15/256). Involvement was bilateral in nine cases and unilateral in six and 24 femoral heads were thus affected. The mean period required for diagnosis of this condition was 10.7 months(within 6 months: 2 hips, between 6-12 months: 10, between 12-24 months: 9, over 24 months: 3). Plain radiographs showed that three cases were Ficat stage I, five were stage II, seven were stage III, and nine were stage IV. MRI indicated that 15 cases were Mitchell class A, one was class C, and three were class D. Correlation between Ficat stage and the period required for diagnosis showed that the longer the latter, the higher the Ficat stage. A comparison of risk factors between the AVN group and the control group showed that the incidence of acute rejection and osteopenia, and the mean daily steroid dose, were higher in the AVN group than in the rejection group and that the difference was statistically significant. The incidence of AVN of the femoral head after renal transplantation was 5.9%. The longer the period required for diagnosis of AVN, the higher the Ficat stage. A comparison of risk factors between the AVN group and the rejection group showed that the incidence of acute rejection and osteopenia as well as the mean daily steroid dose, were higher in the AVN group than

  2. Avascular necrosis of the femoral head after renal transplantation

    International Nuclear Information System (INIS)

    Jeong, Hae Woong; Yoon, Jeong Hee; Kim, Chang Soo

    1999-01-01

    To determine the incidence of avascular necrosis (AVN) of the femoral head after renal transplantation, evaluate plain radiographic and MR findings, and compare known predisposing factors between the AVN group and the control group. Between August 1990 and June 1998, 256 renal transplantations were carried out at the Maryknoll hospital. The incidence of AVN was determined clinically, and in the AVN group, plain radiographic and MR findings were evaluated. A control group of 29 cases was randomly selected from among the remaining 241 patients, and acute rejection, mean daily steroid dose and osteopenia were compared between the AVN group and the control group. The incidence of AVN of the femoral head was 5.9%(15/256). Involvement was bilateral in nine cases and unilateral in six and 24 femoral heads were thus affected. The mean period required for diagnosis of this condition was 10.7 months(within 6 months: 2 hips, between 6-12 months: 10, between 12-24 months: 9, over 24 months: 3). Plain radiographs showed that three cases were Ficat stage I, five were stage II, seven were stage III, and nine were stage IV. MRI indicated that 15 cases were Mitchell class A, one was class C, and three were class D. Correlation between Ficat stage and the period required for diagnosis showed that the longer the latter, the higher the Ficat stage. A comparison of risk factors between the AVN group and the control group showed that the incidence of acute rejection and osteopenia, and the mean daily steroid dose, were higher in the AVN group than in the rejection group and that the difference was statistically significant. The incidence of AVN of the femoral head after renal transplantation was 5.9%. The longer the period required for diagnosis of AVN, the higher the Ficat stage. A comparison of risk factors between the AVN group and the rejection group showed that the incidence of acute rejection and osteopenia as well as the mean daily steroid dose, were higher in the AVN group than

  3. Avascular necrosis of the femoral head at 2 years after pertrochanteric fracture surgery: Case report

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    Bogdan Deleanu

    2016-02-01

    Conclusion: The avascular necrosis of the femoral head is a complication of pertrochanteric fractures that can not be foreseen or avoided. The optimal treatment in these cases is uncemented total hip arthroplasty.

  4. [RESEARCH PROGRESS OF EXPERIMENTAL ANIMAL MODELS OF AVASCULAR NECROSIS OF FEMORAL HEAD].

    Science.gov (United States)

    Yu, Kaifu; Tan, Hongbo; Xu, Yongqing

    2015-12-01

    To summarize the current researches and progress on experimental animal models of avascular necrosis of the femoral head. Domestic and internation literature concerning experimental animal models of avascular necrosis of the femoral head was reviewed and analyzed. The methods to prepare the experimental animal models of avascular necrosis of the femoral head can be mainly concluded as traumatic methods (including surgical, physical, and chemical insult), and non-traumatic methods (including steroid, lipopolysaccharide, steroid combined with lipopolysaccharide, steroid combined with horse serum, etc). Each method has both merits and demerits, yet no ideal methods have been developed. There are many methods to prepare the experimental animal models of avascular necrosis of the femoral head, but proper model should be selected based on the aim of research. The establishment of ideal experimental animal models needs further research in future.

  5. Magnetic resonance imaging of avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Thickman, D.; Axel, L.; Kressel, H.Y.; Velchick, M.; Dalinka, M.; Steinberg, M.; Chen, H.; Fallon, M.

    1986-01-01

    This study investigates the role of magnetic resonance imaging (MR) in identifying avascular necrosis (AVN) of the femoral head and in monitoring its therapy. The detection of AVN, particularly in its early stages, is imperative to give therapeutic intervention the best opportunity for successful management. The results of magnetic resonance imaging are compared with those of the standard diagnostic modalities in evaluation of patients with the lesion. Examinations were performed at 0.12 T with a repetition time (TR) of 143 ms and times to echo (TE's) of 10 or 20 ms. This study represents a retrospective review of 90 hips which were examined in 45 consecutive patients. Of these, 52 hips were biopsied as part of treatment. MR was shown to be sensitive in the detection of AVN. Comparison of MR with radionuclide imaging showed comparable sensitivity and specificity. MR was also noted to be sensitive in the detection of early AVN. Preliminary results suggest that MR can monitor treatment of the affected hip, and may even be able to predict patient response to therapy. Although further work is necessary to determine the role of MR in the evaluation of the patient presenting with hip pain, MR is a sensitive method in detecting AVN and in monitoring its course in patients suspected of having the disease. (orig.)

  6. Magnetic resonance imaging of avascular necrosis of the femoral head

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    Thickman, D; Axel, L; Kressel, H Y; Velchick, M; Dalinka, M; Steinberg, M; Chen, H; Fallon, M

    1986-02-01

    This study investigates the role of magnetic resonance imaging (MR) in identifying avascular necrosis (AVN) of the femoral head and in monitoring its therapy. The detection of AVN, particularly in its early stages, is imperative to give therapeutic intervention the best opportunity for successful management. The results of magnetic resonance imaging are compared with those of the standard diagnostic modalities in evaluation of patients with the lesion. Examinations were performed at 0.12 T with a repetition time (TR) of 143 ms and times to echo (TE's) of 10 or 20 ms. This study represents a retrospective review of 90 hips which were examined in 45 consecutive patients. Of these, 52 hips were biopsied as part of treatment. MR was shown to be sensitive in the detection of AVN. Comparison of MR with radionuclide imaging showed comparable sensitivity and specificity. MR was also noted to be sensitive in the detection of early AVN. Preliminary results suggest that MR can monitor treatment of the affected hip, and may even be able to predict patient response to therapy. Although further work is necessary to determine the role of MR in the evaluation of the patient presenting with hip pain, MR is a sensitive method in detecting AVN and in monitoring its course in patients suspected of having the disease.

  7. Avascular necrosis of the femoral head at 2 years after pertrochanteric fracture surgery: Case report.

    Science.gov (United States)

    Deleanu, Bogdan; Prejbeanu, Radu; Vermesan, Dinu; Honcea, Lucian; Mioc, Mihail Lazar; Tsiridis, Eleftherios; Predescu, Vlad

    2016-02-01

    The avascular necrosis of the femoral head represents the death of bone tissue due to the lack of blood supply. The disease has a progressive evolution and left untreated leads to femoral head collapse and severe arthritis. We present a case of a pertrochanteric fracture which has been successfully operated with a dynamic interlocking trochanteric gamma nail on the right hip. At 2 years after surgery the patient developed an incipient avascular necrosis of the femoral head. Despite the good positioning of the implant, we considered that the source of the pain was an intolerance of the implant, and thus we removed it. After implant removal, the patient was kept under observation and conservative treatment, to prevent further damage to the right hip and allow the healing to occur. At 6 months after the gamma nail was removed the X-rays revealed advanced avascular necrosis of the femoral head and secondary osteoarthritis on the right hip. The patient underwent surgery with an uncemented total hip arthroplasty. There are a few discussions regarding the avascular necrosis of the femoral head. These discussions may include the predisposing risk factors, the treatment of choice and the postoperative complications. The avascular necrosis of the femoral head is a complication of pertrochanteric fractures that can not be foreseen or avoided. The optimal treatment in these cases is uncemented total hip arthroplasty.

  8. Autologous Platelet Concentrates as Treatment for Avascular Necrosis of Femoral Head in a Dog.

    Science.gov (United States)

    Parra, Estefanía; Vergara, Andrea; Silva, Raúl F

    2017-03-01

    Avascular necrosis of the femoral head is a developmental disturbance that generally affects young dogs of small breeds and produces ischemic necrosis of the femoral head resulting in an incongruous and malformed joint. The most common treatment is the excisional arthroplasty of the head and femoral neck. The aim of this study is to describe the treatment of avascular necrosis in a Yorkshire dog using intra-articular injections of autologous platelet concentrate. Evaluations were made at 0, 15, 30, 60, and 120 days of treatment, describing the following parameters: clinical gait analysis, perimetry, goniometry, and radiographic evaluations. The results obtained in this case suggest that the autologous platelet concentrate may be an alternative for the treatment of avascular necrosis of the femoral head in dogs. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Experimental and clinical stuties on microcirculation disturbance in the hormonal avascular necrosis of femoral head

    International Nuclear Information System (INIS)

    Shen Xiaowen

    2007-01-01

    Objective: To find the correlation factors with microcirculation disturbance by animal and clinic exprements; making clear of the pathogenetic mechanism; and providing theoritical evidence for prevention and treatment of the disease. Methods: The rabbits femoral head avascular necrosis models were induced and created by corticoid steroids. The microcirculation including capillary blood flow rate, blood viscosity, blood ingredients and histopathologic change were studied comparatively between the experimental and the control groups in order to explore the correlative factors of the incidence and proper clinical treatment. Results: The expremental group showed intracappillary blood cells aggregation, obviously slow down of blood flow, increase of serum cholesterol and protein, together with decrease of femoral head capillary vasculation. The effective rate for hormone induced femoral head avaseular necrosis through anticoagulation and promotion of microvascular circulation reached 93.75%. Conclusion: Hormone induced femoral head avascular necrosis is a kind of microcirculation disturbance disease. (authors)

  10. Avascular necrosis of bilateral femoral heads in a patient with Fabry's disease.

    LENUS (Irish Health Repository)

    O'Neill, Francis

    2012-07-13

    The underlying cause of avascular necrosis (AVN) of the femoral head is often not apparent. We report the case of a 26 year old builder with a four month history of bilateral hip pain, and a diagnosis of bilateral femoral head avascular necrosis. Fabry\\'s disease was identified as the probable cause. Since 2001, enzyme replacement therapy for Fabry\\'s disease has become available, with a potential to influence the disease process, and this is of potential importance to clinicians treating AVN.

  11. Avascular necrosis of femoral head: findings of contrast-enhanced MR imaging

    International Nuclear Information System (INIS)

    Shin, Yong Moon; Kang, Heung Sik; Kim, Chu Wan; Kim, Hee Joong; Kim, Young Min

    1995-01-01

    To evaluate the findings and the role of contrast enhanced magnetic resonance imaging in avascular necrosis of femoral head. Sixteen patients with avascular necorsis of femoral head were examined with MRI. T1-weighted and T2-weighted image and contrast-enhanced T1-weighted images were obtained. Enhancing characteristics of the necrotic area and synovium were determined. Also a change of the disease extent after enhancement was assessed. Twenty seven avascular necrosis of the femoral head including 11 cases of bilateral lesion were detected. Fifteen cases revealed collapse of the femoral head. The portions of the lesion with low signal intensity on T1-weighted images and high signal intensity on T2-weighted images showed contrast enhancement in 15 cases. However, the potions with low signal intensities both on T1 and T2-weighted images showed enhancement in one case. There was no significant change of the disease extent after enhancement. Synovium showed enhancement in 18 cases, and joint effusion was detected in 23 cases. Contrast enhanced MR images may be helpful in predicting histopathologic findings of avascular necrosis of the femoral head, but not useful for evaluating the extent of disease

  12. Avascular necrosis of femoral head: findings of contrast-enhanced MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Yong Moon; Kang, Heung Sik; Kim, Chu Wan; Kim, Hee Joong; Kim, Young Min [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1995-06-15

    To evaluate the findings and the role of contrast enhanced magnetic resonance imaging in avascular necrosis of femoral head. Sixteen patients with avascular necorsis of femoral head were examined with MRI. T1-weighted and T2-weighted image and contrast-enhanced T1-weighted images were obtained. Enhancing characteristics of the necrotic area and synovium were determined. Also a change of the disease extent after enhancement was assessed. Twenty seven avascular necrosis of the femoral head including 11 cases of bilateral lesion were detected. Fifteen cases revealed collapse of the femoral head. The portions of the lesion with low signal intensity on T1-weighted images and high signal intensity on T2-weighted images showed contrast enhancement in 15 cases. However, the potions with low signal intensities both on T1 and T2-weighted images showed enhancement in one case. There was no significant change of the disease extent after enhancement. Synovium showed enhancement in 18 cases, and joint effusion was detected in 23 cases. Contrast enhanced MR images may be helpful in predicting histopathologic findings of avascular necrosis of the femoral head, but not useful for evaluating the extent of disease.

  13. Ranking of computed tomography in diagnosis of avascular necrosis of femoral head in adults

    International Nuclear Information System (INIS)

    Nebel, G.

    1982-01-01

    On 12 patients (7 males, 5 females) with the diagnosis of avascular (aseptic) necrosis of the femoral head the value of computed tomography was investigated. Stages II-IV were observed (following the staging of Ficat and Arlet). Exept for 2 cases the findings of necrosis on axial CT-slices were always located in the anterior part of the femoral head. The problems of early diagnosis of the disease are discussed. (orig.) [de

  14. Ranking of computed tomography in diagnosis of avascular necrosis of femoral head in adults

    Energy Technology Data Exchange (ETDEWEB)

    Nebel, G

    1982-01-01

    On 12 patients (7 males, 5 females) with the diagnosis of avascular (aseptic) necrosis of the femoral head the value of computed tomography was investigated. Stages II-IV were observed (following the staging of Ficat and Arlet). Exept for 2 cases the findings of necrosis on axial CT-slices were always located in the anterior part of the femoral head. The problems of early diagnosis of the disease are discussed.

  15. MR imaging of avascular femoral head necrosis - pre- and postoperative studies

    International Nuclear Information System (INIS)

    Schedel, H.; Ziegler, L.; Vogl, T.; Hilbertz, T.; Lissner, J.; Buchner, H.

    1992-01-01

    46 patients with avascular necrosis of the femoral head were examined by T 2 - and T 1 -weighted MR before and after infusion of Gd-DTPA. Both sides were involved in 12 cases. The classification was done according to Ficat. In early stages and in postoperative studies a correlation of signal intensity after infusion of Gd-DTPA and clinical symptoms was found. Hyperintensity of the avascular area or of the implanted material was assumed to be vascularised or vital components in 4 cases of Ficat 1 and 15 postoperative studies. Contrariwise, we found in 5 patients with severe postoperative symptoms, low signal intensity areas due to avascular regions. (orig.) [de

  16. Incidence of Avascular Necrosis of the Femoral Head After Intramedullary Nailing of Femoral Shaft Fractures

    Science.gov (United States)

    Kim, Ji Wan; Oh, Jong-Keon; Byun, Young-Soo; Shon, Oog-Jin; Park, Jai Hyung; Oh, Hyoung Keun; Shon, Hyun Chul; Park, Ki Chul; Kim, Jung Jae; Lim, Seung-Jae

    2016-01-01

    Abstract The goal of this study was to determine the incidence of avascular necrosis of the femoral head (AVNFH) after intramedullary nailing of femoral shaft fractures and to identify risk factors for developing AVNFH. We retrospectively reviewed all patients with femoral shaft fractures treated with antegrade intramedullary nailing at 10 institutions. Among the 703 patients enrolled, 161 patients were excluded leaving 542 patients in the study. Average age was 42.1 years with average follow-up of 26.3 months. Patient characteristics and fracture patterns as well as entry point of femoral nails were identified and the incidence of AVNFH was investigated. Patients were divided into 2 groups according to open versus closed physis, open versus closed fractures, and age (<20 versus ≥20 years). Overall incidence of AVNFH was 0.2% (1 of 542): the patient was 15-year-old boy. Of 25 patients with open physis, the incidence of AVNFH was 4%, whereas none of 517 patients with closed physis developed AVNFH (P < 0.001). The incidence of AVNFH in patients aged < 20 versus ≥20 years was 1.1% (1 of 93) and 0.0% (0 of 449), respectively (P = 0.172), which meant that the incidence of AVNFH was 0% in adult with femur shaft fracture. Of 61 patients with open fractures, the incidence of AVNFH was 0%. The number of cases with entry point at the trochanteric fossa or tip of the greater trochanter (GT) was 324 and 218, respectively, and the incidence of AVNFH was 0.3% and 0.0%, respectively (P = 0.412). In patients aged ≥20 years with isolated femoral shaft fracture, there was no case of AVNFH following antegrade intramedullary nailing regardless of the entry point. Therefore, our findings suggest that the risk of AVNFH following antegrade femoral nailing is extremely low in adult patients. PMID:26844518

  17. Macroscopic and microscopic findings in avascular necrosis of the femoral head.

    Science.gov (United States)

    Kamal, Diana; Alexandru, D O; Kamal, C K; Streba, C T; Grecu, D; Mogoantă, L

    2012-01-01

    The avascular necrosis of the femoral head is an illness induced by the cutoff of blood flow to the femoral head and it affects mostly young adults between the ages of 30 and 50 years, raising therapeutic and diagnostic issues. Many risk factors are incriminated in the development of avascular necrosis of the femoral head like: trauma, chronic alcohol consumption, smoking, administration of corticosteroid drugs, most of the cases are considered to be idiopathic. The main goal of our paper is to describe the macroscopic and microscopic variations of the bone structure, which occur in patients with avascular necrosis of the femoral head. The biological material needed for our study was obtained following hip arthroplasty surgery in 26 patients between the ages of 29 and 59 years, which previously were diagnosed with avascular necrosis of the femoral head and admitted in the Orthopedics Department of the Emergency County Hospital of Craiova (Romania) between 2010 and 2011. From a macroscopic point of view, we found well defined areas of necrosis, most of which were neatly demarcated of the adjacent viable tissue by hyperemic areas, loss of shape and contour of the femoral head and transformations of the articular cartilage above the area of necrosis. When examined under the microscope, we found vast areas of fibrosis, narrow bone trabeculae, obstructed blood vessels or blood vessels with clots inside, hypertrophic fat cells, bone sequestration but also small cells and pyknotic nuclei. The microscopic and macroscopic findings on the femoral head sections varied with the patients and the stage of the disease.

  18. Bilateral avascular necrosis of the femoral head due to the use of heroin: A case report.

    Science.gov (United States)

    Ozkunt, Okan; Sarıyılmaz, Kerim; Sungur, Mustafa; Ilen, Ferhat; Dikici, Fatih

    2015-01-01

    Femoral head avascular necrosis is caused by disruption of the blood supply of the femoral head, which finally results in hip dysfunction. Non traumatic osteonecrosis may related with corticosteroid use, alcohol abuse, SLE, hemoglobinopathies or exposure to cytotoxic agents. But avascular necrosis of the femoral head (ANFH) due to heroin use is a rare condition. We report a patient with bilateral ANFH due to heroin use treated by simultaneous bilateral hip arthroplasty. 37 year-old male patient presented with bilateral hip pain that had been occurring for four years. The patient had no history of smoking, excessive drinking, using corticosteroid and the other drugs or trauma but used heroin for 10 years. In clinic and radiologic examination indicated advanced degenerative changes on both hip due to femoral head avascular necrosis. The patient was treated with simultaneous bilateral total hip arthroplasty. After 6 months postoperatively the active hip range of motion was painless. Avascular femoral head necrosis caused by the using of heroin is rare. Ultimately, osteonecrosis of the femoral head occurs through one final common pathway, which is decreased blood flow to the femoral head that leads bone ischemia and death. But it is still unknown that heroin's systemic effects. Intravenous drug use more as a serious problem for today. There is a need for comprehensive studies to demonstrate effects of heroin on bone and vascularity metabolism. Heroin use will be important problem for population. That's why is crucial to understand the effect of heroin. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  19. Stem cell treatment for avascular necrosis of the femoral head: current perspectives

    Directory of Open Access Journals (Sweden)

    Houdek MT

    2014-04-01

    Full Text Available Matthew T Houdek,1 Cody C Wyles,2 John R Martin,1 Rafael J Sierra11Department of Orthopedic Surgery, 2School of Medicine, Mayo Clinic, Rochester, MN, USAAbstract: Avascular necrosis (AVN of the femoral head is a progressive disease that predominantly affects younger patients. Although the exact pathophysiology of AVN has yet to be elucidated, the disease is characterized by a vascular insult to the blood supply of the femoral head, which can lead to collapse of the femoral head and subsequent degenerative changes. If AVN is diagnosed in the early stages of the disease, it may be possible to attempt surgical procedures which preserve the hip joint, including decompression of the femoral head augmented with concentrated bone marrow. The use of autologous stem cells has shown promise in halting the progression of AVN of the femoral head, and subsequently preventing young patients from undergoing total hip arthroplasty. The purpose of this study was to review the current use of stem cells for the treatment of AVN of the femoral head.Keywords: avascular necrosis, femoral head, osteonecrosis, stem cells, concentrated bone marrow

  20. Avascular necrosis of the femoral head in HIV positive patients-an ...

    African Journals Online (AJOL)

    26 consecutive patients (37 hips) with avascular necrosis (AVN) of the femoral head treated surgically at our institution from 1999 to 2008 were reviewed . The aims of the study were to evaluate the risk factors associated with AVN in HIV positive and HIV negative individuals, and assess early response to total hip ...

  1. Nilotinib induced avascular necrosis of femoral head in an adult chronic myeloid leukemia patient.

    Science.gov (United States)

    Thekkudan, Shinto Francis; Nityanand, Soniya

    2018-06-01

    We report a rare case of avascular necrosis of femoral head (AVNFH) in an adult chronic myeloid leukemia - chronic phase (CML-CP) patient during due course of therapy with second line Tyrosine Kinase Inhibitor (TKI), Nilotinib. A high index of clinical suspicion should be kept in any symptomatic CML patient on TKI's.

  2. Polymorphisms of the glucocorticoid receptor and avascular necrosis of the femoral heads after treatment with corticosteroids

    NARCIS (Netherlands)

    R. Bouamar (Rachida); J.W. Koper (Jan); E.F.C. van Rossum (Liesbeth); W. Weimar (Willem); T. van Gelder (Teun)

    2009-01-01

    textabstractA female patient developed avascular necrosis of the femoral heads after receiving low doses of glucocorticosteroids (GC) for 3 months. Genotyping of the GC receptor (GR) showed that she was heterozygous for the Bcl-1 allele and heterozygous for the N363S allele. Interestingly, these GR

  3. Low rate of clinically important avascular necrosis of the femoral head after Ludloff's procedure

    DEFF Research Database (Denmark)

    Holbeck-Brendel, Jesper; Møller-Madsen, Bjarne; Hvid, Ivan

    2018-01-01

    INTRODUCTION: Ludloff's procedure for open reduction of congenital dislocation of the hip (CDH) is recommended for its minimal tissue damage, but is criticised for the risk of late avascular necrosis (AVN) of the femoral head. The aim of present study was primarily to assess the risk of late AVN...

  4. MRI for early diagnosis of avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Kokubo, Takashi; Takatori, Yoshio; Kamogawa, Morihide; Ninomiya, Setsuo; Yoshikawa, Kohki; Itai, Yuji; Iio, Masahiro; Mitamura, Tadayuki

    1988-01-01

    Magnetic resonance imaging (MRI) was performed in forty patients on long-term oral steroid therapy for early detection of avascular necrosis (AN) of the femoral head. In 13 patients, AN was diagnosed in the unilateral femoral head from abnormal plain radiographs while the contralateral femoral head was normal radiographically. In the other 27 patients, radiographs were normal. A total of 67 femoral heads with normal radiographs is studied in this paper. In 36 of 67 femoral heads (54 %), MRI demonstrated abnormal low intensity area. The abnormal findings on MRI were divided into five patterns: whole type (type A), peripheral type (type B), ring or band type (type C), small change type (type D) and distal type (type E). Type A, B, C, D and E were found in 2, 11, 5, 16 and 2 femoral heads, respectively. In cases to be followed up over 6 months, AN was manifested radiographically in 4 femoral heads of 5 in type C and in one of 14 in type D. Meanwhile, in 6 of 41 femoral heads examined (15 %), bone scintigrams was abnormal. Followed-up study over 6 months revealed that AN was manifested radiographically in one femoral head of 6 with abnormal scintigram. However, in 4 of 30 with normal scintigram, AN was manifested subsequently. MRI was a better diagnostic modality for early AN. Ring or band-like low intensity (type C) on MRI was considered to be characteristic pattern of early AN. (author)

  5. MRI for early diagnosis of avascular necrosis of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Kokubo, Takashi; Takatori, Yoshio; Kamogawa, Morihide; Ninomiya, Setsuo; Yoshikawa, Kohki; Itai, Yuji; Iio, Masahiro; Mitamura, Tadayuki

    1988-09-01

    Magnetic resonance imaging (MRI) was performed in forty patients on long-term oral steroid therapy for early detection of avascular necrosis (AN) of the femoral head. In 13 patients, AN was diagnosed in the unilateral femoral head from abnormal plain radiographs while the contralateral femoral head was normal radiographically. In the other 27 patients, radiographs were normal. A total of 67 femoral heads with normal radiographs is studied in this paper. In 36 of 67 femoral heads (54 %), MRI demonstrated abnormal low intensity area. The abnormal findings on MRI were divided into five patterns: whole type (type A), peripheral type (type B), ring or band type (type C), small change type (type D) and distal type (type E). Type A, B, C, D and E were found in 2, 11, 5, 16 and 2 femoral heads, respectively. In cases to be followed up over 6 months, AN was manifested radiographically in 4 femoral heads of 5 in type C and in one of 14 in type D. Meanwhile, in 6 of 41 femoral heads examined (15 %), bone scintigrams was abnormal. Followed-up study over 6 months revealed that AN was manifested radiographically in one femoral head of 6 with abnormal scintigram. However, in 4 of 30 with normal scintigram, AN was manifested subsequently. MRI was a better diagnostic modality for early AN. Ring or band-like low intensity (type C) on MRI was considered to be characteristic pattern of early AN.

  6. BONE GRAFTING ENHANCED BY PLATELET-RICH PLASMA IN TREATMENT OF AVASCULAR NECROSIS OF FEMORAL HEAD

    Directory of Open Access Journals (Sweden)

    A. A. Korytkin

    2018-01-01

    Full Text Available Treatment of avascular necrosis of the femoral head is an issue of current interest while it affects young and employable people. So far there is no well-defined strategy of management which would help to postpone hip arthroplasty and further revision procedure. Hip sparing surgical treatment of avascular necrosis of the femoral head by bone grafting prior to head collapse proved to be a viable option not only during early stages of disease but also at advanced stages. Platelet-rich plasma (PRP addition to treatment plan potentially helps improving bone regeneration in situ.In this article the authors present a case of a 37 years old patient with avascular necrosis of the femoral head at a fragmentation stage (type 4B by ARCO. The authors centrifuged 15 ml of autologous whole blood (1500 RPM obtained by a special double-contoured syringe. During the surgical stage of treatment PRP and morselized bone graft were mixed to introduce and impact into the debrided zone of avascular necrosis. The authors also introduced 0.3–0.4 ml of PRP into the debrided zone of avascular necrosis after bone grafting. At 6 months follow-up CT images of the studied patient demonstrated signs of bone reorganization and no loss of femoral head sphericity. Preoperative Visual Analogue Scale (VAS, Harris Hip Score (HHS and Hip disability and Osteoarthritis Outcome Score (HOOS prior to treatment were 60, 45 and 33 points respectively. Postoperative VAS, HHS and HOOS scores were 10, 78 and 78 respectively. In the authors’ opinion, impaction bone grafting enhanced by PRP helps obtaining good and excellent outcomes not only at early but also at advanced stages of avascular necrosis.

  7. STUDY OF AGE INCIDENCE AND SYMMETRY IN NON - TRAUMATIC AVASCULAR NECROSIS OF FEMORAL HEAD

    Directory of Open Access Journals (Sweden)

    Harinath

    2015-10-01

    Full Text Available INTRODUCION: Avascular necrosis of the femoral head is an increasingly common cause of musculoskeletal disability, and it poses a major diagnostic and therapeutic challenge. The aim of diagnostic imaging procedures in avascular femoral head necrosis is to provide the patient with a stage - adapted therapy. The aim of this paper is to present the age incidence and symmetricity of involvement of the non - traumatic avascular necrosis of femoral head. MATERIALS AND METHODS: This is a prospective observational study done durin g January 2013 to June 2013.The study included a total 30 patients referred to the Department of Radiology, Kurnool medical college, Kurnool, for X ray pelvis with both hips. 10 patients out of them were further investigated with MRI pelvis. RESULTS: More than half of the patients (72.6 % were within the age groups 30 - 50 years with male to female ratio of about 4:1. 60% of patients showed bilateral involvement, 20 % showed right femoral head and 20 % showed left femoral head involvement. CONCLUSION: We con clude that disease affects mostly adults within their 3rd and 5th decade and majority of the patients are being men with bilateral involvement. Our study results are comparable with previous studies. Hence we recommend MRI both hips for early identificatio n of AVN changes in asymptomatic contra-lateral hip or normal appearing hip on X-Ray.

  8. Magnetic resonance imaging of congenital dislocation of the hip with avascular necrosis of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Hayashi, Nobuhiko; Ikeda, Takeshi; Wada, Ikuo [Nagoya City Univ. (Japan). Faculty of Medicine; and others

    1991-04-01

    Magnetic resonance imaging (MRI) was performed on 22 patients (24 joints) with congenital dislocation of the hip (CDH) with avascular necrosis. T1 and T2 weighted images were obtained using spin echo techniques. Since positive images of the articular cartilage were obtained, it was possible to clearly image flattening or thickening of the articular cartilage of the femoral head and acetabulum in the coronal and in the axial plane of the T1 weighted image. There was a high intensity region in the femoral head with avascular necrosis in the coronal T2 weighted image. The wideness of the region increased with severity. Much information can be obtained with MRI and it is a useful technique in evaluating the pathology of CDH with avascular necrosis. (author).

  9. Magnetic resonance imaging of congenital dislocation of the hip with avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Hayashi, Nobuhiko; Ikeda, Takeshi; Wada, Ikuo

    1991-01-01

    Magnetic resonance imaging (MRI) was performed on 22 patients (24 joints) with congenital dislocation of the hip (CDH) with avascular necrosis. T1 and T2 weighted images were obtained using spin echo techniques. Since positive images of the articular cartilage were obtained, it was possible to clearly image flattening or thickening of the articular cartilage of the femoral head and acetabulum in the coronal and in the axial plane of the T1 weighted image. There was a high intensity region in the femoral head with avascular necrosis in the coronal T2 weighted image. The wideness of the region increased with severity. Much information can be obtained with MRI and it is a useful technique in evaluating the pathology of CDH with avascular necrosis. (author)

  10. Bilateral Atraumatic Avascular Necrosis of Both the Humeral and Femoral Heads due to the Corticosteroid Usage

    Directory of Open Access Journals (Sweden)

    Okkes Bilal

    2013-08-01

    Full Text Available Avascular necrosis is frequently associated with femoral head involvement and may also be observed in the knee joint, humeral head, wrist and foot. Avascular necrosis may also affect multiple joints. Bilateral involvement of both humeral and femoral heads is a rare condition in the same patient. A patient who complained about a sustained pain in both of his shoulders and hips for a few years applied to our outpatient clinic. The patient who had oral steroid treatment episodically was diagnosed with ulcerative colitis seven years ago. Arthroscopy-assisted decompression to the shoulder joints and core decompression to both hip joints were applied. The range of motions of both humeral and femoral joints was limited and painful prior to the surgical treatment. A follow-up after five years later showed that the patient's range of motions of joints was normal and no further treatment was necessary. [Arch Clin Exp Surg 2013; 2(4.000: 246-250

  11. [Treatment of avascular necrosis of femoral head after femoral neck fracture with pedicled iliac bone graft].

    Science.gov (United States)

    Wang, Benjie; Zhao, Dewei; Guo, Lin; Yang, Lei; Li, Zhigang; Cui, Daping; Tian, Fengde; Liu, Baoyi

    2011-05-01

    To explore the effectiveness of pedicled iliac bone graft transposition for treatment of avascular necrosis of femoral head (ANFH) after femoral neck fracture. Between June 2002 and December 2006, 22 cases (22 hips, 16 left hips and 6 right hips) of ANFH after femoral neck fracture were treated with iliac bone graft pedicled with ascending branch of the lateral femoral circumflex vessels. There were 18 males and 4 females with an age range from 28 to 48 years (mean, 37.5 years). The time from injury to internal fixation was 2-31 days, and all fractures healed within 12 months after internal fixation. The ANFH was diagnosed at 15-40 months (mean, 22 months) after internal fixation. The ANFH duration was 3-11 months (mean, 8 months). According to Association Research Circulation Osseous (ARCO) staging system, 2 hips were classified as stage IIa, 3 hips as stage IIb, 3 hips as stage IIc, 3 hips as stage IIIa, 7 hips as stage IIIb, and 4 hips as stage IIIc. The preoperative Harris hip score (HHS) was 64.10 +/- 5.95. All incisions healed by first intention and the patients had no complication of lung embolism, sciatic nerve injury, lower limb deep venous thrombosis, and numbness and pain of donor site. All patients were followed up 2.5 to 6.3 years (mean, 4.8 years). The fracture healing time was 8-12 months, and no femoral neck fracture recurred. The HHS was 90.20 +/- 5.35 at last follow-up, showing significant difference when compared with the preoperative value (t = -18.447, P = 0.000). The hip function were excellent in 11 hips, good in 10 hips, fair in 1 hip, and the excellent and good rate was 95.5%. Four hips were radiographically progressed in ARCO staging, 18 hips remained stable with a stable rate of 81.8%. Pedicled iliac bone graft transposition is an ideal option for treatment of ANFH after internal fixation of femoral neck fracture for the advantages of femoral head revascularization, sufficient cancellous bone supply, and relatively simple procedure.

  12. Clinical application of interventional therapy for avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Han Xu; Jin Kesi; Liu Wei; Ma Jun; Shen Jianming; Aziken

    2004-01-01

    Objective: To evaluate the possibility of interventional therapy for avascular necrosis of the femoral head, with different curing methods, way of introduction and cultural heritages. Methods: Vasodilator, thrombolytics and promoting microcirculatory drug were directly injected into the feeding arteries of the avascular necrotic femoral heads, under the condition of applying the blood stoppage belt at the root of thigh with pressure before the drug injection into the femoral pronator and extension arteries. The treatment was repeated 45 d later. Urokinase 10 5 unite/d x 10 were administrated with venous infusion ipsilaterally on the 15th day after the beginning of the therapy. Imaging features and clinical symptoms were recorded and correlatively studied before and after the treament. Results: Symptoms relief especially the pain reached 100% after the treatment with various degrees of bony repair and new bone formation. Furthermore, increase caliber of feeding small arteries for femoral head and multiplicity of microvasculature, shortening of opacification time were revealed by DSA. IV stage bony change showed mild or inconspicuous. Conclusions: Interventional catheterization treatment for avascular femoral head necrosis, especially the patients of fore III stage, is safe and effective. (authors)

  13. [Avascular necrosis of the femoral head in a patient with severe aplastic anaemia].

    Science.gov (United States)

    Plichta, Piotr; Pawelec, Katarzyna

    2011-01-01

    Avascular necrosis (AVN) is a pathological condition associated with numerous processes. Most frequent causes of ischaemia of the femoral head include trauma, corticosteroid therapy, radiation therapy, alcoholism, Gaucher's disease, systemic lupus erythematosus, rheumatoid arthritis. Corticosteroid therapy is considered the most frequent risk factor for developing avascular necrosis. In this paper we report a case of a 19-year old female patient who developed avascular necrosis of the right femoral head following treatment of severe aplastic anaemia. Clinical symptoms included groin pain and fever, painful abduction and internal rotation, tenderness over the right hip joint. The plain X-ray was not specific. However magnetic resonance imaging of the hip revealed changes characteristic for avascular necrosis. Conservative treatment was administrated. Two years after the onset of first clinical symptoms the patient is able to walk without pain, although the range of motion of the right hip joint is partially diminished. We evaluated the possible risk factors of AVN, diagnostic methods and prognosis. The onset of avascular necrosis should be considered as one of the relevant complications in patients with severe aplastic anaemia following immunosuppressive treatment.

  14. Idiopathic avascular necrosis of the femoral heads in five members of a Moroccan family.

    Science.gov (United States)

    Sekkat, Jihane; Rachidi, Ouafaa; Janani, Saadia; Mkinsi, Ouafaa

    2012-10-01

    Avascular necrosis (AVN) is idiopathic in about 40% of cases. The pathophysiology of avascular necrosis remains incompletely elucidated. Here, we report a case that underlines the role for inherited factors in AVN of the femoral heads. Idiopathic AVN of the femoral heads occurred in five members of the same family (a woman, her two paternal aunts, her male paternal cousin and her female paternal cousin) at a mean age of 42.4 years (range, 33-58 years). Standard pelvic radiographs showed Arlet and Ficat stage 4 AVN in three patients and stage 3 in two patients. None of the patients had a history of glucocorticoid therapy, alcohol abuse, or trauma. All five patients underwent investigations for a cause, including blood cell counts, a lipid profile, coagulation tests, testing for antinuclear antibodies, hemoglobin electrophoresis, ultrasonography of the abdomen, and standard radiographs of the long limb bones. The results were normal or negative, ruling out known hereditary causes of AVN such as sickle cell anemia and Gaucher disease. Many cases of familial AVN of the femoral head have been described in patients with sickle cell anemia or Gaucher disease. However, only five families with idiopathic familial AVN of the femoral heads have been reported (three in the US and two in Taiwan). All the patients in these families had isolated bilateral AVN of the femoral heads without AVN at other sites. Copyright © 2012. Published by Elsevier SAS.

  15. Avascularity of the femoral head following intracapsular fracture: a comparative scintigraphic and bioptic study

    Energy Technology Data Exchange (ETDEWEB)

    Hoilund-Carlsen, P F; Widding, A; Uhrenholdt, A; Christoffersen, P; Grieff, J [Copenhagen Univ. (Denmark)

    1980-03-01

    Bioptic and scintigraphic methods of diagnosing avascular necrosis of the femoral head following intracapsular fracture of the femoral neck were compared. During operative treatment of patients, biospy samples of bone marrow were taken from the femoral head about 2 hours after the intravenous injection of sup(99m)Tc-Sn-pyrophosphate; histological examination of the biopsies were also performed. Scintigrams of the femoral head using sup(99m)Tc-pyrophosphate were performed 2 days, 7 days and 6 weeks post-operatively. The biopsies confirmed no morphological changes being apparent in the first few days. The biopsy samples indicated two groups of patients with either high or low activity in the femoral head. However, it was concluded that the use of bone-seeking radionuclides with this technique might be more reliable. Scintigraphic trends divided the patients into three groups, one with persistently normal, another with varying, and a third with decreased activity in the femoral head. It was concluded that very early scintigraphy is probably not the method of choice since the images were often difficult to interpret. For the present, assessment of the viability of the femoral head should rest upon scintigraphic examinations performed about 6 weeks or 3 months after the injury.

  16. Avascular necrosis of the femoral head and M.R.I

    International Nuclear Information System (INIS)

    Gires, F.; Leroy-Willig, A; Chevrot, A.; Wolff, J.L.

    1987-01-01

    Normal and pathologic femoral heads have been studied by MRI at 1.5 Tesla. The study was centered upon avascular necrosis (53 lesions). Twenty normal subjects and three patients with algodystrophy were examined. The osteonecrosis patterns were established from known lesions. A low signal rim surrounds an upper polar zone of conserved (Type I) or decreased (Type II) signal. The lesions age correlates significatively with their type: amongst type I lesions, 6 are asymptomatic and the 21 others have a mean age of 5.5 months; Type II lesions have a mean age of 12.7 months. Fourteen lesions were not seen on plain radiographs and six were not detected by bone scan. The older lesions with femoral head deformation are better depicted by standard radiologic techniques. Conservely MRI is the most efficient examination for recent avascular necrosis lesions [fr

  17. Advances in gene therapy and early imaging monitoring for avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Wang Peng; Lan Xiaoli; Zhang Yongxue; Qi Hongyan

    2012-01-01

    Gene therapy is a method that transfers foreign gene to target cells, so as to correct or compensate the disease which is caused by the gene defects and abnormalities. As a new technology, gene therapy has been used in many fields, such as cancer, cardiovascular and nervous system disease, and it brings some hope for patients with difficult and complicated disease. Avascular necrosis of femoral head is a refractory and common disease in clinical, but the traditional surgery therapy and conservative treatment both have many shortcomings,and the effect is unsatisfactory. As a new technology,gene therapy showed bright future in orthopedics ischemic disease, and its potential feasibility has been confirmed by many animal experiments. This article focuses on the research progress of gene therapy and early monitoring in the avascular necrosis of the femoral head. (authors)

  18. Multiple bony lesions other than femoral heads on {sup 99m}Tc-MDP bone scan in patients with avascular necrosis of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Yun Young; Yang, Seoung Oh; Moon, Dae Hyuk; Ryu, Jin Sook; Weon, Young Cheol; Shin, Myung Jin; Lee, Soo Ho; Lee, Hee Kyung [Asan Medical Center, Ulsan Univ. College of Medicine, Ulsan (Korea, Republic of); Chun, Hae Kyung [St. Francisco Hospital, Seoul (Korea, Republic of)

    1997-03-01

    To evaluate the clinical significance of the multiple increased uptake lesions other than in femoral heads as seen on whole body bone scan in patients with avascular necrosis of femoral heads. One hundred and seventy three patients with clinical diagnosis of avascular necrosis of the emoral head underwent a bone scan using Tc-99m MDP. Increased uptake lesions other than in femoral heads were evaluated, including frequency and common sites of in volvement, and correlated with clinical information and plain radiographic findings. Two hundred patients without AVN, who had undergone a bone scan, were included as a control group. Increased uptake lesions in extrafemoral head locations were found in 36 of 173 patients(20.8%); the location of 79 lesions was other than the femoral head. This result is statistically different from patients without avascular necrosis of femoral head(p<0.0001). The most common site of involvement was the knee joint area(62.5%). Other lesions were located in the mid-shafts of the long bones of the lower extremities, calcaneus, proximal humerus, etc., in order of decreasing frequency. Plain radiographs of 17 lesions were nonspecific, except for three lesions showing definite changes associated with avascular necrosis. The risk factors included alcoholism, the prolonged use of steroids, renal transplantation, herbal medication and working as a working as deep-sea diver. Most patients did not complain of pain, except for two with irreversible osteonecrotic changes as seen on plain radiograph. in patients with avascular necrosis of the femur, increased uptake lesions other than in the femoral head as seen on bone scan, may represent the early stage of osteonecrosis, which shows a characteristic appearance on bone scan. In order to aveid possible misdiagnoses of multiple extrafemoral lesions as bony metastasis or traumatic lesions, in patients with avascular necrosis of the femur these should be carefully evaluated.

  19. Multiple bony lesions other than femoral heads on 99mTc-MDP bone scan in patients with avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Choi, Yun Young; Yang, Seoung Oh; Moon, Dae Hyuk; Ryu, Jin Sook; Weon, Young Cheol; Shin, Myung Jin; Lee, Soo Ho; Lee, Hee Kyung; Chun, Hae Kyung

    1997-01-01

    To evaluate the clinical significance of the multiple increased uptake lesions other than in femoral heads as seen on whole body bone scan in patients with avascular necrosis of femoral heads. One hundred and seventy three patients with clinical diagnosis of avascular necrosis of the emoral head underwent a bone scan using Tc-99m MDP. Increased uptake lesions other than in femoral heads were evaluated, including frequency and common sites of in volvement, and correlated with clinical information and plain radiographic findings. Two hundred patients without AVN, who had undergone a bone scan, were included as a control group. Increased uptake lesions in extrafemoral head locations were found in 36 of 173 patients(20.8%;the location of 79 lesions was other than the femoral head, This result is statistically different from patients without avascular necrosis of femoral head(p<0.0001). The most common site of involvement was the knee joint area(62.5%). Other lesions were located in the mid-shafts of the long bones of the lower extremities, calcaneus, proximal humerus, etc., in order of decreasing frequency. Plain radiographs of 17 lesions were nonspecific, except for three lesions showing definite changes associated with avascular necrosis. The risk factors included alcoholism, the prolonged use of steroids, renal transplantation, herbal medication and working as a working as deep-sea diver. Most patients did not complain of pain, except for two with irreversible osteonecrotic changes as seen on plain radiograph. in patients with avascular necrosis of the femur, increased uptake lesions other than in the femoral head as seen on bone scan, may represent the early stage of osteonecrosis, which shows a characteristic appearance on bone scan. In order to aveid possible misdiagnoses of multiple extrafemoral lesions as bony metastasis or traumatic lesions, in patients with avascular necrosis of the femur these should be carefully evaluated

  20. Avascular necrosis of the femoral head: MR imaging with histologic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Chae Guk; Cha, Seong Sook; Eun, Choong Ki; Yang, Young Il; Choi, Jang Seok [Pusan Paik Hospital, College of Medicine, Inje University, Busan (Korea, Republic of); Park, Dong Woo [College of Medicine, Hanyang University, Seoul (Korea, Republic of)

    1995-07-15

    To correlate MR findings with histologic findings in avascular necrosis (AVN) of the femoral head. MR findings was performed with 8 femoral head specimens using T1-and proton density weighted coronal SE sequences, and compared with contact radiography and histologic sections. In each specimen, necrotic zone in the superior portion of femoral head, repair zone located inferior to the necrotic zone, and rim adjacent to normal bone marrow could be defined. Necrotic zone showed high signal intensity on both T1-and proton density-weighted images in 3 cases which were composed of necrotic bone and marrow, and low signal intensity on both sequences in 2 cases which were composed of necrotic bone marrow with amorphous cellular debris. Mixed high and low signal intensities were seen in 3 cases. The repair zone showed low signal intensity on T1-weighted image and high signal intensity on proton density weighted image in 5 cases which were composed of thickened trabecular bone and mesenchymal tissue and also showed intermediate signal intensity on T1-weighted image and high signal intensity on proton density weighted image in 3 cases which were composed of osteoid, chondroid and undifferentiated mesenchymal cells. Rim shown as the low signal intensity on T1 weighted image in all cases was corresponded to viable thickened trabecular bone. MR imaging would be the best modality in the diagnosis of avascular necrosis of femoral head and when used in conjunction with degree and location of signal intensity, the prediction of histologic finding may be possible.

  1. A tissue engineering strategy for the treatment of avascular necrosis of the femoral head.

    Science.gov (United States)

    Aarvold, A; Smith, J O; Tayton, E R; Jones, A M H; Dawson, J I; Lanham, S; Briscoe, A; Dunlop, D G; Oreffo, R O C

    2013-12-01

    Skeletal stem cells (SSCs) and impaction bone grafting (IBG) can be combined to produce a mechanically stable living bone composite. This novel strategy has been translated to the treatment of avascular necrosis of the femoral head. Surgical technique, clinical follow-up and retrieval analysis data of this translational case series is presented. SSCs and milled allograft were impacted into necrotic bone in five femoral heads of four patients. Cell viability was confirmed by parallel in vitro culture of the cell-graft constructs. Patient follow-up was by serial clinical and radiological examination. Tissue engineered bone was retrieved from two retrieved femoral heads and was analysed by histology, microcomputed tomography (μCT) and mechanical testing. Three patients remain asymptomatic at 22- to 44-month follow-up. One patient (both hips) required total hip replacement due to widespread residual necrosis. Retrieved tissue engineered bone demonstrated a mature trabecular micro-architecture histologically and on μCT. Bone density and axial compression strength were comparable to trabecular bone. Clinical follow-up shows this to be an effective new treatment for focal early stage avascular necrosis of the femoral head. Unique retrieval analysis of clinically translated tissue engineered bone has demonstrated regeneration of tissue that is both structurally and functionally analogous to normal trabecular bone. Copyright © 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  2. Avascular necrosis of the femoral head: MR imaging with histologic correlation

    International Nuclear Information System (INIS)

    Lee, Chae Guk; Cha, Seong Sook; Eun, Choong Ki; Yang, Young Il; Choi, Jang Seok; Park, Dong Woo

    1995-01-01

    To correlate MR findings with histologic findings in avascular necrosis (AVN) of the femoral head. MR findings was performed with 8 femoral head specimens using T1-and proton density weighted coronal SE sequences, and compared with contact radiography and histologic sections. In each specimen, necrotic zone in the superior portion of femoral head, repair zone located inferior to the necrotic zone, and rim adjacent to normal bone marrow could be defined. Necrotic zone showed high signal intensity on both T1-and proton density-weighted images in 3 cases which were composed of necrotic bone and marrow, and low signal intensity on both sequences in 2 cases which were composed of necrotic bone marrow with amorphous cellular debris. Mixed high and low signal intensities were seen in 3 cases. The repair zone showed low signal intensity on T1-weighted image and high signal intensity on proton density weighted image in 5 cases which were composed of thickened trabecular bone and mesenchymal tissue and also showed intermediate signal intensity on T1-weighted image and high signal intensity on proton density weighted image in 3 cases which were composed of osteoid, chondroid and undifferentiated mesenchymal cells. Rim shown as the low signal intensity on T1 weighted image in all cases was corresponded to viable thickened trabecular bone. MR imaging would be the best modality in the diagnosis of avascular necrosis of femoral head and when used in conjunction with degree and location of signal intensity, the prediction of histologic finding may be possible

  3. Marginal zone in femoral head avascular necrosis: scintigraphic characteristics and clinical prognostic value

    International Nuclear Information System (INIS)

    Milcinski, M.; Sedonja, I.; Dolinar, D.; Jevtic, V.

    2002-01-01

    Aim: Marginal zone, seen on magnetic resonance imaging (MRI) in femoral head avascular necrosis, consists of granulation tissue and sclerosis at the junction of necrotic and normal bone. Prognostic value of this finding is not clear. Aim of our study was to evaluate osteoblastic activity of marginal zone with bone scintigraphy and to assess prognostic importance of marginal zone for further evolution of femoral head necrosis. Material and methods: MRI was performed in 37 hips in 26 patients (17 m, 9 f, 20-64 y, mean 42,9 y) with Ficat 0-II avascular necrosis (SE T1W, STIR and SE T1W FAT.SAT after Gd DTPA in the coronal plane and GE FLASH in the sagittal plane). In 26 hips of 17 patients planar and pinhole scintigraphy with 99mTc-DPD was performed. Results: On MRI, marginal zone divided necrotic and normal bone in 26/37 (70,3%) hips, in 14/26 it was thin (2% of femoral head diameter or less), but in 12/26 it was wide (more than 2% of femoral head diameter). In 11/37 (29,7%) hips marginal zone was not seen. Pinhole scintigraphy was performed in 26 hips; in all 10/10 (100%) hips with wide marginal zone, seen on MRI, increased osteoblastic activity was detected, while only in 1/9 (11,1%) hips with thin marginal zone on MRI osteoblastic activity was increased. Patients were followed 1 to 5 years (mean 2,2 y). In hips without marginal zone no collapse of femoral head was seen until now, in 2/11 (18,2%) femoral heads MRI and clinical regression was observed. Ten of 12 lesions with wide marginal zone (83,3 %) collapsed 0,25 to 2,5 (mean 1) years after onset of pain. Two of 12 lesions with wide marginal zone (16,7%) have not collapsed until now. From lesions with thin marginal zone, 4/14 (28,6 %) collapsed 0,7 to 3 (mean 1,9) years after onset of pain, 10/14 (71,4%) did not collapse until now. Conclusion: Increased osteoblastic activity in wide marginal zone between necrotic and vital bone in hip avascular necrosis is bad prognostic factor for femoral head collapse

  4. Avascular necrosis of the femoral head; Chronological change of MR images

    Energy Technology Data Exchange (ETDEWEB)

    Kokubo, Takeshi; Takatori, Yoshio; Kamogawa, Morihide; Nakamura, Toshitaka; Ninomiya, Setsuo; Yoshikawa, Kohki; Itai, Yuji; Iio, Masahiro; Mitamura, Tadayuki [Tokyo Univ. (Japan). Faculty of Medicine

    1990-04-01

    T1-weighted MR images of thirty-six hips in 25 patients with avascular necrosis of the femoral head were obtained two to five times during the course of 2 to 26 months. We investigated these MR images in the light of the chronological change and compared them with plain radiographs. MR images changes in 16 femoral head; in general, the abnormal low intensity area in the femoral head reduced in extent and the internal high intensity area became smaller of disappeared. Thirteen femoral heads among them became more flattened on plain radiographs in the same period. It is noted that four different zones are defined in the femoral head after bone necrosis takes place: the dead bone marrow, the dead marrow which still contains fat, the reactive interface and the hyperemic bone marrow. In T1-weighted MR images, the dead bone marrow, the reactive interface and the hyperemic bone marrow are demonstrated as low intensity area, while the dead marrow containing fat may remain high in intensity. On the basis of this knowledge of histopathology and MR images of this disease, we suggest that reduction of the abnormal low intensity area and disappearance of the internal high intensity area on MR images can be regarded as diminution of hyperemia in the living bone marrow and loss of fat in the dead bone marrow, respectively. (author).

  5. Avascular necrosis of the femoral head; Staging by MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kokubo, Takashi; Takatori, Yoshio; Ninomiya, Setsuo; Sasaki, Yasuhito [Tokyo Univ. (Japan). Faculty of Medicine

    1993-03-01

    Magnetic resonance (MR) images and conventional radiographs were compared in 142 hips with avascular necrosis, and a staging system for the disease based on MR imaging was developed. MR images were classified into three patterns: a band of low signal intensity (class I); an area of low signal intensity with internal spot(s) of high signal (class II); and an area of low signal intensity without internal spots of high signal (class III). Most MR class I lesions were in radiographic stage I (normal) or II (sclerotic or cystic changes without collapse). Most MR class II lesions were in radiographic stage III (segmental collapse), and most MR class III lesions were in stage III or IV (secondary degenerative changes). The MR image classification was closely correlated with radiographic staging (p<0.01, using [chi] square test). We considered that this classification closely reflected the different stages of the disease according to the histopathology of the bone marrow. (author).

  6. Systemic effects of zoledronic acid in children with traumatic femoral head avascular necrosis and Legg-Calve-Perthes disease

    DEFF Research Database (Denmark)

    Johannesen, Jesper; Briody, Julie; McQuade, Mary

    2009-01-01

    Background: Intravenous bisphosphonate therapy is associated with preservation of femoral head sphericity and congruence in 77% of children with traumatic avascular necrosis. The aim was to describe the systemic effects of intravenous zoledronic acid (ZA) on bone and mineral metabolism in otherwise...... normal children and adolescents with femoral head AVN. Material and methods: 37 children (age 10.8+/-2.76 years) diagnosed with avascular necrosis AVN (Slipped Capital Femoral Epiphysis (SCFE), N=20 or Legg-Calve-Perthes disease (LCPD), N=17) were treated with at least 12 months of ZA. Bone mineral...

  7. Effectiveness of the magnetic resonance imaging for the therapy of avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Oda, Yoshinao; Katsuki, Ichirou; Ushijima, Masahiro; Tsutsui, Hideki; Sugioka, Youichi

    1990-01-01

    Recently, some reports demonstrate the usefulness of the magnetic resonance imaging (MRI) for early diagnosis of the avascular necrosis of the femoral head (ANF). In this report we analyzed 64 hips in 40 cases using preoperative plain radiographs, tomography and MRI affected by ANF. And we gained following three conclusions. When rotational osteotomy of the femoral head is to be carried out, two plain views of MRI, parallel and contrary to the axis of the femoral neck, were useful for evaluation of postoperative weight bearing area. In 58 hips with strinct the former two plain views of MRI, atrophy of posterior area of the femoral head was recognized in 54 hips by tomography, and of them abnormal signal in posterior was revealed in 32 hips by MRI. In 28 hips performed anterior rotational osteotomy, atrophy of posterior area of the femoral head was recognized in 26 hips by tomography, and of them abnormal signal in posterior was revealed in 6 hips by MRI. In such cases careful follow-up should be required. (author)

  8. Effectiveness of the magnetic resonance imaging for the therapy of avascular necrosis of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Oda, Yoshinao; Katsuki, Ichirou; Ushijima, Masahiro; Tsutsui, Hideki; Sugioka, Youichi [Kyushu Univ., Fukuoka (Japan). Faculty of Medicine

    1990-03-01

    Recently, some reports demonstrate the usefulness of the magnetic resonance imaging (MRI) for early diagnosis of the avascular necrosis of the femoral head (ANF). In this report we analyzed 64 hips in 40 cases using preoperative plain radiographs, tomography and MRI affected by ANF. And we gained following three conclusions. When rotational osteotomy of the femoral head is to be carried out, two plain views of MRI, parallel and contrary to the axis of the femoral neck, were useful for evaluation of postoperative weight bearing area. In 58 hips with strinct the former two plain views of MRI, atrophy of posterior area of the femoral head was recognized in 54 hips by tomography, and of them abnormal signal in posterior was revealed in 32 hips by MRI. In 28 hips performed anterior rotational osteotomy, atrophy of posterior area of the femoral head was recognized in 26 hips by tomography, and of them abnormal signal in posterior was revealed in 6 hips by MRI. In such cases careful follow-up should be required. (author).

  9. Dasatinib Induced Avascular Necrosis of Femoral Head in Adult Patient with Chronic Myeloid Leukemia

    Directory of Open Access Journals (Sweden)

    Mohamed A. Yassin

    2015-01-01

    Full Text Available Chronic myeloid leukemia (CML is a myeloproliferative neoplasm characterized by the presence of the Philadelphia (Ph chromosome resulting from the reciprocal translocation t(9;22(q34;q11. The molecular consequence of this translocation is the generation of the BCR-ABL fusion gene, which encodes a constitutively active protein tyrosine kinase. The oncogenic protein tyrosine kinase, which is located in the cytoplasm, is responsible for the leukemia phenotype through the constitutive activation of multiple signaling pathways involved in the cell cycle and in adhesion and apoptosis. Avascular necrosis of the femoral head (AVNFH is not a specific disease. It occurs as a complication or secondary to various causes. These conditions probably lead to impaired blood supply to the femoral head. The diagnosis of AVNFH is based on clinical findings and is supported by specific radiological manifestations. We reported a case of a 34-year-old Sudanese female with CML who developed AVNFH after receiving dasatinib as a second-line therapy. Though the mechanism by which dasatinib can cause avascular necrosis (AVN is not clear, it can be postulated because of microcirculatory obstruction of the femoral head. To the best of our knowledge and after extensive literature search, this is the first reported case of AVNFH induced by dasatinib in a patient with CML.

  10. Bilateral Total Hip Arthroplasty in Femoral Head Avascular Necrosis: Functional Outcomes and Complications

    Directory of Open Access Journals (Sweden)

    Afshin Taheriazam

    2016-06-01

    Full Text Available Total hip arthroplasty (THA is one of the successful and cost-benefit surgical treatments. One-stage bilateral THA (BTHA offers many benefits. However, there are concerns about the safety of the procedure and higher complications. We aimed to evaluate the complications and outcomes of one-stage BTHA with Hardinge approach for femoral head avascular necrosis patients. A total of 60 patients from April 2009 and May 2013, were underwent one-stage bilateral total hip arthroplasty (BTHA in Milad and Erfan hospitals, Tehran, Iran. A prospective analysis of the functional outcomes and complications of one-stage BTHA through Hardinge approach in patients with femoral head avascular necrosis (AVN performed. We evaluated all patients clinically and radiologically with serial follow-ups. A clinical hip score based upon the modified Harris Hip Score (MHHS was performed preoperatively and again postoperatively. During period of study 44 men (73.3% and 16 women (26.6% with a mean age of 31.40±4.08 years (range 25 to 36 years at the time of presentation were entered. The mean surgical time was 2.6±0.38 hrs. The mean hospital stay was 3 .50±0.72 days. Hemoglobin level decreased significa ntly after operation (P= 0.046. There was no reported patient with perioperative death, deep venous thrombosis, pulmonary embolism, infection, dislocation, periprosthetic fracture or heterotrophic ossification. The mean preoperative MHHS score was 47.93±7.33 in patients. MHHS score i mproved to 95.06±3.47 in the last follow-up (P=0.0001.Our results recommend the use of one-stage BTHA through Hardinge approach in femoral head avascular necrosis patients.

  11. MR imaging in avascular necrosis of the femoral head: Histologic correlation

    International Nuclear Information System (INIS)

    Lang, P.; Genant, H.K.; Jergesen, H.E.; Chafetz, N.I.; Block, J.; Moseley, M.E.

    1987-01-01

    MR imaging at 2.0 T was performed in six intraoperatively obtained femoral head specimens with avascular necrosis. Contact radiography and gross morphologic and histologic sectioning were performed. A low-signal intensity ring or band surrounding a high-signal-intensity area represented the reactive tissue interface of mesenchymal infiltrate, amorphous cellular debris, and thickened trabecular bone adjacent to the necrotic zone. Segmental areas of decreased signal intensity were observed once the repair process had invaded the entire necrotic zone. Viable and necrotic marrow both demonstrated high signal intensities on short and long repetition time/echo time sequences. MR signal intensities are not tissue specific. In combination with anatomic configuration and location, however, prediction of tissue composition and stage of disease on which the mode of therapy is determined appears possible. MR imaging at 2.0 T provides improved marrow contrast in avascular necrosis

  12. Italian experience on use of E.S.W. therapy for avascular necrosis of femoral head.

    Science.gov (United States)

    Russo, Sergio; Sadile, Francesco; Esposito, Roberto; Mosillo, Giuseppe; Aitanti, Emanuele; Busco, Gennaro; Wang, Ching-Jen

    2015-12-01

    Osteonecrosis (avascular necrosis) of the femoral head is a clinical disease due to a severe bone vascular alteration associated with intense pain and loss of joint function, with an incidence of 0.1% and unknown aetiology. Many classifications exist to describe it and in the final stages the patient will need a total hip arthroplasty. In the early stages, ESWT has given excellent responses.
 The Neapolitan school studied more than 600 patients who had very good results in I and II stages of Ficat and Arlet Classification, with an improve of outcomes in VAS and HSS scores. Moreover it has shown a complete restoration of the signal intensity of the femoral head in MRI. Copyright © 2015. Published by Elsevier Ltd.

  13. Avascular necrosis of the femoral heads: Initial screening and postoperative evaluation with MR imaging

    International Nuclear Information System (INIS)

    Cohen, J.M.; Weinreb, J.C.; Muschler, G.; Erdman, W.A.

    1986-01-01

    Fifty subjects with suspected avascular necrosis (AVN) of the femoral heads underwent MR imaging (0.35 T) of the hips in transverse and coronal planes. Studies were performed utilizing relatively T1-and T2-weighted spin-echo images. AVN was diagnosed in 42 patients (61 femurs) on the basis of decreased signal intensity in the femoral head. MR imaging was the most sensitive technique in detecting AVN when compared with plain radiography (n=31), axial CT (n=17), and technetium bone scanning (n=24). The use of T1-and T2-weighted images helped identify joint effusions and differentiate them from capsular thickening. Six subjects were restudied 6-12 months after core decompression

  14. Magnetic resonance imaging (MRI) of avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Kokubo, Takashi; Yoshikawa, Kohki; Aoki, Shigeki

    1987-01-01

    Thirty-seven patients with the clinical diagnosis of or suspicious of avascular necrosis (AN) of the femoral head were examined by magnetic resonance imaging (MRI). In all patients with AN confirmed from clinical symptoms, past history and plain radiographs, MRI demonstrated abnormal low intensity area in the necrosed femoral head. The abnormal findings on MRI were divided into three patterns: low signal intensity occupying the greater part of the femoral head (type A), low signal intensity localized in the periphery (type B), ring-shaped or band-like low signal intensity (type C). No correlation was found among MRI patterns, radiographic findings and radionuclide bone scan images, except that the type C was not found in the stage IV determined radiographically. In the patients suspicious of AN, the positive rate of MRI was higher than that of radionuclide scan. Abnormal findings on only MRI may not necessarily indicate AN. However, such a patient must be kept under observation, because the possibility exists that only MRI detects early or asymptomatic AN of the femoral head. (author)

  15. Magnetic resonance imaging (MRI) of avascular necrosis of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Kokubo, Takashi; Yoshikawa, Kohki; Aoki, Shigeki

    1987-05-01

    Thirty-seven patients with the clinical diagnosis of or suspicious of avascular necrosis (AN) of the femoral head were examined by magnetic resonance imaging (MRI). In all patients with AN confirmed from clinical symptoms, past history and plain radiographs, MRI demonstrated abnormal low intensity area in the necrosed femoral head. The abnormal findings on MRI were divided into three patterns: low signal intensity occupying the greater part of the femoral head (type A), low signal intensity localized in the periphery (type B), ring-shaped or band-like low signal intensity (type C). No correlation was found among MRI patterns, radiographic findings and radionuclide bone scan images, except that the type C was not found in the stage IV determined radiographically. In the patients suspicious of AN, the positive rate of MRI was higher than that of radionuclide scan. Abnormal findings on only MRI may not necessarily indicate AN. However, such a patient must be kept under observation, because the possibility exists that only MRI detects early or asymptomatic AN of the femoral head.

  16. Hip resurfacing arthroplasty in treatment of avascular necrosis of the femoral head.

    Science.gov (United States)

    Pyda, Michał; Koczy, Bogdan; Widuchowski, Wojciech; Widuchowska, Małgorzata; Stołtny, Tomasz; Mielnik, Michał; Hermanson, Jacek

    2015-01-25

    Hip resurfacing is a conservative type of total hip arthroplasty but its use is controversial, especially in patients with osteonecrosis. The aim of this study was analysis of the clinical and radiographic outcomes of hip resurfacing in patients with osteonecrosis. Between 2007 and 2008, 30 hip resurfacing arthroplasties were performed due to osteoarthritis secondary to avascular necrosis of femoral head staged as Ficat III and IV. Patients were qualified to resurfacing arthroplasty when the extent of avascular necrosis using Kerboul's method was avascular necrosis and head-neck junction was >20°. All patients were evaluated clinically and radiologically before and 60 months after the operation. The mean Harris Hip Score (HHS) score increased from 47.8 to 94.25 (p<0.05). Physical activity level (University of California, Los Angeles activity score--UCLA activity score) improved from 3.7 to 7.55 (p<0.05). No implant migration was observed. Management of osteonecrosis of the hip with resurfacing arthroplasty seems to be effective in strictly-selected patients.

  17. Logistic regression analysis of factors associated with avascular necrosis of the femoral head following femoral neck fractures in middle-aged and elderly patients.

    Science.gov (United States)

    Ai, Zi-Sheng; Gao, You-Shui; Sun, Yuan; Liu, Yue; Zhang, Chang-Qing; Jiang, Cheng-Hua

    2013-03-01

    Risk factors for femoral neck fracture-induced avascular necrosis of the femoral head have not been elucidated clearly in middle-aged and elderly patients. Moreover, the high incidence of screw removal in China and its effect on the fate of the involved femoral head require statistical methods to reflect their intrinsic relationship. Ninety-nine patients older than 45 years with femoral neck fracture were treated by internal fixation between May 1999 and April 2004. Descriptive analysis, interaction analysis between associated factors, single factor logistic regression, multivariate logistic regression, and detailed interaction analysis were employed to explore potential relationships among associated factors. Avascular necrosis of the femoral head was found in 15 cases (15.2 %). Age × the status of implants (removal vs. maintenance) and gender × the timing of reduction were interactive according to two-factor interactive analysis. Age, the displacement of fractures, the quality of reduction, and the status of implants were found to be significant factors in single factor logistic regression analysis. Age, age × the status of implants, and the quality of reduction were found to be significant factors in multivariate logistic regression analysis. In fine interaction analysis after multivariate logistic regression analysis, implant removal was the most important risk factor for avascular necrosis in 56-to-85-year-old patients, with a risk ratio of 26.00 (95 % CI = 3.076-219.747). The middle-aged and elderly have less incidence of avascular necrosis of the femoral head following femoral neck fractures treated by cannulated screws. The removal of cannulated screws can induce a significantly high incidence of avascular necrosis of the femoral head in elderly patients, while a high-quality reduction is helpful to reduce avascular necrosis.

  18. Alterations of sympathetic nerve fibers in avascular necrosis of femoral head.

    Science.gov (United States)

    Li, Deqiang; Liu, Peilai; Zhang, Yuankai; Li, Ming

    2015-01-01

    Avascular necrosis of the femoral head (ANFH) was mainly due to alterations of bone vascularity. And noradrenaline (NA), as the neurotransmitter of the sympathetic nervous system (SNS), leads to the vasoconstriction by activating its α-Receptor. This study was to explore the nerve fiber density of the femoral head in the rabbit model of ANFH. Twenty New Zealand white rabbits were used in this study. The rabbit model of ANFH was established by the injection of methylprednisolone acetate. The nerve fiber density and distribution in the femoral head was determined using an Olympus BH2 microscope. Significant fewer sympathetic nerve fibers was found in the ANFH intertrochanteric bone samples (P = 0.036) with osteonecrosis. The number of sympathetic nerve fibers was compared between the two groups. And less sympathetic nerve fibers were found in later stage ANFH samples in comparison with those of early stages. ANFH might be preceded by an inflammatory reaction, and an inflammatory response might lead to arthritic changes in tissue samples, which in turn reduces the number of sympathetic nerve fibers.

  19. Expression of osteoprotegerin, RNAK and RANKL genes in femoral head avascular necrosis and related signaling pathway.

    Science.gov (United States)

    Miao, Qingtang; Hao, Sibin; Li, Hongmei; Sun, Fang; Wang, Xueling

    2015-01-01

    Femoral head avascular necrosis (AVN) causes the damage of hip joint and related dysfunctions, thus consisting of a clinical challenge. Osteoprotegerin (OPG), receptor activator of nuclear factor κB (RANK) and its ligand (RANKL) all regulate the formation of bones via gene transcriptional regulation for the balance between osteoblasts and osteoclasts. This study thus investigated the expressional profiles of OPG, RANK and RANKL genes in AVN patients, and explored related molecular mediating pathways. Real-time qPCR was used to measure the gene expression of OPG, RANK and RANKL genes in AVN femoral head tissue samples from 42 patients, along with normal tissues. Western blotting analysis was performed to quantify protein levels of OPG and RANKL. There was a trend but not statistically significant elevation of mRNA levels of OPG in femoral head AVN tissues compared to normal tissues (P>0.05). The expression of RNAK and RNAKL, however, was significantly elevated in necrotic tissues (P<0.05). No significant difference in protein levels of OPG or RANKL between groups. The expression of OPG, RANK and RANKL genes exert a crucial role in the progression of AVN, suggesting their roles in mediating bone homeostasis and potential effects on bone destruction.

  20. Tribological changes in the articular cartilage of a human femoral head with avascular necrosis.

    Science.gov (United States)

    Seo, Eun-Min; Shrestha, Suman K; Duong, Cong-Truyen; Sharma, Ashish Ranjan; Kim, Tae-Woo; Vijayachandra, Ayyappan; Thompson, Mark S; Cho, Myung Guk; Park, Sungchan; Kim, Kwanghoon; Park, Seonghun; Lee, Sang-Soo

    2015-06-29

    The present study evaluated the tribological properties of the articular cartilage surface of the human femoral head with postcollapse stage avascular necrosis (AVN) using atomic force microscopy. The cartilage surface in the postcollapse stage AVN of the femoral head was reported to resemble those of disuse conditions, which suggests that the damage could be reversible and offers the possibilities of success of head-sparing surgeries. By comparing the tribological properties of articular cartilage in AVN with that of osteoarthritis, the authors intended to understand the cartilage degeneration mechanism and reversibility of AVN. Human femoral heads with AVN were explanted from the hip replacement surgery of four patients (60-83 years old). Nine cylindrical cartilage samples (diameter, 5 mm and height, 0.5 mm) were sectioned from the weight-bearing areas of the femoral head with AVN, and the cartilage surface was classified according to the Outerbridge Classification System (AVN0, normal; AVN1, softening and swelling; and AVN2, partial thickness defect and fissuring). Tribological properties including surface roughness and frictional coefficients and histochemistry including Safranin O and lubricin staining were compared among the three groups. The mean surface roughness Rq values of AVN cartilage increased significantly with increasing Outerbridge stages: Rq = 137 ± 26 nm in AVN0, Rq = 274 ± 49 nm in AVN1, and Rq = 452 ± 77 nm in AVN2. Significant differences in Rq were observed among different Outerbridge stages in all cases (p AVN0, μ = 0.143 ± 0.025 in AVN1, and μ = 0.171 ± 0.039 in AVN2. Similarly to the statistical analysis of surface roughness, significant statistical differences were detected between different Outerbridge stages in all cases (p AVN. The underlying mechanism of these results can be related to proteoglycan loss within the articular cartilage that is also observed in osteoarthritis. With regard to the tribological properties, the

  1. Transtrochanteric rotational osteotomy for avascular necrosis of the femoral head after unstable slipped capital femoral epiphysis: 10-year clinical results.

    Science.gov (United States)

    Nakashima, Yasuharu; Yamamoto, Takuaki; Fukushi, Jun-Ichi; Motomura, Goro; Hamai, Satoshi; Kohno, Yusuke; Iwamoto, Yukihide

    2016-11-01

    Avascular necrosis of the femoral head (AVN) is the most serious complication after unstable slipped capital femoral epiphysis (SCFE), and is often unsalvageable. We report a minimum 10 years of clinical results for transtrochanteric rotational osteotomy of the femoral head (TRO) for AVN. This study included 7 patients (7 hips) with a mean age at surgery of 13.3 years, and the follow-up period was 15.8 years. All patients had prior treatment via closed reduction and pinning of the unstable SCFE, and showed severely collapsed femoral heads. The direction of rotation was anterior in 3 hips and posterior in 4. The Merle d'Aubigné-Postel score (MDPS) was used for clinical assessment, and joint degeneration was assessed with the Kellgren and Lawrence classification (KL-grade). The spherical intact area of the femoral head was moved to the weight-bearing portion, and subluxation was corrected via rotation combined with intentional varus positioning. The mean MDPS improved from 10.3 points to 15.6 points at 5 years, and it was maintained at 15.0 points by 10 years; 3 hips were excellent, 1 was good, 2 were fair, and 1 showed poor outcomes. No patient experienced re-collapse after TRO or required conversion to hip replacement or arthrodesis. After 10 years, degenerative changes became evident over time, and 2 hips progressed to KL-4 with a decreased MDPS. Although some joint degeneration is inevitable in the long-term, TRO is an effective salvage procedure for treating AVN after unstable SCFE. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  2. Clinical analysis of interventional treatment for avascular necrosis of femoral head in adults

    International Nuclear Information System (INIS)

    Cao Dianbo; Yang Haishan; Zhao Yongsheng; Cheng Tilong

    2001-01-01

    Objective: To study the method and efficacy of interventional therapy for avascular necrosis of femoral head. Methods: A 5.0 F Cobra duct was first super selected into circumflex artery by applying Seldinger's technique and vasoactive drugs were perfused, then into inferior gluteal or obturator artery that are the branches of internal iliac artery. Dissolving and dilative drugs were perfused through micro-artery pump linked to the duct for three days on 30 cases (total 51 heads of femur). Results: Following interventional treatment, there were marked improvement of clinical symptoms, with relief or disappearance of pain (92.2%) and functional improvement in hip joint (87.5%). Increase of vessel numbers, disappearance of blank space, richness of parenchymal staining and establishment of collateral circulations were found around the hip joint. Repair of osteonecrosis at different degrees was observed on regular reexamination. Conclusion: Interventional therapy for ANFH had a significantly therapeutic effect after short-term follow-up

  3. [Experimental study on avascular necrosis of femoral head in chickens induced by different glucocorticoides].

    Science.gov (United States)

    Xiao, Chun-Sheng; Lin, Na; Lin, Shi-Fu; Wan, Rong; Chen, Wei-Heng

    2010-03-01

    To study the effects of Methylprednisolone and Dexamethasone on the avascular necrosis of femoral head in chickens. Thirty-six chickens were randomly divided into 6 groups (n = 6): control group (group A), Methylprednisolone low dose group (group B), Methylprednisolone large dose group (group C), small dose Dexamethasone and horse serum group (group D), middle dose Dexamethasone and horse serum group (group E), and Dexamethasone large dose group (group F). On the 6th and 12th weeks, blood samples were obtained to determine the level of total cholesterol triglyeride (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL). On the 12th week, femoral heads were taken off. Paraffin tissue sections were prepared to detect histopathologic change with hematoxylin and eosin staining. On the 6th week, compared with group A, the level of CHO increased significantly in group C and group F (P < 0.05), and TG increased in group B, C and group E, while HDL decreased in group B, C and group E. On the 12th week, the level of TG and CHO increased in group B, C, E and group F, and HDL decreased in group C, D and group E (P < 0.05). LDL was not detected in most chickens. The ratio of empty lacuna was higher in group C and group E compared with those of the control group (P < 0.05). Methylprednisolone is easier to induce osteonecrosis of femoral head than Dexamethasone. The condition of metabolic disorder in blood may be the basic pathomechanism of steroid-induced necrosis of femoral head.

  4. Contrast-enhanced fat- suppression MR imaging of avascular necrosis of femoral head

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    Oh, Tae Kyoung; Shim, Jae Chan; Lee, Ghi Jai; Jeon, Jeong Dong; Bang, Sun Woo; Kim, Ho Kyun [College of Medicine, Inje University, Seoul (Korea, Republic of)

    2000-02-01

    To evaluate the findings and role of contrast-enhanced fat suppression MR imaging in avascular necrosis (AVN) of the femoral head. In 15 patients with AVN of the femoral head, MR T1-weighted and T2-weighted images and contrast-enhanced fat-suppression T1-weighted images were obtained, and the findings were reviewed. Early and advanced groups were classified on the basis of clinical findings and imaging, and the enhancement pattern was classified as either type I, rim enhancement; type II, surrounding diffuse enhancement; type III, intralesional enhancement; or type IV, II + III. Twenty-four cases of AVN of the femoral head were detected; in nine patients, lesions were bilateral. Eight cases occurred in the early group and 16 in the advanced. All eight in the early group showed the 'double line sign' on T2-weighted images, with a type-I enhancement pattern. In the advanced group, type II (8/16) and type IV (8/16) enhancement patterns were seen. Among the cases showing the type-IV pattern, the intralesional enhancing area showed low signal intensity on T1-weighted images and isosignal intensity on T2-weighted in one case, and low signal intensity on T2-weighted in one case, and low signal intensity on T1-weighted images and high signal intensity on T2-weighted in the other cases. There was no difference in the extent of the disease before and after enhancement. Contrast-enhanced fat-suppression MR images may be helpful in evaluating the extent of AVN of the femoral head and predicting the histopathologic findings of the disease. (author)

  5. Efficacy of Core Decompression of Femoral Head to Treat Avascular Necrosis in Intravenous Drug Users

    Directory of Open Access Journals (Sweden)

    Hossein Soleimani

    2013-04-01

    Full Text Available Core decompression (CD of the femoral head is one of the effective treatments of avascular necrosis (AVN, especially in the early stages of the disease. To investigate further the value of CD in treating the AVN, this study was performed on patients with symptomatic AVN with different etiologies who were treated with CD. This study was carried out on 25 patients (with the total number of 37 femoral head who were diagnosed AVN using X-Ray and MRI. The CD treatments for these patients were started soon after the diagnosis. The results were considered as a success if there was no progression of disease confirmed by X Ray or no subsequent operation was required. Modified Ficat staging was used to record changes before and 2 years after CD treatment. Twenty five patients were participated in this study in which 68% (n=17 were female, 32% (n=8 were male, and the average of the age of the patients were 29.58±4.58. Eight of these patients had systemic lupus erythematous (SLE (32%, 4 rheumatoid arthritis (RA (16%, 3 with kidney transplant (12%, 1 Takayasu’s vasculitis (4% and 1 Wegner vasculitis (4%. Eight of patients had a history of intravenous injection of Temgesic (32%. In patients using Temgesic the changes in Modified Ficat staging were significantly different before and after CD treatment (P=0.03 in comparison with other groups. And in all 8 Temgesic users AVN progressed to the stage 3 and 4 after CD treatment. This study demonstrated that CD treatment to prevent the changes in the femoral head has been more effective in patients with collagen vascular diseases and kidney transplant than patients using intravenous Temgesic. These patients, in spite of early operation, showed no benefit of CD to prevent the changes in the femoral head.

  6. Contrast-enhanced fat- suppression MR imaging of avascular necrosis of femoral head

    International Nuclear Information System (INIS)

    Oh, Tae Kyoung; Shim, Jae Chan; Lee, Ghi Jai; Jeon, Jeong Dong; Bang, Sun Woo; Kim, Ho Kyun

    2000-01-01

    To evaluate the findings and role of contrast-enhanced fat suppression MR imaging in avascular necrosis (AVN) of the femoral head. In 15 patients with AVN of the femoral head, MR T1-weighted and T2-weighted images and contrast-enhanced fat-suppression T1-weighted images were obtained, and the findings were reviewed. Early and advanced groups were classified on the basis of clinical findings and imaging, and the enhancement pattern was classified as either type I, rim enhancement; type II, surrounding diffuse enhancement; type III, intralesional enhancement; or type IV, II + III. Twenty-four cases of AVN of the femoral head were detected; in nine patients, lesions were bilateral. Eight cases occurred in the early group and 16 in the advanced. All eight in the early group showed the 'double line sign' on T2-weighted images, with a type-I enhancement pattern. In the advanced group, type II (8/16) and type IV (8/16) enhancement patterns were seen. Among the cases showing the type-IV pattern, the intralesional enhancing area showed low signal intensity on T1-weighted images and isosignal intensity on T2-weighted in one case, and low signal intensity on T2-weighted in one case, and low signal intensity on T1-weighted images and high signal intensity on T2-weighted in the other cases. There was no difference in the extent of the disease before and after enhancement. Contrast-enhanced fat-suppression MR images may be helpful in evaluating the extent of AVN of the femoral head and predicting the histopathologic findings of the disease. (author)

  7. Magnetic resonance imaging of the femoral head to detect avascular necrosis in active rheumatoid arthritis treated with methylprednisolone pulse therapy

    NARCIS (Netherlands)

    van Vugt, R. M.; Sijbrandij, E. S.; Bijlsma, J. W.

    1996-01-01

    Efficacious management of patients with avascular necrosis of bone (AVN) necessitates the identification of patients with a high risk of collapse of the femoral head. In this prospective study we imaged both hips of 10 patients with active rheumatoid arthritis, who were treated with

  8. Comparison of planar scanning and single photon emission computed tomography in the diagnosis of avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Feiglin, D.H.I.; Levine, M.; Stulberg, B.; Pflanze, W.; O'Donnell, J.K.; Belhobek, G.H.; Go, R.T.; MacIntyre, W.J.

    1986-01-01

    Thirty-nine patients were investigated for avascular necrosis of the femoral head. All hips were studied by plain x-ray and MR imaging, 70 hips studied by radionuclide bone scanning, and 38 were studied by single photon emission CT (SPECT). Core biopsies of the femoral heads from 32 hips were examined. No one reference standard for noninvasive diagnosis of this disease is available. The sensitivity and specificity of the radionuclide studies with respect to SPECT were 77% and 100%; of SPECT with respect to pathologic confirmation, 100% and 57%; of MR imaging with respect to pathologic studies, 100% and 66%. Pathologic sampling is subject to error and may give false negative results with spuriously low specificities for imaging modalities. SPECT is recommended as the radionuclide imaging procedure of choice for detecting avascular necrosis of the femoral head

  9. Avascular necrosis of the femoral head in children with acute lymphoblastic leukemia: a 4- to 9-year follow-up study.

    Science.gov (United States)

    Madadi, Firooz; Shamsian, Bibi Shahin; Alavi, Samin; Madadi, Firoozeh; Eajazi, Alireza; Aslani, Afshin

    2011-10-05

    Avascular necrosis of the femoral head is usually seen in children aged 1.5 to 10 years, reaching a peak incidence between the ages of 4 and 9. Avascular necrosis of the femoral head is a known complication of corticosteroid therapy in acute lymphoblastic leukemia. There are few reports in the literature regarding the natural history of this condition, and there is no consensus on its management. This study examined the natural history of avascular necrosis of the femoral head in children with leukemia. From 1993 to 2006, a total of 865 children with acute lymphoblastic leukemia were admitted to the hematology-oncology ward of a children's hospital. The diagnosis of acute lymphoblastic leukemia was established by bone marrow aspiration. Based on clinical and radiographic findings, avascular necrosis of the femoral head was found in 7 patients; these patients underwent follow-up for 4 to 9 years. Avascular necrosis of the femoral head was clinically symptomatic in all of the children, and they had advanced radiographic collapse of the femoral head. However, the head of the femur was not at risk in any patient based on clinical and radiographic findings. Patients received supportive treatment such as abduction brace and physiotherapy. After 4 to 9 years of follow-up, clinical and radiographic results were satisfactory. Provided that the head of the femur is not at risk, avascular necrosis of the femoral head in children with acute lymphoblastic leukemia may be successfully managed with nonoperative care. Copyright 2011, SLACK Incorporated.

  10. Microstructures and properties of cancellous bone of avascular necrosis of femoral heads

    Science.gov (United States)

    Yao, Xuefeng; Wang, Peng; Dai, Ruchun; Yeh, Hsien Yang

    2010-03-01

    The aim of this study is to investigate microscopic structure and characterize cancellous bone of avascular necrosis of the femoral head (ANFH). The rabbit model of the ANFH is established. The histopathologic features are studied successfully. The differences between the steroid-injection group (S.G.) and the controlled group (C.G.) are examined, including the weight of rabbits, the hematological examination and the three-dimensional structures. It is found that the plasma levels of cholesterol (CHO), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) in S.G. are lower than those in C.G. when the triglyceride (TG) increased in the S.G.; but the bone mineral content (BMC) and the structural model index (SMI) of the organ and tissue decreased significantly in S.G. Three-dimensional structures of the femoral head are obtained using micro-computed tomography (CT) scanning and the mechanical model is established to analyze the influences of these structural changes on the mechanical properties of the cancellous bone.

  11. Bipolar hip arthroplasty for avascular necrosis of femoral head in young adults

    Science.gov (United States)

    Dudani, Baldev; Shyam, Ashok K; Arora, Pankush; Veigus, Arjun

    2015-01-01

    Background: Bipolar hip arthroplasty (BHA) is one of the options for treatment of avascular necrosis (AVN) of the femoral head. Acetabular erosion and groin pain are the most allowing for gross motion between the common complications. We propose that these complications are secondary to improper acetabular preparation allowing for motion between the BHA head and the acetabulum. Materials and Methods: The current study retrospectively evaluated patients’records from case files and also called them for clinical and radiological followup. 96 hips with AVN of the femoral head treated with BHA were included in the study. All patients were males with a mean age of 42 years (range 30-59 years). In all cases, the acetabulum was gently reamed till it became uniformly concentric to achieve tight fitting trial cup. Clinical followup using Harris hip score (HHS) and radiological study for cup migration were done at followup. Results: The mean followup was 7.52 years (range 4-16 years). The HHS significantly improved from a preoperative value of 39.3 (range, 54-30) to a postoperative value of 89.12 (range 74-96). According to HHS grades, the final outcome was excellent in 52 hips, good in 28 and fair in 16 hips. Hip and groin pain was reported in four hips (5%), but did not limit activity. Subsidence (less than 5 mm) of the femoral component was seen in 8 cases. Subgroup analysis showed patients with Ficat Stage 3 having better range of motion, but similar HHS as compared to Ficat Stage 4 patients. Conclusion: Bipolar hip arthroplasty (BHA) using tight fitting cup and acetabular reaming in AVN hip has a low incidence of groin pain, acetabular erosion and revision in midterm followup. Good outcome and mid term survival can be achieved irrespective of the Ficat Stage. PMID:26015634

  12. Spontaneous resolution of avascular necrosis of femoral heads following cure of Cushing's syndrome.

    Science.gov (United States)

    Pazderska, A; Crowther, S; Govender, P; Conlon, K C; Sherlock, M; Gibney, J

    2016-01-01

    Avascular necrosis (AVN) is a rare presenting feature of endogenous hypercortisolism. If left untreated, complete collapse of the femoral head may ensue, necessitating hip replacement in up to 70% of patients. The majority of the described patients with AVN due to endogenous hypercortisolaemia required surgical intervention. A 36-year-old female, investigated for right leg pain, reported rapid weight gain, bruising and secondary amenorrhoea. She had abdominal adiposity with violaceous striae, facial plethora and hirsutism, atrophic skin, ecchymosis and proximal myopathy. Investigations confirmed cortisol excess (cortisol following low-dose 48h dexamethasone suppression test 807nmol/L; 24h urinary free cortisol 1443nmol (normalAVN. She underwent right adrenalectomy and steroid replacement was commenced. Four months after surgery, leg pain had resolved and mobility was normal. Repeat MRI showed marked improvement of radiological abnormalities in both femoral heads, consistent with spontaneous healing of AVN. We report a case of Cushing's syndrome due to primary pigmented nodular adrenocortical disease, presenting with symptomatic AVN of both hips. This was managed conservatively from an orthopaedic perspective. Following cure of hypercortisolaemia, the patient experienced excellent recovery and remains symptom free 4 years after adrenalectomy. This is the first report of a favourable outcome over long-term follow-up of a patient with bilateral AVN of the hip, which reversed with treatment of endogenous hypercortisolaemia. AVN of femoral head can be a presenting feature of hypercortisolism, both endogenous and exogenous.Rarely, treatment of hypercortisolaemia can reverse AVN without the need for orthopaedic intervention.Primary pigmented nodular adrenal disease is a rare cause of ACTH-independent Cushing's syndrome.

  13. Spontaneous resolution of avascular necrosis of femoral heads following cure of Cushing’s syndrome

    Directory of Open Access Journals (Sweden)

    A Pazderska

    2016-05-01

    Full Text Available Avascular necrosis (AVN is a rare presenting feature of endogenous hypercortisolism. If left untreated, complete collapse of the femoral head may ensue, necessitating hip replacement in up to 70% of patients. The majority of the described patients with AVN due to endogenous hypercortisolaemia required surgical intervention. A 36-year-old female, investigated for right leg pain, reported rapid weight gain, bruising and secondary amenorrhoea. She had abdominal adiposity with violaceous striae, facial plethora and hirsutism, atrophic skin, ecchymosis and proximal myopathy. Investigations confirmed cortisol excess (cortisol following low-dose 48h dexamethasone suppression test 807nmol/L; 24h urinary free cortisol 1443nmol (normal<290nmol. Adrenocorticotrophic hormone (ACTH was <5.0pg/mL. CT demonstrated subtle left adrenal gland hypertrophy. Hypercortisolaemia persisted after left adrenalectomy. Histology revealed primary pigmented micronodular adrenal disease. Post-operatively, right leg pain worsened and left leg pain developed, affecting mobility. MRI showed bilateral femoral head AVN. She underwent right adrenalectomy and steroid replacement was commenced. Four months after surgery, leg pain had resolved and mobility was normal. Repeat MRI showed marked improvement of radiological abnormalities in both femoral heads, consistent with spontaneous healing of AVN. We report a case of Cushing’s syndrome due to primary pigmented nodular adrenocortical disease, presenting with symptomatic AVN of both hips. This was managed conservatively from an orthopaedic perspective. Following cure of hypercortisolaemia, the patient experienced excellent recovery and remains symptom free 4 years after adrenalectomy. This is the first report of a favourable outcome over long-term follow-up of a patient with bilateral AVN of the hip, which reversed with treatment of endogenous hypercortisolaemia.

  14. Avascular necrosis of the femoral head following trochanteric fractures in adults: a systematic review.

    Science.gov (United States)

    Barquet, Antonio; Mayora, Gabriel; Guimaraes, Joao Matheus; Suárez, Roberto; Giannoudis, Peter V

    2014-12-01

    Avascular necrosis of the femoral head (ANFH) following trochanteric fractures (TFx) is infrequent. The causal relationship between ANFH and TFx remains controversial. Although several major risk factors for ANFH have been proposed, most of them remain under discussion. In this study we undertook a systematic review of the literature to investigate the incidence of AVN, risk factors and outcomes following Tfx fixation. A comprehensive review of the literature was undertaken using the PRISMA guidelines with no language restriction. Case reports of ANFH and series of TFx with or without cases of ANFH published between inception of journals to December 2013 were eligible for inclusion. Relevant information was divided in two sections. Part I: included the analysis of detailed case reports of ANFH, either published isolated or included in series of TFx, with the objective of establishing potential risk factors, clinical and radiological presentation, time to development, treatment and outcome of this complication. Part II: analyzed series of TFx, which included cases of ANFH with or without details of aetiology, treatment modalities and outcomes, with the objective of assessing the incidence of ANFH in TFx. Overall 80 articles with 192 cases of ANFH after TFx met the inclusion criteria. The most probable developmental pathway appears to be a disruption of the extra osseous arterial blood supply to the femoral head. Suggested risk factors included high-energy trauma with fracture comminution and displacement, and an atypical course of the fracture line, more proximal, at the base of the neck. Most cases were diagnosed within the first two years after fracture. The clinical and radiological features appear to be similar to those of idiopathic avascular necrosis of the femoral head. The incidence of AVFH with a minimum of 1-year follow-up was calculated 0.95%, and with a minimum 2-year follow-up it was 1.37%. Total hip replacement was the mainstay of treatment. The

  15. The role of electrical stimulation in the management of avascular necrosis of the femoral head in adults: a systematic review.

    Science.gov (United States)

    Al-Jabri, Talal; Tan, Jessica Yan Qi; Tong, Gabriel Yihan; Shenoy, Ravikiran; Kayani, Babar; Parratt, Timothy; Khan, Tahir

    2017-07-28

    Avascular necrosis of the femoral head causes significant morbidity and occurs in up to 20,000 people per year. A variety of nonoperative and operative measures have been trialled however a definitive treatment algorithm is yet to be established. Young adults in many cases have undergone multiple surgical procedures in their lifetime with increasing risks of complications. Less invasive techniques may help reduce the number of operations required and positively influence the natural history of the disease process. Our aim was to navigate the literature and examine the results of electrical stimulation of the femoral head in avascular necrosis. The following defined search strategy was used to perform a systematic review using MEDLINE and Google Scholar databases: ((avascular necrosis) OR (osteonecrosis)) AND (femoral head) AND ((electrical stimulation) OR (capacitive coupling) OR (pulsed electromagnetic fields)). Articles were reviewed and data compiled into tables for analysis. Fourty six articles were identified with a total of 10 articles meeting the inclusion criteria. 8 articles were prospective studies and 2 were retrospective. Early Ficat stages showed the best responses to treatment via pulsed electromagnetic fields with improvements in both clinical and radiographic parameters. Direct current and capacitative coupling have had a more ambiguous outcome. Pulsed electromagnetic fields may have a role in the management of early avascular necrosis. The paucity of clinical studies into this technique indicates a need for further studies.

  16. Femoral head avascular necrosis: a frequently missed incidental finding on multidetector CT

    International Nuclear Information System (INIS)

    Barille, M.F.; Wu, Jim S.; McMahon, Colm J.

    2014-01-01

    Aim: To determine the incidence of missed femoral head avascular necrosis (AVN) on pelvic computed tomography (CT) performed for clinical indications other than assessment for AVN. Materials and methods: The study was a Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study. The picture archiving and communication system (PACS) database was queried for patients with diagnosis of femoral head AVN on magnetic resonance imaging (MRI), who also underwent pelvic multidetector CT after or <30 days before the MRI examination. The MRI and CT images of 144 hips of 72 patients (39 patients with reported AVN on MRI and 33 age-matched controls; mean age = 60 years, 28 male, 44 female), were reviewed in consensus by two readers in a randomized, blinded manner. Using MRI-proven CT-visible AVN as a reference standard, the incidence of missed AVN on initial CT interpretation was determined. Results: Readers confirmed AVN in 33 patients on the MRI images. Nine hips with AVN underwent joint replacement of the affected joint(s) prior to subsequent CT and were excluded. Forty-three MRI-proven AVN cases in 28 patients (15 bilateral, 13 unilateral) were available for analysis. The study readers diagnosed 35/43 (81%) MRI-proven AVN cases in 22/28 (79%) patients. Four of the 35 (11%) cases of MRI-proven, CT-visible AVN were prospectively reported in 3/22 (14%) patients at initial clinical interpretation, with a miss rate of 89% per hip and 86% per patient. Conclusion: Multidetector CT has high accuracy for detection of AVN; however, this is frequently missed as an incidental finding (89% missed in the present study). Assessment for signs of femoral AVN should be part of routine search pattern in interpretation of pelvic CT

  17. Femoral head avascular necrosis: a frequently missed incidental finding on multidetector CT.

    Science.gov (United States)

    Barille, M F; Wu, Jim S; McMahon, Colm J

    2014-03-01

    To determine the incidence of missed femoral head avascular necrosis (AVN) on pelvic computed tomography (CT) performed for clinical indications other than assessment for AVN. The study was a Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study. The picture archiving and communication system (PACS) database was queried for patients with diagnosis of femoral head AVN on magnetic resonance imaging (MRI), who also underwent pelvic multidetector CT after or AVN on MRI and 33 age-matched controls; mean age = 60 years, 28 male, 44 female), were reviewed in consensus by two readers in a randomized, blinded manner. Using MRI-proven CT-visible AVN as a reference standard, the incidence of missed AVN on initial CT interpretation was determined. Readers confirmed AVN in 33 patients on the MRI images. Nine hips with AVN underwent joint replacement of the affected joint(s) prior to subsequent CT and were excluded. Forty-three MRI-proven AVN cases in 28 patients (15 bilateral, 13 unilateral) were available for analysis. The study readers diagnosed 35/43 (81%) MRI-proven AVN cases in 22/28 (79%) patients. Four of the 35 (11%) cases of MRI-proven, CT-visible AVN were prospectively reported in 3/22 (14%) patients at initial clinical interpretation, with a miss rate of 89% per hip and 86% per patient. Multidetector CT has high accuracy for detection of AVN; however, this is frequently missed as an incidental finding (89% missed in the present study). Assessment for signs of femoral AVN should be part of routine search pattern in interpretation of pelvic CT. Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  18. MR imaging of avascular necrosis of the femoral head: Evaluation of the prognostic factors

    Energy Technology Data Exchange (ETDEWEB)

    Jin, Uk; Ryu, Kyung Nam; Yoo, Myung Chul; Yoon, Yup [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1994-07-15

    To evaluate the factors influencing the prognosis in avascular necrosis(AVN) of the femoral head by MR. Radiographic and MRI findings of twenty-three patients(30 cases, aged 23-67 years) with AVN identified clinically and radiologically were evaluated. The radiography included follow up study for at least 6 months. The mean age of these patients was 43 years and M : F ratio was 20 : 3. MR imaging was performed at 1.5 T unit using T1- and T2-weighted coronal and T1-weighted sagittal and axial spin echo sequences. We categorized the changes of the femoral head on radiographic follow-ups to three grades of mild , moderate and severe. We also analyzed the changes of the signal intensity and sizes of the lesion at sagittal and coronal MR images. On MR imaging we classified the extent of AVN of the femoral head to 2 grades according to the size of lesion. In the cases of mild changes in femoral head on radiography, the mean age of the patient was 37 years and the extent of AVN was below 1/2 in eleven out of seventeen cases. In the cases of moderate changes, the mean age was 43 years and the extent was above 1/2 in five out of seven cases. In the cases of severe changes, the mean age was 60 years and the extent was above 1/2 in all 6 cases. With 95% confidence coefficient, comparisons in the age and necrosis extent revealed statistical significance in severe versus moderate changes and in severe versus mild changes. Comparisons in the change of signal intensity on T1 and T2 weighted images showed no statistical relationship between each other. We conclude that if patient is younger and has smaller extent of the AVN, bone destruction is slower that these factors may be helpful in predicting the prognosis of AVN. However, the modes of the changes of the signal intensity on T1- and T2-weighted images may not be useful in predicting the prognosis of AVN.

  19. Evidence for Using Alendronate to Treat Adult Avascular Necrosis of the Femoral Head: A Systematic Review

    Science.gov (United States)

    Luo, Ru-Bin; Lin, Tiao; Zhong, Hui-Ming; Yan, Shi-Gui; Wang, Jian-An

    2014-01-01

    Osteonecrosis or avascular osteonecrosis (AVN) of the femoral head is a devastating multifactorial disease that affects 20 000 persons each year in the United States. The purpose of this systematic review was to determine the efficacy and safety of alendronate for adult AVN during short- and long-term follow-up. Electronic databases were searched for randomized or nonrandomized clinical trials, cohort, case-control studies, and series of cases in which alendronate was used for treatment of adult AVN of the femoral head. Relevant articles with adequate data on reduction of pain, improvement of articular function, slowing of bone collapse progression, or need for total hip arthroplasty (THA) were included after applying inclusion and exclusion criteria. Eight articles involving 788 hips with evidence level 1b to 3b were included in this systematic review. Most studies suggested a positive short-term efficacy of alendronate treatment in reducing pain, improving articular function, slowing of bone collapse progression, and delaying the need for THA for adult AVN patients. The favorable long-term results were also presented in those treated patients after 10-year follow-up. In addition, there were no severe adverse effects associated with alendronate treatment observed during short- and long-term follow-up, and most of the included studies suggested use of alendronate in early AVN with small necrotic lesion to achieve better outcomes. The findings support consideration of alendronate use for adult AVN, particularly with early stage and small necrotic size. The lack of large-scale, randomized, and double-blind studies justifies new studies to demonstrate the detailed indication and the optimized strategy of alendronate treatment. Level of evidence: Level 3a. PMID:25424061

  20. Early detection of femoral head avascular necrosis by bone SPECT compared to MRI in renal allograft recipients

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Do Young; Yang, Seoung Oh; Lee, Hee Kyung; Han, Duck Jong; Shin, Myung Jin [Asan Mecical Center, Seoul (Korea, Republic of)

    1997-07-01

    The prevalence of avascular necrosis (AVN) of femoral head in patients who receive immunosuppresive agents after renal transplantation is reported to be 4-29%. Among patients who develop AVN after renal transplantation, 80% become symptomatic within 2 years after transplantation. As the number of renal transplantation has been increased recently, early detection of femoral head AVN is very important because early surgical core decompression of femoral head can prevent collapse of the head. MRI is known to be very sensitive to diagnose femoral head AVN. However in three cases we report here, bone SPECT showed early changes of femoral head AVN, whereas MRI showed no specific abnormality. Case 1. A 53-year-old female received an allograft kidney transplantation in 1994. Preoperative bone scan was normal. She complained of both hip pain on Mar. 18 1997. Bone SPECT showed cold defect in both femoral heads but MRI showed no abnormality. After 3 months, bone SPECT and MRI showed AVN of both femoral heads. She underwent bilateral total hip replacement arthroplasty. AVN of femoral heads was confirmed by microscopic examination. Case 2. A 38-year-old female received an allograft kidney transplantation in Feb. 27 1997. Preoperative bone scan was normal. She ran a fever and creatinine was elevated from 1.2 to 2.8 mg/dL. She took high dose methylprednisolone therapy for acute reanl rejection. After two days, she complained pain in both hip joints and knee joints. Bone SPECT showed cold defects in both femoral heads but MRI showed no abnormality. A follow-up bone SPECT and MRI 20 days later revealed AVN of both femoral heads. Case 3. A 50-year-old male received an allograft kidney transplantation on Jul. 12 1995. Preoperative bone scan was normal. He complained of right hip pain on Jul, 26 1995. His bone SPECT showed cold defects in both femoral heads while MRI showed only minimal hip joint effusion. He also complained of left hip pain on Oct. 2 1995. He was admitted on Mar 17

  1. Early detection of femoral head avascular necrosis by bone SPECT compared to MRI in renal allograft recipients

    International Nuclear Information System (INIS)

    Kang, Do Young; Yang, Seoung Oh; Lee, Hee Kyung; Han, Duck Jong; Shin, Myung Jin

    1997-01-01

    The prevalence of avascular necrosis (AVN) of femoral head in patients who receive immunosuppresive agents after renal transplantation is reported to be 4-29%. Among patients who develop AVN after renal transplantation, 80% become symptomatic within 2 years after transplantation. As the number of renal transplantation has been increased recently, early detection of femoral head AVN is very important because early surgical core decompression of femoral head can prevent collapse of the head. MRI is known to be very sensitive to diagnose femoral head AVN. However in three cases we report here, bone SPECT showed early changes of femoral head AVN, whereas MRI showed no specific abnormality. Case 1. A 53-year-old female received an allograft kidney transplantation in 1994. Preoperative bone scan was normal. She complained of both hip pain on Mar. 18 1997. Bone SPECT showed cold defect in both femoral heads but MRI showed no abnormality. After 3 months, bone SPECT and MRI showed AVN of both femoral heads. She underwent bilateral total hip replacement arthroplasty. AVN of femoral heads was confirmed by microscopic examination. Case 2. A 38-year-old female received an allograft kidney transplantation in Feb. 27 1997. Preoperative bone scan was normal. She ran a fever and creatinine was elevated from 1.2 to 2.8 mg/dL. She took high dose methylprednisolone therapy for acute reanl rejection. After two days, she complained pain in both hip joints and knee joints. Bone SPECT showed cold defects in both femoral heads but MRI showed no abnormality. A follow-up bone SPECT and MRI 20 days later revealed AVN of both femoral heads. Case 3. A 50-year-old male received an allograft kidney transplantation on Jul. 12 1995. Preoperative bone scan was normal. He complained of right hip pain on Jul, 26 1995. His bone SPECT showed cold defects in both femoral heads while MRI showed only minimal hip joint effusion. He also complained of left hip pain on Oct. 2 1995. He was admitted on Mar 17

  2. MR imaging of avascular femoral head necrosis - pre- and postoperative studies. Prae- und postoperative kernspintomographische Untersuchungen bei avaskulaeren Hueftkopfnekrosen

    Energy Technology Data Exchange (ETDEWEB)

    Schedel, H; Ziegler, L; Vogl, T; Hilbertz, T; Lissner, J [Muenchen Univ. (Germany). Radiologische Klinik und Poliklinik; Buchner, H [Muenchen Univ. (Germany). Orthopaedische Klinik und Poliklinik

    1992-05-01

    46 patients with avascular necrosis of the femoral head were examined by T[sub 2]- and T[sub 1]-weighted MR before and after infusion of Gd-DTPA. Both sides were involved in 12 cases. The classification was done according to Ficat. In early stages and in postoperative studies a correlation of signal intensity after infusion of Gd-DTPA and clinical symptoms was found. Hyperintensity of the avascular area or of the implanted material was assumed to be vascularised or vital components in 4 cases of Ficat 1 and 15 postoperative studies. Contrariwise, we found in 5 patients with severe postoperative symptoms, low signal intensity areas due to avascular regions. (orig.).

  3. Screening of Serum Protein Markers for Avascular Osteonecrosis of Femoral Head Differentially Expressed after Treatment with Yuanshi Shengmai Chenggu Tablets

    Directory of Open Access Journals (Sweden)

    Peng Deng

    2018-01-01

    Full Text Available Avascular necrosis of the femoral head (ANFH is an a frequently occurring orthopaedic disease with high morbidity. Traditional Chinese Medicine (TCM Yuanshi Shengmai Chenggu Tablet is a valid prescription for treating steroid-induced femoral head necrosis. However, there are rare investigations about the serum protein marker expression after the acting of drugs on hormone and TCM. In the present study, we aimed to systematically discover and validate the serum biomarkers expression difference in patients with steroid-induced avascular necrosis of femoral head (SANFH after taking Yuanshi Shengmai Chenggu Tablets (SANFH-TCM, so as to reveal the action mechanism of TCM from the molecular level by using isobaric tags for relative and absolute quantification (iTRAQ with multiple reaction monitoring quantification. Significant differences in fibrinogen alpha, fibrinogen beta, fibrinogen gamma, fibronectin, C-reactive protein, apolipoprotein A, apolipoprotein D, and apolipoprotein E were found among SANFH, SANFH-TCM, and healthy controls. Therefore, our study proposes potential biomarkers for SANFH diagnosis and for the prognosis of femoral head necrosis after Traditional Chinese Medicine treatment.

  4. Avascular Necrosis of the Femoral Head After Palliative Radiotherapy in Metastatic Prostate Cancer: Absence of a Dose Threshold?

    Science.gov (United States)

    Daoud, Alia M; Hudson, Mack; Magnus, Kenneth G; Huang, Fleur; Danielson, Brita L; Venner, Peter; Saluja, Ronak; LeGuerrier, Bronwen; Daly, Helene; Emmenegger, Urban; Fairchild, Alysa

    2016-03-06

    Avascular necrosis (AVN) is the final common pathway resulting from insufficient blood supply to bone, commonly the femoral head. There are many postulated etiologies of non-traumatic AVN, including corticosteroids, bisphosphonates, and radiotherapy (RT). However, it is unclear whether there is a dose threshold for the development of RT-induced AVN. In this case report, we describe a patient with prostate cancer metastatic to bone diagnosed with AVN after receiving single-fraction palliative RT to the left femoral head. Potential contributing factors are discussed, along with a review of other reported cases. At present, the RT dose threshold below which there is no risk for AVN is unknown, and therefore detrimental impact from the RT cannot be excluded. Given the possibility that RT-induced AVN is a stochastic effect, it is important to be aware of the possibility of this diagnosis in any patient with a painful hip who has received RT to the femoral head.

  5. Bilateral femoral head avascular necrosis with a very low dose of oral corticosteroid used for panhypopituitarism.

    Science.gov (United States)

    Dharmshaktu, Pramila; Aggarwal, Anshita; Dutta, Deep; Kulshreshtha, Bindu

    2016-01-13

    Avascular necrosis (AVN) of the femoral head is a rare complication related to glucocorticoid administration and traditionally has been associated with high doses and/or prolonged therapy. Occurrence of osteonecrosis with a physiological replacement dose of glucocorticoids has not been reported previously. We report a 38-year-old man with non-secreting pituitary adenoma who developed bilateral AVN while on a very small dose of oral prednisolone for secondary adrenal insufficiency after surgery for pituitary adenoma. The patient was switched to hydrocortisone. Zolindronic acid was administered and the patient underwent bilateral core decompressive surgery resulting in a reduction of hip pain and improvement. When last evaluated, 2 years after diagnosis of AVN, the patient was functionally independent, and was able to do his routine activities with mild pain. The report intends to highlight the occurrence of AVN of the femur even with a very small dose of prednisolone used for treatment of panhypopituitarism. Glucocorticoids may have to be continued in the lowest possible dose using the most physiological preparation such as hydrocortisone when stoppage is not possible. 2016 BMJ Publishing Group Ltd.

  6. Early magnetic resonance imaging and histologic findings in a model of avascular necrosis of femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, Takuya [Kanazawa Univ. (Japan). School of Medicine

    1997-12-01

    The present study was performed to examine early MR images and histologic findings using a canine model of avascular necrosis of femoral head (ANFH). The ANFH model was surgically induced. At three days, 1, 2 and 4 weeks after surgery, the proximal femurs were excised. MR images were obtained in 4 dogs at 3 days and 7 dogs at each of the other intervals. Histologic examinations were performed on 7 dogs at each interval. Three days after surgery, MR showed almost no abnormal findings. Histologic changes included edematous bone marrow and bleeding in the bone marrow in some regions. One week after surgery, empty lacunae in trabecular bones and immature fibrous tissues in the bone marrow were seen in some cases, but appositional bone was not yet apparent. In only one case, abnormal MR findings -a ringlike pattern- were seen. Two weeks after surgery, 4 cases showed appositional bones on histology and abnormalities on MR images. Four weeks after surgery, fibrous tissues had matured and appositional bones had increased. Therefore, all 7 cases showed MR imaging abnormalities. Abnormal MR images included a ringlike pattern, and homogeneous and inhomogeneous patterns. These results indicated that MR imaging shows abnormality 2 weeks after surgery at the latest. (author)

  7. Avascular necrosis of femoral and humeral heads in a HIV (+) patient

    International Nuclear Information System (INIS)

    Ubysz, R.; Wojtycha-Kwasnica, B.; Higersberger, J.

    2004-01-01

    Osteonecrosis (AVN-avascular necrosis) has been reported to occur occasionally among HIV-infected patient. The number of incidences appears to be rising. The hip is most commonly involved and often bilaterally. Osteonecrosis occurred more frequently in case of those patients who used systemically corticosteroids or testosterone, with hiperlipidemia, alcoholism and immune reconstruction. Case Report: A 28- year - old man, presented with a 2-years history of pain involving both hip joints and shoulders. Over the following weeks the pain was progressive. The patient had a history of HIV for 10 years before. He had a history of steroid use due to cerebellitis (3 years before). No other manifestations of AIDS was presented. The radiographs and CT examination presented irregular areas of increased endosteal density and with fragmentation femoral and humeral heads. Osteonecrosis in HIV (+) patients is most commonly associated with steroid use. HIV infected patients with persistent joints pain should be evaluated for this serious complication. Plain radiographs and TK examination help to establish the diagnosis. (author)

  8. Bilateral femoral head avascular necrosis with a very low dose of oral corticosteroid used for panhypopituitarism

    Science.gov (United States)

    Dharmshaktu, Pramila; Aggarwal, Anshita; Dutta, Deep; Kulshreshtha, Bindu

    2016-01-01

    Avascular necrosis (AVN) of the femoral head is a rare complication related to glucocorticoid administration and traditionally has been associated with high doses and/or prolonged therapy. Occurrence of osteonecrosis with a physiological replacement dose of glucocorticoids has not been reported previously. We report a 38-year-old man with non-secreting pituitary adenoma who developed bilateral AVN while on a very small dose of oral prednisolone for secondary adrenal insufficiency after surgery for pituitary adenoma. The patient was switched to hydrocortisone. Zolindronic acid was administered and the patient underwent bilateral core decompressive surgery resulting in a reduction of hip pain and improvement. When last evaluated, 2 years after diagnosis of AVN, the patient was functionally independent, and was able to do his routine activities with mild pain. The report intends to highlight the occurrence of AVN of the femur even with a very small dose of prednisolone used for treatment of panhypopituitarism. Glucocorticoids may have to be continued in the lowest possible dose using the most physiological preparation such as hydrocortisone when stoppage is not possible. PMID:26762348

  9. Stem cell- and growth factor-based regenerative therapies for avascular necrosis of the femoral head

    Science.gov (United States)

    2012-01-01

    Avascular necrosis (AVN) of the femoral head is a debilitating disease of multifactorial genesis, predominately affects young patients, and often leads to the development of secondary osteoarthritis. The evolving field of regenerative medicine offers promising treatment strategies using cells, biomaterial scaffolds, and bioactive factors, which might improve clinical outcome. Early stages of AVN with preserved structural integrity of the subchondral plate are accessible to retrograde surgical procedures, such as core decompression to reduce the intraosseous pressure and to induce bone remodeling. The additive application of concentrated bone marrow aspirates, ex vivo expanded mesenchymal stem cells, and osteogenic or angiogenic growth factors (or both) holds great potential to improve bone regeneration. In contrast, advanced stages of AVN with collapsed subchondral bone require an osteochondral reconstruction to preserve the physiological joint function. Analogously to strategies for osteochondral reconstruction in the knee, anterograde surgical techniques, such as osteochondral transplantation (mosaicplasty), matrix-based autologous chondrocyte implantation, or the use of acellular scaffolds alone, might preserve joint function and reduce the need for hip replacement. This review summarizes recent experimental accomplishments and initial clinical findings in the field of regenerative medicine which apply cells, growth factors, and matrices to address the clinical problem of AVN. PMID:22356811

  10. Diagnostic performance of MR imaging in the assessment of subchondral fractures in avascular necrosis of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Yeh, Lee-Ren [E-Da Hospital and I-Shou University, Department of Radiology, Kaohsiung County (China); Chen, Clement K.H.; Pan, Huay-Ben; Yang, Chien-Fang [Kaohsiung Veterans General Hospital, Department of Radiology, Kaohsiung (China); National Yang-Ming University, School of Medicine, Taipei (China); Huang, Yi-Luan [Kaohsiung Veterans General Hospital, Department of Radiology, Kaohsiung (China)

    2009-06-15

    A prospective study was conducted to determine the accuracy of routine magnetic resonance (MR) imaging in correctly identifying subchondral fracture in avascular necrosis of the femoral head without apparent focal collapse on standard radiographs. Spiral computed tomography (CT) with coronal and sagittal reformations and routine MR imaging with spin-echo T1WI and fat-suppressed spin-echo T2WI coronal, axial, and sagittal images were performed in 28 hips of 25 patients (M/F = 20:5; age 16-76 years) suffering from early-stage avascular necrosis of the femoral head on standard radiographs. The MR images were reviewed by a musculoskeletal radiologist and a general radiologist in blinded fashion. Using CT as the standard of reference, the accuracy of MR imaging in diagnosing subchondral fractures in avascular necrosis was evaluated. When the diagnoses of the two readers were compared with each other, only 16 of the 28 diagnoses (57.5%) agreed. Seventeen of the 28 MR imaging readings (60.7%) made by the musculoskeletal radiologist and 15 of the 28 (53.5%) made by the general radiologist agreed with those of the CT standard. False-positive diagnosis (that is, diagnosis of fracture when no fracture could be seen on CT) was more common than false-negative diagnosis. The accuracy of routine MR imaging in the evaluation of subchondral fracture is not satisfactory. False-positive diagnosis is not uncommon. Interpretation of routine MR imaging readout should be guarded. (orig.)

  11. Diagnostic performance of MR imaging in the assessment of subchondral fractures in avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Yeh, Lee-Ren; Chen, Clement K.H.; Pan, Huay-Ben; Yang, Chien-Fang; Huang, Yi-Luan

    2009-01-01

    A prospective study was conducted to determine the accuracy of routine magnetic resonance (MR) imaging in correctly identifying subchondral fracture in avascular necrosis of the femoral head without apparent focal collapse on standard radiographs. Spiral computed tomography (CT) with coronal and sagittal reformations and routine MR imaging with spin-echo T1WI and fat-suppressed spin-echo T2WI coronal, axial, and sagittal images were performed in 28 hips of 25 patients (M/F = 20:5; age 16-76 years) suffering from early-stage avascular necrosis of the femoral head on standard radiographs. The MR images were reviewed by a musculoskeletal radiologist and a general radiologist in blinded fashion. Using CT as the standard of reference, the accuracy of MR imaging in diagnosing subchondral fractures in avascular necrosis was evaluated. When the diagnoses of the two readers were compared with each other, only 16 of the 28 diagnoses (57.5%) agreed. Seventeen of the 28 MR imaging readings (60.7%) made by the musculoskeletal radiologist and 15 of the 28 (53.5%) made by the general radiologist agreed with those of the CT standard. False-positive diagnosis (that is, diagnosis of fracture when no fracture could be seen on CT) was more common than false-negative diagnosis. The accuracy of routine MR imaging in the evaluation of subchondral fracture is not satisfactory. False-positive diagnosis is not uncommon. Interpretation of routine MR imaging readout should be guarded. (orig.)

  12. Role of Ayurveda in the conservative management of avascular necrosis of the femoral head: A case study.

    Science.gov (United States)

    Chaturvedi, Ashutosh; Kumar, M Ashvini; Lohith, B A; Praveen, B S; Swathi, C

    2016-01-01

    Avascular necrosis (AVN) of the femoral head is the most common type of necrosis affecting the bones. Management of AVN aims at the preservation of structure, function and relief of from pain. Many surgical procedures such as drilling and insertion of bone grafts, modified Whitman or Colonna reconstruction and insertion of prosthesis are carried out to remedy the condition but all these procedures are costly with the prognosis being poor. Signs and symptoms of Avascular necrosis are nearer to asthivāha srotoduṣṭi vikāra (disorders of musculoskeletal origin) and can be considered with gambhīra avasthā (chronic stage). An effort has been made in the present study to evaluate the efficiency of Ayurvedic formulations in the conservative management of AVN of the femoral head. A case of AVN with bilateral femoral head was treated with rūkṣaṇa (Drying therapy) followed by śodhana (bio purification) and bṛhmaṇa (rejuvenation). Patient was observed for complications during whole course of treatment, untoward complications were not seen. Patient was observed for symptomatic improvements based on assessment done by the questionnaire over graded signs and symptoms before and after treatment. The results were encouraging. The therapy provided marked relief from pain, tenderness, stiffness and improvement in the gait. Conservative management of AVN through Ayurvedic principles provides significant relief and improves quality of life.

  13. Role of Ayurveda in the conservative management of avascular necrosis of the femoral head: A case study

    Directory of Open Access Journals (Sweden)

    Ashutosh Chaturvedi

    2016-01-01

    Full Text Available Avascular necrosis (AVN of the femoral head is the most common type of necrosis affecting the bones. Management of AVN aims at the preservation of structure, function and relief of from pain. Many surgical procedures such as drilling and insertion of bone grafts, modified Whitman or Colonna reconstruction and insertion of prosthesis are carried out to remedy the condition but all these procedures are costly with the prognosis being poor. Signs and symptoms of Avascular necrosis are nearer to asthivāha srotoduşṃi vikāra (disorders of musculoskeletal origin and can be considered with gambhīra avasthā (chronic stage. An effort has been made in the present study to evaluate the efficiency of Ayurvedic formulations in the conservative management of AVN of the femoral head. A case of AVN with bilateral femoral head was treated with rūkşaṃa (Drying therapy followed by śodhana (bio purification and bṃhmaṃa (rejuvenation. Patient was observed for complications during whole course of treatment, untoward complications were not seen. Patient was observed for symptomatic improvements based on assessment done by the questionnaire over graded signs and symptoms before and after treatment. The results were encouraging. The therapy provided marked relief from pain, tenderness, stiffness and improvement in the gait. Conservative management of AVN through Ayurvedic principles provides significant relief and improves quality of life.

  14. Risk stratification for avascular necrosis of the femoral head after internal fixation of femoral neck fractures by post-operative SPECT/CT

    Energy Technology Data Exchange (ETDEWEB)

    Han, Sang Won; Oh, Min Young; Yoon, Seok Ho; Kim, Jin Soo; Chang, Jae Suk; Ryu, Jin Sook [Asan Medical CenterUniversity of Ulsan College of Medicine, Seoul (Korea, Republic of); Kim, Ji Wan [Dept. of Orthopedic Surgery, Haeundae Paik Hospital, Inje University, Busan (Korea, Republic of)

    2017-03-15

    Avascular necrosis (AVN) of the femoral head is a major complication after internal fixation of a femoral neck fracture and determines the functional prognosis. We investigated postoperative bone single-photon emission computed tomography/computed tomography (SPECT/CT) for assessing the risk of femoral head AVN. We retrospectively reviewed 53 consecutive patients who underwent bone SPECT/CT within 2 weeks of internal fixation of a femoral neck fracture and follow-up serial hip radiographs over at least 12 months. Nine patients developed femoral head AVN. In 15 patients who showed normal uptake on immediate postoperative SPECT/CT, no AVN occurred, whereas 9 of 38 patients who showed cold defects of the femoral head later developed AVN. The negative predictive value of immediate postoperative SPECT/CT for AVN was 100 %, whereas the positive predictive value was 24 %. Among 38 patients with cold defects, 1 developed AVN 3 months postoperatively. A follow-up bone SPECT/CT was performed in the other 37 patients at 2–10 months postoperatively. The follow-up bone SPECT/CT revealed completely normalized femoral head uptake in 27, partially normalized uptake in 8, and persistent cold defects in 2 patients. AVN developed in 3.7 % (1/27), 62.5 % (5/8), and 100 % (2/2) of each group, respectively. According to the time point of imaging, radiotracer uptake patterns of the femoral head on postoperative bone SPECT/CT indicate the risk of AVN after internal fixation of femoral neck fractures differently. Postoperative bone SPECT/CT may help orthopedic surgeons determine the appropriate follow-up of these patients.

  15. Risk stratification for avascular necrosis of the femoral head after internal fixation of femoral neck fractures by post-operative SPECT/CT

    International Nuclear Information System (INIS)

    Han, Sang Won; Oh, Min Young; Yoon, Seok Ho; Kim, Jin Soo; Chang, Jae Suk; Ryu, Jin Sook; Kim, Ji Wan

    2017-01-01

    Avascular necrosis (AVN) of the femoral head is a major complication after internal fixation of a femoral neck fracture and determines the functional prognosis. We investigated postoperative bone single-photon emission computed tomography/computed tomography (SPECT/CT) for assessing the risk of femoral head AVN. We retrospectively reviewed 53 consecutive patients who underwent bone SPECT/CT within 2 weeks of internal fixation of a femoral neck fracture and follow-up serial hip radiographs over at least 12 months. Nine patients developed femoral head AVN. In 15 patients who showed normal uptake on immediate postoperative SPECT/CT, no AVN occurred, whereas 9 of 38 patients who showed cold defects of the femoral head later developed AVN. The negative predictive value of immediate postoperative SPECT/CT for AVN was 100 %, whereas the positive predictive value was 24 %. Among 38 patients with cold defects, 1 developed AVN 3 months postoperatively. A follow-up bone SPECT/CT was performed in the other 37 patients at 2–10 months postoperatively. The follow-up bone SPECT/CT revealed completely normalized femoral head uptake in 27, partially normalized uptake in 8, and persistent cold defects in 2 patients. AVN developed in 3.7 % (1/27), 62.5 % (5/8), and 100 % (2/2) of each group, respectively. According to the time point of imaging, radiotracer uptake patterns of the femoral head on postoperative bone SPECT/CT indicate the risk of AVN after internal fixation of femoral neck fractures differently. Postoperative bone SPECT/CT may help orthopedic surgeons determine the appropriate follow-up of these patients

  16. Necrosis avascular de cabeza y cuello de fémur en un paciente con sida Avascular osteonecrosis of femoral head and neck in an AIDS patient

    Directory of Open Access Journals (Sweden)

    María F. Villafañe

    2004-04-01

    Full Text Available La osteonecrosis avascular (ONA es una complicación que se describe con frecuencia creciente en pacientes infectados por el virus de la inmunodeficiencia humana tipo-1 (HIV-1. En su localización más común compromete la cabeza y cuello del fémur con dolor e impotencia funcional, en una o ambas caderas. Su etiología es multifactorial y la terapia antirretroviral de alta eficacia (HAART con inhibidores de proteasa (IP puede estar relacionada con la patogenia. En su evolución puede requerir el reemplazo total de la cadera con la colocación de una prótesis. Se presenta un paciente hemofílico, HIV-1 seropositivo, que desarrolló una ONA bilateral de cabeza y cuello de fémur mientras se encontraba bajo HAART.Avascular osteonecrosis (AON has increased in the last few years in patients infected with the human immunodeficiency virus type-1 (HIV-1. The most commonly affected bone is the femoral head and neck. Frequently these bilateral and clinical findings include moderate to severe pain and functional impotence of the affected joints. The etiology is multifactorial and highly active antiretroviral therapy (HAART with protease inhibitors (PI is probably related to its development. In the evolution, a total hip replacement may be needed. We present an hemophilic patient with AIDS, who developed a bilateral AON of the femoral head and neck during HAART.

  17. Magnetic resonance imaging of the femoral head to detect avascular necrosis in active rheumatoid arthritis treated with methylprednisolone pulse therapy

    Energy Technology Data Exchange (ETDEWEB)

    Vugt, R.M. van; Sijbrandij, E.S.; Bijlsma, J.W.J. [Univ. Hospital Utrecht (Netherlands)

    1996-03-01

    Efficacious management of patients with avascular necrosis of bone (AVN) necessitates the identification of patients with a high risk of collapse of the femoral head. In this prospective study we imaged both hips of 10 patients with active rheumatoid arthritis, who were treated with methylprednisolone pulse therapy. MRI and conventional radiography were performed before MP-pulse therapy and 6 and 12 months thereafter. Two patients showed unilateral changes compatible with AVN. One patient became symptomatic and revealed characteristic radiographic abnormalities. The other patient remained asymptomatic and the MRI appearance returned to normal after 6 months. 18 refs., 2 figs., 1 tab.

  18. Magnetic resonance imaging of the femoral head to detect avascular necrosis in active rheumatoid arthritis treated with methylprednisolone pulse therapy

    International Nuclear Information System (INIS)

    Vugt, R.M. van; Sijbrandij, E.S.; Bijlsma, J.W.J.

    1996-01-01

    Efficacious management of patients with avascular necrosis of bone (AVN) necessitates the identification of patients with a high risk of collapse of the femoral head. In this prospective study we imaged both hips of 10 patients with active rheumatoid arthritis, who were treated with methylprednisolone pulse therapy. MRI and conventional radiography were performed before MP-pulse therapy and 6 and 12 months thereafter. Two patients showed unilateral changes compatible with AVN. One patient became symptomatic and revealed characteristic radiographic abnormalities. The other patient remained asymptomatic and the MRI appearance returned to normal after 6 months. 18 refs., 2 figs., 1 tab

  19. Difference between T1 and T2 weighted MR images in avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Kokubo, Takashi; Yoshikawa, Koki; Itai, Yuzo; Iio, Masahiro; Takatori, Yoshio; Kamogawa, Morihide; Ninomiya, Setsuo

    1990-01-01

    T 1 and T 2 weighted MR images were compared in 32 hips with avascular necrosis, and the difference between them was discussed. In 27 of 32 hips, abnormal low intensity area in the affected femoral head is smaller in T 2 weighted images than in T 1 weighted images. The area of low intensity on T 1 weighted image and high on T 2 weighted image might be granuloma in reactive tissue and surrounding hyperemia. The difference between T 1 and T 2 weighted images must be taken into consideration especially in determination of the border of affected bone. (author)

  20. [Acupotomy and acupuncture in the treatment of avascular necrosis of femoral head at the early and middle stages:a clinical randomized controlled trial].

    Science.gov (United States)

    Wang, Zhanyou; Zhou, Xuelong; Xie, Lishuang; Liang, Dongyue; Wang, Ying; Zhang, Hong-An; Zheng, Jinghong

    2016-10-12

    To compare the efficacy difference between acupotomy and acupuncture in the treatment of avascular necrosis of femoral head at the early and middle stages. The randomized controlled prospective study method was adopted. Sixty cases of avascular necrosis of femoral head at Ficat-ArletⅠto Ⅱ stages were randomized into an acupotomy group (32 cases) and an acupuncture group (28 cases) by the third part. In the acupotomy group, the acupotomy was adopted for the loose solution at the treatment sites of hip joint, once every two weeks, totally for 3 times. In the acupuncture group, ashi points around the hip joint were selected and stimulated with warm acupuncture therapy, once every day, for 6 weeks. Harris hip score was observed before and after treatment. The efficacy was evaluated in the two groups. Harris hip score was improved significantly after treatment in the two groups (both P avascular necrosis of femoral head at the early and middle stages.

  1. Genetic traits of avascular necrosis of the femoral head analyzed by array comparative genomic hybridization and real-time polymerase chain reaction.

    Science.gov (United States)

    Hwang, Jung-Taek; Baik, Seung-Ho; Choi, Jin-Soo; Lee, Kweon-Haeng; Rhee, Seung-Koo

    2011-01-03

    In an attempt to observe the genetic traits of avascular necrosis of the femoral head, we analyzed the genomic alterations in blood samples of 18 patients with avascular necrosis of the femoral head (9 idiopathic and 9 alcoholic cases) using the array comparative genomic hybridization method and real-time polymerase chain reaction. Several candidate genes were identified that may induce avascular necrosis of the femoral head, and we investigated their role in the pathomechanism of osteonecrosis of bone. The frequency of each candidate gene over all the categories of avascular necrosis of the femoral head was also calculated by real-time polymerase chain reaction. The highest frequency specific genes in each category were FLJ40296, CYP27C1, and CTDP1. FLJ40296 and CYP27C1 had the highest frequency (55.6%) in the idiopathic category. FLJ40296 had a high frequency (44.4%) in the alcoholic category, but CYP27C1 had a relatively low frequency (33.3%) in the alcoholic category. However, CTDP1 showed a significantly high frequency (55.6%) in the alcoholic category and a low frequency (22.2%) in the idiopathic category. Although we statistically analyzed the frequency of each gene with Fisher's exact test, we could not prove statistical significance due to the small number of samples. Further studies are needed with larger sample numbers. If the causal genes of avascular necrosis of the femoral head are found, they may be used for early detection, prognosis prediction, and genomic treatment of avascular necrosis of the femoral head in the future. Copyright 2011, SLACK Incorporated.

  2. Results of treatment in patients with non traumatic avascular necrosis of the femoral head by monitor assisted core decompression

    International Nuclear Information System (INIS)

    Piperovski, T.

    2001-01-01

    The authors tried to evaluate the results of treatment in 32 patients (39 hips) with non-traumatic avascular necrosis (AVN) of the femoral head by monitor assisted core decompression. Average age - 44 years, 19 were male and 13 female. 7 patients had bilateral involvement. The diagnosis AVN has been made by anteroposterior and lateral conventional radiographs bone scintigraphy and MRI. It is also done histopathological examinations of the specimens taken during the operation in order to confirm the primary diagnosis. It is established early diagnosis in stage I, stage IIA and IIB (the modified staging system of Ficat and Arlet is used, in combination with the system of Steinberg at al.) All patients have been treated by core decompression. The operative technique used is modified Phemister, which is similar to Ficat- Arlet. After the operation periodically x-ray and MRI investigations are done. The mean follow up time is 4 years. 79.37% of the hips showed radiographic and MRI stabilization within 2-4 years after core decompression. In 10.25% the results are moderate and in the rest (10.25%) total or bi-polar hip prosthesis have been implanted. The benefit of core decompression in patients with non-traumatic avascular necrosis of the femoral head is justified

  3. [The role of core decompression for the treatment of femoral head avascular necrosis in renal transplant recipients].

    Science.gov (United States)

    Zivcić-Cosić, Stela; Stalekar, Hrvoje; Mamula, Mihaela; Miletić, Damir; Orlić, Lidija; Racki, Sanjin; Cicvarić, Tedi

    2012-10-01

    Avascular bone necrosis is a relatively rare but significant complication in renal transplant recipients because it causes progressive pain and invalidity. It can be the consequence of the action of numerous causative factors, but it is mostly connected to corticosteroid treatment.The underlying pathophysiologic mechanism is a diminished blood flow to the bone leading to necrosis and bone destruction. During the past 25-years period, 570 renal transplantations and five combined kidney and pancreas transplantations were performed in our centre. A part of the patients was lost to follow-up due to the separation of Croatia from the former Republic of Yugoslavia. After transplantation, we revealed aseptic necrosis of the femoral head in five female patients. All patients had a history of treatment with pulse doses of corticosteroids. At transplantation the average age of the patients was 52.2 yrs (range 46 to 62 yrs), and dialytic treatment before transplantation lasted in average 9.2 yrs (range 2.5 to 21.2 yrs). The period between renal transplantation and the development of clinical signs of avascular bone necrosis lasted in average 1.2 yrs (range 0.3 to 2.3 yrs). We will demonstrate our 62-year old female patient with terminal renal failure caused by post-streptococcal glomerulonephritis, who was treated with peritoneal dialysis 2.5 years before renal transplantation. Twenty months before renal transplantation the patient received pulse doses of corticosteroids, together with immunoglobulins and plasmapheresis, for the treatment of an acute polyradiculoneuritis Guillaine Barré. After transplantation a standard immunosuppressive protocol was applied which included tacrolimus, mycophenolate mofetil, corticosteroids and induction with basiliximab. Four months after transplantation the patient started to feel pain in the right hip after longer standing, in addition to the earlier long-lasting problems caused by bilateral coxarthrosis. The pelvic radiograph showed

  4. [Effect of vascular endothelial growth factor and tumor necrosis factor receptor for treatment of avascular necrosis of the femoral head in rabbits].

    Science.gov (United States)

    Hu, Zhi-ming; Zhou, Ming-qian; Gao, Ji-min

    2008-12-01

    To evaluate the therapeutic effect of vascular endothelial growth factor (VEGF) and tumor necrosis factor receptor (TNFR) on avascular necrosis of the femoral head in rabbits. Avascular necrosis of the femoral head was induced in 26 New Zealand white rabbits by injections of horse serum and prednisolone. The rabbits were then divided into VEGF/TNFR treatment group, VEGF treatment group, and untreated model group, with another 4 normal rabbits as the normal control group. In the two treatment groups, the therapeutic agents were injected percutaneously into the femoral head. Enzyme-linked immunosorbent assay was performed to determine the concentration of TNF-alpha in rabbit serum followed by pathological examination of the changes in the bone tissues, bone marrow hematopoietic tissue and the blood vessels in the femoral head. Compared with the model group, the rabbits with both VEGF and TNFR treatment showed decreased serum concentration of TNF-alpha with obvious new vessel formation, decreased empty bone lacunae in the femoral head and hematopoietic tissue proliferation in the bone marrow cavity. Percutaneous injection of VEGF and TNFR into the femoral head can significantly enhance bone tissue angiogenesis and ameliorate osteonecrosis in rabbits with experimental femoral head necrosis.

  5. [S3 Guideline. Part 3: Non-Traumatic Avascular Necrosis in Adults - Surgical Treatment of Atraumatic Avascular Femoral Head Necrosis in Adults].

    Science.gov (United States)

    Maus, U; Roth, A; Tingart, M; Rader, C; Jäger, M; Nöth, U; Reppenhagen, S; Heiss, C; Beckmann, J

    2015-10-01

    The present article describes the guidelines for the surgical treatment of atraumatic avascular necrosis (aFKN). These include joint preserving and joint replacement procedures. As part of the targeted literature, 43 publications were included and evaluated to assess the surgical treatment. According to the GRADE and SIGN criteria level of evidence (LoE), grade of recommendation (EC) and expert consensus (EK) were listed for each statement and question. The analysed studies have shown that up to ARCO stage III, joint-preserving surgery can be performed. A particular joint-preserving surgery currently cannot be recommended as preferred method. The selection of the method depends on the extent of necrosis. Core decompression performed in stage ARCO I (reversible early stage) or stage ARCO II (irreversible early stage) with medial or central necrosis with an area of less than 30 % of the femoral head shows better results than conservative therapy. In ARCO stage III with infraction of the femoral head, the core decompression can be used for a short-term pain relief. For ARCO stage IIIC or stage IV core decompression should not be performed. In these cases, the indication for implantation of a total hip replacement should be checked. Additional therapeutic procedures (e.g., osteotomies) and innovative treatment options (advanced core decompression, autologous bone marrow, bone grafting, etc.) can be discussed in the individual case. In elective hip replacement complications and revision rates have been clearly declining for decades. In the case of an underlying aFKN, however, previous joint-preserving surgery (osteotomies and grafts in particular) can complicate the implantation of a THA significantly. However, the implant life seems to be dependent on the aetiology. Higher revision rates for avascular necrosis are particularly expected in sickle cell disease, Gaucher disease, or kidney transplantation patients. Furthermore, the relatively young age of the patient

  6. The application of PRP combined with TCP in repairing avascular necrosis of the femoral head after femoral neck fracture in rabbit.

    Science.gov (United States)

    Zhang, X-L; Wang, Y-M; Chu, K; Wang, Z-H; Liu, Y-H; Jiang, L-H; Chen, X; Zhou, Z-Y; Yin, G

    2018-02-01

    In view of the high occurrence of avascular necrosis of the femoral head (ANFH) after femoral neck fracture and the difficulties in the treatment, our work aimed to explore the effects of platelet-rich plasma (PRP) combined with tri-calcium phosphate (TCP) on the repair of ANFH after femoral neck fracture and to provide reference for clinical treatment. Thirty New Zealand white rabbits were randomly divided into control group, TCP group, and PRP+TCP group. The rabbit ANFH model was established and femoral head tissues were collected. HE staining was used for histological observation. Image analysis and statistical analysis were used to calculate the New Bone Area fraction (NBA %). The levels of bone morphogenetic protein (BMP)-7, transforming growth factor (TGF)-β1, basic fibroblast growth factor (bFGF), interleukin (IL)-6 and tumor necrosis factor (TNF)-a in serum were detected by Enzyme-Linked ImmunoSorbent Assay (ELISA). The new bone area of TCP group was significantly lower than that of PRP+TCP group (pPRP+TCP groups (pPRP+TCP group was higher than that in TCP group. TCP and PRP+TCP can both significantly reduce the content of IL-6 and TNF-a (pPRP+TCP group compared with the TCP group at 8 weeks after injection. PRP combined with TCP, which can promote new bone formation and inhibit inflammatory response, showed higher efficiency in repairing ANFH than internal fixation alone.

  7. Outcome of total hip arthroplasty for avascular necrosis of the femoral head in systemic lupus erythematosus.

    Science.gov (United States)

    Woo, Min Su; Kang, Joon Soon; Moon, Kyoung Ho

    2014-12-01

    This study evaluated the result of total hip arthroplasty (THA) for avascular necrosis of the femur head (AVNFH) in systemic lupus erythematosus (SLE) patients. Nineteen THAs were performed on 13 patients with SLE. The results of these patients were compared with the results of the control group (19 patients) who had THR due to AVNFH with none-SLE conditions. The Harris hip score increased from a preoperative average of 65.3 points to 94.9 at the most recent follow-up. In the control group, the mean HHS was 67.2 preoperatively and 96.1 postoperatively at the last follow-up. No significant difference was found between SLE patients and non-SLE patients who underwent hip arthroplasty. In conclusion, THA is an acceptable treatment for achieving functional improvement in patients who had SLE and AVNFH. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Difference between T sub 1 and T sub 2 weighted MR images in avascular necrosis of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Kokubo, Takashi; Yoshikawa, Koki; Itai, Yuzo; Iio, Masahiro; Takatori, Yoshio; Kamogawa, Morihide; Ninomiya, Setsuo [Tokyo Univ. (Japan). Faculty of Medicine

    1990-01-01

    T{sub 1} and T{sub 2} weighted MR images were compared in 32 hips with avascular necrosis, and the difference between them was discussed. In 27 of 32 hips, abnormal low intensity area in the affected femoral head is smaller in T{sub 2} weighted images than in T{sub 1} weighted images. The area of low intensity on T{sub 1} weighted image and high on T{sub 2} weighted image might be granuloma in reactive tissue and surrounding hyperemia. The difference between T{sub 1} and T{sub 2} weighted images must be taken into consideration especially in determination of the border of affected bone. (author).

  9. Bilateral avascular necrosis of the femoral head following asynchronous postictal femoral neck fractures: a case report and review of the literature.

    Science.gov (United States)

    Venkatadass, K; Avinash, M; Rajasekaran, S

    2018-05-01

    Bilateral avascular necrosis (AVN) following postictal bilateral fracture neck of the femur is a rare occurrence. Here, we report a case of bilateral AVN of the femoral head following an asynchronous bilateral postictal fracture neck of the femur. A 16-year-old autistic boy presented with left hip pain following an episode of seizures and radiographs showed Delbet type II fracture neck of the left femur. This was treated by closed reduction and cancellous screw fixation and skeletal traction for 6 weeks. At 3 months, follow-up radiograph showed union of the fracture, but he had developed segmental AVN with collapse of the head. At 8 months, the patient presented with pain in the right hip following another episode of seizures and radiograph of the pelvis showed a fresh Delbet type II fracture neck of the right femur with established AVN of the left femoral head. He underwent closed reduction and cancellous screw fixation of the right hip and implant exit of the left hip. At the 6-month follow-up after this surgery, his radiograph of the pelvis showed AVN with collapse and extrusion of the femoral head on the right side as well. Literature review shows an increased risk of fracture neck of the femur among epileptics. The incidence of AVN is maximum in Delbet type I, followed by Delbet type II and type III in that order. Although there are no clear guidelines on the management of post-traumatic AVN of the femoral head, the majority have reported that most of them will eventually develop arthritis and will require total hip replacement at a later date. Upon extensive literature search, no case report of bilateral fracture neck of the femur with bilateral AVN was found and hence this case was reported.

  10. The physiopathology of avascular necrosis of the femoral head: an update.

    Science.gov (United States)

    Guerado, Enrique; Caso, Enrique

    2016-12-01

    The physiopathology of the femoral head bone necrosis is similar for children and for adults. The disease is characterized by apoptosis of bone cells - bone marrow and bone forming cells-resulting in head collapse with a subsequent lesion of the overlying cartilage, and therefore flattening of the rounded surface shape of the head articulating with the acetabulum, provoking, eventually, secondary osteoarthritis. When the disease becomes clinically evident already destructive phenomena have occurred and collapse will eventually ensue. In children, because epiphyseal cartilage has growth capabilities, lost epiphyseal height can be recovered, however in adults collapse is irreversible. In this paper the physiopathology of this disease is examined as well as its implication for treatment. Prevention by genetic studies is discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Superselective angiographic findings and the blood supply in the cases of avascular necrosis of the femoral head: a preliminary study

    International Nuclear Information System (INIS)

    Zhou Weisheng; Wang Fangjun; Ling Yisheng; Zhao Tianqing

    2003-01-01

    Objective: To study the superselective angiographic findings and blood supply in the case of avascular necrosis of the femoral head (ANFH). Methods: One hundred and sixty five patients (214 hips) with ANFH proved by clinic and radiology underwent superselective angiography and DSA findings were retrospectively studied. Results: Abnormal angiographic findings of the medial circumflex artery and its branches, with or without other abnormal vascularities, could be obtained in 162 hips out of 211 (98.6%). Angiographic findings of ANFH were the followings: abnormal superior and inferior capsular branch of the medial circumflex artery, especially the former one; abnormalities in the ascending branch of lateral circumflex artery; opacification of the femoral head and neck in the parenchymal phase of DSA; revasculization of the small arterial branches or a hypervascular area surrounding the necrotic lesions; anastomosis between the medial circumflex artery and the inferior and superior gluteal arteries; and the venous stasis. Conclusion: Morphological changes of blood vessels in ANFH are demonstrated by superselective angiography, in which the medial circumflex artery and its branches are mostly involved, or in some cases, accompanied by venous stasis

  12. Expression profile of osteoprotegerin, RANK and RANKL genes in the femoral head of patients with avascular necrosis.

    Science.gov (United States)

    Samara, Stavroula; Dailiana, Zoe; Chassanidis, Christos; Koromila, Theodora; Papatheodorou, Loukia; Malizos, Konstantinos N; Kollia, Panagoula

    2014-02-01

    Femoral head avascular necrosis (AVN) is a recalcitrant disease of the hip that leads to joint destruction. Osteoprotegerin (OPG), Receptor Activator of Nuclear Factor kappa-B (RANK) and RANK ligand (RANKL) regulate the balance between osteoclasts-osteoblasts. The expression of these genes affects the maturation and function of osteoblasts-osteoclasts and bone remodeling. In this study, we investigated the molecular pathways leading to AVN by studying the expression profile of OPG, RANK and RANKL genes. Quantitative Real Time-PCR was performed for evaluation of OPG, RANK and RANKL expression. Analysis was based on parallel evaluation of mRNA and protein levels in normal/necrotic sites of 42 osteonecrotic femoral heads (FHs). OPG and RANKL protein levels were estimated by western blotting. The OPG mRNA levels were higher (insignificantly) in the necrotic than the normal site (p > 0.05). Although the expression of RANK and RANKL was significantly lower than OPG in both sites, RANK and RANKL mRNA levels were higher in the necrotic part than the normal (p < 0.05). Protein levels of OPG and RANKL showed no remarkable divergence. Our results indicate that differential expression mechanisms for OPG, RANK and RANKL that could play an important role in the progress of bone remodeling in the necrotic area, disturbing bone homeostasis. This finding may have an effect on the resulting bone destruction and the subsequent collapse of the hip joint. Copyright © 2013. Published by Elsevier Inc.

  13. Cotransplantation of bone marrow mononuclear cells and umbilical cord mesenchymal stem cells in avascular necrosis of the femoral head.

    Science.gov (United States)

    Cai, J; Wu, Z; Huang, L; Chen, J; Wu, C; Wang, S; Deng, Z; Wu, W; Luo, F; Tan, J

    2014-01-01

    We sought to investigate the therapeutic effects of cotransplantation of autologous bone marrow mononuclear cells (BMMNCs) and allogeneic umbilical cord mesenchymal stem cells (UC-MSCs) on avascular necrosis of the femoral head (ANFH). In all, 30 patients (49 hips; 24 males and 6 females) with ANFH were enrolled. According to the system of the Association Research Circulation Osseous, there were 24 hips in phase II and 25 hips in phase Ⅲ. Blood supply to the femoral head was evaluated by using digital subtraction angiography. Generally, 60 to 80 mL of autologous BMMNCs and 30 to 50 mL of UC-MSCs were infused into the femoral head artery. Harris scores including pain and joint function were used to evaluate the effects before and 3, 6, 9, and 12 months after transplantation. Computed tomography and radiographs were performed before and 12 months after the treatment. Clinical symptoms of pain and claudication were gradually improved. After the treatment, 93.3% (28/30), 86.7% (26/30), and 86.7% (26/30) of patients showed relief of hip pain, improvement of joint function, and extended walking distances, respectively. The Harris scores were increased significantly at 3, 6, and 12 months posttransplant compared with those pretransplant. In addition, the bone lesions in 89.7% of hips (44/49) were improved as showed on computed tomography after transplantation. Cotransplantation of autologous BMMNCs and allogeneic UC-MSCs showed therapeutic effect on ANFH without severe adverse effects. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Aspects of postoperative magnetic resonance imaging of patients with avascular necrosis of the femoral head, treated by advanced core decompression

    Energy Technology Data Exchange (ETDEWEB)

    Lazik, Andrea; Lauenstein, Thomas C.; Theysohn, Jens M. [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Landgraeber, Stefan; Classen, Tim [University Hospital Essen, Department of Orthopedics, Essen (Germany); Kraff, Oliver [University of Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany)

    2015-10-15

    To analyze remodeling processes after advanced core decompression (ACD) in patients with avascular femoral head necrosis by means of 3T MRI and to identify indicators for clinical outcome considering the defect size and characteristics of the bone graft and of the neighboring regeneration tissue. Thirty-four hips, with preexisting preoperative MRIs in 21 cases, were examined 1-34 months (mean 12.7) postoperatively by 3T MRI. The volume of necrosis was measured manually pre- and postoperatively to calculate absolute as well as percentage necrosis reduction. The signal intensity of the bone graft was quantified using a 4-point scale. Border phenomena between the bone graft and bone were described and classified into groups. Wilcoxon sign-rank test was used to identify correlations between the analyzed items and clinical signs of femoral head collapse after a mean follow-up time of 28.6 months (10.4-46.8). Mean percentage reduction of necrosis was significantly higher in asymptomatic patients (59.36 %) compared to patients with signs of femoral head collapse (28.78 %, p = 0.008). Signal intensity of the bone graft increased in T1w and T2w TIRM sequences over time after surgery and was significantly higher in asymptomatic patients. Five border phenomena between the bone graft and healthy bone were identified. Among them, the so-called ''rail sign'' representing three layers of remodeling tissue correlated with the histological observations. A variety of border phenomena representing remodeling processes have been described using 3T MRI. Beneath the percentage amount of necrosis reduction, we identified the signal intensity of the bone graft as an indicator for clinical outcome. (orig.)

  15. Aspects of postoperative magnetic resonance imaging of patients with avascular necrosis of the femoral head, treated by advanced core decompression.

    Science.gov (United States)

    Lazik, Andrea; Landgraeber, Stefan; Claßen, Tim; Kraff, Oliver; Lauenstein, Thomas C; Theysohn, Jens M

    2015-10-01

    To analyze remodeling processes after advanced core decompression (ACD) in patients with avascular femoral head necrosis by means of 3T MRI and to identify indicators for clinical outcome considering the defect size and characteristics of the bone graft and of the neighboring regeneration tissue. Thirty-four hips, with preexisting preoperative MRIs in 21 cases, were examined 1-34 months (mean 12.7) postoperatively by 3T MRI. The volume of necrosis was measured manually pre- and postoperatively to calculate absolute as well as percentage necrosis reduction. The signal intensity of the bone graft was quantified using a 4-point scale. Border phenomena between the bone graft and bone were described and classified into groups. Wilcoxon sign-rank test was used to identify correlations between the analyzed items and clinical signs of femoral head collapse after a mean follow-up time of 28.6 months (10.4-46.8). Mean percentage reduction of necrosis was significantly higher in asymptomatic patients (59.36%) compared to patients with signs of femoral head collapse (28.78%, p = 0.008). Signal intensity of the bone graft increased in T1w and T2w TIRM sequences over time after surgery and was significantly higher in asymptomatic patients. Five border phenomena between the bone graft and healthy bone were identified. Among them, the so-called "rail sign" representing three layers of remodeling tissue correlated with the histological observations. A variety of border phenomena representing remodeling processes have been described using 3T MRI. Beneath the percentage amount of necrosis reduction, we identified the signal intensity of the bone graft as an indicator for clinical outcome.

  16. Aspects of postoperative magnetic resonance imaging of patients with avascular necrosis of the femoral head, treated by advanced core decompression

    International Nuclear Information System (INIS)

    Lazik, Andrea; Lauenstein, Thomas C.; Theysohn, Jens M.; Landgraeber, Stefan; Classen, Tim; Kraff, Oliver

    2015-01-01

    To analyze remodeling processes after advanced core decompression (ACD) in patients with avascular femoral head necrosis by means of 3T MRI and to identify indicators for clinical outcome considering the defect size and characteristics of the bone graft and of the neighboring regeneration tissue. Thirty-four hips, with preexisting preoperative MRIs in 21 cases, were examined 1-34 months (mean 12.7) postoperatively by 3T MRI. The volume of necrosis was measured manually pre- and postoperatively to calculate absolute as well as percentage necrosis reduction. The signal intensity of the bone graft was quantified using a 4-point scale. Border phenomena between the bone graft and bone were described and classified into groups. Wilcoxon sign-rank test was used to identify correlations between the analyzed items and clinical signs of femoral head collapse after a mean follow-up time of 28.6 months (10.4-46.8). Mean percentage reduction of necrosis was significantly higher in asymptomatic patients (59.36 %) compared to patients with signs of femoral head collapse (28.78 %, p = 0.008). Signal intensity of the bone graft increased in T1w and T2w TIRM sequences over time after surgery and was significantly higher in asymptomatic patients. Five border phenomena between the bone graft and healthy bone were identified. Among them, the so-called ''rail sign'' representing three layers of remodeling tissue correlated with the histological observations. A variety of border phenomena representing remodeling processes have been described using 3T MRI. Beneath the percentage amount of necrosis reduction, we identified the signal intensity of the bone graft as an indicator for clinical outcome. (orig.)

  17. Different Recipient Vessels for Free Microsurgical Fibula Flaps in the Treatment of Avascular Necrosis of the Femoral Head: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Tu, Yiji; Chen, Zenggan; Lineaweaver, William Charles; Zhang, Feng

    2017-12-01

    Several recipient vessels can be used in free microsurgical fibula flaps (MFFs) for the treatment of avascular necrosis of the femoral head (ANFH). Few articles investigate the influence of different recipient vessels on outcomes of MFF for ANFH. A comprehensive literature search of databases including PubMed-Medline, Ovid-Embase, and Cochrane Library was performed to collect the related studies. The Medical Subject Headings used were "femur head necrosis" and "bone transplantation." The relevant words in title or abstract included but not limited to "fibula flap," "fibular flap," "vascularized fibula," "vascularized fibular," "free fibula," "free fibular," "femoral head necrosis," "avascular necrosis of femoral head," and "ischemic necrosis of femoral head." The methodological index for nonrandomized studies was adopted for assessing the studies included in this review. Finally, 15 studies encompassing a total of 1267 patients (1603 hips) with ANFH were pooled in the overall analysis. Recipient vessels for MFF included the ascending branch of the lateral circumflex femoral artery and vein in 8 studies, descending branch of the lateral circumflex femoral artery and vein in 2 studies, second perforating branch of the deep femoral artery and vein in 4 studies, and inferior gluteal artery and vein in 1 study. Preoperative and postoperative average Harris hip score and pooled analyses of the rate of conversion, radiographic progression, and hip surgery-related complications showed no significant difference on the outcomes of MFF on ANFH between using different recipient vessels. Different recipient vessels did not affect outcomes in MFF procedures for ANFH. High-quality randomized controlled trials and prospective studies would be necessary to clarify reliable advantages and disadvantages between different recipient vessels. Until then, surgeons are justified in using ascending branch of the lateral circumflex femoral artery and vein, descending branch of the lateral

  18. Modifications to advanced Core decompression for treatment of Avascular necrosis of the femoral head

    OpenAIRE

    Landgraeber, Stefan; Warwas, Sebastian; Claßen, Tim; Jäger, Marcus

    2017-01-01

    Background “Advanced Core Decompression” (ACD) is a new technique for treatment of osteonecrosis of the femoral head (ONFH) that includes removal of the necrotic tissue using a percutaneous expandable reamer followed by refilling of the drill hole and the defect with an injectable, hard-setting, composite calcium sulphate (CaSO4)-calcium phosphate (CaPO4) bone graft substitute. As autologous bone has been shown to be superior to all other types of bone grafts, the aim of the study is to prese...

  19. Vascular endothelial growth factor/bone morphogenetic protein-2 bone marrow combined modification of the mesenchymal stem cells to repair the avascular necrosis of the femoral head

    Science.gov (United States)

    Ma, Xiao-Wei; Cui, Da-Ping; Zhao, De-Wei

    2015-01-01

    Vascular endothelial cell growth factor (VEGF) combined with bone morphogenetic protein (BMP) was used to repair avascular necrosis of the femoral head, which can maintain the osteogenic phenotype of seed cells, and effectively secrete VEGF and BMP-2, and effectively promote blood vessel regeneration and contribute to formation and revascularization of tissue engineered bone tissues. To observe the therapeutic effect on the treatment of avascular necrosis of the femoral head by using bone marrow mesenchymal stem cells (BMSCs) modified by VEGF-165 and BMP-2 in vitro. The models were avascular necrosis of femoral head of rabbits on right leg. There groups were single core decompression group, core decompression + BMSCs group, core decompression + VEGF-165/BMP-2 transfect BMSCs group. Necrotic bone was cleared out under arthroscope. Arthroscopic observation demonstrated that necrotic bone was cleared out in each group, and fresh blood flowed out. Histomorphology determination showed that blood vessel number and new bone area in the repair region were significantly greater at various time points following transplantation in the core decompression + VEGF-165/BMP-2 transfect BMSCs group compared with single core decompression group and core decompression + BMSCs group (P < 0.05). These suggested that VEGF-165/BMP-2 gene transfection strengthened osteogenic effects of BMSCs, elevated number and quality of new bones and accelerated the repair of osteonecrosis of the femoral head. PMID:26629044

  20. Management of avascular necrosis of femoral head at pre-collapse stage

    Directory of Open Access Journals (Sweden)

    Sen Ramesh

    2009-01-01

    Full Text Available In osteonecrosis the success of interventions that forestall or prevent femoral head collapse and maintain hip function would represent a substantial achievement in the treatment of this disease. A review of recent literature regarding bisphosphonate, anticoagulant, and vasodilators and biophysical modalities have demonstrated efficacy in reducing pain and delaying disease progression in early stage osteonecrosis. Though it has been considered still insufficient, to support their routine use in the treatment or prevention of osteonecrosis of the hip. Core decompression with modification of technique is still one of the safest and most commonly employed procedures with evidence based success in the pre-collapse stage of AVN of femoral head. The additional use of bone morphogenic protein, and bone marrow stem cells may provide the opportunity to enhance the results of core decompression. At present, the use of large vascularised cortical grafts, the other surgical procedure with high success rate is still not common due to technical difficulty in surgery. Likewise osteotomies are also not getting common as arthroplasty is getting more acceptable, so is awaited without any intermediate big surgical interventions.

  1. The impact of high total cholesterol and high low-density lipoprotein on avascular necrosis of the femoral head in low-energy femoral neck fractures.

    Science.gov (United States)

    Zeng, Xianshang; Zhan, Ke; Zhang, Lili; Zeng, Dan; Yu, Weiguang; Zhang, Xinchao; Zhao, Mingdong; Lai, Zhicheng; Chen, Runzhen

    2017-02-17

    Avascular necrosis of the femoral head (AVNFH) typically constitutes 5 to 15% of all complications of low-energy femoral neck fractures, and due to an increasingly ageing population and a rising prevalence of femoral neck fractures, the number of patients who develop AVNFH is increasing. However, there is no consensus regarding the relationship between blood lipid abnormalities and postoperative AVNFH. The purpose of this retrospective study was to investigate the relationship between blood lipid abnormalities and AVNFH following the femoral neck fracture operation among an elderly population. A retrospective, comparative study was performed at our institution. Between June 2005 and November 2009, 653 elderly patients (653 hips) with low-energy femoral neck fractures underwent closed reduction and internal fixation with cancellous screws (Smith and Nephew, Memphis, Tennessee). Follow-up occurred at 1, 6, 12, 18, 24, 30, and 36 months after surgery. Logistic multi-factor regression analysis was used to assess the risk factors of AVNFH and to determine the effect of blood lipid levels on AVNFH development. Inclusion and exclusion criteria were predetermined to focus on isolated freshly closed femoral neck fractures in the elderly population. The primary outcome was the blood lipid levels. The secondary outcome was the logistic multi-factor regression analysis. A total of 325 elderly patients with low-energy femoral neck fractures (AVNFH, n = 160; control, n = 165) were assessed. In the AVNFH group, the average TC, TG, LDL, and Apo-B values were 7.11 ± 3.16 mmol/L, 2.15 ± 0.89 mmol/L, 4.49 ± 1.38 mmol/L, and 79.69 ± 17.29 mg/dL, respectively; all of which were significantly higher than the values in the control group. Logistic multi-factor regression analysis showed that both TC and LDL were the independent factors influencing the postoperative AVNFH within femoral neck fractures. This evidence indicates that AVNFH was significantly

  2. [S3 guideline. Part 2: Non-Traumatic Avascular Femoral Head Necrosis in Adults - Untreated Course and Conservative Treatment].

    Science.gov (United States)

    Roth, A; Beckmann, J; Smolenski, U; Fischer, A; Jäger, M; Tingart, M; Rader, C; Peters, K M; Reppenhagen, S; Nöth, U; Heiss, C; Maus, U

    2015-10-01

    In Germany there are 5000 to 7000 new cases of atraumatic avascular necrosis of the femoral head in adults per year. It occurs mostly in middle age. An increased frequency of idiopathic cases can be observed. Chemotherapy, corticoids and kidney transplants are frequently associated with the disease. In most cases the disease occurs on both sides. Early diagnosis is of particular importance, since in early stages it is most likely to avoid late damage with joint destruction. Whereas previously the temporary operational joint preservation and subsequent joint replacement were often the only option of treatment, conservative and joint-preserving measures today play an increasing role. After the AWMF guidelines for S3 guideline clinical questions were formulated. Over the period from 01/01/1970 to 31/05/2013 a literature search was conducted. Systematic reviews, metaanalyses, original papers and clinical trials of all designs were evaluated. There were a total of 3715 references, of which 422 for the assessment regarding SIGN were eligible and finally 180 were in accord with the defined inclusion and exclusion criteria. For the untreated course and the assessment of conservative measures, a total of 42 references was suitable. In formulating the recommendations the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system was used, which distinguishes A "shall", B "should" and 0 "can". If left untreated, the aFKN within 2 years leads to a subchondral fracture and subsequent collapse. After the diagnosis of femoral head necrosis, the risk of a disease of the opposite side is high within the next 2 years, then unlikely. The sole conservative treatment brings no benefit for the treatment of atraumatic avascular necrosis in the adult. Although it improves function, less pain can be obtained, and surgical intervention can be delayed, the progression is not stopped. Conservative treatment must therefore always be part of the overall treatment. In ARCO

  3. Stem Cell Therapy for Avascular Necrosis of Femoral Head in Sickle Cell Disease: Report of 11 Cases and Review of Literature.

    Science.gov (United States)

    Sadat-Ali, Mir; Azam, Md Q; Elshabouri, Ezzat M; Tantawy, Ahmad M; Acharya, Sadananda

    2017-11-30

    Sickle cell disease (SCD) is quite common in eastern Saudi Arabia and Avascular necrosis of femoral head (ANFH) occurs in 30% of the young patients leading to early joint arthroplasty. This study was conducted to assess the benefits of injection of osteoblasts in the avascular lesions of the head of femur. A preset technique was used, 10 CC of bone marrow aspiration was performed under local anesthesia and aseptic technique. Osteoblasts were separated from the bone marrow cells. The avascular area was drilled and 10 million osteoblasts were transplanted at the lesion site. Patients were seen in the out patient clinic after two weeks for removal of the suture and addressed the questionnaire and examined for the range of movement. The follow up MRI was performed at 4 months. The average age was 20.2±3.9 years. The mean hemoglobin S was 81.6±4.8 percent. Quality of Life Score for Chronic Hip Disease was assessed and found at 8.6 (1 being the severe limitation and 10 being normal), whereas Harris hip score improved from 41.7±5.1 to 88.93±3.6 (p avascular lesions. The short term results were good and we believe the injection of osteoblast in the avascular lesion of head of femur is a less invasive procedure devoid of any untoward complications and merits such treatment in large patient group with longer follow up.

  4. MR imaging of avascular necrosis of the femoral head: Correlation with radiography, radionuclide scan and clinical finding

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Sik; Woo, Young Hoon; Joo, Yang Goo; Lee, Sung Moon; Zeon, Seok Kil; Suh, Soo Jhi; Kang, Chang Soo [School of Medicine, Keimyung University, Taegu (Korea, Republic of)

    1992-03-15

    To explore the ability of magnetic resonance imaging(MRI) in the diagnosis of avascular necrosis(AVN) of the femoral head, we compared appearances on MRI of 85 proven AVN lesions with those on radiographs(n=79) and radionuclide scans(n=75). Clinical symptoms(n=85) were also correlated. All MR studies included coronal and axial T1WI and coronal T2WI. All lesions involved the anterosuperterior aspect of the femoral head and were surrounded by a low signal intensity rim on both T1 and T2WI. The signal intensity of the lesions was variable depending on the disease course, and the lesions were divided into four classes according to the classification suggested by Mitchell. Radiographs were normal in 16%(13/79) of the lesions which were in MR class A(10), B(1), C(2). The radionuclide scans showed normal in 16%(12/75) of the lesions which were in MR class A(8). B(1), C(2), D(1). On the other hand, 93% of the lesions with MR class A(27/29) showed stage 1 and 2 lesions on radiographs. Clinical symptoms were absent in 25%(21/85) of the lesions, and among these,81%(17/21) were MR class A. Conclusively, MR is superior to the radiography and radionuclide scan in the early detection of AVN, and can also show the exact location, extent and signal characteristic of the lesion. Therefore, Mr is essential in diagnosis and management of AVN.

  5. MR imaging of avascular necrosis of the femoral head: Correlation with radiography, radionuclide scan and clinical finding

    International Nuclear Information System (INIS)

    Kim, Jung Sik; Woo, Young Hoon; Joo, Yang Goo; Lee, Sung Moon; Zeon, Seok Kil; Suh, Soo Jhi; Kang, Chang Soo

    1992-01-01

    To explore the ability of magnetic resonance imaging(MRI) in the diagnosis of avascular necrosis(AVN) of the femoral head, we compared appearances on MRI of 85 proven AVN lesions with those on radiographs(n=79) and radionuclide scans(n=75). Clinical symptoms(n=85) were also correlated. All MR studies included coronal and axial T1WI and coronal T2WI. All lesions involved the anterosuperterior aspect of the femoral head and were surrounded by a low signal intensity rim on both T1 and T2WI. The signal intensity of the lesions was variable depending on the disease course, and the lesions were divided into four classes according to the classification suggested by Mitchell. Radiographs were normal in 16%(13/79) of the lesions which were in MR class A(10), B(1), C(2). The radionuclide scans showed normal in 16%(12/75) of the lesions which were in MR class A(8). B(1), C(2), D(1). On the other hand, 93% of the lesions with MR class A(27/29) showed stage 1 and 2 lesions on radiographs. Clinical symptoms were absent in 25%(21/85) of the lesions, and among these,81%(17/21) were MR class A. Conclusively, MR is superior to the radiography and radionuclide scan in the early detection of AVN, and can also show the exact location, extent and signal characteristic of the lesion. Therefore, Mr is essential in diagnosis and management of AVN

  6. Avascular necrosis of the femoral head post heart-transplantation and steroid dosage.

    Science.gov (United States)

    Foley-Nolan, D; Daly, C; Barry, C; Woods, A; Neligan, M; Coughlan, R J

    1992-12-01

    Avascular necrosis (avn) post heart-transplantation has been considered to be due to the high doses of steroids used to immunosuppress these patients in attempting to prevent transplant rejection. This study shows that avascular necrosis occurs even when low dose steroids regimes are used and demonstrates no significant correlation between steroid dosage and the development of avn. Patients with symptomatic avn benefit from early diagnosis and management of their condition in that the need for total joint arthroplasty can be prevented in many cases.

  7. Avascular necrosis of the femoral head. Diagnostic and prognostic value of IRM

    Energy Technology Data Exchange (ETDEWEB)

    Sarrat, P; Lopez-Vazquez, M; Bouscarle, B; Acquaviva, P C; Lafforgue, P; Bernard, P

    1988-01-01

    The authors report their experience of magnetic resonance imaging (MRI) in the investigation of aseptic osteonecrosis (AON) of the femoral head in a series of 22 pathological hips (14 patients). The 5 radiologically normal pathological hips were suspected by the presence of a more advanced contralateral lesion and were confirmed by histology (trephine) or by the subsequent radiological course. MRI was performed with a superconductor apparatus (0.5 T) using weighted T1 (30-450 ms) and T2 (40-200 ms - 3 echos) sequences in frontal and sagittal scans allowing optimal evaluation of the topography and volume of the necrosis. Morphologically (T1), the low signal border is the most significant image. This is the first anomaly to be seen and it determines the final volume of the lesion. The reduction in the superior pole signal is not specific, but is correlated with the stage of the disease: it is normal in the earlier forms and gradually decreases as fibrosis develops. On the T2 scans, the features of the signal were identical to those of T1, but there was a ''double border'' (low signal border duplicated externally, in our experience, by a high signal), the appearance of which seems to be pathognomonic, but dependent on the type of imaging. In comparison with other imaging techniques (computed tomography, scintigraphy), MRI is the most sensitive method, providing an early diagnosis and a correlation with the stage of the lesion and assisting the choice of treatment.

  8. Early avascular necrosis of the femoral head: relationship of the findings of preoperative MRI and the long-term results of core decompression

    Energy Technology Data Exchange (ETDEWEB)

    Park, Dal Soo; Jeong, Gun Young [Taejeon Eulji Hospital, Taejeon (Korea, Republic of); Kwon, Soon Tae [Chungnam National Univ. College of Medicine, Taejeon (Korea, Republic of)] [and others

    1997-10-01

    To evaluate potential correlation between the extent and site of avascular necrosis (AVN), as determined by preoperative magnetic resonance (MR) imaging, and the development of femoral head collapse. Using clinical, radiographic and MR imaging criteria, twenty hips in 15 patients were selected for core decompression. Preoperative MR results were classified into three categories: group A, less than 15% involvement of the weight-bearing portion of the femoral head; group B, 15%-30% involvement; group C, more than 30% involvement, according to ARCO staging. We also established three groups according to site of involvement of the femoral head namely medial, middle and lateral. Of 20 cases, three were stage Ia; two, Ib; four, Ic; three, 2a; two, 2b; and 6, 2c. Ten cases of Ia, Ib, 2a or 2b showed no femoral head collapse during follow-up of at least 24 months, while ten cases of Ic or 2c showed femoral head collapse. The prognosis of core decompression in patients with early AVN is related to the area of lesion in the femoral head.

  9. Early avascular necrosis of the femoral head: relationship of the findings of preoperative MRI and the long-term results of core decompression

    International Nuclear Information System (INIS)

    Park, Dal Soo; Jeong, Gun Young; Kwon, Soon Tae

    1997-01-01

    To evaluate potential correlation between the extent and site of avascular necrosis (AVN), as determined by preoperative magnetic resonance (MR) imaging, and the development of femoral head collapse. Using clinical, radiographic and MR imaging criteria, twenty hips in 15 patients were selected for core decompression. Preoperative MR results were classified into three categories: group A, less than 15% involvement of the weight-bearing portion of the femoral head; group B, 15%-30% involvement; group C, more than 30% involvement, according to ARCO staging. We also established three groups according to site of involvement of the femoral head namely medial, middle and lateral. Of 20 cases, three were stage Ia; two, Ib; four, Ic; three, 2a; two, 2b; and 6, 2c. Ten cases of Ia, Ib, 2a or 2b showed no femoral head collapse during follow-up of at least 24 months, while ten cases of Ic or 2c showed femoral head collapse. The prognosis of core decompression in patients with early AVN is related to the area of lesion in the femoral head

  10. Evaluation of the muscle morphology of the obturator externus and piriformis as the predictors of avascular necrosis of the femoral head in acetabular fractures.

    Science.gov (United States)

    Maini, Lalit; Kumar, Santosh; Batra, Sahil; Gupta, Rajat; Arora, Sumit

    2016-08-01

    Avascular necrosis (AVN) of femoral head is a recognised complication of fracture dislocation of the hip joint but is not studied frequently in relation to acetabulum fractures. The aim was to establish the relationship between obturator externus and piriformis muscle morphology in acetabulum fractures and potenital development of AVN of the femoral head. Twenty-five fractures were included in this prospective study and were subjected to radiological assessment and computed tomography of the pelvis. Magnetic resonance imaging (MRI) of the hip was performed to assess the morphology of obturator externus and piriformis, and findings were compared intraoperatively (in 15 cases). Serial radiographs were taken at monthly intervals to assess the development of avascular necrosis. The patients with no evidence of AVN on radiographs at 6 months had additional MRI scans to look for such changes. Three patients developed AVN of femoral head and two had complete tears of piriformis and/or obturator externus muscles on the pre-operative MRI with the findings confirmed intraoperatively (p = 0.013). None of the patients without changes of AVN at 6-month follow-up had complete tears of either or both muscles. Of these patients, there was one case each of T-type fracture, isolated posterior wall fracture with hip dislocation, and posterior wall with transverse fracture of the acetabulum. Complete tears of obturator externus and/or piriformis muscles are a strong predictor of future development of AVN of the femoral head.

  11. Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years.

    Science.gov (United States)

    Song, Hyung Keun; Choi, Ho June; Yang, Kyu Hyun

    2016-12-01

    The aim of our study was to identify the risk factors for avascular necrosis of the femoral head (AVN) and fixation failure (FF) after screw osteosynthesis in patients with valgus angulated femoral neck fractures. We conducted a retrospective study of 308 patients (mean age, 72.5 years, range, 50-97 years), with a mean follow-up of 21.4 months (range, 12-64 months). The risk for failure in treatment (FIT) associated with patient- and fracture-related factors was evaluated by logistic regression analyses. FIT was identified in 32 cases (10.3%): 22 cases (7.1%) of AVN and 10 cases (3.2%) of FF. Initial valgus tilt>15° (p=0.023), posterior tilt>15° (p=0.012), and screw sliding distance (p=0.037) were significantly associated with FIT. FIT occurred in 7 patients (5.2%) with B1.2.1 fractures and 17 patients (48.6%) with B1.1.2 fractures (p15° (B1.1.2) compared to patients with 15° are reasonable candidates for primary arthroplasty due to high risk of FIT. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Effectiveness of Lower Energy Density Extracorporeal Shock Wave Therapy in the Early Stage of Avascular Necrosis of the Femoral Head.

    Science.gov (United States)

    Han, Yong; Lee, June-Kyung; Lee, Bong-Yeon; Kee, Hoi-Sung; Jung, Kwang-Ik; Yoon, Seo-Ra

    2016-10-01

    To evaluate the effectiveness of lower energy flux density (EFD) extracorporeal shock wave therapy (ESWT) in the early stage of avascular necrosis (AVN) of the femoral head. Nineteen patients and 30 hips were enrolled. All subjects received 4 weekly sessions of ESWT, at different energy levels; group A (n=15; 1,000 shocks/session, EFD per shock 0.12 mJ/mm 2 ) and group B (n=15; 1,000 shocks/session, EFD per shock 0.32 mJ/mm 2 ). We measured pain by using the visual analog scale (VAS), and disability by using the Harris hip score, Hip dysfunction and Osteoarthritis Outcome Score (HOOS), and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). To determine the effect of the lower EFD ESWT, we assessed the VAS, Harris hip score, HOOS, WOMAC of the subjects before and at 1, 3, and 6 months. In both groups, the VAS, Harris hip score, HOOS, and WOMAC scores improved over time (p<0.05). Lower EFD ESWT may be an effective method to improve the function and to relieve pain in the early stage of AVN.

  13. Stem cell therapy for the treatment of early stage avascular necrosis of the femoral head: a systematic review

    Science.gov (United States)

    2014-01-01

    Background Avascular necrosis (AVN) of the femoral head (FH) is believed to be caused by a multitude of etiologic factors and is associated with significant morbidity in younger populations. Eventually, the disease progresses and results in FH collapse. Thus, a focus on early disease management aimed at joint preservation by preventing or delaying progression is key. The use of stem cells (SC) for the treatment of AVN of the FH has been proposed. We undertook a systematic review of the medical literature examining the use of SC for the treatment of early stage (precollapse) AVN of the FH, in both pre-clinical and clinical studies. Methods Data collected included: Pre-clinical studies – model of AVN, variety and dosage of SC, histologic and imaging analyses. Clinical studies – study design, classification and etiology of AVN, SC dosage and treatment protocol, incidence of disease progression, patient reported outcomes, volume of necrotic lesion and hip survivorship. Results In pre-clinical studies, the use of SC uniformly demonstrated improvements in osteogenesis and angiogenesis, yet source of implanted SC was variable. In clinical studies, groups treated with SC showed significant improvements in patient reported outcomes; however hip survivorship was not affected. Discrepancies regarding dose of SC, AVN etiology and disease severity were present. Conclusions Routine use of this treatment method will first require further research into dose and quality optimization as well as confirmed improvements in hip survivorship. PMID:24886648

  14. Correlation of cumulative corticosteroid treatment with magnetic resonance imaging assessment of avascular femoral head necrosis in patients with multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Nilufer Kale

    2010-10-01

    Full Text Available Increased risk of osteoporosis, fractures, and avascular necrosis (AVN has been suggested in multiple sclerosis (MS. Patients with MS are often exposed to corticosteroid treatment (CST during the disease course and conflicting reports exist regarding complications of CST. Our study aims to investigate the association between cumulative doses of CST and radiographic evaluation of AVN of the femoral head in MS. Twenty-six MS patients (mean age, 38.4±10 yr were enrolled and prospectively evaluated for AVN by magnetic resonance imaging (MRI. The mean disease duration was 11.5±8.5 years and mean expanded disability status scale (EDSS score was 3±2. The cumulative dosage of CST varied between 20 g and 60 g; patients were grouped into two categories: 1 CST between 20-40 g, 17 (65% patients; 2 CST ≥40 g; 9 (35% patients. The relationship between cumulative CST dosage and MRI diagnosis of AVN was stat­istically insignificant (P>0.9. Clarification of the cumulative effect of CST in the development of AVN is of great importance for future long-term steroid treatment strategies.

  15. Avascular necrosis of femoral heads post-adrenal surgery for Cushing's syndrome: a rare presentation.

    LENUS (Irish Health Repository)

    2012-01-31

    Avascular necrosis (AVN) is a well-recognized complication of patients on high-dose steroids for a long time. Exogenous hypercortisolism is a well known cause of AVN and a number of cases have been reported. Cushing\\'s syndrome describes hypercortisolism of any cause endogenous or exogenous. A variety of traumatic and non-traumatic factors contribute to the aetiology of AVN although exogenous glucocorticoids administration and alcoholism are among the most common non-traumatic causes. AVN secondary to endogenous hypercortisolism is rare and very few case reports are available describing this complication. No literature is available on AVN presenting post-adrenal surgery. Here we present a young woman who presented with avascular necrosis of both hips 1 year after adrenalectomy for Cushing\\'s syndrome.

  16. Experimental survey on percutaneous injection of calcium phosphate cement in preventing the articular surface collapsing secondary to avascular necrosis of femoral head

    International Nuclear Information System (INIS)

    Hou Changlong; Lv Weifu; Zhang Xuebin; Wang Weiyu; Zhang Xingming

    2007-01-01

    Objective: To study the technical way for animal model of ANFH with TAE (transcatheter arterial embolization)and to observe the image and pathologic changes of percutaneous injection with CPC (Calcium Phosphate Cement)in preventing the articular surface collapsing secondary to ANFH (avascular necrosis of femoral head)in pigs and its feasibility and safety. Methods: Branch arteries of the pig's left femoral head were embolized with woolly threads. Twenty pigs were randomly divided into A and B groups, and after about 1 month changes were assessed by imagings. Group A(n=8)was served as control of model contrast group, with only TAE and then surveyed the avascular necrosis features of femoral head by imaging together with pathologic and histologic examinations. Group B (n=12) was designated as percutaneous injection with CPC for interventional treatment group of ANFH at the stage Ficat II. Results: The animal models of ANFH in early stage were established by embolization of feeding arteries. In Group A, bone collapse occurred in 1.5 months after TAE, with imaging features of femoral head necrosis aggravated gradually. In group B, technical success of percutaneous injection with CPC was high and technical criteria included precise injection time, vigorous percutaneous fixing of bone, suitable proportion of CPC powder to liquid. CT scan of femoral head with injection CPC showed that it diffused well. Volume of bone trabecula (TBV)and percentage of bone lacuna (PBL)at unit area under microscopy were also inspected in two groups. TBV and PBL of two groups were compared in different special times and calculated especially for group B (P<0.05). Conclusion: The percutaneous injection of CPC to femoral head is a quite safe and effective palliative therapy for ANFH in early stage. (authors)

  17. Comparison of Outcomes of Total Hip Arthroplasty between Patients with Ankylosing Spondylitis and Avascular Necrosis of the Femoral Head.

    Science.gov (United States)

    Lee, Sun-Ho; Lee, Gun-Woo; Seol, Young-Jun; Park, Kyung-Soon; Yoon, Taek-Rim

    2017-09-01

    The objective of this study was to compare clinical and radiological outcomes of total hip arthroplasty (THA) between ankylosing spondylitis (AS) of the hip joint and avascular necrosis (AVN) of the femoral head. Thirty patients (30 hips) underwent cementless THA for AS between 2003 and 2012. They were compared to 30 patients (30 hips) who underwent the same procedure for AVN of the femoral head. Each group was matched for age and gender, and both groups had similar preoperative demographic characteristics. All cases were followed for minimum 4 postoperative years. Clinical evaluation was based on operation time, intraoperative blood loss, quantity of postoperative drainage, Harris Hip Score (HHS), and range of motion (ROM). Radiological results were evaluated by acetabular cup anteversion and inclination, femoral stem orientation, pre- and postoperative leg length discrepancy, and postoperative complications. The operation time was significantly longer in the AS group (120.2 ± 26.2 min) than in the AVN group (79.5 ± 11.1 min). The volume of postoperative drainage was significantly greater in the AS group (764.5 ± 355.4 mL vs. 510.5 ± 195.6 mL). Preoperative HHS was lower in the AS group (55.6 ± 13.8 vs. 59.2 ± 2.8). Similarly, postoperative HHS was significantly lower in the AS group (92.8 ± 2.7 vs. 97.4 ± 2.6). The arc of ROM was improved from 146.5° ± 13.2° preoperatively to 254.7° ± 17.2° postoperatively in the AS group and from 182.6° ± 15.5° to 260.4° ± 13.7° in the AVN group. Implant position and postoperative leg length discrepancy were not different between the groups. However, three cases of heterotopic ossification was observed in the AS group, whereas only 1 case was found in the AVN group. One deep infection and one aseptic stem loosening were found in the AS group, whereas none was observed in the AVN group. Cementless THA showed satisfactory clinical and radiological results in both groups, despite the longer operation time

  18. Prediction of traumatic avascular necrosis of the femoral head by single photon emission computerized tomography and computerized tomography: an experimental study in dogs

    Directory of Open Access Journals (Sweden)

    SHEN Feng

    2012-02-01

    Full Text Available 【Abstract】 Objective: To evaluate the femoral head perfusion and to predict the traumatic avascular necrosis (AVN of the femoral head by single photon emission computerized tomography and computerized tomography (SPECT/CT. Methods: Totally 18 adult beagle dogs were divided randomly into three equal-sized (n=6 groups. Subsequently different degrees of ischemia model were developed by destroying blood vessels of the femoral head. The left hip received sham operation as normal control and the right hip underwent blood interruption. In Group A, the ligamentum teres was cut off. In Group B, the marrow cavity of the right femoral neck was destroyed while in Group C, the soft tissues at the base of the femoral neck were stripped in addition to the resection of the ligamentum teres and destruction of the marrow cavity. Three hours after surgery, SPECT/CT was performed. Laser Doppler Flowmetry (LDF measurements were also obtained at three different time points (before operation, immediately and three hours after operation in order to assess the change process of blood supply to the femoral head. Results: SPECT/CT showed no significant difference in the radionuclide uptake between the right and left femoral heads in Group A (t=-0.09, P=0.94 and Group B (t= 0.52, P=0.62. However, in Group C, it was 261±62 for the right femoral head, only 12% of that in the left femoral head. LDF measurements indicated that the femoral head perfusion was decreased from (45.0±3.3 PU to (39.1±3.7 PU in Group A, from (44.0±2.7 PU to (34.3±2.6 PU in Group B, and from (47.3±2.1 PU to (4.96±0.6 PU in Group C immediately after operation. However, the perfusion was restored and returned to normal values three hours after operation except in Group C. Conclusion: SPECT/CT could assess the perfusion of the femoral head semiquantitatively, which might be useful in predicting the development of traumatic AVN. Key words: Femur head necrosis; Femoral head; Tomography, emission

  19. The usefulness of postoperative pinhole bone scintigraphy in the assessment of prognosis after multiple drilling or vascularized bone graft in patients with avascular necrosis of femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Young An; Kim, Sung Hoon; Cheon, Kyung Ah; Park, Young Ha; Jeong, Soo Kyo [College of Medicine, The Catholic Univ., Seoul (Korea, Republic of); Song Moon Kab [Eulji Medical Center, Taejon (Korea, Republic of)

    1999-08-01

    It is important to evaluate the healing process of avascular necrosis (AVN) involving femoral head after treatment. The purpose of this study was to assess the usefulness of pinhole bone scintigraphy in the AVN of femoral head after surgery. We analyzed the changing pattern of pinhole bone scintigram in 21 femoral heads of 16 patients (14 lesions/11 male, 7 lesions/5 female, mean age : 39.4 yrs) before and after multiple drilling or vascularized bone grafting for AVN of the femoral head. In all patients, pre-operative scintigrams were obtained at 1 to 3 months before treatment and the first post-operative scintigrams were obtained at 1 to 3 months after treatment. All patients were followed for 2 to 4 years after operation. The findings of the pinhole scintigrams were divided into three patterns: 1) curvilinear, 2) scattered spotty and 3) underdetermined. The 10 of 11 lesions with curvilinear pattern had good postoperative clinical and radiological follow-up findings. However, all 6 lesions with scattered spotty pattern showed poor postoperative findings, which necessitated total hip joint replacement. Of the 4 lesions with undetermined pattern, 2 required total hip joint replacement. There was significant difference in postoperative prognosis between the curvilinear and scattered spotty patterns (p<0.05). We conclude that the pattern of pinhole bone scintigram obtained within 1 to 3 months after multiple drilling or vascularized bone graft operation is a useful prognostic indicator in the AVN of femoral head.

  20. The usefulness of postoperative pinhole bone scintigraphy in the assessment of prognosis after multiple drilling or vascularized bone graft in patients with avascular necrosis of femoral head

    International Nuclear Information System (INIS)

    Jeong, Young An; Kim, Sung Hoon; Cheon, Kyung Ah; Park, Young Ha; Jeong, Soo Kyo; Song Moon Kab

    1999-01-01

    It is important to evaluate the healing process of avascular necrosis (AVN) involving femoral head after treatment. The purpose of this study was to assess the usefulness of pinhole bone scintigraphy in the AVN of femoral head after surgery. We analyzed the changing pattern of pinhole bone scintigram in 21 femoral heads of 16 patients (14 lesions/11 male, 7 lesions/5 female, mean age : 39.4 yrs) before and after multiple drilling or vascularized bone grafting for AVN of the femoral head. In all patients, pre-operative scintigrams were obtained at 1 to 3 months before treatment and the first post-operative scintigrams were obtained at 1 to 3 months after treatment. All patients were followed for 2 to 4 years after operation. The findings of the pinhole scintigrams were divided into three patterns: 1) curvilinear, 2) scattered spotty and 3) underdetermined. The 10 of 11 lesions with curvilinear pattern had good postoperative clinical and radiological follow-up findings. However, all 6 lesions with scattered spotty pattern showed poor postoperative findings, which necessitated total hip joint replacement. Of the 4 lesions with undetermined pattern, 2 required total hip joint replacement. There was significant difference in postoperative prognosis between the curvilinear and scattered spotty patterns (p<0.05). We conclude that the pattern of pinhole bone scintigram obtained within 1 to 3 months after multiple drilling or vascularized bone graft operation is a useful prognostic indicator in the AVN of femoral head

  1. Bone mesenchymal stem cells co-expressing VEGF and BMP-6 genes to combat avascular necrosis of the femoral head.

    Science.gov (United States)

    Liao, Hongxing; Zhong, Zhixiong; Liu, Zhanliang; Li, Liangping; Ling, Zemin; Zou, Xuenong

    2018-01-01

    The aim of the present study was to investigate the potential of bone mesenchymal stem cells (BMSCs) treated with a combination of vascular endothelial growth factor (VEGF) and bone morphogenetic protein-6 (BMP-6) genes for the treatment of avascular necrosis of the femoral head (ANFH). Rat BMSCs were isolated and purified using a density gradient centrifugation method. The purity and characteristics of the BMSCs were detected by cell surface antigens identification using flow cytometry. The experimental groups were administered with one of the following adeno-associated virus (AAV) vector constructs: AAV-green fluorescent protein (AAV-GFP), AAV-BMP-6, AAV-VEGF or AAV-VEGF-BMP-6. The expression of VEGF and BMP-6 was detected by reverse transcription-quantitative polymerase chain reaction, western blotting and ELISA assays. The effects of VEGF and BMP-6 on BMSCs were evaluated by angiogenic and osteogenic assays. The transfected BMSCs were combined with a biomimetic synthetic scaffold poly lactide-co-glycolide (PLAGA) and they were then subcutaneously implanted into nude mice. After four weeks, the implants were analyzed with histology and subsequent immunostaining to evaluate the effects of BMSCs on blood vessel and bone formation in vivo . In the AAV-VEGF-BMP-6 group, the expression levels of VEGF and BMP-6 were significantly increased and human umbilical vein endothelial cells tube formation was significantly enhanced compared with other groups. Capillaries and bone formation in the AAV-VEGF-BMP-6 group was significantly higher compared with the other groups. The results of the present study suggest that BMSCs expressing both VEGF and BMP-6 induce an increase in blood vessels and bone formation, which provides theoretical support for ANFH gene therapy.

  2. [Fracture Type and Injury-to-Surgery Interval as Risk Factors for Avascular Necrosis of the Femoral Head after Internal Fixation of Intracapsular Femoral Neck Fracture].

    Science.gov (United States)

    Popelka, O; Skála-Rosenbaum, J; Bartoška, R; Waldauf, P; Krbec, M; Džupa, V

    2015-01-01

    The aim of the study was to investigate the occurrence of avascular necrosis (AVN) of the femoral head following the osteosynthesis of intracapsular fracture of the femoral neck in relation to the time interval between injury and surgery and the type of fracture. The data of patients with intracapsular fractures of the femoral neck surgically treated in the period from 2001 to 2011 were reviewed. Of 1555 patients treated for this fracture, 125 (7%) underwent osteosynthesis. The evaluated group included 115 patients who came for examination at one-year follow-up. There were 59 (52%) women and 56 (48%) men. Dynamic hip screw (DHS) osteosynthesis with an anti-rotation screw was performed in 103 patients and lag-screw osteosynthesis involving three parallel cannulated cancellous screws was employed in 12 patients. The patients were allocated to groups according to the injury-to-surgery interval and to sub-groups on the basis of the Garden classification of femoral fracture stage. In the group of 58 patients treated within 6 h of injury, AVN developed in 10 (17%). When the type of fracture was considered, 4% of the non-displaced fractures and 30% of the displaced fractures developed AVN. The patients with Garden stage I and II (non-displaced) fractures treated within 6 h of injury had a significantly lower risk of AVN development than those with Garden stage III or IV (displaced) fractures. The group treated between 6 and 24 post-injury hours comprised 21 patients, of whom four (19%) had AVN. In non-displaced and displaced fracture sub-groups, 25% of the patients in the former and 16% in the latter had AVN. The stage of displacement had no effect on AVN development. The two groups together (patients treated by 24 h) had a significantly lower AVN incidence than the patients treated after 24 h (p = 0.0025). In this group of 36 patients, 16 had AVN (44%) and the fracture stage made no significant difference (p = 0.6985; nondisplacement sub-group, 41%; displacement sub

  3. Post-traumatic avascular necrosis of the femoral head predicted by preoperative technetium-99m antimony-colloid scan: an experimental and clinical study

    International Nuclear Information System (INIS)

    Turner, J.H.

    1983-01-01

    Technetium-99m antimony colloid was used to visualize the bone marrow of the head of the femur within twenty-four hours after interruption of the blood supply by subcapital osteotomy and section of the ligamentum teres in thirteen rabbits and within twenty-four hours after a subcapital fracture in thirty patients. Of the rabbits, all showed loss of marrow radioactivity over the affected femoral head. Bone-imaging with technetium-99m methylene diphosphonate, in contrast, failed to demonstrate any abnormality in the avascular head of the femur for as long as forty-eight hours after osteotomy. This difference between the marrow scan and the bone scan was attributed to earlier loss of function in the marrow cells than in the osteocytes. The thirty patients who had a preoperative scan within twenty-four hours after sustaining a subcapital fracture were treated by internal fixation with a Richards screw and plate and were followed for as long as two years, or until the patient died or radiographs showed evidence of avascular necrosis. The preoperative technetium-99m antimony-colloid activity in the head of the fractured femur was normal in sixteen patients and absent in fourteen; two of the fourteen had no activity in either hip, which precluded assessment of the fractured hip in these patients. In fifteen of the sixteen hips, preservation of the uptake in the marrow of the head of the fractured femur preoperatively predicted normal healing. Late segmental collapse developed in the remaining hip. In eleven of the twelve patients who had loss of marrow activity in the femoral head preoperatively, avascular necrosis developed within two years

  4. Avascular necrosis associated with nailing of femoral neck fracture

    International Nuclear Information System (INIS)

    Stroemqvist, B.; Hansson, L.I.

    1983-01-01

    Two patients with femoral neck fractures, one displaced and one undisplaced, are presented. Preoperative intravital staining with tetracycline and Tc-MDP scintimetry both showed intact femoral head circulation while Tc-MDP-scintimetry 1 week after operation showed pronounced circulatory deficiency. SR 85 -scintimetry performed at the same time was inconclusive. Segmental collapse was observed radiographically, 8 and 12 months postoperatively. The major vascular injury resulting in avascularity most probably occured during the procedure of osteosynthesis, and Tc-MDP-scintimetry was found suitable for early postoperative recognition of avascular necrosis in both fractures. (author)

  5. Avascular necrosis associated with nailing of femoral neck fracture

    Energy Technology Data Exchange (ETDEWEB)

    Stroemqvist, B; Hansson, L I [Department of Orthopaedic Surgery, University Hospital in Lund, Sweden

    1983-01-01

    Two patients with femoral neck fractures, one displaced and one undisplaced, are presented. Preoperative intravital staining with tetracycline and Tc-MDP scintimetry both showed intact femoral head circulation while Tc-MDP-scintimetry 1 week after operation showed pronounced circulatory deficiency. Sr/sup 85/-scintimetry performed at the same time was inconclusive. Segmental collapse was observed radiographically, 8 and 12 months postoperatively. The major vascular injury resulting in avascularity most probably occured during the procedure of osteosynthesis, and Tc-MDP-scintimetry was found suitable for early postoperative recognition of avascular necrosis in both fractures.

  6. F-18 fluoride positron emission tomography/computed tomography in the diagnosis of avascular necrosis of the femoral head: Comparison with magnetic resonance imaging

    Science.gov (United States)

    Gayana, Shankaramurthy; Bhattacharya, Anish; Sen, Ramesh Kumar; Singh, Paramjeet; Prakash, Mahesh; Mittal, Bhagwant Rai

    2016-01-01

    Objective: Femoral head avascular necrosis (FHAVN) is one of the increasingly common causes of musculoskeletal disability and poses a major diagnostic and therapeutic challenge. Although radiography, scintigraphy, computed tomography (CT), and magnetic resonance imaging (MRI) have been widely used in the diagnosis of FHAVN, positron emission tomography (PET) has recently been evaluated to assess vascularity of the femoral head. In this study, the authors compared F-18 fluoride PET/CT with MRI in the initial diagnosis of FHAVN. Patients and Methods: We prospectively studied 51 consecutive patients with a high clinical suspicion of FHAVN. All patients underwent MRI and F-18 fluoride PET/CT, the time interval between the two scans being 4–10 (mean 8) days. Two nuclear medicine physicians blinded to the MRI report read the PET/CT scans. Clinical assessment was also done. Final diagnoses were made by surgical pathology or clinical and radiologic follow-up. Results: A final diagnosis of avascular necrosis (AVN) was made in 40 patients. MRI was 96.5% sensitive, 100% specific, and 98.03% accurate while PET/CT was 100% sensitive, specific, and accurate in diagnosing FHAVN. The agreement between the two imaging modalities for the diagnosis of AVN was 96.07%. Conclusion: F-18 fluoride PET/CT showed good agreement with MRI in the initial diagnosis of FHAVN and can be better than MRI in detecting early disease. PMID:26917886

  7. F-18 fluoride positron emission tomography/computed tomography in the diagnosis of avascular necrosis of the femoral head: Comparison with magnetic resonance imaging

    International Nuclear Information System (INIS)

    Gayana, Shankaramurthy; Bhattacharya, Anish; Sen, Ramesh Kumar; Singh, Paramjeet; Prakash, Mahesh; Mittal, Bhagwant Rai

    2016-01-01

    Femoral head avascular necrosis (FHAVN) is one of the increasingly common causes of musculoskeletal disability and poses a major diagnostic and therapeutic challenge. Although radiography, scintigraphy, computed tomography (CT), and magnetic resonance imaging (MRI) have been widely used in the diagnosis of FHAVN, positron emission tomography (PET) has recently been evaluated to assess vascularity of the femoral head. In this study, the authors compared F-18 fluoride PET/CT with MRI in the initial diagnosis of FHAVN. We prospectively studied 51 consecutive patients with a high clinical suspicion of FHAVN. All patients underwent MRI and F-18 fluoride PET/CT, the time interval between the two scans being 4–10 (mean 8) days. Two nuclear medicine physicians blinded to the MRI report read the PET/CT scans. Clinical assessment was also done. Final diagnoses were made by surgical pathology or clinical and radiologic follow-up. A final diagnosis of avascular necrosis (AVN) was made in 40 patients. MRI was 96.5% sensitive, 100% specific, and 98.03% accurate while PET/CT was 100% sensitive, specific, and accurate in diagnosing FHAVN. The agreement between the two imaging modalities for the diagnosis of AVN was 96.07%. F-18 fluoride PET/CT showed good agreement with MRI in the initial diagnosis of FHAVN and can be better than MRI in detecting early disease

  8. Effects of Focused Extracorporeal Shock Waves on Bone Marrow Mesenchymal Stem Cells in Patients with Avascular Necrosis of the Femoral Head.

    Science.gov (United States)

    Zhai, Lei; Sun, Nan; Zhang, Bo; Liu, Shui-Tao; Zhao, Zhe; Jin, Hai-Chao; Ma, Xin-Long; Xing, Geng-Yan

    2016-03-01

    To observe the effect of extracorporeal shock waves (ESWs) on bone marrow mesenchymal stem cells (MSCs) in patients with avascular necrosis of the femoral head, we collected bone marrow donated by patients and then cultivated and passaged MSCs in vitro using density gradient centrifugation combined with adherence screening methods. The P3 generation MSCs were divided into the ESW group and the control group. The cell counting kit for MSCs detected some proliferation differences. Cytochemistry, alkaline phosphatase staining and Alizarin red staining were used to determine alkaline phosphatase content. Simultaneously, real-time polymerase factor α1, osteocalcin and peroxisome proliferator-activated receptor γ. Together, the results of our study first indicate that moderate ESW intensity, which is instrumental in enhancing MSC proliferation, inducing conversion of MSCs into osteoblasts, and inhibiting differentiation of MSCs into adipocytes from MSCs, is one of the effective mechanisms for treating avascular necrosis of the femoral head. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  9. In vitro and in vivo evaluation of calcium phosphate composite scaffolds containing BMP-VEGF loaded PLGA microspheres for the treatment of avascular necrosis of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Hao-Xuan [Department of Orthopedics, Shandong University Qilu Hospital, Jinan, Shandong (China); Zhang, Xiu-Ping [School of Public Health, Fudan University, Shanghai (China); Xiao, Gui-Yong [School of Materials Science and Engineering, Shandong University, Jinan, Shandong (China); Key Laboratory for Liquid–Solid Structural Evolution and Processing of Materials, Ministry of Education, Shandong University, Jinan, Shandong (China); Hou, Yong; Cheng, Lei; Si, Meng; Wang, Shuai-Shuai [Department of Orthopedics, Shandong University Qilu Hospital, Jinan, Shandong (China); Li, Yu-Hua, E-mail: qiluyuhua@126.com [Department of Orthopedics, Shandong University Qilu Hospital, Jinan, Shandong (China); Nie, Lin, E-mail: hoho05@126.com [Department of Orthopedics, Shandong University Qilu Hospital, Jinan, Shandong (China)

    2016-03-01

    Avascular necrosis of the femoral head (ANFH) is difficult to treat due to high pressure and hypoxia, and reduced levels of growth factors such as bone morphogenetic protein (BMP), and vascular endothelial growth factor (VEGF). We generated a novel calcium phosphate (CPC) composite scaffold, which contains BMP-VEGF-loaded poly-lactic-co-glycolic acid (PLGA) microspheres (BMP-VEGF-PLGA-CPC). The BMP-VEGF-loaded microspheres have an encapsulation efficiency of 89.15% for BMP, and 78.55% for VEGF. The BMP-VEGF-PLGA-CPC scaffold also demonstrated a porosity of 62% with interconnected porous structures, and pore sizes of 219 μm and compressive strength of 6.60 MPa. Additionally, bone marrow mesenchymal stem cells (BMSCs) were seeded on scaffolds in vitro. Further characterization showed that the BMP-VEGF-PLGA-CPC scaffolds were biocompatible and enhanced osteogenesis and angiogenesis in vitro. Using a rabbit model of ANFH, BMP-VEGF-PLGA-CPC scaffolds were implanted into the bone tunnels of core decompression in the femoral head for 6 and 12 weeks. Radiographic and histological analysis demonstrated that the BMP-VEGF-PLGA-CPC scaffolds exhibited good biocompatibility, and osteogenic and angiogenic activity in vivo. These results indicate that the BMP-VEGF-PLGA-CPC scaffold may improve the therapeutic effect of core decompression surgery and be used as a treatment for ANFH. - Highlights: • BMP-VEGF-PLGA-CPC scaffolds were biocompatible and enhanced osteogenesis and angiogenesis in vitro. • BMP-VEGF-PLGA-CPC scaffolds exhibited good biocompatibility, and osteogenic and angiogenic activity in vivo. • BMP-VEGF-PLGA-CPC scaffolds provided a new approach for the treatment of avascular necrosis of the femoral head (ANFH).

  10. In vitro and in vivo evaluation of calcium phosphate composite scaffolds containing BMP-VEGF loaded PLGA microspheres for the treatment of avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Zhang, Hao-Xuan; Zhang, Xiu-Ping; Xiao, Gui-Yong; Hou, Yong; Cheng, Lei; Si, Meng; Wang, Shuai-Shuai; Li, Yu-Hua; Nie, Lin

    2016-01-01

    Avascular necrosis of the femoral head (ANFH) is difficult to treat due to high pressure and hypoxia, and reduced levels of growth factors such as bone morphogenetic protein (BMP), and vascular endothelial growth factor (VEGF). We generated a novel calcium phosphate (CPC) composite scaffold, which contains BMP-VEGF-loaded poly-lactic-co-glycolic acid (PLGA) microspheres (BMP-VEGF-PLGA-CPC). The BMP-VEGF-loaded microspheres have an encapsulation efficiency of 89.15% for BMP, and 78.55% for VEGF. The BMP-VEGF-PLGA-CPC scaffold also demonstrated a porosity of 62% with interconnected porous structures, and pore sizes of 219 μm and compressive strength of 6.60 MPa. Additionally, bone marrow mesenchymal stem cells (BMSCs) were seeded on scaffolds in vitro. Further characterization showed that the BMP-VEGF-PLGA-CPC scaffolds were biocompatible and enhanced osteogenesis and angiogenesis in vitro. Using a rabbit model of ANFH, BMP-VEGF-PLGA-CPC scaffolds were implanted into the bone tunnels of core decompression in the femoral head for 6 and 12 weeks. Radiographic and histological analysis demonstrated that the BMP-VEGF-PLGA-CPC scaffolds exhibited good biocompatibility, and osteogenic and angiogenic activity in vivo. These results indicate that the BMP-VEGF-PLGA-CPC scaffold may improve the therapeutic effect of core decompression surgery and be used as a treatment for ANFH. - Highlights: • BMP-VEGF-PLGA-CPC scaffolds were biocompatible and enhanced osteogenesis and angiogenesis in vitro. • BMP-VEGF-PLGA-CPC scaffolds exhibited good biocompatibility, and osteogenic and angiogenic activity in vivo. • BMP-VEGF-PLGA-CPC scaffolds provided a new approach for the treatment of avascular necrosis of the femoral head (ANFH).

  11. Sildenafil improves blood perfusion in steroid-induced avascular necrosis of femoral head in rabbits via a protein kinase G-dependent mechanism.

    Science.gov (United States)

    Song, Qichun; Ni, Jianlong; Jiang, Hongyuan; Shi, Zhibin

    2017-10-01

    The aim of the study were to evaluate the effect of sildenafil against avascular necrosis of femoral head (ANFH) in a rabbit model, and to study the role of protein kinase G (PKG) pathway and vascular endothelial growth factor (VEGF) in ANFH. Three weeks after inducing ANFH with methylprednisolone injection, 45 female adult New Zealand white rabbits were divided into three groups and treated as follows: group SI received daily intraperitoneal sildenafil with a dose of 10 mg/kg per day; group SD received daily sildenafil identically to group SI plus auricular vein injection DT3 (a specific PKG inhibitor); group NS received only normal saline. The blood perfusion function in the femoral head was measured by perfusion MRI and ink artery infusion. Bilateral femora heads were examined histopathologically for the presence of osteonecrosis; VEGF of tissue was examined by Western blot analysis; cGMP level and PKG activity were also measured. The incidence of ANFH in SI group was significantly lower than that observed in NS and SD groups (p < 0.05). VEGF in SI group was increased compared to NS group. cGMP level and PKG activity were also significantly different between NS and SI group (p < 0.05). However, these effects of sildenafil in SD group were all markedly inhibited by the administration of DT3 compared to SI group. Sildenafil appear to increase the perfusion of femoral head by up-regulating VEGF through PKG pathway. The increased perfusion of femoral head could prevent ANFH. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

  12. [Arthroscopy-guided core decompression and bone grafting combined with selective arterial infusion for treatment of early stage avascular necrosis of femoral head].

    Science.gov (United States)

    Guo, Hao-Shan; Tian, Yi-Jun; Liu, Gang; An, Long; Zhou, Zhan-Guo; Liu, Huan-Zhen

    2018-01-25

    To observe the clinical effects of arthroscopy-guided core decompression and bone grafting combined with selective arterial infusion for early stage avascular necrosis of femoral head. From January 2010 to December 2014, 76 patients(76 hips) diagnosed as Ficat II stage avascular necrosis of femoral head were randomly divided into experimental group and control group. In the experimental group, there were 27 males and 8 females aged from 24 to 55 years old with an average of (43.96±6.81) years, treated with arthroscopic-guided core decompression and bone grafting combined with selective arterial infusion. Along the direction of the femoral neck, an 8 mm-diameter tunnel to necrotic areas was drilled, then curettage of necrotic bone was performed under arthroscope, and the iliac bone was grafted. In the control group, there were 29 males and 12 females aged from 26 to 56 years old with an average of (44.62±7.33) years, treated with percutaneous core decompression combined with selective arterial infusion. The preoperative and postoperative Harris scores were recorded and the changes of X-rays were analyzed. All the patients were followed up with an average of 30 months. Postoperative follow-up at 12 months showed that there was significant difference in imaging outcome between two groups( P 0.05), but there was significant difference in postoperative Harris score( P necrosis are effective. Using arthroscopic-guided core decompression method, the necrotic bone can be positioned and scraped more accurately, and can obtain better results. Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.

  13. Prospective early detection of avascular necrosis of the femoral head with MR imaging in high-risk patients: Is it clinically relevant

    International Nuclear Information System (INIS)

    Von Schulthess, G.K.; Binswanger, U.

    1987-01-01

    To evaluate the clinical relevance of early detection of avascular necrosis (AVN) of the femoral head in a high-risk group, the authors performed MR imaging in 16 renal transplant patients receiving prednisone. Imaging was done at 3-month intervals over 8-24 months. Of the 15 patients remaining in the study (one underwent nephrectomy), two have shown clear MR imaging signs of early AVN persisting for 12 months without clinical symptoms. One patient had an abrupt onset of clinically relevant AVN before the second control MR imaging study was done. These results suggest that MR imaging may detect clinically irrelevant AVN, and that even short intervals between examinations may be too long to provide a warning of impending AVN

  14. In vitro and in vivo evaluation of calcium phosphate composite scaffolds containing BMP-VEGF loaded PLGA microspheres for the treatment of avascular necrosis of the femoral head.

    Science.gov (United States)

    Zhang, Hao-Xuan; Zhang, Xiu-Ping; Xiao, Gui-Yong; Hou, Yong; Cheng, Lei; Si, Meng; Wang, Shuai-Shuai; Li, Yu-Hua; Nie, Lin

    2016-03-01

    Avascular necrosis of the femoral head (ANFH) is difficult to treat due to high pressure and hypoxia, and reduced levels of growth factors such as bone morphogenetic protein (BMP), and vascular endothelial growth factor (VEGF). We generated a novel calcium phosphate (CPC) composite scaffold, which contains BMP-VEGF-loaded poly-lactic-co-glycolic acid (PLGA) microspheres (BMP-VEGF-PLGA-CPC). The BMP-VEGF-loaded microspheres have an encapsulation efficiency of 89.15% for BMP, and 78.55% for VEGF. The BMP-VEGF-PLGA-CPC scaffold also demonstrated a porosity of 62% with interconnected porous structures, and pore sizes of 219 μm and compressive strength of 6.60 MPa. Additionally, bone marrow mesenchymal stem cells (BMSCs) were seeded on scaffolds in vitro. Further characterization showed that the BMP-VEGF-PLGA-CPC scaffolds were biocompatible and enhanced osteogenesis and angiogenesis in vitro. Using a rabbit model of ANFH, BMP-VEGF-PLGA-CPC scaffolds were implanted into the bone tunnels of core decompression in the femoral head for 6 and 12 weeks. Radiographic and histological analysis demonstrated that the BMP-VEGF-PLGA-CPC scaffolds exhibited good biocompatibility, and osteogenic and angiogenic activity in vivo. These results indicate that the BMP-VEGF-PLGA-CPC scaffold may improve the therapeutic effect of core decompression surgery and be used as a treatment for ANFH. Copyright © 2015 Elsevier B.V. All rights reserved.

  15. First MRI results of the therapeutic course of avascular femoral head necrosis after femoral core decompression; Erste kernspintomographische Ergebnisse des Therapieverlaufs bei avaskulaerer Femurkopfnekrose nach Femurkerndekompression

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, H.F. [Strahlenklinik und Poliklinik, Virchow Klinikum, Humboldt Univ, Berlin (Germany); Schedel, H. [Strahlenklinik und Poliklinik, Virchow Klinikum, Humboldt Univ, Berlin (Germany); Schneller, A. [Strahlenklinik und Poliklinik, Virchow Klinikum, Humboldt Univ, Berlin (Germany); Eisenschenk, A. [Universitaetsklinikum Benjamin Franklin, Berlin (Germany). Orthopaedische Klinik und Poliklinik; Wicht, L. [Strahlenklinik und Poliklinik, Virchow Klinikum, Humboldt Univ, Berlin (Germany); Siekmann, R. [Strahlenklinik und Poliklinik, Virchow Klinikum, Humboldt Univ, Berlin (Germany); Felix, R. [Strahlenklinik und Poliklinik, Virchow Klinikum, Humboldt Univ, Berlin (Germany)

    1997-03-01

    The vascular femoral head necrosis is a serious illness, especially when appearing in patients aged 30 to 50 years. Many etiologic factors cause a femoral head necrosis such as, for example, high-dose steroids, abuse of alcohol, defect of bone marrow and trauma of the hip. Often the X-ray photograph leads to the diagnosis in the second stage (ARCO 1992) or in the third stage, when the femoral head has begun to collapse. The stage IIc and III shows an evident enhancement in contrast media in MRI. Contrast enhancement is demonstrated by STIR, FATSAT, T1-weighted and dynamic screening sequence. The characteristics of the contrast media enhancement argue for an active concomitant process of destruction and regeneration. This stage has the best chances for a drug or a surgical therapy. The evaluation of the signal intensity by the dynamic screening sequence is considered as an objective contribution for the staging of the femoral head necrosis. This enables one to differentiate between the curable stage IIc and the stage III, showing the beginning of breakdown of the femoral head. (orig.) [Deutsch] Die avaskulaere Femurkopfnekrose (AVN) ist eine schwerwiegende Erkrankung, die insbesondere bei Patienten im Alter zwischen 30 und 50 Jahren auftritt. Ein Vielzahl von aetiologischen Faktoren wie Einnahme von hohen Dosen Steroiden ueber mehrere Monate, Alkoholmissbrauch, Knochenmarkschaeden und Huefttraumata spielen unabhaengig voneinander eine Rolle. Die Diagnose erfolgt ueblicherweise im zweiten Stadium (ARCO 1992) auf dem Roentgenbild oder im Stadium III, wenn der Femurkopf begonnen hat mechanisch nachzugeben. Eine deutliche kernspintomographisch nachweisbare Kontrastmittelaufnahme zeigen die Stadien ARCO IIc und III, wie die Werte der Dynamic Screening Sequence, der STIR-, der FATSAT und der T{sub 1}-gewichteten Sequenzen belegen. Das Kontrastmittelaufnahmeverhalten spricht fuer einen gleichzeitig aktiven destruierenden und regenerativen Prozess, der fuer einen operativen

  16. The correlation between Salter's criteria for avascular necrosis of the femoral head and Kalamchi's prognostic classification following the treatment of developmental dysplasia of the hip.

    Science.gov (United States)

    Tsukagoshi, Y; Kamegaya, M; Kamada, H; Saisu, T; Morita, M; Kakizaki, J; Tomaru, Y; Yamazaki, M

    2017-08-01

    The aim of this study was to evaluate the correlation between Salter's criteria and Kalamchi's classification of avascular necrosis in patients treated for developmental dysphasia of the hip (DDH). The study involved a retrospective analysis of 123 patients (123 hips) with DDH treated by operative and non-operative reduction before the age of two years, with a minimum follow-up of ten years. Salter's criteria (S1 to S4) were determined from radiographs obtained at one to two years post-reduction, whilst the Kalamchi grade was determined from radiographs obtained at ten or more years of age. Early post-reduction radiographs were also used to evaluate the centre-head distance discrepancy (CHDD) and the occurrence of a dome-shaped deformity of the proximal femoral metaphysis (D-shaped metaphysis). The prognosis was described as good (Kalamchi grade K0 or KI), fair (Kalamchi grade KII) or poor (Kalamchi grade KIII or KIV) for analysis and correlation with the early Salter criteria, CHDD and D-shaped metaphysis. S1 and S2 criteria were predictive of a poor prognosis. The outcome following S3, S4 and S3 + S4 varied; 18 (40%) had a good prognosis, 17 (38%) a fair prognosis and ten (22%) a poor prognosis. A CHDD ≥ 10% and a D-shaped metaphysis were also predictive of a poor prognosis. The Salter criteria were predictive of the Kalamchi grade of avascular necrosis in patients with DDH aged ten or more years after reduction of the hip. Cite this article: Bone Joint J 2017;99-B:1115-20. ©2017 The British Editorial Society of Bone & Joint Surgery.

  17. Early treatment with the von Rosen splint for neonatal instability of the hip is safe regarding avascular necrosis of the femoral head

    Science.gov (United States)

    Wenger, Daniel; Samuelsson, Hanna; Düppe, Henrik; Tiderius, Carl Johan

    2016-01-01

    Background and purpose — Avascular necrosis of the femoral head (AVN) is a complication in treatment of developmental dysplasia of the hip (DDH). We evaluated the risk of AVN after early treatment in the von Rosen splint and measured the diameter of the ossific nucleus at 1 year of age. Children and methods — All children born in Malmö, Sweden, undergo clinical screening for neonatal instability of the hip (NIH). We reviewed 1-year radiographs of all children treated early for NIH in our department from 2003 through 2010. The diameter of the ossific nucleus was measured, and signs of AVN were classified according to Kalamchi-MacEwen. Subsequent radiographs, taken for any reason, were reviewed and a local registry of diagnoses was used to identify subsequent AVN. Results — 229 of 586 children referred because of suspected NIH received early treatment (age ≤ 1 week) for NIH during the study period. 2 of the 229 treated children (0.9%, 95% CI: 0.1–3.1) had grade-1 AVN. Both had spontaneous resolution and were asymptomatic during the observation time (6 and 8 years). 466 children met the inclusion criteria for measurement of the ossific nucleus. Neonatally dislocated hips had significantly smaller ossific nuclei than neonatally stable hips: mean 9.4 mm (95% CI: 9.1–9.8) vs. 11.1 mm (95% CI: 10.9–11.3) at 1 year (p < 0.001). Interpretation — Early treatment with the von Rosen splint for NIH is safe regarding AVN. The ossification of the femoral head is slower in children with NIH than in untreated children with neonatally stable hips. PMID:26730503

  18. Rapid magnetic resonance imaging protocol for detecting femoral head avascular necrosis: A case series-it′s utility in the general population in developing countries

    Directory of Open Access Journals (Sweden)

    M Sanjay Khaladkar

    2015-01-01

    Full Text Available Introduction: Osteonecrosis of the femoral head is an increasing cause of musculoskeletal disability, common among the younger population, between the third and fifth decade of life, affecting mainly men, thereby requiring prompt diagnosis and early intervention. Aims and Objectives: The aim was to formulate a limited magnetic resonance imaging (MRI examination protocol for detection of avascular necrosis (AVN in clinically suspected cases that can be performed rapidly and will be inexpensive. Materials and Methods: Forty-five patients suspected clinically and or on conventional radiography for AVN of the femoral head were referred for MRI hip. MRI hip was done on 1.5 T Siemens Avanto. Of 45, 36 were detected to have AVN (total 58 hips, whereas 9 did not have AVN on MRI. Initially, coronal T1-weighted image (T1WI sequence was obtained as limited MRI protocol, followed by complete MRI examination. Results: Maximum patients belonged to age group 31-40 (30.5%. 32 (88.88% patients were males and 4 (11.11% were females. Bilateral AVN was detected in 44 (61.1% and unilateral in 14 patients (38.8%. Pre collapsed stage (Stages I and II was detected in 18 hips (31.03%, collapsed stage (Stages III and IV was detected in 40 hips (68.9%. Peripheral low-intensity rim was seen on T1WI in all 58 cases of AVN. Double line sign on T2-weighted image was seen in 33/58 (56.8%. Conclusion: Our study concluded that coronal T1W sequence is an easy, rapid and cost-effective method of detecting unilateral or bilateral AVN.

  19. Avascular necrosis of the femoral head in patients treated for leukaemia. Assessment of the need for a diagnostic protocol.

    Science.gov (United States)

    Alguacil Pinel, J; Vila Vives, P; Salom Taverner, M

    To evaluate the incidence of avascular necrosis of the hip in leukaemia patients treated in our hospital with high doses of corticosteroids in order to evaluate the necessity for an early detection protocol. Observational-descriptive and retrospective study from 2005 to 2016 of 253 patients diagnosed with paediatric leukaemia. Patients with musculoskeletal pathology were identified and patients with avascular necrosis were analysed. A total of 26 patients (10%) had musculoskeletal symptoms. Three patients with avascular necrosis (1.2%) were analysed. One girl, 7 years old, was treated conservatively with traction - suspension and discharge. Two boys, an 11 and a 15.4 year-old,who developed graft-versus-host disease secondary to bone marrow transplantation, and whose treatment included high doses of corticosteroids, developed avascular necrosis of the hip. One was treated with bisphosphonates and forage and the other ended up with a total hip arthroplasty. The occurrence of musculoskeletal symptoms during the treatment of leukaemia is different according to the bibliographic series (0.43 -12.6%). Some authors observe an increased risk in female patients between the ages of 10 and 17. A retrospective study reveals that there is a delay of 3.9 months in the diagnosis of CAP since the onset of pain. Other authors relate NAV to loading joints, age and high doses of corticosteroids. Based on the low incidence of avascular necrosis of the hip in our 14-year-old population treated for leukaemia, the creation of diagnostic protocols seems not to be necessary. However, close monitoring of patients with potential risk factors recognized in the literature, is advisable. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Effects of Wenyangbushen formula on the expression of VEGF, OPG, RANK and RANKL in rabbits with steroid-induced femoral head avascular necrosis.

    Science.gov (United States)

    Song, Hong-Mei; Wei, Ying-Chen; Li, Nan; Wu, Bin; Xie, Na; Zhang, Kun-Mu; Wang, Shi-Zhong; Wang, He-Ming

    2015-12-01

    The present study aimed to investigate the effects of Wenyangbushen formula on the mRNA and protein expression levels of vascular endothelial growth factor (VEGF), osteoprotegerin (OPG), receptor activator of nuclear factor (NF)‑κβ ligand (RANK), and RANK ligand (RANKL) in a rabbit model of steroid‑induced avascular necrosis of the femoral head (SANFH). The present study also aimed to examine the potential mechanism underlying the effect of this formula on the treatment of SANFH. A total of 136 New Zealand rabbits were randomly divided into five groups: Normal group, model group, and three groups treated with the traditional Chinese medicine (TCM), Wenyangbushen decoction, at a low, moderate and high dose, respectively. The normal group and positive control group were intragastrically administered with saline. The TCM groups were treated with Wenyangbushen decoction at the indicated dosage. Following treatment for 8 weeks, the mRNA and protein expression levels of VEGF, OPG, RANK and RANKL in the femoral head tissues were determined using reverse transcription‑quantitative polymerase chain reaction and western blot analyses, respectively. The data revealed that Wenyangbushen decoction effectively promoted the growth of bone cells, osteoblasts and chondrocytes, and prevented cell apoptosis in the SANFH. The mRNA and protein expression levels of OPG and VEGF were increased, while the levels of RANK and RANKL were reduced in the necrotic tissue of the model group, compared with those in the normal rabbits. Wenyangbushen treatment prevented these changes, manifested by an upregulation in the expression levels of VEGF and OPG, and downregulation in the expression levels of RANK and RANKL in a dose‑dependent manner. It was concluded that treatment with Wenyangbushen formula alleviated necrosis of the femoral head induced by steroids. It was observed to promote bone cell, osteoblast and chondrocyte growth, as well as prevent cell apoptosis. In addition, it

  1. Diffusion-weighted magnetic resonance imaging of femoral head osteonecrosis in two groups of patients: Legg-Perthes-Calve and Avascular necrosis.

    Science.gov (United States)

    Ozel, Betul Duran; Ozel, Deniz; Ozkan, Fuat; Halefoglu, Ahmet M

    2016-03-01

    The aim of this prospective study was to evaluate the value of diffusion-weighted magnetic resonance imaging (DW-MRI) in patients with osteonecrosis. Patients were divided into two subgroups as avascular necrosis (AVN) of femoral head for adult group and Legg-Calvé-Perthes (LCP) patients for children. Seventeen patients with femoral head AVN (mean age 42.3 years) and 17 patients with LCP (mean age 8.2 years) were included in this study. Diagnosis confirmed with clinical and other imaging procedures among the patients complaining hip pain. DW images were obtained using the single-shot echo planar sequence and had b values of 0, 500, 1000 s/mm(2). The apparent diffusion coefficient (ADC) values were measured from ADC maps in epiphysis of patients with AVN, both from metaphysis and epiphysis in patients with LCP, respectively. Mann-Whitney U test was used to compare ADC values. The mean ADC value of femoral heads (1.285 ± 0.204 × 10(-3) mm(2)/s) was increased in patients with AVN when compared to normal bone tissue (0.209 ± 0.214 × 10(-3) mm(2)/s) (p < 0.01). The mean ADC values (×10(-3) mm(2)/s) of both metaphysis (0.852 ± 0.293) and epiphysis (0.843 ± 0.332) were also increased in patients with LCP and differences were statistically significant (p < 0.01). As a result, osteonecrosis shows increased ADC values. But it is a controversial concept that DWI offers a valuable data to conventional MRI or not. However, as there are report states, there is a correlation between the stage of the disease with ADC values in the LCP disease. DWI is a fast, without-contrast administration technique and provides quantitative values additional to conventional MR techniques; we believe DWI may play an additional assistance to the diagnosis and treatment for LCP patients. Multicentric larger group studies may provide additional data to this issue.

  2. Bone marrow aspirate concentrate in combination with intravenous iloprost increases bone healing in patients with avascular necrosis of the femoral head: a matched pair analysis

    Directory of Open Access Journals (Sweden)

    Hakan Pilge

    2017-01-01

    Full Text Available With disease progression, avascular necrosis (AVN of the femoral head may lead to a collapse of the articular surface. The exact pathophysiology of AVN remains unclear, although several conditions are known that can result in spontaneous cell death, leading to a reduction of trabecular bone and the development of AVN. Hip AVN treatment is stage-dependent in which two main stages of the disease can be distinguished: pre-collapse (ARCO 0-II and post-collapse stage (ARCO III-IV, crescent sign. In the pre-collapse phase, core decompression (CD, with or without the addition of bone marrow (e.g. bone marrow aspirate concentrate, BMAC or bone graft, is a common treatment alternative. In the postcollapse phase, THA (total hip arthroplasty must be performed in most of the patients. In addition to surgical treatment, the intravenous application of Iloprost has been shown to have a curative potential and analgesic effect. From October 2009 to October 2014, 49 patients with AVN (stages I-III were treated with core decompression at our institution. All patients were divided into group A (CD + BMAC and group B (CD alone. Of these patients, 20 were included in a matched pair analysis. The patients were matched to age, gender, ARCO-stage, Kerboul combined necrotic angle, the cause of AVN, and whether Iloprost-therapy was performed. The Merle d’Aubigné Score and the Kerboul combined necrotic angle in a-p and lateral radiographs were evaluated pre- and postoperatively. The primary endpoint was a total hip arthroplasty. In group A, two patients needed THA while in group B four patients were treated with THA. In group A, the Merle d’Aubigné Score improved from 13.5 (pre-operatively to 15.3 (postoperatively. In group B there was no difference between the pre- (14.3 and postoperative (14.1 assessment. The mean of the Kerboul angle showed no difference in both groups compared pre- to postoperatively (group A: pre-op 212°, postop 220°, group B: pre-op 213

  3. Complete resolution of avascular necrosis of the human femoral head treated with adipose tissue-derived stem cells and platelet-rich plasma.

    Science.gov (United States)

    Pak, Jaewoo; Lee, Jung Hun; Jeon, Jeong Ho; Lee, Sang Hee

    2014-12-01

    We report a case of a 43-year-old man with early stage (stage 1) avascular necrosis (AVN) of the femoral head treated with adipose tissue-derived stem cells (ASCs) and platelet-rich plasma (PRP). ASC-containing stromal vascular fraction was mixed with PRP and hyaluronic acid. This mixture was then injected into the diseased hip under ultrasound guidance. The affected hip was reinjected weekly with additional PRP for 4 weeks. The patient was followed-up with sequential magnetic resonance imaging (MRI) scans at 3, 18, and 21 months after treatment, together with Visual Analogue Scale (VAS) Walking Index, Functional Rating Index, Harris Hip Score, and Range of Motion (ROM) assessments. The patient's severe hip pain was considerably improved at 3 months after treatment, with pain scores, ROM and MRI showing near complete resolution of AVN. Pain scores, ROM and MRI at 18 and 21 months after treatment indicated complete resolution of AVN. This case represents the first evidence of complete resolution of early stage AVN of the hip following treatment with ASCs/PRP. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  4. Magnetic resonance imaging of the femoral head necrosis

    Energy Technology Data Exchange (ETDEWEB)

    Narita, Shinya; Asada, Kanji; Yoshida, Kenjiro and others

    1986-06-01

    Ten patients with avascular femoral head necrosis and four normal adults were examined by magnetic resonance imaging (MRI). In addition, the relationship between MRI and pathophysiology of three operated-on avascular femoral heads was evaluated. The medullary cavities of the normal femoral heads had a strong signal intensity on the saturation recovery (SR) image due to fat marrow, and the T/sub 1/ relaxation time was 160 +- 11 msec. In avascular femoral head necrosis, the necrotic area had a low signal intensity on the SR image and a prolonged T/sub 1/ relaxation time, while the reactive fibrous area had more prolonged T/sub 1/ relaxation time. For these reasons, MRI was found to show the pathological changes of avascular femoral head necrosis and can be expected to be useful for making early diagnoses and operation planning.

  5. Magnetic resonance imaging of the femoral head necrosis

    International Nuclear Information System (INIS)

    Narita, Shinya; Asada, Kanji; Yoshida, Kenjiro

    1986-01-01

    Ten patients with avascular femoral head necrosis and four normal adults were examined by magnetic resonance imaging (MRI). In addition, the relationship between MRI and pathophysiology of three operated-on avascular femoral heads was evaluated. The medullary cavities of the normal femoral heads had a strong signal intensity on the saturation recovery (SR) image due to fat marrow, and the T 1 relaxation time was 160 ± 11 msec. In avascular femoral head necrosis, the necrotic area had a low signal intensity on the SR image and a prolonged T 1 relaxation time, while the reactive fibrous area had more prolonged T 1 relaxation time. For these reasons, MRI was found to show the pathological changes of avascular femoral head necrosis and can be expected to be useful for making early diagnoses and operation planning. (author)

  6. Identification of avascular necrosis in the dysplastic proximal femoral epiphysis

    International Nuclear Information System (INIS)

    Mandell, G.A.; Harcke, H.T.; MacKenzie, W.G.; Bassett, G.S.; Scott, C.I. Jr.; Wills, J.S.

    1989-01-01

    Bilateral radiographic irregularities and deformities of the proximal femoral epiphyses are features of both multiple epiphyseal dysplasia and bilateral idiopathic avascular necrosis. In the past these entities have been difficult to differentiate. This report documents radiographically the occurrence of avascular necrosis in 10 patients with multiple epiphyseal dysplasia by recognizing the superimposition of sclerosis and subchondral fissuring on pre-existing symmetrically irregular proximal femoral ossification centers. Scintigraphic (photopenia) or magnetic resonance (loss of signal) criteria of avascular necrosis confirm its added presence and help to establish an imaging scheme to identify avascular necrosis superimposed on multiple epiphyseal dysplasia. (orig.)

  7. Identification of avascular necrosis in the dysplastic proximal femoral epiphysis

    Energy Technology Data Exchange (ETDEWEB)

    Mandell, G A; Harcke, H T [Alfred I. duPont Inst., Wilmington, DE (USA). Dept. of Medical Imaging; MacKenzie, W G; Bassett, G S [Alfred I. duPont Inst., Wilmington, DE (USA). Dept. of Orthopaedics; Scott, Jr, C I [Alfred I. duPont Inst., Wilmington, DE (USA). Dept. of Genetics; Wills, J S [Medical Center of Delaware, Newark, DE (USA). Dept. of Radiology

    1989-07-01

    Bilateral radiographic irregularities and deformities of the proximal femoral epiphyses are features of both multiple epiphyseal dysplasia and bilateral idiopathic avascular necrosis. In the past these entities have been difficult to differentiate. This report documents radiographically the occurrence of avascular necrosis in 10 patients with multiple epiphyseal dysplasia by recognizing the superimposition of sclerosis and subchondral fissuring on pre-existing symmetrically irregular proximal femoral ossification centers. Scintigraphic (photopenia) or magnetic resonance (loss of signal) criteria of avascular necrosis confirm its added presence and help to establish an imaging scheme to identify avascular necrosis superimposed on multiple epiphyseal dysplasia. (orig.).

  8. Avascular osteonecrosis of the femoral condyle after arthroscopic surgery

    International Nuclear Information System (INIS)

    Al-Kaar, M.; Garcia, J.; Fritschy, D.; Bonvin, J.C.

    1997-01-01

    Avascular osteonecrosis of the femoral condyle after arthroscopic surgery. Retrospective review of 10 patients who presented with avascular necrosis of the ipsilateral femoral condyle following arthroscopic meniscectomy (9 medial, 1 lateral). The bone lesions were evaluated by radiography and MRI, which were repeated for few patients. MRI allows earlier diagnosis of avascular necrosis of the femoral condyle and offers an evaluation of extent of the lesions whose evolution is variable: 3 patients required a knee prosthesis, the other 7 patients were treated medically. (authors)

  9. Management of stage I and II A/B avascular necrosis of femoral head with core decompression autologous cancellous bone grafting and platelet rich plasma factors

    Directory of Open Access Journals (Sweden)

    Tushar Agarwal

    2015-01-01

    Full Text Available Background: Avascular necrosis (AVN of the femoral head is a progressive disease that generally affects patients in the third through fifth decades of life; if left untreated, it leads to complete deterioration of the hip joint. Treatments range from simple decompression of the femoral head, to bone grafting of the involved area, or by using a vascularized fibular graft with varying degree of success. In most instances, the disease progresses further causing secondary arthritis. We present a study of management of early stage AVN (stage I and II A/B of Ficat Arlet classification with core decompression autologous cancellous bone grafting along with platelet rich plasma. Aims: To evaluate the results of the above modality in the management of AVN of the hip. Settings and Design: This prospective study of 30 cases was done during the period of 2011-2013. Materials and Methods: Patients with stage I and II A/B were treated with the above modality and were followed up for 1-year. The results were evaluated on the basis of progression or remission of the disease by radiographic studies, preoperative and postoperative Harris hip score (HHS, age and sex distribution. Statistical Analysis Used: Primer software for calculating the statistical data was used and paired t-test was applied to all the data. Results: Show males were more affected than females and average age group of presentation in stage I and II was 29 years (22-55. The most common cause was idiopathic followed by steroid use. Average preoperative HHS was 56.80 and postoperative HHS was 79.73. 60% (18 showed remission of the disease (radiographically compared to preoperative stage at 1-year follow-up, in 30% (9 disease did not progress further and 10% (3 progressed and required arthroplasty. Conclusion: Management of stage I and II A/B AVN of femur showed good satisfactory results in terms of disease remission and prevention of the further progress of the disease by the above method at 1

  10. Effects of hypoxia on osteogenic differentiation of mesenchymal stromal cells used as a cell therapy for avascular necrosis of the femoral head.

    Science.gov (United States)

    Ciapetti, Gabriela; Granchi, Donatella; Fotia, Caterina; Savarino, Lucia; Dallari, Dante; Del Piccolo, Nicola; Donati, Davide Maria; Baldini, Nicola

    2016-09-01

    Avascular necrosis of the femoral head (AVN) occurs as common result of various conditions or develops as a primary entity, with a high freqency in young adults. Because of its tendency toward osteoarthritis requiring total hip arthroplasty, alternative treatments are being advocated, including cell therapy with mesenchymal stromal cells (MSCs). Because osteonecrotic bone is a severely hypoxic tissue, with a 1-3% oxygen tension, the survival and function of multipotent cells is questionable. In this study, the proliferative, immunophenotypic and osteogenic properties of bone marrow (BM)-derived MSCs from a clinical series of patients with AVN were evaluated under in vitro conditions mimicking the hypoxic milieu of AVN to verify the rationale for cell therapy. MSCs retrieved from the iliac crest (BM-MSC) were isolated, expanded and induced to osteogenic differentiation under a 2% pO2 atmosphere (hypoxia) in comparison with the standard 21% pO2 (normoxia) that is routinely used in cell culture assays. Both proliferation and colony-forming ability were significantly enhanced in hypoxia-exposed BM-MSCs compared with BM-MSCs under normoxia. The expression of bone-related genes, including alkaline phosphatase, Type I collagen, and osteocalcin was significantly increased under hypoxia. Moreover, mineral deposition after osteogenic induction was not hampered, but in some cases even enhanced under low oxygen tension. These findings support autologous cell therapy as an effective treatment to stimulate bone healing in the hypoxic microenvironment of AVN. Copyright © 2016 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

  11. Femoral head necrosis; Hueftkopfnekrose

    Energy Technology Data Exchange (ETDEWEB)

    Kramer, J.; Scheurecker, G.; Scheurecker, A.; Stoeger, A.; Huber, A. [Roentgeninstitut am Schillerpark, Linz (Austria); Hofmann, S. [Orthopaedisches Landeskrankenhaus Stolzalpe (Austria)

    2009-05-15

    The epidemiology and pathohistogenesis of avascular femoral head necrosis has still not been clarified in detail. Because the course of the disease runs in stages and over a long time period nearly always culminates in the necessity for a total hip prosthesis, an exact radiological evaluation is of paramount importance for the treatment. There is a need for a common staging system to enable comparison of different therapy concepts and especially their long-term results. In this article the ARCO staging system is described in full detail, which includes all radiological modalities as well as histopathological alterations. (orig.) [German] Bei der avaskulaeren Femurkopfnekrose handelt es sich um ein Krankheitsbild, dessen Ursachen noch immer nicht vollstaendig geklaert sind. Da die Erkrankung stadienhaft verlaeuft und ueber einen laengeren Zeitraum betrachtet nahezu immer in einem prothetischen Hueftersatz muendet, ist eine genaue radiologische Abklaerung fuer die Behandlung von enormer Bedeutung. Um Langzeiterfolge verschiedener Therapiekonzepte vergleichen zu koennen, sind eine exakte Beschreibung und darauf basierend die Verwendung einer einheitlichen Stadieneinteilung wuenschenswert. In der vorliegenden Arbeit wird die ARCO-Stadieneinteilung im Detail beschrieben, die alle bildgebenden Methoden beruecksichtigt und histopathologische Veraenderungen mit einbezieht. (orig.)

  12. Long-term Outcome of Multiple Small-diameter Drilling Decompression Combined with Hip Arthroscopy versus Drilling Alone for Early Avascular Necrosis of the Femoral Head.

    Science.gov (United States)

    Li, Ji; Li, Zhong-Li; Zhang, Hao; Su, Xiang-Zheng; Wang, Ke-Tao; Yang, Yi-Meng

    2017-06-20

    Avascular necrosis of femoral head (AVNFH) typically presents in the young adults and progresses quickly without proper treatments. However, the optimum treatments for early stage of AVNFH are still controversial. This study was conducted to evaluate the therapeutic effects of multiple small-diameter drilling decompression combined with hip arthroscopy for early AVNFH compared to drilling alone. This is a nonrandomized retrospective case series study. Between April 2006 and November 2010, 60 patients (98 hips) with early stage AVNFH participated in this study. The patients underwent multiple small-diameter drilling decompression combined with hip arthroscopy in 26 cases/43 hips (Group A) or drilling decompression alone in 34 cases/55 hips (Group B). Patients were followed up at 6, 12, and 24 weeks, and every 6 months thereafter. Radiographs were taken at every follow-up, Harris scores were recorded at the last follow-up, the paired t-test was used to compare the postoperative Harris scores. Surgery effective rate of the two groups was compared using the Chi-square test. All patients were followed up for an average of 57.6 months (range: 17-108 months). Pain relief and improvement of hip function were assessed in all patients at 6 months after the surgery. At the last follow-up, Group A had better outcome with mean Harris' scores improved from 68.23 ± 11.37 to 82.07 ± 2.92 (t = -7.21, P = 0.001) than Group B with mean Harris' scores improved from 69.46 ± 9.71 to 75.79 ± 4.13 (t = -9.47, P = 0.037) (significantly different: t = -2.54, P = 0.017). The total surgery effective rate was also significantly different between Groups A and B (86.0% vs. 74.5%; χ2 = 3.69, P = 0.02). For early stage of AVNFH, multiple small-diameter drilling decompression combined with hip arthroscopy is more effective than drilling decompression alone.

  13. Long-term Outcome of Multiple Small-diameter Drilling Decompression Combined with Hip Arthroscopy versus Drilling Alone for Early Avascular Necrosis of the Femoral Head

    Science.gov (United States)

    Li, Ji; Li, Zhong-Li; Zhang, Hao; Su, Xiang-Zheng; Wang, Ke-Tao; Yang, Yi-Meng

    2017-01-01

    Background: Avascular necrosis of femoral head (AVNFH) typically presents in the young adults and progresses quickly without proper treatments. However, the optimum treatments for early stage of AVNFH are still controversial. This study was conducted to evaluate the therapeutic effects of multiple small-diameter drilling decompression combined with hip arthroscopy for early AVNFH compared to drilling alone. Methods: This is a nonrandomized retrospective case series study. Between April 2006 and November 2010, 60 patients (98 hips) with early stage AVNFH participated in this study. The patients underwent multiple small-diameter drilling decompression combined with hip arthroscopy in 26 cases/43 hips (Group A) or drilling decompression alone in 34 cases/55 hips (Group B). Patients were followed up at 6, 12, and 24 weeks, and every 6 months thereafter. Radiographs were taken at every follow-up, Harris scores were recorded at the last follow-up, the paired t-test was used to compare the postoperative Harris scores. Surgery effective rate of the two groups was compared using the Chi-square test. Results: All patients were followed up for an average of 57.6 months (range: 17–108 months). Pain relief and improvement of hip function were assessed in all patients at 6 months after the surgery. At the last follow-up, Group A had better outcome with mean Harris’ scores improved from 68.23 ± 11.37 to 82.07 ± 2.92 (t = −7.21, P = 0.001) than Group B with mean Harris’ scores improved from 69.46 ± 9.71 to 75.79 ± 4.13 (t = –9.47, P = 0.037) (significantly different: t = –2.54, P = 0.017). The total surgery effective rate was also significantly different between Groups A and B (86.0% vs. 74.5%; χ2 = 3.69, P = 0.02). Conclusion: For early stage of AVNFH, multiple small-diameter drilling decompression combined with hip arthroscopy is more effective than drilling decompression alone. PMID:28584206

  14. Subchondral insufficiency fractures of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Davies, M.; Cassar-Pullicino, V.N. [Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, SY10 7AG, Shropshire (United Kingdom); Darby, A.J. [Department of Pathology, Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, SY10 7AG, Shropshire (United Kingdom)

    2004-02-01

    The aim of this study was to increase awareness of, and to show the variable clinical and radiological features of, subchondral insufficiency fractures of the femoral head. The clinical and radiological findings in 7 patients with subchondral insufficiency fractures of the femoral head were reviewed retrospectively. The diagnosis was confirmed histologically in 4 patients. Radiographs were performed in all patients, MRI in 5 and scintigraphy in 4 patients. Radiographs showed varying degrees of femoral head collapse in 4 patients. In the remaining 3 patients radiographs showed a normal femoral head, regional osteoporosis and focal sclerosis, respectively. Magnetic resonance imaging showed a low-signal band on T1- and T2-weighted images in the subchondral bone adjacent or parallel to the articular surface associated with bone marrow oedema. Scintigraphy showed increased uptake in the femoral head. Insufficiency fractures of the femoral head are easily overlooked or confused with avascular necrosis and, when there is significant joint destruction, osteoarthritis. Unsuspected insufficiency fracture of the femoral head can lead to significant and rapid loss of bone stock in osteoporotic patients waiting for arthroplasty for osteoarthritis. Increased awareness of this condition will hopefully lead to earlier diagnosis and a successful outcome of conservative treatment. (orig.)

  15. Evaluation of a pig femoral head osteonecrosis model

    Directory of Open Access Journals (Sweden)

    Kim Harry

    2010-03-01

    Full Text Available Abstract Background A major cause of osteonecrosis of the femoral head is interruption of a blood supply to the proximal femur. In order to evaluate blood circulation and pathogenetic alterations, a pig femoral head osteonecrosis model was examined to address whether ligature of the femoral neck (vasculature deprivation induces a reduction of blood circulation in the femoral head, and whether transphyseal vessels exist for communications between the epiphysis and the metaphysis. We also tested the hypothesis that the vessels surrounding the femoral neck and the ligamentum teres represent the primary source of blood flow to the femoral head. Methods Avascular osteonecrosis of the femoral head was induced in Yorkshire pigs by transecting the ligamentum teres and placing two ligatures around the femoral neck. After heparinized saline infusion and microfil perfusion via the abdominal aorta, blood circulation in the femoral head was evaluated by optical and CT imaging. Results An angiogram of the microfil casted sample allowed identification of the major blood vessels to the proximal femur including the iliac, common femoral, superficial femoral, deep femoral and circumflex arteries. Optical imaging in the femoral neck showed that a microfil stained vessel network was visible in control sections but less noticeable in necrotic sections. CT images showed a lack of microfil staining in the epiphysis. Furthermore, no transphyseal vessels were observed to link the epiphysis to the metaphysis. Conclusion Optical and CT imaging analyses revealed that in this present pig model the ligatures around the femoral neck were the primary cause of induction of avascular osteonecrosis. Since the vessels surrounding the femoral neck are comprised of the branches of the medial and the lateral femoral circumflex vessels, together with the extracapsular arterial ring and the lateral epiphyseal arteries, augmentation of blood circulation in those arteries will improve

  16. Dynamic MR imaging: Follow-up study after femoral head core decompression and rhBMP-2 instillation in patients with avascular necrosis of the femoral head; Dynamische Magnetresonanztomographie (MRT): Verlaufsbeobachtung nach Femurkerndekompression und Auffuellung mit rekombinantem, humanem Bone morphogenetic Protein-2 (rhBMP-2) bei avaskulaerer Femurkopfnekrose

    Energy Technology Data Exchange (ETDEWEB)

    Schedel, H. [Klinik Prof. Schedel, Kellberg (Germany); Schneller, A. [Humboldt-Universitaet, Berlin (Germany). Klinik fuer Allgemein- und Transplantationschirurgie; Vogl, T.; Mueller, H.F.; Maeurer, J.; Felix, R. [Humboldt-Universitaet, Berlin (Germany). Strahlenklinik und Poliklinik; Suedkamp, N. [Humboldt-Universitaet, Berlin (Germany). Unfall- und Wiederherstellungschirurgie; Eisenschenk, A. [Freie Univ. Berlin (Germany). Orthopaedische Klinik und Poliklinik

    2000-07-01

    Material and Methods: Six patients with avascular necrosis of the femoral head ARCO-stage I- or II-lesions were treated surgically by femoral head core decompression. Three of these patients were additionally treated with rhBMP-2-instillation. The progression or regression could be confirmed by T1- and T2-weighted spinecho-sequences (zero, four, ten, sixteen weeks and 24 months follow up). Results: Corresponding ARCO-classification with partly more sensitive measurement of vitality signs in comparison to the optical X-ray classification. The objective, quantitative measurement of signalintensity post contrast medium reduces the influence of experience and level of education. The dynamic sequences results are reproducable. (orig.) [German] Material und Methoden: Sechs Patienten mit avaskulaerer Nekrose des Femurkopfes des Stadiums I oder II nach ARCO wurden einer Femurkerndekompression unterzogen. Drei dieser Patienten erhielten zusaetzlich eine rhBMP-2-Auffuellung. Zum Zeitpunkt null, vier, zehn, sechszehn Wochen und 24 Monaten post OP erfolgte die kernspintomographische Untersuchung mit T1- und T2-gewichteten Sequenzen unter besonderer Beruecksichtigung der dynamischen Untersuchungssequenz nach Gabe von Gd-DTPA (Gadopentetsaeure, Dimegluminsalz; Magnevist {sup trademark}) zur Dokumentation der Signalintensitaetssteigerung pro Zeiteinheit in der Nekroseregion. Ergebnisse: Uebereinstimmende Stadienklassifikation nach ARCO mit zum Teil empfindlicherer Messung von Vitalitaetszeichen im Vergleich zu rein visuellen roentgenologischen Einteilung. Die objektive, quantitative Messung des Signalintensitaetssteigerungsverhaltens nach Kontrastmittelgabe im Bereich der Femurkopfnekrose kann den Einfluss von subjektiven Eigenschaften des Untersuchers (Erfahrung, Ausbildungsstand) reduzieren, wobei die Ergebnisse der Dynamiksequenzen objektiv reproduzierbar sind. (orig.)

  17. Total hip arthroplasty survival in femoral head avascular necrosis versus primary hip osteoarthritis: Case-control study with a mean 10-year follow-up after anatomical cementless metal-on-metal 28-mm replacement.

    Science.gov (United States)

    Ancelin, D; Reina, N; Cavaignac, E; Delclaux, S; Chiron, P

    2016-12-01

    Total hip arthroplasty is the most widely used procedure to treat avascular necrosis (AVN) of the femoral head. Few studies have compared the outcomes of THA in femoral head AVN and primary hip osteoarthritis. Therefore we performed a case-control study to compare THA for femoral head AVN vs. primary hip osteoarthritis in terms of: (1) prosthesis survival, (2) complication rates, (3) functional outcomes and radiographic outcomes, (4) and to determine whether specific risk factors for THA failure exist in femoral head AVN. THA survival is similar in femoral head AVN and primary hip osteoarthritis. We compared two prospective cohorts of patients who underwent THA before 65 years of age, one composed of cases with femoral head AVN and the other of controls with primary hip osteoarthritis. In both cohorts, a cementless metal-on-metal prosthesis with a 28-mm cup and an anatomical stem was used. Exclusion criteria were THA with other types of prosthesis, posttraumatic AVN, and secondary osteoarthritis. With α set at 5%, to obtain 80% power, 246 patients were required in all. Prosthesis survival was assessed based on time to major revision (defined as replacement of at least one implant fixed to bone) and time to aseptic loosening. The other evaluation criteria were complications, Postel-Merle d'Aubigné (PMA) score, and the Engh and Agora Radiographic Assessment (ARA) scores for implant osseointegration. The study included 282 patients, 149 with AVN and 133 with osteoarthritis. Mean age was 47.8±10.2 years (range, 18.5-65) and mean follow-up was 11.4±2.8 years (range, 4.5-18.3 years). The 10-year survival rates were similar in the two groups: for major revision, AVN group, 92.5% (95% confidence interval [95% CI], 90.2-94.8) and osteoarthritis group, 95.3% (95% CI, 92.9-97.7); for aseptic loosening, AVN group, 98.6% (95% CI, 97.6-98.6) and osteoarthritis, 99.2% (95% CI, 98.4-100). The AVN group had higher numbers of revision for any reason (19 vs. 6, P=0.018) and

  18. Impaired osteogenic differentiation associated with connexin43/microRNA-206 in steroid-induced avascular necrosis of the femoral head.

    Science.gov (United States)

    Liu, Gang; Luo, Gaobin; Bo, Zhandong; Liang, Xiaonan; Huang, Jie; Li, Donghui

    2016-08-01

    Connexin(Cx)43 and microRNA(miR)-206 play an important role in osteogenesis. However, their role in steroid-induced femoral head osteonecrosis (SANFH) is still ambiguous. The present study aimed to establish a rabbit model and investigate osteogenesis in steroid-induced femoral head osteonecrosis occurring via Cx43/miR-206 and the changes of Wnt/β-catenin signal pathway-related proteins. A total of 72 adult New Zealand white rabbits were divided randomly into a model group (Group A) and a control group (Group B) of 36 rabbits each. Group A was injected intravenously with lipopolysaccharide (10μg/kg body weight, once per day). After 48h, three injections of methylprednisolone (MPS; 20mg/kg body weight) were administered intramuscularly at 24-hour intervals. Group B were fed and housed under identical conditions but received saline injections. All animals were sacrificed at two, four, and eight weeks from the first MPS injection. Typical early osteonecrosis symptoms were observed in Group A. The expression of miR-206 in Group A was significantly higher than that of Group B. The mRNA and protein levels of Cx43, β-catenin, runt-related transcription factor 2, and alkaline phosphatase gradually decreased while Dickkopf-1 (Dkk-1) gradually increased in Group A compared with Group B. These findings indicated that Cx43/miR-206 is involved in the pathogenesis of early stage SANFH and may be associate with Wnt/β-catenin signal pathway. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Simultaneous avascular necrosis of both medial and lateral femoral condyles

    International Nuclear Information System (INIS)

    Mansberg, R.

    2002-01-01

    Full text: Avascular necrosis (AVN) of a femoral condyle is a common orthopaedic condition. While both medial and lateral femoral condyles may be involved either singly or sequentially the simultaneous occurrence of AVN of both femoral condyles is extremely uncommon. A 57-year-old male is presented who developed the onset of severe left sided knee pain suddenly at rest. Plain and tomographic radiography was unremarkable and a bone scan was performed. Markedly increased vascularity was demonstrated in the left knee with intense osteoblastic activity in the left medial and femoral condyles more marked in the lateral femoral condyle. A diagnosis of AVN of both femoral condyles was made and a MRI exam was performed to confirm this unusual diagnosis. The MRI showed a diffuse increase in intensity bilaterally with subtle bony change in the subarticular bone consistent with AVN more marked in the left lateral femoral condyle. The patients' symptoms resolved with supportive treatment. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  20. Exosomes secreted from mutant-HIF-1α-modified bone-marrow-derived mesenchymal stem cells attenuate early steroid-induced avascular necrosis of femoral head in rabbit.

    Science.gov (United States)

    Li, Haile; Liu, Danping; Li, Chen; Zhou, Shanjian; Tian, Dachuan; Xiao, Dawei; Zhang, Huan; Gao, Feng; Huang, Jianhua

    2017-12-01

    Mesenchymal stem cells (MSCs)-derived exosomes exhibit protective effects on damaged or diseased tissues. Hypoxia-inducible factor 1α (HIF-1α) plays a critical role in bone development. However, HIF-1α is easily biodegradable under normoxic conditions. The bone-marrow-derived mesenchymal stem cells (BMSCs) were transfected with adenovirus carrying triple point-mutations (amino acids 402, 564, and 803) in the HIF-1α coding sequence (CDS). The mutant HIF-1α can efficiently express functional proteins under normoxic conditions. To date, no study has reported the role of exosomes secreted by mutant HIF-1α modified BMSCs in the recovery of the early steroid-induced avascular necrosis of femoral head (SANFH). In this study, we firstly analyzed exosomes derived from BMSCs modified by mutant (BMSC-Exos MU ) or wild-type HIF-1α (BMSC-Exos WT ). In vitro, we investigated the osteogenic differentiation capacity of BMSCs modified by BMSC-Exos MU or BMSC-Exos WT , and the angiogenesis effects of BMSC-Exos MU and BMSC-Exos WT on human umbilical vein endothelial cells (HUVECs). Besides, the healing of the femoral head was also assessed in vivo. We found that the potential of osteogenic differentiation of BMSCs treated with BMSC-Exos MU was higher than the wild-type group in vitro. In addition, BMSC-Exos MU stimulated the proliferation, migration, and tube formation of HUVECs in a dose-dependent manner. Compared with the BMSC-Exos WT or PBS control group, the injection of BMSC-Exos MU into the necrosis region markedly accelerated the bone regeneration and angiogenesis, which were indicated by the increased trabecular reconstruction and microvascular density. Taken together, our data suggest that BMSC-Exos MU facilitates the repair of SANFH by enhancing osteogenesis and angiogenesis. © 2017 International Federation for Cell Biology.

  1. Femoral head injuries: Which treatment strategy can be recommended?

    NARCIS (Netherlands)

    Henle, Philipp; Kloen, Peter; Siebenrock, Klaus A.

    2007-01-01

    Despite different operative and non-operative treatment regimens, the outcome after femoral head fractures has changed little over the past decades. The initial trauma itself as well as secondary changes such as posttraumatic osteoarthritis, avascular necrosis or heterotopic ossification is often

  2. Fludarabine inhibits STAT1-mediated up-regulation of caspase-3 expression in dexamethasone-induced osteoblasts apoptosis and slows the progression of steroid-induced avascular necrosis of the femoral head in rats.

    Science.gov (United States)

    Feng, Zhenhua; Zheng, Wenhao; Tang, Qian; Cheng, Liang; Li, Hang; Ni, Wenfei; Pan, Xiaoyun

    2017-08-01

    Steroid-induced avascular necrosis of the femoral head (SANFH) is a major limitation of long-term or excessive clinical administration of glucocorticoids. Fludarabine, which is a compound used to treat various hematological malignancies, such as chronic lymphocytic leukemia, acts by down-regulating signal transducer and activator of transcription 1 (STAT1) by inhibiting STAT1 phosphorylation in both normal and cancer cells. This study assessed the effects of fludarabine in vitro (primary murine osteoblasts) and in vivo (rat SANFH model). In vitro, pretreatment with fludarabine significantly inhibited Dexamethasone (Dex)-induced apoptosis in osteoblasts, which was examined by TUNEL staining. Treatment with Dex caused a remarkable decrease in the expression of Bcl-2; an increase in cytochrome c release; activation of BAX, caspase-9, and caspase-3; and an obvious enhancement in STAT1 phosphorylation. However, treatment resulted in the up-regulation of caspase-3 expression. Enhanced P-STAT1 activity and up-regulation of caspase-3 expression were also observed in osteoblasts. In vivo, the subchondral trabeculae in fludarabine-treated rats exhibited less bone loss and a lower ratio of empty lacunae. Taken together, our results suggest that STAT1-mediated up-regulation of caspase-3 is involved in osteoblast apoptosis induced by Dex and indicates that fludarabine may serve as a potential agent for the treatment of SANFH.

  3. Diagnostic scope of computer tomography in hip disease - Paget's disease, femoral head necrosis, coxarthrosis, coxarthritis

    Energy Technology Data Exchange (ETDEWEB)

    Nebel, G; Lingg, G; Reid, W

    1982-10-01

    The value of computer tomography was investigated in Paget's disease of the hip, femoral head necrosis (adult avascular and osteoradionecrosis), coxarthrosis and coxarthritis (bacterial and rheumatoid). The greatest value of CT is in the diagnosis of adult avascular necrosis of the femoral head and is valuable for localising the necrotic area in the axial plane. This is of value in planning surgical treatment (displacement osteotomy or endoprosthesis). In Paget's disease, coxarthrosis and coxarthritis, CT provides only additional or more precise information.

  4. Diagnostic scope of computer tomography in hip disease - Paget's disease, femoral head necrosis, coxarthrosis, coxarthritis

    International Nuclear Information System (INIS)

    Nebel, G.; Lingg, G.; Reid, W.

    1982-01-01

    The value of computer tomography was investigated in Paget's disease of the hip, femoral head necrosis (adult avascular and osteoradionecrosis), coxarthrosis and coxarthritis (bacterial and rheumatoid). The greatest value of CT is in the diagnosis of adult avascular necrosis of the femoral head and is valuable for localising the necrotic area in the axial plane. This is of value in planning surgical treatment (displacement osteotomy or endoprosthesis). In Paget's disease, coxarthrosis and coxarthritis, CT provides only additional or more precise information. (orig.) [de

  5. Avascular osteonecrosis of the femoral condyle after arthroscopic surgery; Osteonecrose aseptique du condyle femoral apres meniscectomie par voie arthroscopique

    Energy Technology Data Exchange (ETDEWEB)

    Al-Kaar, M.; Garcia, J. [Hopital Cantonal Geneve, Geneva (Switzerland); Fritschy, D.; Bonvin, J.C. [Policlinique de Chirurgie, Hopital Cantonal Universitaire, Geneve (Switzerland)

    1997-04-01

    Avascular osteonecrosis of the femoral condyle after arthroscopic surgery. Retrospective review of 10 patients who presented with avascular necrosis of the ipsilateral femoral condyle following arthroscopic meniscectomy (9 medial, 1 lateral). The bone lesions were evaluated by radiography and MRI, which were repeated for few patients. MRI allows earlier diagnosis of avascular necrosis of the femoral condyle and offers an evaluation of extent of the lesions whose evolution is variable: 3 patients required a knee prosthesis, the other 7 patients were treated medically. (authors). 21 refs.

  6. Avascular necrosis of femoral and/or humeral heads in multiple myeloma: results of a prospective study of patients treated with dexamethasone-based regimens and high-dose chemotherapy.

    Science.gov (United States)

    Talamo, Giampaolo; Angtuaco, Edgardo; Walker, Ronald C; Dong, Li; Miceli, Marisa H; Zangari, Maurizio; Tricot, Guido; Barlogie, Bart; Anaissie, Elias

    2005-08-01

    To assess the prevalence, time of onset, risk factors, and outcome of avascular necrosis (AVN) of bone in patients with multiple myeloma undergoing antineoplastic therapy. A total of 553 consecutive assessable patients were enrolled onto a treatment protocol consisting of dexamethasone-containing induction chemotherapy, autologous stem-cell transplantation, consolidation chemotherapy, and maintenance with interferon alfa. Patients were randomly assigned to receive thalidomide (269 patients) or no thalidomide (284 patients) throughout the study period. With a median follow-up of 33 months (range, 5 to 114 months), AVN of the femoral head(s) developed in 49 patients (9%). Median time to onset of AVN was 12 months (range, 2 to 41 months). Three risk factors for AVN were identified by multivariate analysis: cumulative dexamethasone dose (odds ratio [OR], 1.028; 95% CI, 1.012 to 1.044; P = .0006 [per 40 mg dexamethasone]), male sex (OR, 0.390; 95% CI, 0.192 to 0.790; P = .009), and younger age (OR, 0.961; 95% CI, 0.934 to 0.991 per year; P = .0122). Thalidomide-treated patients had a prevalence of AVN similar to that of the control group (8% v 10%, respectively; P = .58). AVN-related pain and limited range of motion of the affected joint were present in only nine and four patients, respectively, and four patients underwent hip replacement because of AVN. Fluorine-18 fluorodeoxyglucose positron emission tomography failed to detect abnormal uptake in the AVN-affected bones. AVN is a rare and usually asymptomatic complication during myeloma therapy. Cumulative dexamethasone dose, male sex, and younger age, but not thalidomide, increase the risk of AVN.

  7. Nontraumatic femoral head necrosis. Classification of bone scintigraphic findings and diagnostic value of SPECT following planar imaging

    Energy Technology Data Exchange (ETDEWEB)

    Minoshima, Satoshi; Uchida, Yoshitaka; Anzai, Yoshimi; Uno, Kimiichi; Arimizu, Noboru [Chiba Univ. (Japan). School of Medicine

    1994-09-01

    This study was conducted to determine bone scintigraphic findings in nontraumatic femoral head avascular necrosis and diagnostic value of SPECT imaging following a conventional planar imaging. Forty-three femoral heads in twenty-six cases with idiopathic femoral head necrosis (n=2), systemic lupus erythematosus (n=22), aplastic anemia (n=1), and renal transplantation (n=1) were studied. The diagnosis for femoral head necrosis was based on magnetic resonance imaging as well as other diagnostic studies in all cases. Scintigraphic findings of planar and SPECT images were classified into six categories: normal (N); cold or decrease (C); partial increase with cold or decrease (PH+C); ring-like increase with a cold center (RH+C); partial increase (PH); diffuse and/or irregular increase (DH). Avascular necrosis was confirmed in twenty-four femoral heads, in which planar and SPECT images showed scintigraphic findings of N (n=3, 2), C (n=1, 3), PH+C (n=2, 8), RH+C (n=2, 3), PH (n=9, 2), and DH (n=7, 6), respectively. Femoral heads without avascular necrosis demonstrated planar and SPECT findings of N (n=16, 12), C (n=0, 6), and DH (n=3, 1), respectively. When considering C, PH+C, and RH+C as diagnostic findings for avascular necrosis, sensitivities of planar and SPECT images were 21% and 58%, and specificities were 100% and 68%, respectively. In nineteen femoral heads with normal planar findings (N), SPECT correctly identified avascular necrosis in two femoral heads and misidentified six normal femoral heads as avascular necrosis. In nineteen femoral heads with nondiagnostic abnormalities (PH, DH), SPECT correctly identified avascular necrosis in seven femoral heads and showed no false positive. Diagnostic planar findings in five femoral heads were concordant with SPECT diagnosis. These results indicate that SPECT imaging is most valuable when planar images show nondiagnostic abnormalities based on the proposed classification of scintigraphic findings. (author).

  8. Nontraumatic femoral head necrosis. Classification of bone scintigraphic findings and diagnostic value of SPECT following planar imaging

    International Nuclear Information System (INIS)

    Minoshima, Satoshi; Uchida, Yoshitaka; Anzai, Yoshimi; Uno, Kimiichi; Arimizu, Noboru

    1994-01-01

    This study was conducted to determine bone scintigraphic findings in nontraumatic femoral head avascular necrosis and diagnostic value of SPECT imaging following a conventional planar imaging. Forty-three femoral heads in twenty-six cases with idiopathic femoral head necrosis (n=2), systemic lupus erythematosus (n=22), aplastic anemia (n=1), and renal transplantation (n=1) were studied. The diagnosis for femoral head necrosis was based on magnetic resonance imaging as well as other diagnostic studies in all cases. Scintigraphic findings of planar and SPECT images were classified into six categories: normal (N); cold or decrease (C); partial increase with cold or decrease (PH+C); ring-like increase with a cold center (RH+C); partial increase (PH); diffuse and/or irregular increase (DH). Avascular necrosis was confirmed in twenty-four femoral heads, in which planar and SPECT images showed scintigraphic findings of N (n=3, 2), C (n=1, 3), PH+C (n=2, 8), RH+C (n=2, 3), PH (n=9, 2), and DH (n=7, 6), respectively. Femoral heads without avascular necrosis demonstrated planar and SPECT findings of N (n=16, 12), C (n=0, 6), and DH (n=3, 1), respectively. When considering C, PH+C, and RH+C as diagnostic findings for avascular necrosis, sensitivities of planar and SPECT images were 21% and 58%, and specificities were 100% and 68%, respectively. In nineteen femoral heads with normal planar findings (N), SPECT correctly identified avascular necrosis in two femoral heads and misidentified six normal femoral heads as avascular necrosis. In nineteen femoral heads with nondiagnostic abnormalities (PH, DH), SPECT correctly identified avascular necrosis in seven femoral heads and showed no false positive. Diagnostic planar findings in five femoral heads were concordant with SPECT diagnosis. These results indicate that SPECT imaging is most valuable when planar images show nondiagnostic abnormalities based on the proposed classification of scintigraphic findings. (author)

  9. A cementless, proximally fixed anatomic femoral stem induces high micromotion with nontraumatic femoral avascular necrosis: A finite element study

    Directory of Open Access Journals (Sweden)

    Wen-Chuan Chen

    2014-07-01

    Full Text Available Decrease in bone mineral density of metaphysis in patients with nontraumatic avascular necrosis of the femoral head (AVN is considered the main factor leading to aseptic loosening of the femoral component. Researchers have hypothesized that a cementless, anatomic stem fixed proximally to the metaphysis has a higher risk for aseptic loosening than a straight stem that is fixed at the diaphysis in patients with nontraumatic AVN. The purpose of the current study was to evaluate the effects of cancellous bone stiffness at the metaphysis and stem geometry on the micromotion of the femoral stem relative to the femur. The VerSys (straight and ABG (anatomic femoral stems were enrolled in this finite element study to determine the performance of prosthetic micromotion. The simulated load to the hip joint during heel strike was assigned. Results showed that the VerSys model represented better resistance in micromotion between the bone/stem interface than the ABG model in either normal or poor cancellous bone stiffness at the metaphysis. The bone quality at the metaphysis of patients with nontraumatic AVN should be considered prior to selecting a femoral stem. In consideration of initial stability, acementless, straight stem that fits the isthmus is more favourable than an anatomic stem that is fixed to the proximal area of the canal.

  10. Upregulation of microRNA-320 decreases the risk of developing steroid-induced avascular necrosis of femoral head by inhibiting CYP1A2 both in vivo and in vitro.

    Science.gov (United States)

    Wei, Ji-Hua; Luo, Qun-Qiang; Tang, Yu-Jin; Chen, Ji-Xia; Huang, Chun-Lan; Lu, Ding-Gui; Tang, Qian-Li

    2018-06-20

    Steroid-induced avascular necrosis of femoral head (SANFH) occurs frequently in patients receiving high-dose steroid treatment for these underlying diseases. The target of this study is to investigate the effect of microRNA-320 (miR-320) on SANFH by targeting CYP1A2. CYP1A2 expression was detected using immunohistochemistry. Specimens were collected from patients with SANFH and femoral neck fracture. Seventy rats were assigned into seven groups. The targeting relationship between miR-320 and CYP1A2 was verified by bioinformatics website and dual luciferase reporter gene assay. RT-qPCR and Western blot analysis were used to detect miR-320 and CYP1A2 expressions. The enzymatic activity of CYP1A2 was detected by fluorescence spectrophotometry. Hemorheology and microcirculation were measured in rats. MiR-320 expression decreased and CYP1A2 expression and enzymatic activity increased in SANFH patients compared to those with femoral neck fracture. CYP1A2 was the target gene of miR-320. Hemorheology and microcirculation results showed that up-regulated expression of CYP1A2 promoted the development of SANFH while increased expression of miR-320 inhibited the development of SANFH. Compared with the SANFH group, the SANFH + miR-320 mimic group showed increased miRNA-320 expression, and decreased CYP1A2 expression and enzymatic activity. Opposite results were found in the SANFH + miR-320 inhibitor group. The SANFH + miR-320 inhibitor + pCR-CYP1A2_KO group showed decreased miRNA-320 expression and the SANFH + pCR-CYP1A2_KO group showed decreased CYP1A2 expression and enzymatic activity. Our findings provide evidences that miR-320 might inhibit the development of SANFH by targeting CYP1A2. Copyright © 2018 Elsevier B.V. All rights reserved.

  11. Management of non-traumatic avascular necrosis of the femoral head-a comparative analysis of the outcome of multiple small diameter drilling and core decompression with fibular grafting.

    Science.gov (United States)

    Mohanty, S P; Singh, K A; Kundangar, R; Shankar, V

    2017-04-01

    The purpose of this study was to compare the clinical and radiological outcomes of multiple small diameter drilling and core decompression with fibular strut grafting in the management of non-traumatic avascular necrosis (AVN) of the femoral head. Outcomes of patients with AVN treated by multiple small diameter drilling (group 1) were compared retrospectively with patients treated by core decompression and fibular grafting (group 2). Harris hip score (HHS) was used to assess the clinical status pre- and postoperatively. Modified Ficat and Arlet classification was used to assess the radiological stage pre- and postoperatively. Forty-six patients (68 hips) were included in this study. Group 1 consisted of 33 hips, and group 2 consisted of 35 hips. In stages I and IIB, there was no statistically significant difference in the final HHS between the two groups. However, in stages IIA and III, hips in group 2 had a better final HHS (P < 0.05). In terms of radiographic progression, there was no statistical difference between hips in stages I, IIA and stage IIB. However, in stage III, hips belonging to group 2 had better results (P < 0.05). Kaplan-Meier survivorship analysis showed better outcome in group 2 in stage III (P < 0.05). Hips with AVN in the precollapse stage can be salvaged by core decompression with or without fibular grafting. Multiple small diameter drilling is relatively simple and carries less morbidity and hence preferred in stages I and II. However, in stage III disease, core decompression with fibular strut grafting gives better results.

  12. Radionuclide patterns of femoral head disease

    Energy Technology Data Exchange (ETDEWEB)

    Webber, M M; Wagner, J; Cragin, M D [California Univ., Los Angeles (USA). Dept. of Radiological Sciences

    1977-12-01

    The pattern of uptake of bone marrow specific radio-sup(99m)Tc sulfur colloid and the pattern of uptake of bone mineral specific radio-sup(99m)Tc pryophosphate may be valuable in assessing bone vascularity in diseases suspected of causing impaired blood supply, or indicate the presence of reactive bone formation. The low energy of the technetium label has been shown to be superior to /sup 18/F and /sup 85/Sr, and leads to greater imaging detail on the scans. Femoral head scanning with mineral and/or marrow specific radionuclides offers the clinician a method of evaluating the status of the femoral head and possibly an early diagnosis of avascular necrosis before roentgenographic changes occur. This study, which reports on a 5-year experience using radionuclide scanning to assess femoral head vascularity, begins with baseline or normal studies followed by variations of the normal pattern. Typical scan patterns of hip pathology described above are also presented.

  13. Inter-observer and intra-observer reliability in the radiographic diagnosis of avascular necrosis of the femoral head following reconstructive hip surgery in children with cerebral palsy.

    Science.gov (United States)

    Hesketh, Kim; Sankar, Wudbhav; Joseph, Benjamin; Narayanan, Unni; Mulpuri, Kishore

    2016-04-01

    The incidence of avascular necrosis (AVN) following reconstructive hip surgery in cerebral palsy (CP) ranges from 0 to 69 % in the current literature. The purpose of this study was to determine the inter- and intra-observer reliability of radiographically diagnosing AVN in children with CP after hip surgery. A retrospective review of 65 children with CP who had reconstructive hip surgery between 2009 and 2012 at BC Children's Hospital was completed. Anterior-posterior and lateral radiographs were presented to four pediatric orthopaedic surgeons over two rounds. Surgeons were asked to review the set of unidentified radiographs and comment 'yes' or 'no' for the presence of AVN. Two weeks later the same set of radiographs was sent in a different order and the surgeons were again asked to comment on AVN. Inter- and intra-observer reliability was determined using kappa statistics. The intra-observer reliability ranged from 0.65 to 0.88 with an average score of 0.76. Inter-observer reliability showed greater variability, ranging from 0.41 to 0.77 with an average score of 0.56 across all surgeons. Although the intra-rater reliability produced a strength of "good" and the inter-rater reliability a strength of "moderate" agreement, the variability within these scores is clinically important as it demonstrates the difficulty in identifying AVN. This may explain the variability in AVN that is reported in the literature. The need for further education and research in the diagnosis of AVN in children with CP who have undergone reconstructive hip surgery is clinically necessary.

  14. Indomethacin induced avascular necrosis of head of femur

    Science.gov (United States)

    Prathapkumar, K; Smith, I; Attara, G

    2000-01-01

    Chemically induced avascular necrosis of bone is a well documented entity. Indomethacin is one of the causes of this condition but is often difficult to recognise. Review of the literature shows that only one case of indomethacin induced avascular necrosis has been reported in the English language between 1966 and the present.
The case of a young healthy man, who developed avascular necrosis of head of femur after prolonged administration of indomethacin, is reported here.


Keywords: indomethacin; avascular necrosis PMID:10964124

  15. 99mTc-MDP scintigraphy of femoral head necrosis following femoral neck fracture

    International Nuclear Information System (INIS)

    Lee, Soon Jin; Lee, Jun Hyung; Kim, Eun Kyung; Lee, Sun Wha; Kim, Soon Yong

    1985-01-01

    Secondary ischemic necrosis of femoral head due to loss of blood supply following to femoral neck fracture is well known. The regional distribution of bone-seeking radiopharmaceuricals in the skeleton can depend on a number of factors, but bone blood flow is a major physiological determinant of regional skeletal uptake of Tc-99m polyphosphate and bone imaging may thus be used for the evaluation of vascularity of the femoral head. The authors made a comparative study of scintigraphic findings and operative findings of 28 cases of femoral neck fracture treated at Kyung Hee University Hospital from April 1980 to May 1984. The results were as follows: 1. In 16 cases of proven avascular necorsis of femoral head, scintigraphy showed absent or decreased activity in 14 cases (87.5%), while radiography showed increased density in 10 cases (62.5%). 2. In 12 cases of proven vital femoral head, scintigraphy showed increased activity in 9 cases (75%) and radiography showed decreased density in 9 cases (75%). 3. 99mTc-MDP scintigraphy was an excellent and useful method for assessing bone vitality of femoral head

  16. {sup 99m}Tc-MDP scintigraphy of femoral head necrosis following femoral neck fracture

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Soon Jin; Lee, Jun Hyung; Kim, Eun Kyung; Lee, Sun Wha; Kim, Soon Yong [Kyung Hee University School of Medicine, Seoul (Korea, Republic of)

    1985-02-15

    Secondary ischemic necrosis of femoral head due to loss of blood supply following to femoral neck fracture is well known. The regional distribution of bone-seeking radiopharmaceuricals in the skeleton can depend on a number of factors, but bone blood flow is a major physiological determinant of regional skeletal uptake of Tc-99m polyphosphate and bone imaging may thus be used for the evaluation of vascularity of the femoral head. The authors made a comparative study of scintigraphic findings and operative findings of 28 cases of femoral neck fracture treated at Kyung Hee University Hospital from April 1980 to May 1984. The results were as follows: 1. In 16 cases of proven avascular necorsis of femoral head, scintigraphy showed absent or decreased activity in 14 cases (87.5%), while radiography showed increased density in 10 cases (62.5%). 2. In 12 cases of proven vital femoral head, scintigraphy showed increased activity in 9 cases (75%) and radiography showed decreased density in 9 cases (75%). 3. 99mTc-MDP scintigraphy was an excellent and useful method for assessing bone vitality of femoral head.

  17. The early assessment of avascular necrosis of femur head in dogs by dynamic bone imaging

    International Nuclear Information System (INIS)

    Li Peiyong; Zhang Huan; Zhang Jixian; Zhu Chengmo; Sun Zhengming; Yang Qingming

    1998-01-01

    Avascular necrosis of femoral head (AVN) was induced unilaterally in 10 dogs by frozen. Dynamic bone imaging was performed before, and 1,3,5,7,12,19 and 33 days after operation. The perfusion index of femoral head (FPI) was calculated by the graphical approach of time-activity curves and quantitation of data. Based on histological examination, pathological lesions on 10 dogs could be classified into four stages: edema, hemorrhage, liquidation, and granulation formation with focal fibrosis, etc. Decreased FPI index was found in all lesions of 10 dogs by dynamic bone imaging. Until 19 days after operation, the uptake was reduced compared to the normal side, whereas after 33 days, its uptake was increased. Perfusion index was considered to reveal the blood flow condition in femoral head. It can be used to detect the early stage of AVN and to understand the effects of various modes of therapy

  18. Biophysical stimulation in osteonecrosis of the femoral head

    Directory of Open Access Journals (Sweden)

    Massari Leo

    2009-01-01

    Full Text Available Osteonecrosis of the femoral head is the endpoint of a disease process that results from insufficient blood flow and bone-tissue necrosis, leading to joint instability, collapse of the femoral head, arthritis of the joint, and total hip replacement. Pain is the most frequent clinical symptom. Both bone tissue and cartilage suffer when osteonecrosis of the femoral head develops. Stimulation with pulsed electromagnetic fields (PEMFs has been shown to be useful for enhancing bone repair and for exerting a chondroprotective effect on articular cartilage. Two Italian studies on the treatment of avascular necrosis of the femoral head with PEMFs were presented in this review. In the first study, 68 patients suffering from avascular necrosis of the femoral head were treated with PEMFs in combination with core decompression and autologous bone grafts. The second one is a retrospective analysis of the results of treatment with PEMFs of 76 hips in 66 patients with osteonecrosis of the femoral head. In both studies clinical information and diagnostic imaging were collected at the beginning of the treatment and at the time of follow up. Statistical analysis was performed using chi-square test. Both authors hypothesize that the short-term effect of PEMF stimulation may be to protect the articular cartilage from the catabolic effect of inflammation and subchondral bone-marrow edema. The long-term effect of PEMF stimulation may be to promote osteogenic activity at the necrotic area and prevent trabecular fracture and subchondral bone collapse. PEMF stimulation represents an important therapeutic opportunity to resolve the Ficat stage-I or II disease or at least to delay the time until joint replacement becomes necessary.

  19. MRI-guidance in percutaneous core decompression of osteonecrosis of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Kerimaa, Pekka; Vaeaenaenen, Matti; Ojala, Risto; Tervonen, Osmo; Blanco Sequeiros, Roberto [Oulu University Hospital, Department of Radiology (Finland); Hyvoenen, Pekka; Lehenkari, Petri [Oulu University Hospital, Department of Surgery (Finland)

    2016-04-15

    The purpose of this study was to evaluate the usefulness of MRI-guidance for core decompression of avascular necrosis of the femoral head. Twelve MRI-guided core decompressions were performed on patients with different stages of avascular necrosis of the femoral head. The patients were asked to evaluate their pain and their ability to function before and after the procedure and imaging findings were reviewed respectively. Technical success in reaching the target was 100 % without complications. Mean duration of the procedure itself was 54 min. All patients with ARCO stage 1 osteonecrosis experienced clinical benefit and pathological MRI findings were seen to diminish. Patients with more advanced disease gained less, if any, benefit and total hip arthroplasty was eventually performed on four patients. MRI-guidance seems technically feasible, accurate and safe for core decompression of avascular necrosis of the femoral head. Patients with early stage osteonecrosis may benefit from the procedure. (orig.)

  20. MRI-guidance in percutaneous core decompression of osteonecrosis of the femoral head

    International Nuclear Information System (INIS)

    Kerimaa, Pekka; Vaeaenaenen, Matti; Ojala, Risto; Tervonen, Osmo; Blanco Sequeiros, Roberto; Hyvoenen, Pekka; Lehenkari, Petri

    2016-01-01

    The purpose of this study was to evaluate the usefulness of MRI-guidance for core decompression of avascular necrosis of the femoral head. Twelve MRI-guided core decompressions were performed on patients with different stages of avascular necrosis of the femoral head. The patients were asked to evaluate their pain and their ability to function before and after the procedure and imaging findings were reviewed respectively. Technical success in reaching the target was 100 % without complications. Mean duration of the procedure itself was 54 min. All patients with ARCO stage 1 osteonecrosis experienced clinical benefit and pathological MRI findings were seen to diminish. Patients with more advanced disease gained less, if any, benefit and total hip arthroplasty was eventually performed on four patients. MRI-guidance seems technically feasible, accurate and safe for core decompression of avascular necrosis of the femoral head. Patients with early stage osteonecrosis may benefit from the procedure. (orig.)

  1. Steroid Induced Bilateral Avascular Necrosis of Head of Femur in an Adult Male Patient - A Case Report.

    Science.gov (United States)

    Jadeja, Dharamvirsinh; Solanki, Vipul; Chavada, Bhavesh; Tripathi, Chandrabhanu

    2016-01-01

    A 28 year old male patient, known case of pemphigus vulgaris was on dexamethasone pulse therapy. Total 7 pulses were given after that he developed avascular necrosis of head of femur on both sides, which was confirmed by digital X- ray and MRI. Avascular necrosis is a disabling and progressive condition in young patients gradually leads to femoral head collapse and eventual total hip arthroplasty. As per WHO-UMC causality assessment criteria, the association between reaction and drug was possible, Naranjo's score was 7. According to Modified Schumock and Thornton's criteria, this reaction was not preventable. The Modified Hartwig and Siegel's scale showed that the reaction was severe (level 6). Here we present a case where the use of steroid for pemphigus vulgaris resulting in the development of bilateral avascular necrosis of head of femur.

  2. Two Cases of Avascular Necrosis of the Femur Head after Whole Pelvic Radiation Therapy for the Treatment of Cervical Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Jeong Il; Huh, Seung Jae; Park, Won; Oh, Dong Ryul; Lee, Jung Ae [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2008-06-15

    Avascular necrosis (AVN) is a disease characterized by the temporary or permanent loss of the blood supply to the bones, resulting from many possible causes, including radiation therapy. The femoral head is known to be the most common site of AVN. The authors encountered two cases of AVN of the femoral head among 557 patients with cervical cancer treated with whole pelvic radiation therapy at the Samsung Medical Center. AVN of the femoral head was presented with a sclerotic density change in a plain roentgenography and a decreased signal intensity lesion on the T1 and T2 weighted phases of a magnetic resonance image (MRI). Although it is a very rare complication after whole pelvic radiation therapy, AVN of the femoral head should be considered when characteristic imaging findings appear on follow-up examinations.

  3. Two Cases of Avascular Necrosis of the Femur Head after Whole Pelvic Radiation Therapy for the Treatment of Cervical Cancer

    International Nuclear Information System (INIS)

    Yu, Jeong Il; Huh, Seung Jae; Park, Won; Oh, Dong Ryul; Lee, Jung Ae

    2008-01-01

    Avascular necrosis (AVN) is a disease characterized by the temporary or permanent loss of the blood supply to the bones, resulting from many possible causes, including radiation therapy. The femoral head is known to be the most common site of AVN. The authors encountered two cases of AVN of the femoral head among 557 patients with cervical cancer treated with whole pelvic radiation therapy at the Samsung Medical Center. AVN of the femoral head was presented with a sclerotic density change in a plain roentgenography and a decreased signal intensity lesion on the T1 and T2 weighted phases of a magnetic resonance image (MRI). Although it is a very rare complication after whole pelvic radiation therapy, AVN of the femoral head should be considered when characteristic imaging findings appear on follow-up examinations

  4. Avascular Necrosis in the Contralateral Hip in Patients With Congenital Femoral Deficiency: A Report of 3 Cases.

    Science.gov (United States)

    Brown, Timothy S; Wimberly, Robert L; Birch, John G

    2017-01-01

    Congenital femoral deficiency is an uncommon clinical entity. We report 3 patients who developed avascular necrosis of the hip in the long (normal) leg during longitudinal observation and/or treatment of congenital femoral deficiency. Patients were identified in limb length discrepancy clinic and their charts were retrospectively reviewed for clinical and radiographic data collection. We describe the occurrence of idiopathic avascular necrosis in the normal limb in patients being followed for limb length discrepancy. Although no conclusion could be drawn about the etiology of the avascular necrosis, we describe a previously undocumented relationship between congenital femoral deficiency and avascular necrosis in the contralateral hip. This occurred in our congenital femoral deficiency population at a rate higher than expected compared with published incidences of avascular necrosis of the hip in children. Level IV-case series.

  5. Osteochondral lesion of the bilateral femoral heads in a young athletic patient

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jung Eun; Ryu, Kyung Nam; Park, Ji Seon; Cho, Yoon Je [Kyung Hee University Hospital, Seoul (Korea, Republic of); Yoon, So Hee; Park, So Young; Jin, Wook [Dept. of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul (Korea, Republic of); Lee, Kyung Ryeol [Dept. of Radiology, Jeju National University Hospital, Jeju (Korea, Republic of)

    2014-12-15

    Osteochondral lesions of the femoral head are uncommon and few studies have reported their imaging findings. Since joints are at risk of early degeneration after osteochondral damage, timely recognition is important. Osteochondral lesions of femoral head may often be necessary to differentiate from avascular necrosis. Here, we report a case of osteochondral lesions on bilateral femoral heads. This lesion manifested as subchondral cysts in initial radiographs, which led to further evaluation by computed tomography arthrography and magnetic resonance imaging, which revealed overlying cartilage defects.

  6. Evaluation of femoral head viability via bone scintigraphy in the postoperative pediatric patient

    International Nuclear Information System (INIS)

    Parikh, Ashishkumar K.; Washington, Eleby R.; Spottswood, Stephanie E.; Bobbey, Adam J.

    2018-01-01

    Evaluating postoperative patients with hardware is challenging following surgical intervention for hip maladies such as femoral neck fractures and slipped capital femoral epiphysis (SCFE). These children are at increased risk of developing avascular necrosis, and imaging may be requested to confirm or exclude this diagnosis. Children with Legg-Calve-Perthes disease can be monitored for restoration of blood flow to the capital femoral epiphysis to guide management and help with prognosis. Although MRI is sensitive for detecting early avascular necrosis, the presence of hardware degrades image quality. This report examines the utility of bone scans for evaluating femoral head perfusion in children who have undergone surgery for femoral neck fractures, SCFE or Legg-Calve-Perthes disease. A retrospective review of 20 patients (22 scans) after fixation for femoral neck fracture, SCFE or Legg-Calve-Perthes disease from 2012 to 2015 was performed. The bone scan findings were correlated with the intraoperative findings or clinical follow-up. Twenty-one of the 22 (95%) bone scans in 19 of the 20 (95%) patients demonstrated findings consistent with clinical outcomes and/or the intraoperative appearance of the femoral head. Four of 20 patients (20%) had bone scan features of avascular necrosis, defined as ''absent'' or ''moderately diminished'' femoral head activity, which were confirmed intraoperatively and resulted in poor outcomes. Radionuclide imaging of hips in the postoperative setting is a valuable modality for assessing the risk of avascular necrosis, a complication of femoral neck fractures and SCFE and for evaluating the restoration of flow to the capital femoral epiphyses of children with Legg-Calve-Perthes disease. (orig.)

  7. Subchondral bone density distribution in the human femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Wright, David A.; Meguid, Michael; Lubovsky, Omri; Whyne, Cari M. [Sunnybrook Research Institute, Orthopaedic Biomechanics Laboratory, Toronto, Ontario (Canada)

    2012-06-15

    This study aims to quantitatively characterize the distribution of subchondral bone density across the human femoral head using a computed tomography derived measurement of bone density and a common reference coordinate system. Femoral head surfaces were created bilaterally for 30 patients (14 males, 16 females, mean age 67.2 years) through semi-automatic segmentation of reconstructed CT data and used to map bone density, by shrinking them into the subchondral bone and averaging the greyscale values (linearly related to bone density) within 5 mm of the articular surface. Density maps were then oriented with the center of the head at the origin, the femoral mechanical axis (FMA) aligned with the vertical, and the posterior condylar axis (PCA) aligned with the horizontal. Twelve regions were created by dividing the density maps into three concentric rings at increments of 30 from the horizontal, then splitting into four quadrants along the anterior-posterior and medial-lateral axes. Mean values for each region were compared using repeated measures ANOVA and a Bonferroni post hoc test, and side-to-side correlations were analyzed using a Pearson's correlation. The regions representing the medial side of the femoral head's superior portion were found to have significantly higher densities compared to other regions (p < 0.05). Significant side-to-side correlations were found for all regions (r {sup 2} = 0.81 to r {sup 2} = 0.16), with strong correlations for the highest density regions. Side-to-side differences in measured bone density were seen for two regions in the anterio-lateral portion of the femoral head (p < 0.05). The high correlation found between the left and right sides indicates that this tool may be useful for understanding 'normal' density patterns in hips affected by unilateral pathologies such as avascular necrosis, fracture, developmental dysplasia of the hip, Perthes disease, and slipped capital femoral head epiphysis. (orig.)

  8. Subchondral stress fracture of femoral head in a healthy adult

    Directory of Open Access Journals (Sweden)

    Anand Ashish

    2010-01-01

    Full Text Available Subchondral fracture of the femoral head is an uncommon entity and usually occurs as an insufficiency fracture associated with poor bone quality or as a fatigue fracture in young military recruits. This condition should be considered in the differential diagnosis of acute hip pain in young patients along with transient osteoporosis and avascular necrosis of the hip. We report a case of acute onset hip pain in an asymptomatic healthy adult in which the diagnosis was made by magnetic resonance imaging and the patient responded well to conservative treatment.

  9. Corticosteroid Reduces Blood Flow to Femoral Heads in Rabbits.

    Science.gov (United States)

    Hou, S.M.; Liu, T.K.; Kao, M.C.

    1994-12-01

    Avascular necrosis of the femoral head is one of the common problems in orthopedic practice in Taiwan. The subchondral bone loses its blood supply which weakens its biomechanical support. Steroid overuse is one of many possible etiologies in reducing blood flow to the femoral head. Laser Doppler velocimeter is a precise monitor of regional blood flow of bone which is expressed in perfusion units (PU). In the control group the rabbits were injected with normal saline and there were no statistical differences between blood flow to the right hip (39.26 +/- 5.64 PU) and left hip (38.58 +/- 4.35 PU). In group B a weekly injection of methylprednisolone into rabbits for 6 weeks demonstrated the reduction of blood flow of femoral head (24.74 +/- 3.13 PU) by the laser Doppler velocimeter. The flow decreased further (15.93 +/- 2.33 PU) by 12 weeks of steroid treatment. In group C after a weekly injection of steroid for 6 weeks the flow became 31.63 +/- 4.79 PU. The steroid was then discontinued for 3 weeks and the flow was 34.6 +/- 1.34 PU. In group D the blood flow was 25.89 +/- 4.01 PU after 6 weeks of steroid treatment and we stopped the steroid for 6 weeks, the blood flow became 29.86 +/- 2.59 PU. The merit of our experiment established a model of study in avascular necrosis of the femoral head in rabbits. Copyright 1994 S. Karger AG, Basel

  10. MRI appearance of femoral head osteonecrosis following core decompression and bone grafting

    Energy Technology Data Exchange (ETDEWEB)

    Chan, T W; Dalinka, M K; Kressel, H Y [Pennsylvania Univ. Hospital, Philadelphia, PA (USA). Dept. of Radiology; Steinberg, M E [Pennsylvania Univ. Hospital, Philadelphia, PA (USA). Dept. of Orthopedic Surgery

    1991-02-01

    We used magnetic resonance imaging (MRI) to evaluate retrospectively 32 hips with avascular necrosis of the femoral head before and after core decompression and bone grafting. At a median follow-up time of 15 months, 4 of 9 large lesions had undergone femoral head collapse; 2 small lesions had decreased in size; and 14 small, 6 moderate, and 5 large lesions were unchanged. One hip with biopsy-proven avascular necrosis had diffuse marrow edema which resolved after surgery. The signal pattern within the lesions was analyzed in 17 hips. MRI can demonstrate changes in size and signal characteristics as well as femoral head collapse after core decompression and bone grafting. Changes in the surrounding marrow signal, including resolution of marrow edema and reconversion from fatty to hemopoietic marrow, can also be detected. (orig./GDG).

  11. To study the role of dynamic magnetic resonance imaging in assessing the femoral head vascularity in intracapsular femoral neck fractures

    Energy Technology Data Exchange (ETDEWEB)

    Kaushik, Abhishek, E-mail: abhiortho27@gmail.co [Department of Orthopedics, 513, Thermal Colony, Sector-22, Faridabad 121005, Haryana (India); Sankaran, Balu; Varghese, Mathew [Department of Orthopedics, St Stephen' s Hospital, Tis hazari, Delhi, New Delhi 110054 (India)

    2010-09-15

    Intracapsular femoral neck fractures remain unsolved fractures even after improvement in techniques of diagnosis and internal fixation. Individuals who sustain displaced femoral neck fractures are at high risk of developing avascular necrosis and non-union. Although several methods for predicting the viability of femoral head have been reported, they are not effective or widely used because of unreliability, potential complications and technical difficulties. Dynamic MRI was introduced in the recent past as a simple, non-invasive technique to predict the femoral head viability after the femoral neck fractures. In this study role of dynamic MRI was studied in 30 patients with 31 intracapsular femoral neck fractures. Fractures were divided in to three types according to dynamic curve patterns on MRI evaluation and were followed up for 6 months to 2 years to observe the final outcome. Sensitivity, Specificity and the Accuracy of dynamic MRI in predicting vascularity after femoral neck fracture are 87%, 88% and 87%, respectively. Type A or Type B curve pattern is a positive factor to successful osteosynthesis with p value <0.0001 (Chi-square test). This is a statistically significant value. From this finding it can be suggested that the reliability of dynamic curves A and B in predicting maintained vascularity of femoral head is high. This investigation can be used to predict the vascularity of femoral head after intracapsular femoral neck fractures. There was a good correlation between the outcomes of fractures and dynamic MRI curves done within 48 h of injury. This signifies the role of dynamic MRI in predicting the vascularity of femoral head as early as 48 h. A treatment algorithm can be suggested on the basis of dynamic MRI curves. The fractures with Type C dynamic curve should be considered as fractures with poor vascularity of femoral head and measures to enhance the vascularity of femoral head along with rigid internal fixation should be undertaken to promote

  12. To study the role of dynamic magnetic resonance imaging in assessing the femoral head vascularity in intracapsular femoral neck fractures

    International Nuclear Information System (INIS)

    Kaushik, Abhishek; Sankaran, Balu; Varghese, Mathew

    2010-01-01

    Intracapsular femoral neck fractures remain unsolved fractures even after improvement in techniques of diagnosis and internal fixation. Individuals who sustain displaced femoral neck fractures are at high risk of developing avascular necrosis and non-union. Although several methods for predicting the viability of femoral head have been reported, they are not effective or widely used because of unreliability, potential complications and technical difficulties. Dynamic MRI was introduced in the recent past as a simple, non-invasive technique to predict the femoral head viability after the femoral neck fractures. In this study role of dynamic MRI was studied in 30 patients with 31 intracapsular femoral neck fractures. Fractures were divided in to three types according to dynamic curve patterns on MRI evaluation and were followed up for 6 months to 2 years to observe the final outcome. Sensitivity, Specificity and the Accuracy of dynamic MRI in predicting vascularity after femoral neck fracture are 87%, 88% and 87%, respectively. Type A or Type B curve pattern is a positive factor to successful osteosynthesis with p value <0.0001 (Chi-square test). This is a statistically significant value. From this finding it can be suggested that the reliability of dynamic curves A and B in predicting maintained vascularity of femoral head is high. This investigation can be used to predict the vascularity of femoral head after intracapsular femoral neck fractures. There was a good correlation between the outcomes of fractures and dynamic MRI curves done within 48 h of injury. This signifies the role of dynamic MRI in predicting the vascularity of femoral head as early as 48 h. A treatment algorithm can be suggested on the basis of dynamic MRI curves. The fractures with Type C dynamic curve should be considered as fractures with poor vascularity of femoral head and measures to enhance the vascularity of femoral head along with rigid internal fixation should be undertaken to promote

  13. Outcome of pinning in patients with slipped capital femoral epiphysis: risk factors associated with avascular necrosis, chondrolysis, and femoral impingement.

    Science.gov (United States)

    Ulici, Alexandru; Carp, Madalina; Tevanov, Iulia; Nahoi, Catalin Alexandru; Sterian, Alin Gabriel; Cosma, Dan

    2018-06-01

    Objective This study aimed to assess the principal risk factors that could lead to the most common long-term complications of slipped capital femoral epiphysis, such as avascular necrosis, chondrolysis, and hip impingement. Methods We conducted a single-centre, retrospective study and evaluated patients (70 patients, 81 hips) who were treated for slipped capital femoral epiphysis from 2010 to 2015 and who underwent pinning. We measured the severity of displacement radiologically using the Southwick angle. Postoperative radiographs were evaluated for the most frequent long-term complications of avascular necrosis (AVN), chondrolysis, and femoral acetabular impingement (FAI). Results We found seven cases of AVN, 14 cases of chondrolysis, and 31 hips had an α angle of 60°. Sex, ambulation, and symptoms did not affect development of these complications. Patients with a normal weight were almost two times more likely to develop FAI. Patients with moderate and severe slips had a similar percentage of AVN. In severe slips, 85.7% of patients had an α angle higher than 60°. Conclusions This study shows that severe slips have a higher risk of developing AVN and hip impingement. Every patient who suffers from SCFE (even the mildest forms) should be regularly checked for FAI.

  14. Finding the unexpected: pathological examination of surgically resected femoral heads

    International Nuclear Information System (INIS)

    Fornasier, V.L.; Battaglia, D.M.

    2005-01-01

    To study the clinically diagnosed disease process but also identify additional, clinically undetected pathologies in femoral heads resected for replacement arthroplasty. A retrospective review was carried out of the pathological findings in 460 surgically resected femoral heads. Serial sections were submitted to low-energy fine-detail radiography, then decalcified sections stained by the WHO method were examined. The preoperative clinical and imaging diagnoses were compared with the pathological findings and special interest was placed on assessing the clinical significance of any unexpected, clinically undetected findings. The most common findings included the presence of bone islands (solitary osteomas) and areas of avascular necrosis in addition to the primary joint disease for which the patient underwent surgery. The preoperative symptomatology did not distinguish between the known primary disease and the additional pathological findings. Some of the clinically unidentified lesions were of a size that fell below the ability of current clinical investigations to detect. However, the finding of lesions by tissue fine-detail radiography indicates that current, more sensitive clinical imaging techniques may identify them. Careful examination of surgically resected femoral heads is important to ensure that all pathologies are identified and assessed for clinical relevance. (orig.)

  15. Finding the unexpected: pathological examination of surgically resected femoral heads

    Energy Technology Data Exchange (ETDEWEB)

    Fornasier, V.L. [St. Michael' s Hospital, University of Toronto, Department of Laboratory Medicine and Pathobiology, Toronto, Ontario (Canada); Battaglia, D.M. [St. Michael' s Hospital, University of Toronto, Department of Laboratory Medicine and Pathobiology, Toronto, Ontario (Canada); St. Michael' s Hospital, University of Toronto, Division of Pathology, Toronto, Ontario (Canada)

    2005-06-01

    To study the clinically diagnosed disease process but also identify additional, clinically undetected pathologies in femoral heads resected for replacement arthroplasty. A retrospective review was carried out of the pathological findings in 460 surgically resected femoral heads. Serial sections were submitted to low-energy fine-detail radiography, then decalcified sections stained by the WHO method were examined. The preoperative clinical and imaging diagnoses were compared with the pathological findings and special interest was placed on assessing the clinical significance of any unexpected, clinically undetected findings. The most common findings included the presence of bone islands (solitary osteomas) and areas of avascular necrosis in addition to the primary joint disease for which the patient underwent surgery. The preoperative symptomatology did not distinguish between the known primary disease and the additional pathological findings. Some of the clinically unidentified lesions were of a size that fell below the ability of current clinical investigations to detect. However, the finding of lesions by tissue fine-detail radiography indicates that current, more sensitive clinical imaging techniques may identify them. Careful examination of surgically resected femoral heads is important to ensure that all pathologies are identified and assessed for clinical relevance. (orig.)

  16. SEX DETERMINATION FROM FEMORAL HEAD DIAMETERS IN ...

    African Journals Online (AJOL)

    hi-tech

    2000-03-01

    Mar 1, 2000 ... In medico-legal cases where sophisticated methods of sex determination is lacking, these ... scientific methods(3). Using the visual method ... between the sexes and the values of the right and left femoral head diameters.

  17. Symmetric visualization of the femoral heads in reticuloendothelial bone marrow scanning in adults

    Energy Technology Data Exchange (ETDEWEB)

    Munz, D L; Hoer, G

    1983-03-01

    Two hundred and twenty seven consecutive patients of either sex aged 15-84 suffering from various benign and malignant disorders were studied by sup(99m)Tc-HSA-MM reticuloendothelial bone marrow scintigraphy. In all patients, symmetric findings concerning visualization or nonvisualization of the femoral heads could be seen. Femoral heads were clearly visualized in 48%, nonvisualized in 43%, and equivocally visualized in 9%. In patients with clearly visualized femoral heads, the bone marrow showed peripheral extension in 81%, whereas in patients with nonvisualized femoral heads, bone marrow extension was observed in only 42%. There was a correlation between the degree of bone marrow extension and the ability to visualize femoral heads. There was no obvious difference between males and females, nor patients with various diseases or treatments, amongst nor between different age groups. Two hypotheses are suggested to explain the correspondence between presence of bone marrow tissue in the femoral heads and peripheral extension of the bone marrow organ. Nonvisualization of the femoral heads alone is insufficient to establish the diagnosis of avascular necrosis.

  18. Prognostic value of dynamic MRI in assessing post-traumatic femoral head vascularity

    Energy Technology Data Exchange (ETDEWEB)

    Kaushik, Abhishek; Varghese, Mathew [St Stephen' s Hospital, Department of Orthopaedics, Delhi, New Delhi (India); Sankaran, Balu [St Stephen' s Hospital, Delhi, New Delhi (India)

    2009-06-15

    The vascular status of femoral heads in the post-traumatic period of intracapsular femoral neck fracture (ICFNF) remains uncertain until the patient actually develops avascular necrosis (AVN). Several methods for predicting the viability of femoral head have been reported, that are not effective or widely used because of unreliability, potential complications, and technical difficulties. The present study involved the use of Dynamic MRI (DMRI) in assessing femoral head vascularity to predict AVN. The role of DMRI was studied prospectively in 30 patients with 31 ICFNF. Fractures were divided in to three types (Type A, B, or C) based on the femoral head vascularity shown by dynamic curve patterns on MRI evaluation. Type A was preserved vascularity, Type B was some decrease in vascularity but still viable while Type C was significantly reduced vascularity. These were followed-up for 6 months to 2 years to observe the final outcome in terms of union, non-union, or AVN. We found that Type A curves correlate well with vascular status and Type C curves correlate well with poor vascularity of the femoral heads. No AVN was seen in any of Type A (13/31) or Type B (eight out of 31). Five cases showed AVN and all of them were of Type C dynamic curves. Dynamic MRI is a reliable tool to evaluate vascularity of femoral heads and thus reduces the uncertainty of outcome of treatment of ICFNFs. DMRI can be a useful tool to formulate a treatment algorithm in management of ICFNF. (orig.)

  19. Prognostic value of dynamic MRI in assessing post-traumatic femoral head vascularity

    International Nuclear Information System (INIS)

    Kaushik, Abhishek; Varghese, Mathew; Sankaran, Balu

    2009-01-01

    The vascular status of femoral heads in the post-traumatic period of intracapsular femoral neck fracture (ICFNF) remains uncertain until the patient actually develops avascular necrosis (AVN). Several methods for predicting the viability of femoral head have been reported, that are not effective or widely used because of unreliability, potential complications, and technical difficulties. The present study involved the use of Dynamic MRI (DMRI) in assessing femoral head vascularity to predict AVN. The role of DMRI was studied prospectively in 30 patients with 31 ICFNF. Fractures were divided in to three types (Type A, B, or C) based on the femoral head vascularity shown by dynamic curve patterns on MRI evaluation. Type A was preserved vascularity, Type B was some decrease in vascularity but still viable while Type C was significantly reduced vascularity. These were followed-up for 6 months to 2 years to observe the final outcome in terms of union, non-union, or AVN. We found that Type A curves correlate well with vascular status and Type C curves correlate well with poor vascularity of the femoral heads. No AVN was seen in any of Type A (13/31) or Type B (eight out of 31). Five cases showed AVN and all of them were of Type C dynamic curves. Dynamic MRI is a reliable tool to evaluate vascularity of femoral heads and thus reduces the uncertainty of outcome of treatment of ICFNFs. DMRI can be a useful tool to formulate a treatment algorithm in management of ICFNF. (orig.)

  20. Analysis on blood biochemical markers for risk factor of alcoholic avascular necrosis of the femoral head%酒精性股骨头坏死风险因素的血液生化指标分析

    Institute of Scientific and Technical Information of China (English)

    张颖; 孙瑞波; 张蕾蕾; 刘又文

    2017-01-01

    [Objective] To explore the risk factors of alcoholic osteonecrosis of the femoral head (ONFH) from blood biochemical markers by comparison of the patients with the healthy persons.[Methods] A retrospective study was conducted on 156 patients with alcoholic femoral head who were admitted to our hospital from March 2012 to October 2015.Of them,16 patients were excluded from this study for tumor or tuberculosis,and the remaining 140 patients were included.Other 140 normal patients were selected as the control from the Physical Examination Center database.One-way analysis of variance and Student's t test was used to screen the biochemical markers with significant difference to the health.The variables beyond the normal range were screened out and defined as potential risk factors.Finally,the risk factors were further evaluated by Stepwise logistic regression.[Results] The CO2CP (OR=19.36,P<0.001),CHOL (OR=66.56,P<0.001),TG (OR=97.66,P<0.001),HDL(OR=74.37,P<0.001) and LDL (OR=22.92,P<0.001) showed statistically significances in the regression equation,which indicated that CO2CP (down),CHOL (rise),TG (high),HDL (down),LDL (rise) were strong risk factors for alcoholic ONFH.[Conclusion]CO2CP (decreased),CHOL (elevated),TG (elevated),HDL (decreased),LDL (elevated) are strong risk factors for the occurrence of alcoholic ONFH.For alcohol abuse individual,blood biochemical tests can be carried out to screen out the risk of alcohol induced osteonecrosis of the femoral head.%[目的]通过比较酒精性股骨头坏死患者和健康人,探索酒精性股骨头坏死风险因素的血液生化指标.[方法]本研究经过回顾性筛选2012年3月~2015年10月本院收治的酒精性股骨头患者156例,其中16例因合并肿瘤或结核被排除,最终纳入140例作为坏死组.自本院检验中心数据库中抽取140例健康人作为对照组.对纳入的各组生化指标进行单因素方差分析并进行Student's t检验,筛选出有统计学意义的

  1. Evaluation of femoral head vascularization in slipped capital femoral epiphysis before and after cannulated screw fixation with use of contrast-enhanced MRI: initial results

    International Nuclear Information System (INIS)

    Staatz, G.; Honnef, D.; Hohl, C.; Schmidt, T.; Guenther, R.W.; Kochs, A.; Roehrig, H.

    2007-01-01

    In this study we used contrast-enhanced magnetic resonance imaging (MRI) to evaluate the vascularization of the femoral head in children with slipped capital femoral epiphysis (SCFE) before and after cannulated screw fixation. Eleven consecutive children with SCFE, seven boys and four girls, aged 10-15 years were included in the study. There were no preslips; four children had acute, three acute-on-chronic, and four chronic SCFE. The MRI examinations were performed in a 1.5 Tesla MR scanner with use of a coronal STIR sequence, a coronal contrast-enhanced T1-weighted spin-echo sequence, and a sagittal three-dimensional gradient-echo sequence. Morphology, signal intensities, and contrast-enhancement of the femoral head were assessed by two radiologists in consensus. Morphologic distortion of the physis, bone marrow edema within the metaphysis and epiphysis, and joint effusion were the preoperative MRI findings of SCFE in each child. In nine children, the vascularization of the femoral head before and after surgery was normal. In one child, a preoperative avascular zone in the superolateral aspect of the epiphysis revascularized completely after surgery. One child with severe SCFE developed avascular necrosis of the femoral head after open reduction of the slip. We conclude that MRI allows for accurate evaluation of the femoral head vascularization before and after surgery in children with SCFE. (orig.)

  2. Evaluation of femoral head vascularization in slipped capital femoral epiphysis before and after cannulated screw fixation with use of contrast-enhanced MRI: initial results

    Energy Technology Data Exchange (ETDEWEB)

    Staatz, G. [Friedrich-Alexander-University Erlangen-Nuernberg, Department of Radiology, Division of Pediatric Radiology, Erlangen (Germany); University Hospital of the RWTH Aachen, Department of Diagnostic Radiology, Aachen (Germany); Honnef, D.; Hohl, C.; Schmidt, T.; Guenther, R.W. [University Hospital of the RWTH Aachen, Department of Diagnostic Radiology, Aachen (Germany); Kochs, A.; Roehrig, H. [University Hospital of the RWTH Aachen, Department of Orthopaedic Surgery, Aachen (Germany)

    2007-01-15

    In this study we used contrast-enhanced magnetic resonance imaging (MRI) to evaluate the vascularization of the femoral head in children with slipped capital femoral epiphysis (SCFE) before and after cannulated screw fixation. Eleven consecutive children with SCFE, seven boys and four girls, aged 10-15 years were included in the study. There were no preslips; four children had acute, three acute-on-chronic, and four chronic SCFE. The MRI examinations were performed in a 1.5 Tesla MR scanner with use of a coronal STIR sequence, a coronal contrast-enhanced T1-weighted spin-echo sequence, and a sagittal three-dimensional gradient-echo sequence. Morphology, signal intensities, and contrast-enhancement of the femoral head were assessed by two radiologists in consensus. Morphologic distortion of the physis, bone marrow edema within the metaphysis and epiphysis, and joint effusion were the preoperative MRI findings of SCFE in each child. In nine children, the vascularization of the femoral head before and after surgery was normal. In one child, a preoperative avascular zone in the superolateral aspect of the epiphysis revascularized completely after surgery. One child with severe SCFE developed avascular necrosis of the femoral head after open reduction of the slip. We conclude that MRI allows for accurate evaluation of the femoral head vascularization before and after surgery in children with SCFE. (orig.)

  3. Femoral head vitality after intracapsular hip fracture

    International Nuclear Information System (INIS)

    Stroemqvist, B.

    1983-01-01

    Femoral head vitality before, during and at various intervals from the operation was determined by tetracycline labeling and/or 99 sp (m)Tc-MDP scintimetry. In a three-year follow-up, healing prognosis could be determined by scintimetry 3 weeks from operation; deficient femoral head vitality predicting healing complications and retained vitality predicting uncomplicated healing. A comparison between pre- and postoperative scintimetry indicated that further impairment of the femoral head vitality could be caused by the operative procedure, and as tetracycline labeling prior to and after fracture reduction in 370 fractures proved equivalent, it was concluded that the procedure of osteosynthesis probably was responsible for capsular vessel injury, using a four-flanged nail. The four-flanged nail was compared with a low-traumatic method of osteosynthesis, two hook-pins, in a prospective randomized 14 month study, and the postoperative femoral head vitality was significantly better in the hook-pin group. This was also clearly demonstrated in a one-year follow-up for the fractures included in the study. Parallel to these investigations, the reliability of the methods of vitality determination was found satisfactory in methodologic studies. For clinical purpose, primary atraumatic osteosynthesis, postoperative prognostic scintimetry and early secondary arthroplasty when indicated, was concluded to be the appropriate approach to femoral neck fracture treatment. (Author)

  4. Biomechanical comparisons between a new avascular necrosis of femaral head stem based on Chinese patients with avascular necrosis and two other designs.

    Science.gov (United States)

    Zhang, Qiang; Cheng, Cheng-Kung; Wei, Hung-Wen; Dong, Xiang; Chen, Yi-Ting; Lai, Yu-Shu; Wang, Yan

    2013-01-01

    There is a relatively high failure rate of the femoral component in patients with avascular necrosis at the intermediate-term follow-up. Improving the geometrical fit of the femoral stem against the medullary canal may help to provide long-term survivorship of the hip replacement for patients with avascular necrosis. We designed a specific stem, based on morphometric studies of proximal femoral canals in Chinese avascular necrosis patients and evaluated the stem by finite element analyses, comparing the novel stem with two commercially available and commonly used stems. The morphometric data from avascular necrosis patients showed specific geometric differences in the proximal femoral canal, including profile curves in both the sagittal and coronary planes than the patients with femoral neck fracture. The shorter stemmed prostheses (Fitmore(®) and our stem) performed better than the longer stemmed prosthesis (VerSys(®)). This is the first study to investigate the femoral geometries of Chinese avascular necrosis patients. Our stem provides better stability and is theoretically beneficial to bone ingrowth, which may increase the long-term stability and fixation of the implant.

  5. Bone marrow oedema on MR imaging indicates ARCO stage 3 disease in patients with AVN of the femoral head.

    Science.gov (United States)

    Meier, Reinhard; Kraus, Tobias M; Schaeffeler, Christoph; Torka, Sebastian; Schlitter, Anna Melissa; Specht, Katja; Haller, Bernhard; Waldt, Simone; Rechl, Hans; Rummeny, Ernst J; Woertler, Klaus

    2014-09-01

    To test the hypothesis that bone marrow oedema (BME) observed on MRI in patients with avascular necrosis (AVN) of the femoral head represents an indicator of subchondral fracture. Thirty-seven symptomatic hips of 27 consecutive patients (53% women, mean age 49.2) with AVN of the femoral head and associated BME on magnetic resonance (MR) imaging were included. MR findings were correlated with computed tomography (CT) of the hip and confirmed by histopathological examination of the resected femoral head. Imaging studies were analysed by two radiologists with use of the ARCO classification. On MR imaging a fracture line could be identified in 19/37 (51%) cases, which were classified as ARCO stage 3 (n = 15) and stage 4 (n = 4). The remaining 18/37 (49%) cases were classified as ARCO stage 2. However, in all 37/37 (100%) cases a subchondral fracture was identified on CT, indicating ARCO stage 3/4 disease. The extent of subchondral fractures and the femoral head collapse was graded higher on CT as compared to MRI (P AVN, BME of the femoral head represents a secondary sign of subchondral fracture and thus indicates ARCO stage 3 disease. BME on MRI in AVN of femoral head indicates a subchondral fracture. BME in AVN of the femoral head represents ARCO stage 3/4 disease. CT identifies subchondral fractures and femoral head collapse better than MR imaging. This knowledge helps to avoid understaging and to trigger adequate treatment.

  6. Closed bone graft epiphysiodesis for avascular necrosis of the capital femoral epiphysis.

    Science.gov (United States)

    Thompson, George H; Lea, Ethan S; Chin, Kenneth; Liu, Raymond W; Son-Hing, Jochen P; Gilmore, Allison

    2013-07-01

    Avascular necrosis (AVN) of the capital femoral epiphysis (CFE) after an unstable slipped capital femoral epiphysis (SCFE), femoral neck fracture or traumatic hip dislocation can result in severe morbidity. Treatment options for immature patients with AVN are limited, including a closed bone graft epiphysiodesis (CBGE). However, it is unclear whether this procedure prevents AVN progression. We investigated whether early MRI screening and CBGE prevented the development of advanced AVN changes in the CFE and the rates of complications with this approach. We prospectively followed all 13 patients (seven boys, six girls) with unstable SCFEs (six patients), femoral neck fractures (five patients), and traumatic hip dislocations (two patients) and evidence of early AVN treated between 1984 and 2012. Mean age at initial injury was 12 years (range, 10-16 years). Nine of the 13 patients had followup of at least 2 years or until conversion to THA (mean, 4.5 years; range, 0.8-8.5 years), including two with unstable SCFEs, the five with femoral neck fractures, and the two with traumatic hip dislocations. All patients had technetium scans and/or MRI within 1 to 2 months of their initial injury (before CBGE) and all had evidence of early (Ficat 0) AVN. Patients were followed clinically and radiographically for AVN progression. Six of the nine hips did not develop typical clinical or radiographic evidence of AVN. These six patients have been followed 6.3 years (range, 4.3-9.1 years) from initial injury and 5.9 years (range, 3.8-8.5 years) from CBGE. The remaining three patients were diagnosed with AVN at periods ranging from 3 to 6 months after CBGE. Early recognition and treatment of AVN with a CBGE may alter the natural history of this complication. Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

  7. Aseptic necrosis of femoral head complicating thalassemia

    International Nuclear Information System (INIS)

    Orzincolo, C.; Castaldi, G.; Scutellary, P.N.; Bariani, L.; Pinca, A.

    1986-01-01

    Aseptic necrosis of the femoral head is described in 4 patients, selected from 280 patients with homozygous β-thalassemia (Cooley anemia). The incidence of the complication appears to be very high (14.5per mille) in thalassemia, compared to the general population. The possible mechanism are discussed. (orig.)

  8. Long-term result of cementless femoral stem in avascular necrosis of the hip.

    Science.gov (United States)

    Cheung, Kin W; Chiu, Kwok H; Chung, Kwong Y

    2015-01-01

    Avascular necrosis (AVN) of the hip may have extensive involvement of the proximal femur which may affect boney ingrowth into cementless femoral stems. From 1994 to 2004, 182 total hip arthroplasties (in 144 patients, 117 AVN hips and 65 non-AVN hips) were performed using hydroxyapatite coated femoral stems. All patients were followed up prospectively. Mean age was 51 years and mean follow-up 14.7 years (range 9.7-19.1 years). Four stems were revised because of aseptic loosening, 3 in AVN group and 1 in non-AVN group. The overall mechanical failure rate was 2.2%, the mechanical failure rate in AVN and non-AVN group was 2.6% and 1.5% respectively (p = 1). The 19.1 year survival using revision for aseptic loosening as an endpoint for AVN and non-AVN patients were 97.1% and 96.2% respectively (p = 0.654). Stable boney ingrowth was present in 99.5% hips. This study represents 1 of the largest series reporting the long-term follow-up of the use of cementless femoral stems in treating AVN of the hip. We report excellent long-term survival of cementless total hip arthroplasty used in managing AVN of the hip and is comparable to that seen in non-AVN total hip arthroplasty.

  9. Use of the medial femoral condyle vascularized bone flap in traumatic avascular necrosis of the navicular: a case report.

    Science.gov (United States)

    Holm, Janson; Vangelisti, Garrett; Remmers, Jared

    2012-01-01

    The medial femoral condyle vascularized bone flap has a high success rate in published literature regarding its use in nonunions and avascular necrosis of the upper and lower extremities. It is reported to have minimal donor site morbidity and the ability to provide structural support and torsional strength to load-bearing areas. The flap has found particular success in the treatment of scaphoid nonunions. The tarsal navicular, similar to the scaphoid, is largely articular cancellous bone with little surface area for vascular inflow. These anatomic features make the navicular prone to nonunion and avascular necrosis in traumatic scenarios. We describe a case of nonunion and avascular necrosis of the tarsal navicular occurring as sequelae of a high-impact midfoot injury sustained in an automobile accident. After an initial attempt at open reduction and internal fixation with midfoot bridge plating, subsidence and nonunion resulted. An attempt at arthrodesis of the talonavicular and naviculocuneiform joints was then undertaken. This too failed, leading to the development of additional collapse and avascular necrosis. The site was treated with a medial femoral condyle vascularized bone flap. In this single case, the patient returned to pain-free ambulation and reported excellent outcomes and functional capacity. Although we present a successful case, a larger case series is necessary to establish the use of this flap as a reliable option for the treatment of nonunion and avascular necrosis of the tarsal navicular. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Femoral head fracture without hip dislocation

    Directory of Open Access Journals (Sweden)

    Aggarwal Aditya K

    2013-10-01

    Full Text Available 【Abstract】Femoral head fractures without dislocation or subluxation are extremely rare injuries. We report a neglected case of isolated comminuted fracture of femoral head without hip dislocation or subluxation of one year duration in a 36-year-old patient who sustained a high en- ergy trauma due to road traffic accident. He presented with painful right hip and inability to bear full weight on right lower limb with Harris hip score of 39. He received cementless total hip replacement. At latest follow-up of 2.3 years, functional outcome was excellent with Harris hip score of 95. Such isolated injuries have been described only once in the literature and have not been classified till now. The purpose of this report is to highlight the extreme rarity, possible mechanism involved and a novel classification system to classify such injuries. Key words: Femur head; Hip dislocation; Classification; Arthroplasty, replacement, hip

  11. Biphasic threat to femoral head perfusion in abduction: arterial hypoperfusion and venous congestion

    Energy Technology Data Exchange (ETDEWEB)

    Yousefzadeh, David K. [Comer Children' s Hospital, Department of Radiology, Chicago, IL (United States); University of Chicago, Department of Radiology, Chicago, IL (United States); Jaramillo, Diego [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Johnson, Neil [Cincinnati Children' s Hospital, Department of Radiology, Cincinnati, OH (United States); Doerger, Kirk [Radiology Associates of Northern Kentucky, Crestview Hills, KY (United States); Sullivan, Christopher [University of Chicago, Department of Surgery, Chicago, IL (United States)

    2010-09-15

    Hip abduction can cause avascular necrosis (AVN) of the femoral head in infants. To compare the US perfusion pattern of femoral head cartilage in neutral position with that in different degrees and duration of abduction, testing the venous congestion theory of post-abduction ischemia. In 20 neonates, the Doppler flow characteristics of the posterosuperior (PS) branch of the femoral head cartilage feeding vessels were evaluated in neutral and at 30 , 45 , and 60 abduction. In three neonates the leg was held in 45-degree abduction and flow was assessed at 5, 10, and 15 min. Male/female ratio was 11/9 with a mean age of 1.86 {+-} 0.7 weeks. The peak systolic velocities (PSV) declined in all three degrees of abduction. After 15 min of 45-degree abduction, the mean PSV declined and showed an absent or reversed diastolic component and undetectable venous return. No perfusion was detected at 60-degree abduction. Abduction-induced femoral head ischemia is biphasic and degree- and duration-dependent. In phase I there is arterial hypoperfusion and in phase II there is venous congestion. A new pathogeneses for femoral head ischemia is offered. (orig.)

  12. Selective arteriography in femoral head fractures

    Energy Technology Data Exchange (ETDEWEB)

    Mannella, P; Galeotti, R; Borrelli, M; Benea, G; Massari, L; Chiarelli, G M

    1986-01-01

    The choice between conservative and radical operation in case of femoral neck fractures is very important because it is the determining factor for a successfull therapy. In case of epiphysial necrosis, an endoprosthesis as well as an osteosynthesis will be carried out. Selective arteriography of the medical circumflex artery represents the most reliable study to establish, immediately after the fractures, the possible presence of a post-traumatic ischemic necrosis. Angiography, as a reliable diagnostic tool, has to be carried out in the most selective way and needs the image subtraction technique. The authors report their preliminary results on the reliability of angiography in the femoral epiphyseal ischemic necrosis diagnosed by comparing the results of angiography with the wood light test carried out on the surgically removed femoral head. 18 refs.

  13. Radiofrequency ablation of two femoral head chondroblastomas

    Energy Technology Data Exchange (ETDEWEB)

    Petsas, Theodore [Department of Radiology, University of Patras (Greece); Megas, Panagiotis [Department of Orthopaedic Surgery, University of Patras (Greece)]. E-mail: panmegas@med.upatras.gr; Papathanassiou, Zafiria [Department of Radiology, University of Patras (Greece)

    2007-07-15

    Chondroblastoma is a rare benign cartilaginous bone tumor. Surgical resection is the treatment of choice for pain relief and prevention of further growth. Open surgical techniques are associated with complications, particularly when the tumors are located in deep anatomical sites. The authors performed RF ablation in two cases of subarticular femoral head chondroblastomas and emphasize its positive impact. The clinical course, the radiological findings and the post treatment results are discussed.

  14. Closed reduction of slipped capital femoral epiphysis: high-risk factor for avascular necrosis.

    Science.gov (United States)

    Kitano, Toshio; Nakagawa, Keisuke; Wada, Mayuko; Moriyama, Michiko

    2015-07-01

    How should we treat acute/unstable slipped capital femoral epiphysis (SCFE) without the development of avascular necrosis (AVN)? To answer this question, we investigated the risk factors of AVN development after SCFE. Seventy-six hips of 64 patients were classified using two kinds of classification systems, Loder's classification based on instability and the conventional classification based on the duration of symptom, because both classifications are related to AVN development. Of 21 unstable SCFEs, seven hips developed AVN. Of 35 hips defined as acute or acute on chronic, nine hips developed AVN. Two stable SCFEs of Loder's classification developed AVN, one was acute and the other was acute on chronic. No hips of chronic SCFE developed AVN. The factor that had influenced AVN development was only closed reduction, whether purposefully or inadvertently, in an acute or unstable SCFE. On the basis of the findings of this study, one should not embark on any modality of closed reduction for an unstable or acute form of SCFE, as there is a high risk for occurrence of AVN. For the same reason, a traction table should not be used for SCFE fixation, so as to avoid an inadvertent reduction or force that can lead to AVN.

  15. Bone marrow oedema on MR imaging indicates ARCO stage 3 disease in patients with AVN of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Meier, Reinhard; Schaeffeler, Christoph; Waldt, Simone; Rummeny, Ernst J.; Woertler, Klaus [Klinikum rechts der Isar, Technische Universitaet Muenchen, Department of Diagnostic and Interventional Radiology, Munich (Germany); Kraus, Tobias M. [Klinikum rechts der Isar, Technische Universitaet Muenchen, Department of Orthopaedics, Munich (Germany); Berufsgenossenschaftliche Unfallklinik Tuebingen, Department of Trauma and Orthopaedics, Tuebingen (Germany); Torka, Sebastian [Klinikum rechts der Isar, Technische Universitaet Muenchen, Department of Orthopaedics, Munich (Germany); Berufsgenossenschaftliche Unfallklinik Murnau, Department of Trauma and Orthopaedics, Murnau (Germany); Schlitter, Anna Melissa; Specht, Katja [Klinikum rechts der Isar, Technische Universitaet Muenchen, Institute of Pathology, Munich (Germany); Haller, Bernhard [Klinikum rechts der Isar, Technische Universitaet Muenchen, Institute of Medical Statistics and Epidemiology, Munich (Germany); Rechl, Hans [Klinikum rechts der Isar, Technische Universitaet Muenchen, Department of Orthopaedics, Munich (Germany)

    2014-09-15

    To test the hypothesis that bone marrow oedema (BME) observed on MRI in patients with avascular necrosis (AVN) of the femoral head represents an indicator of subchondral fracture. Thirty-seven symptomatic hips of 27 consecutive patients (53 % women, mean age 49.2) with AVN of the femoral head and associated BME on magnetic resonance (MR) imaging were included. MR findings were correlated with computed tomography (CT) of the hip and confirmed by histopathological examination of the resected femoral head. Imaging studies were analysed by two radiologists with use of the ARCO classification. On MR imaging a fracture line could be identified in 19/37 (51 %) cases, which were classified as ARCO stage 3 (n = 15) and stage 4 (n = 4). The remaining 18/37 (49 %) cases were classified as ARCO stage 2. However, in all 37/37 (100 %) cases a subchondral fracture was identified on CT, indicating ARCO stage 3/4 disease. The extent of subchondral fractures and the femoral head collapse was graded higher on CT as compared to MRI (P < 0.05). Histopathological analysis confirmed bone necrosis and subchondral fractures. In patients with AVN, BME of the femoral head represents a secondary sign of subchondral fracture and thus indicates ARCO stage 3 disease. circle BME on MRI in AVN of femoral head indicates a subchondral fracture. (orig.)

  16. Bone marrow oedema on MR imaging indicates ARCO stage 3 disease in patients with AVN of the femoral head

    International Nuclear Information System (INIS)

    Meier, Reinhard; Schaeffeler, Christoph; Waldt, Simone; Rummeny, Ernst J.; Woertler, Klaus; Kraus, Tobias M.; Torka, Sebastian; Schlitter, Anna Melissa; Specht, Katja; Haller, Bernhard; Rechl, Hans

    2014-01-01

    To test the hypothesis that bone marrow oedema (BME) observed on MRI in patients with avascular necrosis (AVN) of the femoral head represents an indicator of subchondral fracture. Thirty-seven symptomatic hips of 27 consecutive patients (53 % women, mean age 49.2) with AVN of the femoral head and associated BME on magnetic resonance (MR) imaging were included. MR findings were correlated with computed tomography (CT) of the hip and confirmed by histopathological examination of the resected femoral head. Imaging studies were analysed by two radiologists with use of the ARCO classification. On MR imaging a fracture line could be identified in 19/37 (51 %) cases, which were classified as ARCO stage 3 (n = 15) and stage 4 (n = 4). The remaining 18/37 (49 %) cases were classified as ARCO stage 2. However, in all 37/37 (100 %) cases a subchondral fracture was identified on CT, indicating ARCO stage 3/4 disease. The extent of subchondral fractures and the femoral head collapse was graded higher on CT as compared to MRI (P < 0.05). Histopathological analysis confirmed bone necrosis and subchondral fractures. In patients with AVN, BME of the femoral head represents a secondary sign of subchondral fracture and thus indicates ARCO stage 3 disease. circle BME on MRI in AVN of femoral head indicates a subchondral fracture. (orig.)

  17. Evaluation of perfusion of the femoral head after femoral neck fracture using bone scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Yamaguchi, Satoshi; Ishido, Yasuhiro [Saiseikai Sendai Hospital, Kagoshima (Japan); Okano, Toshihiro [Ibusuki National Hospital, Kagoshima (Japan); Komiya, Setsuro [Kagoshima Univ. (Japan). Faculty of Medicine

    2002-09-01

    We treated 13 patients for femoral neck fracture. They consisted of 2 males and 11 females, and were classified according to Garden stage classification; Stage I, 3 cases; Stage II, 2 cases; Stage III, 2 cases; Stage IV, 4 cases. Two trochanteric fracture cases were used by control. We evaluated perfusion of the femoral head after femoral neck fracture using bone scintigraphy, which is considered useful for evaluation of perfusion of the femoral neck before operation. (author)

  18. Evaluation of perfusion of the femoral head after femoral neck fracture using bone scintigraphy

    International Nuclear Information System (INIS)

    Yamaguchi, Satoshi; Ishido, Yasuhiro; Okano, Toshihiro; Komiya, Setsuro

    2002-01-01

    We treated 13 patients for femoral neck fracture. They consisted of 2 males and 11 females, and were classified according to Garden stage classification; Stage I, 3 cases; Stage II, 2 cases; Stage III, 2 cases; Stage IV, 4 cases. Two trochanteric fracture cases were used by control. We evaluated perfusion of the femoral head after femoral neck fracture using bone scintigraphy, which is considered useful for evaluation of perfusion of the femoral neck before operation. (author)

  19. Transient osteoporosis or femoral head necrosis Early diagnosis via MRI. Transitorische Osteoporose oder Femurkopfnekrose Fruehdiagnose mit der MRT

    Energy Technology Data Exchange (ETDEWEB)

    Higer, H P; Grimm, J; Pedrosa, P; Apel, R; Bandilla, K [Stiftung Deutsche Klinik fuer Diagnostik, Wiesbaden (Germany, F.R.). Fachbereich Kernspintomographie; Stiftung Deutsche Klinik fuer Diagnostik, Wiesbaden (Germany, F.R.). Fachbereich Rheumatologie; Mainz Univ. (Germany, F.R.). Orthopaedische Klinik und Poliklinik)

    1989-04-01

    Transient osteoporosis of the hip is a syndrome that does not seem to be widely known; this is also true for its radiological appearance. It is often mistaken for avascular necrosis of the femoral head, metastatic or inflammatory disease. These differential diagnoses lead to more or less invasive procedures, although transient osteoporosis does not require more than immobilisation for complete remission. MRI was done in 38 patients with acute hip pain, 13 had femoral head necrosis and 8 transient osteoporosis. Follow-up studies via MRI in patients with transient osteoporosis revealed 3 stages (diffuse, focal, residual) during the clinical course of which stage II is similar to femoral head necrosis but always without the typical sclerotic rim. (orig.).

  20. Benign aggressive lesions of femoral head and neck: Is salvage possible?

    Directory of Open Access Journals (Sweden)

    Yogesh Panchwagh

    2018-01-01

    Full Text Available Background: Benign aggressive bone lesions of the femoral head and neck are mostly seen in young adults and warrant treatment for pain, impending fracture or established fracture, and disease clearance. It becomes challenging to treat them effectively while attempting salvage of the femoral head and yet achieving long term disease control with minimum complications. We describe our technique and experience in dealing with these lesions which can achieve the above-mentioned goals and can be easily replicated. Materials and Methods: We analyzed 15 cases of surgically treated, biopsy-proven benign, locally aggressive lesions affecting the femoral head and neck in skeletally mature individuals. All cases were treated with extended curettage through anterolateral modified Smith–Petersen approach along with tricortical iliac crest bone graft (combined with fibular graft in some cases reconstruction with or without suitable internal fixation. Results: All, except one, patients were available for follow up. The age ranged from 18 to 43 years and the follow up ranged between 24 and 124 months (average 78 months. These included aneurysmal bone cysts (9, giant cell tumors (4, and fibrous dysplasia (2. The indication was pain (8, with impending (2 or established pathological neck femur fracture (5. In all cases, there was satisfactory healing of lesion and timely rehabilitation. Nonunion, avascular necrosis or local recurrences were not seen. The MSTS functional score was good or excellent in all (range 26–29, average 28. Conclusion: Benign aggressive lesions affecting femoral head and neck in young and middle-aged adults pose a treatment challenge. A sturdy, lasting reconstruct with acceptable functional outcome and minimal recurrence rate can be achieved by salvaging the femoral head and neck using curettage and reconstruction, obviating the need for replacement at such an early age.

  1. Leptin ameliorates ischemic necrosis of the femoral head in rats with obesity induced by a high-fat diet.

    Science.gov (United States)

    Zhou, Lu; Jang, Kyu Yun; Moon, Young Jae; Wagle, Sajeev; Kim, Kyoung Min; Lee, Kwang Bok; Park, Byung-Hyun; Kim, Jung Ryul

    2015-03-23

    Obesity is a risk factor for ischemic necrosis of the femoral head (INFH). The purpose of this study was to determine if leptin treatment of INFH stimulates new bone formation to preserve femoral head shape in rats with diet-induced obesity. Rats were fed a high-fat diet (HFD) or normal chow diet (NCD) for 16 weeks to induce progressive development of obesity. Avascular necrosis of the femoral head (AVN) was surgically induced. Adenovirus-mediated introduction of the leptin gene was by intravenous injection 2 days before surgery-induced AVN. At 6 weeks post-surgery, radiologic and histomorphometric assessments were performed. Leptin signaling in tissues was examined by Western blot. Osteogenic markers were analyzed by real-time RT-PCR. Radiographs showed better preservation of femoral head architecture in the HFD-AVN-Leptin group than the HFD-AVN and HFD-AVN-LacZ groups. Histology and immunohistochemistry revealed the HFD-AVN-Leptin group had significantly increased osteoblastic proliferation and vascularity in infarcted femoral heads compared with the HFD-AVN and HFD-AVN-LacZ groups. Intravenous injection of leptin enhanced serum VEGF levels and activated HIF-1α pathways. Runx 2 and its target genes were significantly upregulated in the HFD-AVN-Leptin group. These results indicate that leptin resistance is important in INFH pathogenesis. Leptin therapy could be a new strategy for INFH.

  2. Avascular necrosis of the hip in multiple epiphyseal dysplasia

    International Nuclear Information System (INIS)

    Mackenzie, W.G.; Bassett, G.S.; Mandell, G.A.; Scott, C.I. Jr.

    1989-01-01

    We observed radiographic changes of avascular necrosis (AVN) of the capital femoral epiphysis in 9 hips of 11 patients with multiple epiphyseal dysplasia (MED). Plain roentgenography, bone scintigraphy, and magnetic resonance imaging (MRI) studies all revealed characteristic asymmetric changes in the presence of AVN superimposed on dysplastic femoral heads

  3. Idiopathic Avascular Necrosis of First Metatarsal Head in a Pediatric Patient.

    Science.gov (United States)

    Kwon, Young-Uk; Choi, Jang-Seok; Kong, Gyu-Min; Ha, Byung-Ho

    Idiopathic avascular necrosis of the first metatarsal head rarely occurs in pediatrics. The present case of avascular necrosis of the first metatarsal head occurred in a 13-year-old male who came to the clinic with a 9-month history of pain in the first metatarsophalangeal joint. Conservative treatment had been applied for 9 months, but the pain had not been relieved. Therefore, surgical treatment, including decompression and debridement, was performed in the first metatarsal head of the patient. After 6 months of follow-up monitoring, full range of motion of the first metatarsophalangeal joint was observed, and the pain had disappeared. No any other complications had developed during 18 months of follow-up monitoring. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  4. The unipolar ASR : Viable option in unsalvageable femoral head conditions in the young patient

    Directory of Open Access Journals (Sweden)

    Marya SKS

    2006-01-01

    Full Text Available Background: The management of unsalvageable femoral head conditions in the young patient has remained an unresolved dilemma. Articular surface replacement of the hip has recently made some headway in terms of providing near-normal hip joint mechanics and function. However, this surgery has been limited to early stages of arthritis only with reasonable maintenance of head-neck congruity and morphology. Femoral neck fractures, osteonecrosis with large segment collapse, advanced arthritis with femoral incongruity, etc are traditional contraindications to the resurfacing technique. Methods: We present here a report on our series of 20 cases of unsalvageable femoral heads in young patients (age range, 27 to 52yrs, over a twelve month period (Aug 2004 to Jul 2005, treated with the unipolar ASR prosthesis. Fifteen patients (two had bilateral hip pathology had primary or secondary arthritis (degenerative, post-traumatic, ankylosing spondylitis and post-avascular necrosis while three had old operated femoral neck fractures. All patients underwent hip replacement surgery using the Unipolar ASR prosthesis. Results: Clinical and radiological results at 6-month follow up have been very encouraging and warrant further study. At an average of 4 months post-operatively, patients were able to squat, sit on the ground and perform light sporting activities. Conclusions: The Unipolar ASR prosthesis is an extension of the articular resurfacing technique employing similar principles (large size bearings, metal-on-metal interfaces, and has incorporated the advantages of the uncemented technique. We propose that this technique be more frequently used so as to brighten the prognosis of the young active patient with unsalvageable hip conditions, especially in the Asian scenario.

  5. Assessment of femoral head vascularity by technetium-99m antimony colloid bone marrow imaging within 24 hours of subcapital fracture: a prospective study of 30 patients followed for 2 years

    International Nuclear Information System (INIS)

    Turner, J.H.

    1982-01-01

    The rationale of preoperative imaging of bone marrow was based upon the demonstration of histochemical abnormalities secondary to ischaemia which first become apparent in marrow cells of the femoral head following interruption of the blood supply by subcapital fracture. These marrow abnormalities predate changes in bone cells by several days and may explain the absence of abnormality on conventional bone scans performed on avascular femoral heads within 24 hours of subcapital fracture. The use of an endoprosthesis for fresh femoral neck fractures in unselected patients results in high mortality, high infection rate, high incidence of thromboembolic disease and poor long term results. The successful prediction of avascular necrosis in 92% of 28 patients with active bone marrow in the femoral head in this study is sufficiently accurate to allow appropriate selection of patients for internal fixation or primary prosthetic replacement on the basis of preoperative Tc-99m antimony colloid imaging

  6. Three-dimensional MRI Analysis of Femoral Head Remodeling After Reduction in Patients With Developmental Dysplasia of the Hip.

    Science.gov (United States)

    Tsukagoshi, Yuta; Kamada, Hiroshi; Kamegaya, Makoto; Takeuchi, Ryoko; Nakagawa, Shogo; Tomaru, Yohei; Tanaka, Kenta; Onishi, Mio; Nishino, Tomofumi; Yamazaki, Masashi

    2018-05-02

    Previous reports on patients with developmental dysplasia of the hip (DDH) showed that the prereduced femoral head was notably smaller and more nonspherical than the intact head, with growth failure observed at the proximal posteromedial area. We evaluated the shape of the femoral head cartilage in patients with DDH before and after reduction, with size and sphericity assessed using 3-dimensional (3D) magnetic resonance imaging (MRI). We studied 10 patients with unilateral DDH (all female) who underwent closed reduction. Patients with avascular necrosis of the femoral head on the plain radiograph 1 year after reduction were excluded. 3D MRI was performed before reduction and after reduction, at 2 years of age. 3D-image analysis software was used to reconstruct the multiplanes. After setting the axial, coronal, and sagittal planes in the software (based on the femoral shaft and neck axes), the smallest sphere that included the femoral head cartilage was drawn, the diameter was measured, and the center of the sphere was defined as the femoral head center. We measured the distance between the center and cartilage surface every 30 degrees on the 3 reconstructed planes. Sphericity of the femoral head was calculated using a ratio (the distance divided by each radius) and compared between prereduction and postreduction. The mean patient age was 7±3 and 26±3 months at the first and second MRI, respectively. The mean duration between the reduction and second MRI was 18±3 months. The femoral head diameter was 26.7±1.5 and 26.0±1.6 mm on the diseased and intact sides, respectively (P=0.069). The ratios of the posteromedial area on the axial plane and the proximoposterior area on the sagittal plane after reduction were significantly larger than before reduction (P<0.01). We demonstrated that the size of the reduced femoral head was nearly equal to that of the intact femoral head and that the growth failure area of the head before reduction, in the proximal posteromedial

  7. Avascular Necrosis of the Metacarpal Head: A Review of 4 Cases.

    Science.gov (United States)

    Aldekhayel, Salah; Ghanad, Erfan; Mudgal, Chaitanya S

    2018-04-03

    To report on 4 cases of avascular necrosis of the metacarpal head. We retrospectively reviewed 4 patients who received a diagnosis of avascular necrosis of the metacarpal head and were treated from 2000 to 2016. All patients were males with involvement of the dominant hand. Three patients had a history of trauma and/or fractures in another finger and one had a history of fracture in the same finger. The diagnosis was confirmed on regular x-rays and magnetic resonance imaging. Nonsurgical management was offered to all patients (rest, placement of an orthosis, and nonsteroidal anti-inflammatory drugs) for 3 to 6 months. Two patients responded well to nonsurgical management and improved in their symptoms. One patient refused surgical intervention and continued to have persistent pain. The other patient was treated with curettage and bone graft and had total resolution of pain symptoms with full active range of motion. A high index of suspicion is required to diagnose and treat avascular necrosis of the metacarpal head correctly. Treatment options are numerous and require further studies to investigate their effectiveness in the treatment of this rare disease. Therapeutic V. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  8. 'Femoral head necrosis' in metabolic and hormonal osteopathies

    International Nuclear Information System (INIS)

    Heuck, F.H.W.; Treugut, H.

    1984-01-01

    The pathogenesis of bone necrosis is discussed with special attention and with respect to metabolic, hormonal, and vascular factors. The influence of statics and dynamics of the hip joint bones for the development of aseptic necrosis are discussed. 45 patients with ''idiopathic femoral head necroses'' were observed, including 6 cases of renal osteopathy following renal transplantation and immune suppression therapy, 14 cases of long term corticoid therapy, and 11 cases of liver diseases of different genesis. The femoral head necrosis understood as complication of an osteopathy. In our patients there were 31 males and 14 females - which means higher involvement of males. Plain radiological findings and CT-findings of changes of the femoral heat structure in different stages of the disease are described. Early diagnosis of metabolic and hormonal osteopathies is demanded for a joint keeping therapy of the beginning femoral head necrosis. (orig.) [de

  9. Structural and functional studies of bioobjects prepared from femoral heads

    Energy Technology Data Exchange (ETDEWEB)

    Kirilova, I. A., E-mail: IKirilova@niito.ru; Podorozhnaya, V. T., E-mail: VPodorognaya@niito.ru [Research Institute of Traumatology and Orthopedics n.a. Ya.L. Tsivyan, 17, Frunze, Novosibirsk, 630091 (Russian Federation); Sharkeev, Yu. P., E-mail: sharkeev@ispms.tsc.ru [Institute of Strength Physics and Materials Science SB RAS, 2/4, pr. Akademicheskii, Tomsk, 634021 (Russian Federation); National Research Tomsk Polytechnic University, 30, Lenin Avenue, Tomsk, 634050 (Russian Federation); Popova, K. S., E-mail: kseniya@ispms.tsc.ru; Uvarkin, P. V., E-mail: uvarkin@ispms.tsc.ru [Institute of Strength Physics and Materials Science SB RAS, 2/4, pr. Akademicheskii, Tomsk, 634021 (Russian Federation)

    2015-11-17

    Results of examination of physicomechanical characteristics of samples of medial femoral head cuts are presented. The samples of medial femoral head cuts resected in 6 patients with coxarthrosis in primary endoprosthetic replacement of a coxofemoral joint have been tested for micro- and nanohardness. Young’s modulus and elemental composition of bone tissue have been investigated. To estimate the architectonics of cancellous tissue of the femoral head, adjacent cuts of the same patient have been analyzed. The porosity of bone tissue was estimated from macroscopic images obtained using macrophotography. The total porosity is calculated as the ratio of the total length of straight line segments overlapping pores to the total length of secants. A three-point bending test of the samples has shown that their strength changed from 0.187 to 1.650 MPa and their elasticity modulus changes from 1.69 to 8.15 MPa. The microhardness of the samples changes in the range 220–265 MPa and the average microhardness of medial femoral head cuts is 240 MPa. The elemental composition of medial femoral head cuts is represented by basic Ca, P, O, Na and Mg elements as well as by Sn, S, Fe, Cr, and C in microamounts. The atomic Ca to P ratio for bone tissue is 1.55. It is revealed that pores of the upper part of the femoral head have a more regular shape and in the lower part they are more elongated along the cut and occupy a larger volume. The lower part of the femoral head has a higher porosity (39 and 33%) than the upper part (34 and 30%). The total porosity of all samples does not exceed 37%.

  10. Aseptic necrosis of the femoral head following treatment of malignant lymphomas

    Energy Technology Data Exchange (ETDEWEB)

    Kuhn, E; Kovacs, A

    1986-01-01

    Three cases with avascular necrosis of the femoral head are reported of which one showed bilateral disease. Two patients with Hodgkin's disease of mixed cellularity underwent polychemotherapy; the third with gastric centroblastic non-Hodgkin lymphoma received abdominal irradiation followed by 3 courses of polychemotherapy. Total dose of prednisolone administered varied between 4,080-7,045 mg. Time elapsed between appearance of pain and significant radiologic features was several months. Patients with Hodgkin's disease were young and were both exposed to significant physical strain. Multiple factors are thought to be responsible for this late sequel of therapy in which the role of cortisone is stressed. Computed tomography is of great value in detecting disease at an early phase and depicting its real extent.

  11. A systematic review of undisplaced femoral neck fracture treatments for patients over 65 years of age, with a focus on union rates and avascular necrosis.

    Science.gov (United States)

    Xu, Dan-Feng; Bi, Fang-Gang; Ma, Chi-Yuan; Wen, Zheng-Fa; Cai, Xun-Zi

    2017-02-10

    It remains unclear whether conservative treatment should be used to treat the common undisplaced femoral neck fractures that develop in the elderly. Herein, we systematically review the rates of union and avascular necrosis after conservative and surgical treatment of undisplaced femoral neck fractures. We searched the EMBASE, PubMed, OVID, Cochrane Library, Web of Science, and Scopus databases for randomized controlled trials or observational studies that assessed the outcomes of conservative or surgical treatments of undisplaced femoral neck fractures. No language or publication year limitation was imposed. Statistical analyses were performed with the aid of the chi-squared test. We evaluated the quality of each publication and the risk of bias. Twenty-nine studies involving 5071 patients were ultimately included; 1120 patients were treated conservatively and 3951 surgically. The union rates were 68.8% (642/933) and 92.6% (635/686) in the former and latter groups, respectively (p avascular necrosis rate in the conservatively treated group was 10.3% (39/380), while it was 7.7% (159/2074) in the surgically treated group (p = 0.09). Surgery to treat undisplaced femoral neck fractures was associated with a higher union rate and a tendency toward less avascular necrosis than conservative treatment.

  12. Radiation-induced femoral head necrosis

    African Journals Online (AJOL)

    2011-03-25

    Mar 25, 2011 ... had open medial menisectomy of the left knee following medial meniscal tear ... postoperative recovery and mobilised full weight-bearing immediately [Figure 6]. ... obtained from the oncologists at the time of this review), and there was a ... previous trauma such as femoral neck fracture, Gaucher's disease ...

  13. Fracturing of revision of a cobalt-chrome femoral head after fracturing of a ceramic femoral head, with diffuse metallosis. Case report

    Directory of Open Access Journals (Sweden)

    Pedro Miguel Dantas Costa Marques

    2013-04-01

    Full Text Available We presente a case of a fracture of a cobalt-chrome femoral head after revision of a hip total prosthesis with ceramic femoral head fracture. During surgery we found the cobalt-chrome femoral head fracture, wear of the polyethylene and massive metallosis in muscular and cartilaginous tissue. Both femoral stem and acetabular cup were stable and without apparent wearing. After surgical debridement, we promoted the substitution of the femoral head and the acetabular polyethylene by similar ones. After 12 months of follow-up, the patient has no pain complaints, function limit or systemic signs associated with malign metallosis

  14. Investigating Clinical Failure of Bone Grafting through a Window at the Femoral Head Neck Junction Surgery for the Treatment of Osteonecrosis of the Femoral Head.

    Directory of Open Access Journals (Sweden)

    Wei Zuo

    Full Text Available This study aimed to analyze the clinical factors related to the failure of bone grafting through a window at the femoral head-neck junction.In total, 119 patients (158 hips underwent bone grafting for treatment of avascular necrosis of the femoral head. The patients were classified by their ARCO staging and CJFH classification. All patients were clinically and radiographically followed up every three months during the first year and every six months in the following year. The clinical follow-up comprised determination of pre- and postoperative Harris hip scores, while serial AP, frog lateral radiographs, and CT scan were used for the radiographic follow-up.The clinical failure of bone grafting was observed in 40 patients. The clinical failure rates in patients belonging to ARCO stage II period, IIIa, and III (b + c were 25.9%, 16.2%, and 61.5%, respectively, while those in patients belonging to (C + M + L1 type and L2, L3 type disease groups were 1.7%, 38.9%, and 39%, respectively. The clinical failure rates in patients aged below 40 and those aged 40 and over were 20.5% and 39.0%, respectively (all P < 0.05.Disease type, disease stage, and patient age are risk factors for failure of bone graft surgery. Patients belonging to ARCO stage II and IIIa showed a good overall response rate, while patients belonging to ARCO stage IIIb and IIIc and those with necrotic lesions involving the lateral pillar (L2 and L3 type showed high surgical failure rates.

  15. A Scapholunate Ligament-Sparing Technique Utilizing the Medial Femoral Condyle Corticocancellous Free Flap to Reconstruct Scaphoid Nonunions With Proximal Pole Avascular Necrosis.

    Science.gov (United States)

    Kazmers, Nikolas H; Thibaudeau, Stephanie; Levin, L Scott

    2016-09-01

    This article demonstrates a technique for the treatment of scaphoid fracture waist and proximal pole nonunions with avascular necrosis using a free vascularized medial femoral condyle flap. We present our surgical technique and representative case examples in which the scapholunate ligament, a key structure required to preserve carpal kinematics, is spared. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  16. Assessment of femoral head perfusion by dynamic MR imaging

    International Nuclear Information System (INIS)

    Ochi, Ryuya; Nakano, Tetsuo; Miyazono, Kazuki; Tsurugami, Hiroshi; Fukuda, Tomohiro; Inaba, Daisuke; Takada, Koji

    2004-01-01

    We studied femoral head perfusion in 21 femoral neck fractures using dynamic MR imaging (MRI) between November 2001 and July 2002. MRI patterns divided into four groups when the results between the fractured side and unaffected side were compared. Femoral head perfusion at the fractured side was normal in Type A, about half in Type B, and absent in Type C. When perfusion at both the fractured side and unaffected side was absent, Exceptional Type was suspected. The Garden I group consisted of one Type B. The Garden II group consisted of one Type A, six Type B, one Type C, and two Exceptional Type. The Garden III group consisted of two Type B and one Type C, and the Garden IV group consisted of six Type C and one Exceptional Type. Post operations of by internal fixation confirmed the incidence of aseptic necrosis using MRI. (author)

  17. [SURGICAL HIP DISLOCATION APPROACH FOR TREATMENT OF FEMORAL HEAD FRACTURE].

    Science.gov (United States)

    Tang, Yanfeng; Liu, Youwen; Zhu, Yingjie; Li, Jianming; Li, Wuyin; Li, Qiyi; Jia, Yudong

    2015-11-01

    To discuss the value of surgical hip dislocation approach in the treatment of femoral head fracture. A retrospectively analysis was made on the clinical data of 15 patients with femoral head fractures treated through surgical hip dislocation approach between January 2010 and February 2013. There were 11 men and 4 women with an average age of 30.8 years (range, 15-63 years). The causes included traffic accident injury in 9 cases, falling injury from height in 5 cases, and sports injury in 1 case. According to Pipkin typing, 2 cases were rated as type I, 7 cases as type II, 1 case as type III, and 5 cases as type IV. The interval of injury and operation was 2-10 days (mean, 4.1 days). Reduction was performed in 10 patients within 6 hours after injury, and then bone traction was given for 4-6 weeks except 5 patients who received reduction in the other hospital. Primary healing of incision was obtained in all patients after surgery without complications of dislocation and lower limbs deep venous thrombosis. The mean follow-up time was 29.9 months (range, 25-36 months). During follow-up, there was no infection, breakage of internal fixation, or nonunion of femoral greater trochanter fracture. In 3 patients having necrosis of the femoral head, 2 had no obvious symptoms [staging as IIa and IIb respectively according to Association Research Circulation Osseous (ARCO) staging system], and 1 (stage IIIb) had nonunion of the femoral neck fracture, who underwent total hip arthroplasty (THA). In 4 patients having myositis ossificans (2 cases of grade I, 1 case of grade II, and 1 case of grade III based on Brooker grading), no treatment was given in 3 cases and the focus was removed during THA in 1 case. According to the Thompson-Epstein scale at last follow-up, the results were excellent in 9 cases, good in 3 cases, fair in 1 case, and poor in 2 cases, and the excellent and good rate was 80%. Surgical hip dislocation approach can not only protect the residual vessels of the

  18. Blood flow and microdialysis in the human femoral head

    DEFF Research Database (Denmark)

    Bøgehøj, Morten; Emmeluth, Claus; Overgaard, Søren

    2007-01-01

    BACKGROUND: If it would be possible to detect lack of flow and/or the development of ischemia in bone, we might have a way of predicting whether a broken bone will heal. We established microdialysis (MD) and laser Doppler (LD) flow measurement in the human femoral head in order to be able to detect...

  19. Bone scintigraphy in idiopathic aseptic femoral head necrosis (IAFHN)

    Energy Technology Data Exchange (ETDEWEB)

    Dodig, D; Ugarkovic, B; Orlic, D

    1983-01-01

    Idiopathic aseptic femoral head necrosis (IAFHN) is a disease of unknown aetiology most commonly affecting adults, producing functional impairment of the hip joint and immobility. Characteristic macroscopic, microscopic and radiologic features include: (1) changes in joint cartilage, (2) subchondral necrotic area, (3) changes in fibrous tissue, and (4) osteosclerosis and vascular proliferation. The diagnosis is based on clinical and X-ray examinations. More recently scintigraphy has been used in diagnosing IAFHN. It is a very sensitive, but non-specific method. Nineteen patients aged 25-57 years were included in our study. Scintigrams were divided in four groups: (1) normal, (2) uniformly increased activity in the femoral head, (3) non-uniformly increased activity in the femoral head, and (4) a photon deficient area in the femoral head. A comparison of scintigraphy and radiological examination suggests that a photon deficient area corresponds with stage III of radiological classification, non-uniformly increased activity with stage II, and uniformly increased activity with stage I. These results indicate that scintigraphy can be used for staging of disease.

  20. Surgery for pathological proximal femoral fractures, excluding femoral head and neck fractures: resection vs. stabilisation.

    Science.gov (United States)

    Zacherl, Max; Gruber, Gerald; Glehr, Mathias; Ofner-Kopeinig, Petra; Radl, Roman; Greitbauer, Manfred; Vecsei, Vilmos; Windhager, Reinhard

    2011-10-01

    Pathological femoral head and neck fractures are commonly treated by arthroplasty. Treatment options for the trochanteric region or below are not clearly defined. The purpose of this retrospective, comparative, double-centre study was to analyse survival and influences on outcome according to the surgical technique used to treat pathological proximal femoral fractures, excluding fractures of the femoral head and neck. Fifty-nine patients with 64 fractures were operated up on between 1998 and 2004 in two tertiary referral centres and divided into two groups. One group (S, n = 33) consisted of patients who underwent intramedullary nailing alone, and the other group (R, n = 31) consisted of patients treated by metastatic tissue resection and reconstruction by means of different implants. Median survival was 12.6 months with no difference between groups. Surgical complications were higher in the R group (n = 7) vs. the S group (n = 3), with no statistically significant difference. Patients with surgery-related complications had a higher survival rate (p = 0.049), as did patients with mechanical implant failure (p = 0.01). Survival scoring systems did not correlate with actual survival. Resection of metastases in patients with pathological fractures of the proximal femur, excluding femoral head and neck fractures, has no influence on survival. Patients with long postoperative survival prognosis are at risk of implant-related complications.

  1. Femoral head allograft disinfection system using moderate heat

    International Nuclear Information System (INIS)

    Knaepler, H.; Von Garrel, T.

    1999-01-01

    The employment of a reliable thermal viral inactivation process, which minimally manipulates tissues, for surgically retrieved femoral head allografts addresses the increased concerns with virus transmissibility while minimizing the loss of biological properties. The newest European and German surgical bone banking guidelines have incorporated the use of independently validated then-nal viral inactivation methods in place of repeat serological testing of donor. Our investigations have shown that heat treatment at 80 degree C for a minimum of 10 minutes provides safe, good quality cancellous bone allografts and increases the cost-effectiveness and simplicity of managing a hospital frozen femoral head bone bank. Human femoral head centers were contaminated with different vegetative bacterial and viral suspensions. A core temperature of 80 degree C for 10 minutes was sufficient to fully inactivate 3 x 106 ml Staphylococcus aureus and Streptococcus faecalis, and >5 loglo steps of cytomeglia (herpes group), polio (enterovirus), and yellow fever (arbovirus) viruses. A one hour treatment in a water bath set at 80 degree sufficient to fully inactivate E. coli, proteus vulgaris, and Pseudomonas aerog. vegetative suspensions; 20 minutes was sufficient to fully inactivate the D antigen (rhesus factor) but had no effect on A or B antigens. Several biomechanical and biological properties of bone following a one hour treatment in a water bath set at 80 degree C were investigated. Employing compression and tension tests, 80 degree C treated human and porcine cancellous bone blocks showed reductions in properties ranging from 8-19% compared to untreated control groups. Osteointegration at 3 months following treatment of explanted and then reimplanted autograft rat diaphyseal segment was 15% less than untreated controls. Subsequently, a thermal disinfection system for femoral heads from living donors (Lobator Marburg Bone Bank System, Telos GmbH, Hungen, Germany) was developed. A

  2. Variance of [sup 99m]Tc-MDP bone imaging among the repairing process after experimental femoral head necrosis

    Energy Technology Data Exchange (ETDEWEB)

    Shibiao, Sang; Yimin, Jiang; Jinxi, Wang [Suzhou Medical Coll., Suzhou, JS (China). First Affiliated Hospital

    1993-05-01

    Six of 26 adult mongrel dogs were used as controls. Avascular necrosis of the left femoral head was induced by freezing method with liquid nitrogen and the right side being used as a self-control. The 20 dogs were divided into four groups, 5 dogs each which was sacrificed successively at 1/2, 2,2 and 6 months after operation. All of the femoral heads were studied by radionuclide bone imaging, radiological, histological and biochemical examinations. The results were as follows: [sup 99m]Tc-MDP bone imaging showed a decreased uptake at the early stage, and was gradually increased later, and reached its peak values at precollape stage at four months. Hypermetabolism state was still maintained at collapsed stage. Above changes was in coincidence with the bone imaging. As for the repairing process after necrosis, the hypermetabolic reaction in bone imaging of the femoral head correlates well with the proliferation of vessels and bone marrow cells and also the activity of tissue collagenase. Therefore, a poor bony reconstruction in the weight-bearing portion could be an important cause for late segmental collapse.

  3. Prevalence of HIV infection among the patients with an avascular ...

    African Journals Online (AJOL)

    Objective: To study the prevalence of HIV infection among the risk factors associated with the avascular necrosis of the femoral head in Ouagadougou, Burkina Faso. Design: Multicenter retrospective study. Setting: Rheumatology consultations and Orthopedic-Traumatology Surgery Department Of The University Hospital ...

  4. Confronting hip resurfacing and big femoral head replacement gait analysis

    Directory of Open Access Journals (Sweden)

    Panagiotis K. Karampinas

    2014-03-01

    Full Text Available Improved hip kinematics and bone preservation have been reported after resurfacing total hip replacement (THRS. On the other hand, hip kinematics with standard total hip replacement (THR is optimized with large diameter femoral heads (BFH-THR. The purpose of this study is to evaluate the functional outcomes of THRS and BFH-THR and correlate these results to bone preservation or the large femoral heads. Thirty-one patients were included in the study. Gait speed, postural balance, proprioception and overall performance. Our results demonstrated a non-statistically significant improvement in gait, postural balance and proprioception in the THRS confronting to BFH-THR group. THRS provide identical outcomes to traditional BFH-THR. The THRS choice as bone preserving procedure in younger patients is still to be evaluated.

  5. Early MRI Detection and Closed Bone Graft Epiphysiodesis May Alter the Course of Avascular Necrosis Following Unstable Slipped Capital Femoral Epiphysis.

    Science.gov (United States)

    Napora, Joshua K; Gilmore, Allison; Son-Hing, Jochen P; Grimberg, Dominic C; Thompson, George H; Liu, Raymond W

    2018-04-01

    Unstable slipped capital femoral epiphysis (SCFE) has an increased incidence of avascular necrosis (AVN). Early identification and surgical intervention for AVN may help preserve the femoral head. We retrospectively reviewed 48 patients (50 hips) with unstable SCFE managed between 2000 and 2014. AVN was diagnosed based on 2 different postoperative protocols. Seventeen patients (17 hips) had a scheduled magnetic resonance imaging (MRI) between 1 and 6 months from initial surgery, and the remaining 31 patients (33 hips) were evaluated by plain radiographs alone. If AVN was diagnosed, we offered core decompression and closed bone graft epiphysiodesis (CBGE) to mitigate its affects. At final follow-up, we assessed progression of AVN using the Steinberg classification. Overall 13 hips (26%) with unstable SCFEs developed AVN. MRI revealed AVN in 7 of 17 hips (41%) at a mean of 2.5 months postoperatively (range, 1.0 to 5.2 mo). Six hips diagnosed by MRI received surgical intervention (4 CBGE, 1 free vascularized fibula graft, and 1 repinning due to screw cutout) at a mean of 4.1 months (range, 1.3 to 7.2 mo) postoperatively. None of the 4 patients treated with CBGE within 2 months postoperatively progressed to stage IVC AVN. The 2 patients treated after 4 months postoperatively both progressed to stage VC AVN.Plain radiographs demonstrated AVN in 6 of 33 hips (18%) at a mean of 6.8 months postoperatively (range, 2.1 to 21.1 mo). One patient diagnosed with stage IVB AVN at 2.4 months had screw cutout and received CBGE at 2.5 months from initial pinning. The remaining 5 were not offered surgical intervention. Five of the 6 radiographically diagnosed AVN, including the 1 treated with CBGE, progressed to stage IVC AVN or greater. Although all patients with positive MRI scans developed radiographic AVN, none of the 4 patients treated with CBGE within 2 months after pinning developed grade IVC or greater AVN. Early MRI detection and CBGE may mitigate the effects of AVN after

  6. Is the timing of surgery associated with avascular necrosis after unstable slipped capital femoral epiphysis? A multicenter study.

    Science.gov (United States)

    Kohno, Yusuke; Nakashima, Yasuharu; Kitano, Toshio; Irie, Taichi; Kita, Atsushi; Nakamura, Tomoyuki; Endo, Hirosuke; Fujii, Yosuke; Kuroda, Takayuki; Mitani, Shigeru; Kitoh, Hiroshi; Matsushita, Masaki; Hattori, Tadashi; Iwata, Koji; Iwamoto, Yukihide

    2017-01-01

    An unstable slipped capital femoral epiphysis (SCFE) is associated with a high rate of avascular necrosis (AVN). The etiology of AVN seems to be multifactorial, although it is not thoroughly known. The aims of our study were to determine the rate of AVN after an unstable SCFE and to investigate the risk factors for AVN, specifically evaluating the notion of an "unsafe window", during which medical interventions would increase the risk for AVN. This retrospective multicenter study included 60 patients with an unstable SCFE diagnosed between 1985 and 2014. Timing of surgery was evaluated for three time periods, from acute onset of symptoms to surgery: period I, 7 days. Multivariate logistic regression analysis was used to identify risk factors for AVN. Closed reduction and pinning was performed in 43 patients and in situ pinning in 17. Among these cases, 16 patients (27%) developed AVN. The rate of AVN was significantly higher in patients treated by closed reduction and pinning (15/43, 35%) than in those treated by in situ pinning (1/17, 5.9%) (p = 0.022). In patients treated by closed reduction and pinning, the incidence of AVN was 2/11 (18%) in period I, 10/13 (77%) in period II and 3/15 (20%) in period III, showing the significantly higher rate in period II (p = 0.002). The surgery provided in period II was identified as an independent risk factor for the development of AVN. Our rate of AVN was 27% using two classical treatment methods. Time-to-surgery, between 24 h and 7 days, was independently associated with AVN, supporting the possible existence of an "unsafe window" in patients with unstable SCFE treated by closed reduction and pinning. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  7. Osteonecrosis of the femoral head after bone marrow transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jeong Mi; Jun, Jeong Su; Park, Chang Suk; Kim, Yong Sik; Kwon, Soon Yong; Kim, Yoo Jin; Kim, Chun Choo [The Catholic University of Korea College of Medicine, Seoul (Korea, Republic of)

    2003-07-01

    To retrospectively review findings of osteonecrosis of the femoral head after bone marrow transplantation. We reviewed the clinical and MR findings of osteonecrosis of the femoral head in 23 of 1112 patients who underwent marrow transplantation during a five-year follow-up period lasting from 1996 to 2000. Mean age at the time of diagnosis was 31 (range, 20-47) years, and the mean time from transplant to diagnosis was 17 months. All patients developed variable graft-versus-host disease and seventeen were treated with high-dose prednisolone and/or cysclosporin for severe acute or extensive chronic graft versus host disease. Osteonecrosis was diagnosed by magnetic resonance (MR) imaging, which allowed early detection of disease assessment of its stage. At the time of diagnosis, 15 hips were at stage I, 28 at stage II, two at stage III, and none at stage IV, according to the international ARCO classification system. Osteonecrosis of femoral diaphyses, the lower lumbar spine, or pelvic bones in the MR field was also found to have occurred in 11 patients. Initial treatment was conservative: 21 hips underwent surgery [core decompression (n=10), vascularized fibular bone graft (n=5), and joint replacement (n=6)]. In patients receiving high-dose steroids for the treatment of graft-versus-host disease, MR screening might help detect osteonecrosis at an early stage.

  8. Avascular Necrosis

    Science.gov (United States)

    ... Financial Reports Watchdog Ratings Feedback Contact Select Page Avascular Necrosis Home > Cancer Resources > Late Effects of Treatment > Avascular Necrosis Avascular necrosis (AVN) is a disorder resulting from ...

  9. MR evaluation of the articular cartilage of the femoral head during traction. Correlation with resected femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Nakanishi, K. [Osaka Seamens Insurance Hospital (Japan). Dept. of Radiology; Tanaka, H.; Narumi, Y.; Nakamura, H. [Osaka Univ. Medical School (Japan). Dept. of Radiology; Nishii, T.; Masuhara, K. [Osaka Univ. Medical School (Japan). Dept. of Orthopedic Surgery

    1999-01-01

    Objective: The purpose was to evaluate the articular cartilage of the hip joint with MR during traction and compare the findings with the resected specimen or arthroscopic findings. Material and Methods: Eight healthy volunteers, 5 patients with osteonecrosis, 5 with acetabular dysplasia, and 5 with advanced osteoarthrosis underwent MR imaging to evaluate the articular cartilage of the hip joint. Coronal fat-suppressed 3D spoiled gradient-echo (SPGR) images were obtained during traction. Identical imaging was performed of all the resected femoral heads of the osteonecrosis and advanced osteoarthrosis patients, and was correlated with the macroscopic pathological findings. Results: The traction was effective and the femoral articular cartilage was clearly identified in all 8 control subjects, and in all cases of osteonecrosis and acetabular dysplasia. In 4 cases of osteonecrosis, chondral fracture was identified in the boundary between the necrosis and the normal area. In all cases of advanced osteoarthrosis, cartilage was identified only at the medial side. The MR images of osteonecrosis and advanced osteoarthrosis corresponded well with the MR images of the resected femoral heads and the macroscopic findings. (orig.)

  10. Corticosteroid administration within 2 weeks after renal transplantation affects the incidence of femoral head osteonecrosis

    Science.gov (United States)

    Saito, Masazumi; Ueshima, Keiichiro; Fujioka, Mikihiro; Ishida, Masashi; Goto, Tsuyoshi; Arai, Yuji; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Fukushima, Wakaba; Kubo, Toshikazu

    2014-01-01

    Background and purpose It has been suggested that avascular osteonecrosis (AVN) of the femoral head occurs early after systemic steroid administration. The purpose of this study was to investigate the risks regarding development of AVN at a very early stage after renal transplantation. Methods The presence or absence of AVN was determined by MRI at 4 weeks, at 6–12 weeks, at 24 weeks, and at 12 months after renal transplantation in 286 patients (183 males) with a mean age of 39 (16–65) years. The relationship between AVN and age, sex, absence or presence of acute rejection (AR), type of transplanted kidney (living or cadaveric), type of immune suppressor, and total dose of orally administered steroids given in the 2-week period after transplantation was investigated. Results There were no statistically significant correlations between the development of AVN and age, sex, absence or presence of AR, type of transplanted kidney, or type of immune suppressor. A significant dose-response relationship was found between development of AVN and the total dose of steroid administered in the first 2 weeks after surgery. Interpretation We found a relationship between AVN development and steroid dose in the early postoperative period, and we also showed a dose-response relationship. PMID:24786907

  11. A micro-architectural evaluation of osteoporotic human femoral heads to guide implant placement in proximal femoral fractures.

    Science.gov (United States)

    Jenkins, Paul J; Ramaesh, Rishikesan; Pankaj, Pankaj; Patton, James T; Howie, Colin R; Goffin, Jérôme M; Merwe, Andrew van der; Wallace, Robert J; Porter, Daniel E; Simpson, A Hamish

    2013-10-01

    The micro-architecture of bone has been increasingly recognized as an important determinant of bone strength. Successful operative stabilization of fractures depends on bone strength. We evaluated the osseous micro-architecture and strength of the osteoporotic human femoral head. 6 femoral heads, obtained during arthroplasty surgery for femoral neck fracture, underwent micro-computed tomography (microCT) scanning at 30 μm, and bone volume ratio (BV/TV), trabecular thickness, structural model index, connection density, and degree of anisotropy for volumes of interest throughout the head were derived. A further 15 femoral heads underwent mechanical testing of compressive failure stress of cubes of trabecular bone from different regions of the head. The greatest density and trabecular thickness was found in the central core that extended from the medial calcar to the physeal scar. This region also correlated with the greatest degree of anisotropy and proportion of plate-like trabeculae. In the epiphyseal region, the trabeculae were organized radially from the physeal scar. The weakest area was found at the apex and peripheral areas of the head. The strongest region was at the center of the head. The center of the femoral head contained the strongest trabecular bone, with the thickest, most dense trabeculae. The apical region was weaker. From an anatomical and mechanical point of view, implants that achieve fixation in or below this central core may achieve the most stable fixation during fracture healing.

  12. Femoral head epiphysis growth and development among Chinese children aged 0-5 years.

    Science.gov (United States)

    Luo, Jiayou; Tang, Jin; Zhou, Libo; Zeng, Rong; Mou, Jinsong; Zhang, Lingli

    2009-05-01

    The aim of this study was to examine the pattern of femoral head epiphysis growth and development among Chinese children. Between January and December, 2007, we randomly sampled 1,450 healthy Chinese children (0-5 years old) from Hunan Provincial Children's Hospital in Changsha, Hunan, China. The diameter of femoral head epiphysis was measured by pelvic X-ray photography and processed by medical image processing software. The growth of femoral head epiphysis in girls was 2-3 months earlier than that in boys. The diameter of femoral head epiphysis increased with advancing age in both girls and boys, but the diameter of femoral head epiphysis in 2, 3, 4, 6, and 10-month-old girls was significantly larger than that in boys. Cubic regression equations between the diameter of femoral head epiphysis and age were created for boys and girls that could be used to predict the diameter of femoral head epiphysis. In conclusion, there was gender difference in femoral head epiphysis growth and development among Chinese children, and our prediction models will provide the guidance for early diagnosis of diseases related to the growth and development of the femoral head epiphysis.

  13. Multiplanar CT assessment of femoral head displacement in slipped capital femoral epiphysis

    Energy Technology Data Exchange (ETDEWEB)

    Monazzam, Shafagh [Rady Children' s Hospital and Health Center, Department of Orthopedics, San Diego, CA (United States); Dwek, Jerry R. [Rady Children' s Hospital and Health Center, Department of Radiology, San Diego, CA (United States); Hosalkar, Harish S. [Center for Hip Preservation, Department of Orthopedic Surgery, TriCity Medical Center, Oceanside, CA (United States)

    2013-12-15

    With recent changing approaches to the management of slipped capital femoral epiphysis (SCFE), the accurate radiographic assessment of maximum extent of displacement is crucial for planning surgical treatment. To determine what plane best represents the maximum SCFE displacement as quantified by the head-neck angle difference (HNAD), whether HNAD can quantitatively differentiate the SCFE cohort from the normal cohort, based on CT, and how Southwick slip angle (SSA) compares to HNAD. We reviewed 19 children with SCFE (23 affected hips) with preoperative CT scans and 27 age- and sex-matched children undergoing abdominal CT for non-orthopedic problems. Head-neck angle (HNA), the angle between the femoral epiphysis and the neck axis, was measured in three planes on each hip and the HNAD (affected - unaffected hip) was determined. SSA was measured on radiographs. The coronal HNAD (mean 8.7 ) was less than both the axial-oblique (mean 30.7 ) and sagittal (mean 37.4 ) HNADs, which were also greater than the HNADs of the normal cohort. Grouping HNAD measurements by SSA severity classification did not consistently distinguish between SCFE severity levels. Axial-oblique and sagittal planes best represent the maximum SCFE displacement while biplanar radiograph may underestimate the extent of the displacement, thereby potentially altering the management between in situ pinning and capital realignment. (orig.)

  14. Femoral head osteonecrosis: Volumetric MRI assessment and outcome

    International Nuclear Information System (INIS)

    Bassounas, Athanasios E.; Karantanas, Apostolos H.; Fotiadis, Dimitrios I.; Malizos, Konstantinos N.

    2007-01-01

    Effective treatment of femoral head osteonecrosis (FHON) requires early diagnosis and accurate assessment of the disease severity. The ability to predict in the early stages the risk of collapse is important for selecting a joint salvage procedure. The aim of the present study was to evaluate the outcome in patients treated with vascularized fibular grafts in relation to preoperative MR imaging volumetry. We studied 58 patients (87 hips) with FHON. A semi-automated octant-based lesion measurement method, previously described, was performed on the T1-w MR images. The mean time of postoperative follow-up was 7.8 years. Sixty-three hips were successful and 24 failed and converted to total hip arthroplasty within a period of 2-4 years after the initial operation. The rate of failures for hips of male patients was higher than in female patients. The mean lesion size was 28% of the sphere equivalent of the femoral head, 24 ± 12% for the successful hips and 37 ± 9% for the failed (p < 0.001). The most affected octants were antero-supero-medial (58 ± 26%) and postero-supero-medial (54 ± 31%). All but postero-infero-medial and postero-infero-lateral octants, showed statistically significant differences in the lesion size between patients with successful and failed hips. In conclusion, the volumetric analysis of preoperative MRI provides useful information with regard to a successful outcome in patients treated with vascularized fibular grafts

  15. Shoulder Arthroplasty for Humeral Head Avascular Necrosis Is Associated With Increased Postoperative Complications.

    Science.gov (United States)

    Burrus, M Tyrrell; Cancienne, Jourdan M; Boatright, Jeffrey D; Yang, Scott; Brockmeier, Stephen F; Werner, Brian C

    2018-02-01

    Humeral head avascular necrosis (AVN) of differing etiologies may lead to shoulder arthroplasty due to subchondral bone collapse and deformity of the articular surface. There have been no large studies evaluating the complications for these patients after they undergo total shoulder arthroplasty (TSA). The first objective of this study is to evaluate the complication rate after TSA in patients with humeral head AVN. The secondary objective is to compare the complication rates among the different etiologies of the AVN. Patients who underwent TSA were identified in the PearlDiver database using ICD-9 codes. Patients who underwent shoulder arthroplasty for humeral head AVN were identified using ICD-9 codes and were subclassified according to AVN etiology (posttraumatic, alcohol use, chronic steroid use, and idiopathic). Complications evaluated included postoperative infection within 6 months, dislocation within 1 year, revision shoulder arthroplasty up to 8 years postoperatively, shoulder stiffness within 1 year, and periprosthetic fracture within 1 year and systemic complications within 3 months. Postoperative complication rates were compared to controls. The study cohorts included 4129 TSA patients with AVN with 141,778 control TSA patients. Patients with posttraumatic AVN were significantly more likely to have a postoperative infection (OR 2.47, P  AVN was associated with a significantly increased risk for a postoperative infection (OR 1.72, P  = 0.004), revision surgery (OR 1.33, P  = 0.040), fracture (OR 2.76, P  = 0.002), and systemic complication (OR 1.59, P  AVN were not significantly associated with any of the postoperative evaluated complications. TSA in patients with humeral head AVN is associated with significantly increased rates of numerous postoperative complications compared to patients without a diagnosis of AVN, including infection, dislocation, revision arthroplasty, stiffness, periprosthetic fracture, and medical complications

  16. Varus femoral osteotomy improves sphericity of the femoral head in older children with severe form of Legg-Calvé-Perthes disease.

    Science.gov (United States)

    Terjesen, Terje; Wiig, Ola; Svenningsen, Svein

    2012-09-01

    In the Norwegian prospective study on Legg-Calvé-Perthes disease (LCPD), we found varus femoral osteotomy gave better femoral head sphericity at a mean of 5 years postoperative than physiotherapy in children older than 6.0 years at diagnosis with femoral head necrosis of more than 50%. That study did not include separate analyses for hips with 100% necrosis and those with a percentage of necrosis between 50% and 100%. We asked whether (1) femoral osteotomy improves femoral head sphericity at followup in all patients with more than 50% femoral head necrosis or in selected groups only and (2) there is a critical age between 6.0 and 10.0 years over which femoral osteotomy does not improve the prognosis. We treated 70 patients with unilateral LCPD, age at diagnosis of more than 6.0 years, and femoral head necrosis of more than 50% with varus femoral osteotomy between 1996 and 2000. We classified necrosis using the Catterall classification. We established a control group of 51 similar children who received physiotherapy. At the 5-year followup visit, the hips were graded according to femoral head shape: spherical, ovoid, or flat. At 5-year followup, there was no difference between the treatment groups in radiographic outcome in Catterall Group 3 hips. In Catterall Group 4 hips, femoral head sphericity was better in the osteotomy group, with flat femoral heads in 14% compared to 75% after physiotherapy. The same trend toward better head sphericity occurred when the lateral pillar classification was used. In children aged 6.0 to 10.0 years, in whom the whole femoral head is affected, femoral head sphericity 5 years after femoral osteotomy was better than that after physiotherapy.

  17. Management of osteonecrosis of the femoral head: A novel technique

    Directory of Open Access Journals (Sweden)

    Ahmed M Samy

    2016-01-01

    Full Text Available Background: Osteonecrosis of the femoral head (ONFH is a debilitating disease in orthopedics, frequently progressing to femoral head collapse and osteoarthritis. It is thought to be a multifactorial disease. ONFH ultimately results in femoral head collapse in 75-85% of untreated patients. Total hip arthroplasty (THA yields satisfactory results in the treatment of the end stage of the disease. However, disease typically affects males between the ages of 20 and 40 years and joint replacement is not the ideal option for younger patients. Recently, mesenchymal stem cells and platelet rich plasma (PRP have been used as an adjunct to core decompression to improve clinical success in the treatment of precollapse hips. Materials and Methods: A prospective study of 40 hips in 30 patients was done. There were 19 males and 11 females with a mean age 36.7 ± 6.93 years. The indication for the operation was restricted primarily to modified Ficat stages IIb and III. 16 hips (40% had stage IIb and 24 hips (60% had stage III ONFH. The period of follow up ranged between 36-50 months with a mean 41.4 ± 3.53 months. All patients were assessed clinically during pre- and post-operative period according to the Harris Hip Score (HHS, Visual Analog Score (VAS and radiologically by X-rays. Magnetic resonance imaging (MRI was done preoperatively to confirm the diagnosis and every 6 months postoperatively for assessment of healing. The operative procedure include removal of necrotic area with drilling then the cavity was filled with a composite of bone graft mixed with PRP. Results: The mean HHS improved from 46.0 ± 7.8 preoperatively to 90.28 ± 19 at the end of followup ( P < 0.0001. The mean values of VAS were 78 ± 21 and 35 ± 19 at preoperatively period and final followup, respectively, with an average reduction of 43 points. Conclusion: We found that the use of PRP with collagen sheet can increase the reparable capacity after drilling of necrotic segment in stage

  18. Short-term curative effects of porous bioceramics rod treatment in earli-stage avascular necrosis of the femoral head%多孔生物陶瓷棒置入术治疗早期股骨头缺血性坏死的近期疗效分析

    Institute of Scientific and Technical Information of China (English)

    汪冉; 钱金黔; 叶有晨

    2015-01-01

    目的:探讨多孔生物陶瓷棒置入术治疗早期股骨头坏死的近期临床疗效。方法2011年10月至2013年6月对13例(14髋)早期股骨头缺血性坏死患者应用多孔生物陶瓷棒置入术治疗。按Steinberg分期标准:Ⅰ期5例6髋,Ⅱa期5例,Ⅱb期3例。采用Harris髋关节评分系统评估置入前后髋关节功能改善情况。根据Steinberg分期系统进行影像学评价。结果13例患者均进行随访,随访时间6~22个月,平均16.8个月。Harris评分由术前(69.23±7.90)分提高到术后(85.30±9.80)分,优良率92.9%,治疗前后比较差异有统计学意义(P<0.05)。随访摄片髋关节影像学表现稳定,近期股骨头无明显坏死进展。结论采用生物陶瓷棒置入术治疗早期股骨头坏死,手术操作简便,手术时间短,可阻止影像学进展,缓解症状,近期疗效满意。%Objective To explore the curative effect of treatment in early-stage avascular necrosis with porous bioceramics rod. Methods There were 13 patients of early-stage ANFH (14 hips) who were treated with porous bioceramics rod from October 2011 to June 2013. According to the Steinberg assessment, the study included 5 patients in Ⅰ term, 5 patients in Ⅱa term and 3 patients in Ⅱb term. The curative effects were evaluated according to Harris scoring system as well as the radiography grading system of Steinberg. Results All the 13 patients were followed up for 6-22 months, average 16.8 months. Harris scoring was up to 85.30±9.80 from 69.23±7.90 after operation, excellent rate reached to 92.9%. There existed a significant difference between the two group (P<0.05). Conclusion Treating early-stage ANFH with porous bioceramics rod is easy to operate and the operation time is short. It can prevent the radiographic progression, alleviate the symptom, achieve curative effect satisfaction.

  19. Alterations of the blood pool in the femoral head before and after renal transplantation

    International Nuclear Information System (INIS)

    Hamaguchi, Hiroyuki; Fujioka, Mikihiro; Inoue, Shigehiro; Shibatani, Masahiko; Kubo, Toshikazu; Kubota, Takao; Ushijima, Yo; Nishimura, Tsunehiko

    2003-01-01

    The pathogenesis of idiopathic osteonecrosis of the femoral head (ION) is thought to be an ischemic event. The purpose of this study is to investigate alterations of the blood pool in the femoral head before and after renal transplantation. After renal transplantation, all patients received the same immunosuppressive therapy: corticosteroids, cyclosporin-A, and azathioprine. We performed 3-phase bone scintigraphy on 16 renal allograft recipients within 1 week before renal transplantation, and between week 4 and 9 after renal transplantation. Regions of interest (ROI) were assigned bilaterally in the femoral head, diaphysis, and soft tissue. The head-to-diaphysis ratios (HD ratios) were then calculated. Idiopathic osteonecrosis of the femoral head occurred in 2 femoral heads of 1 patient. The HD ratio before renal transplantation (mean HD±SD, 1.52±0.30) and the HD ratio after renal transplantation (1.28±0.30) were significantly different (P=0.000024). The HD ratios before and after renal transplantation were significantly different, indicating that the administration of steroids diminished the blood pool in the femoral head. A low HD ratio before renal transplantation revealed a poor blood pool in the femoral head, which may be a risk factor for ION. (author)

  20. Neural network diagnosis of avascular necrosis from magnetic resonance images

    Science.gov (United States)

    Manduca, Armando; Christy, Paul S.; Ehman, Richard L.

    1993-09-01

    We have explored the use of artificial neural networks to diagnose avascular necrosis (AVN) of the femoral head from magnetic resonance images. We have developed multi-layer perceptron networks, trained with conjugate gradient optimization, which diagnose AVN from single sagittal images of the femoral head with 100% accuracy on the training data and 97% accuracy on test data. These networks use only the raw image as input (with minimal preprocessing to average the images down to 32 X 32 size and to scale the input data values) and learn to extract their own features for the diagnosis decision. Various experiments with these networks are described.

  1. Revascularization of femoral head ischemic necrosis with vascularized bone graft: A CT scan experimental study

    International Nuclear Information System (INIS)

    Gonzalez del Pino, J.; Knapp, K.; Gomez Castresana, F.; Benito, M.

    1990-01-01

    An ischemic necrosis of the femoral head was induced in 15 mongrel adult dogs using the technique described by Gartsman et al. Five weeks later, a free vascularized rib graft was transferred into the previously induced ischemic femoral head. High resolution computed tomographic scanning was used to evaluate revascularization 4, 8 and 12 weeks after grafting. The femoral head exhibited new vessel formation throughout the study. Arterial terminal branches arising from the rib graft medullary and periosteal circulations extended beyond the rib graft, entered the head, and reached the subchondral plate. Even where the rib graft did not replenish the central core of the head, there was vascular supply from the grafted bone's vascular tree. These results suggest that a free vascularized bone graft is able to revascularize an experimentally induced ischemic femoral head necrosis. (orig.)

  2. Traumatic subchondral fracture of the femoral head in a healed trochanteric fracture.

    Science.gov (United States)

    Lee, Sang Yang; Niikura, Takahiro; Iwakura, Takashi; Kurosaka, Masahiro

    2014-07-11

    An 82-year-old woman sustained a trochanteric fracture of the left femur after a fall. Fracture fixation was performed using proximal femoral nail antirotation (PFNA) II, and she was able to walk with a T-cane after 3 months. Eleven months following the operation, the patient presented with left hip pain after a fall. Radiographs showed a subchondral collapse of the femoral head located above the blade tip. The authors removed the PFNA-II and subsequently performed cemented bipolar hemiarthroplasty. Histological evaluation of the femoral head showed osteoporosis with no evidence of osteonecrosis. Repair tissue, granulation tissue and callus formation were seen at the collapsed subchondral area. Based on these findings, a traumatic subchondral fracture of the femoral head in a healed trochanteric fracture was diagnosed. A traumatic subchondral fracture of the femoral head may need to be considered as a possible diagnosis after internal fixation of the trochanteric fracture. 2014 BMJ Publishing Group Ltd.

  3. Dynamic gadolinium-enhanced MRI evaluation of porcine femoral head ischemia and reperfusion

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, T. [Clinic for Orthopaedics and Sports Traumatology, Dreifaltigkeits-Krankenhaus GmbH, Aachener Str. 445-449, 50933 Koeln (Germany); Drescher, W. [Department of Orthopaedics, Christian Albrechts University, Kiel (Germany); Becker, C. [Department of Orthopaedics, Heinrich Heine University, Duesseldorf (Germany); Sangill, R.; Stoedkilde-Joergensen, H. [Institute for Magnetic Resonance Imaging Tomography, University of Aarhus, Skejby Hospital, Aarhus (Denmark); Heydthausen, M. [Computing Center, Heinrich Heine University, Duesseldorf (Germany); Hansen, E.S.; Buenger, C. [Spine Section, Department of Orthopaedics, University of Aarhus (Denmark)

    2003-02-01

    To examine the potential of gadolinium (Gd)-enhanced dynamic MRI in the detection of early femoral head ischemia. Furthermore, to apply a three-compartment model to achieve a clinically applicable MR index for femoral head perfusion during the steady state and arterial hip joint tamponade.Design and materials In a porcine model femoral head perfusion was measured by radioactive tracer microspheres and by using a dynamic Gd-enhanced MRI protocol. Femoral head perfusion measurements and MRI tests were performed unilaterally before, during and after the experimentally induced ischemia of one of the hip joints. Ischemia was induced by increasing intra-articular pressure to 250 mmHg. All pigs showed ischemia of the femoral head epiphysis under hip joint tamponade followed by reperfusion to the same level as before joint tamponade. In two cases perfusion after removal of tamponade continued to be low. In dynamic MRI measurements increases in signal intensity were seen after intravenous infusion of Gd-DTPA, followed by a slow decrease in signal intensity. The signal-intensity curve during femoral head ischemia had a minor increase. Also the coefficient determined was a helpful indicator of femoral head ischemia. Femoral head blood flow as measured by microspheres fell significantly under joint tamponade. Early detection of this disturbed regional blood flow was possible using a dynamic MRI procedure. A biomathematical model resulted from the evaluation of the intervals of signal intensity over time which allows detection of bone blood flow changes at a very early stage. Using this new method earlier detection of femoral head necrosis may be possible. (orig.)

  4. For early diagnosis of the fracture healing, nonunion and avascular necorsis

    International Nuclear Information System (INIS)

    Kim, Y. C.; Lee, S. H.; Lee, Y. C.; Whang, I. S.; Kim, H. S.

    1981-01-01

    Complications of non-union and avascular necrosis during fracture healing process are the most important problems. Early detection of the evidence of non-union and avascular necrosis and follow-up study of fracture healing process will reduce complications and sequellae in fracture patients. Femoral neck and tibial shaft are the most important fracture sites where non-union and/or avascular necorsis are frequently developed. Osteomedullography was performed in 30 cases of fracture, 21 femoral neck, 8 tibial shafts and 1 talar neck, in the Department of Radiology of national Medical Center during the period form August 1977 to March 1981. The following results were obtained: 1. 16 patients of femoral neck fracture were performed osteomedullography one. Non-union showing no crossing vein through the fracture site was noted in 12 cases from 16 patients. 4 cases from the 12 patients of non-union showed decreased viability but 2 case revealed good viability of the femoral head. 1 case from 4 case of good union of fracture showed no evidence of viability of the femoral head. 2. More than twice of osteomedullography were performed in 5 cases of femoral neck fracture, and crossing vein was not appeared in 4 cases at 3 weeks after fracture. 3 cases showed crossing veins at 6 weeks, and 1 case revealed evidence of avascular necrosis of the femoral head at 9 weeks. 3. In 8 cases of tibial shaft fracture, 4 cases were non-union. Another 4 cases revealed intraosseous veins crossing in fracture site or additional Kaski's osteomedullographic signs, indicating bony union. 4. One talar neck fracture showed bony union with decreased viability of the bony on 12 months after fracture. 5. Osteomedullography is considered as very important study for the early diagnosis of the fracture healing, non-union and avascular necrosis

  5. For early diagnosis of the fracture healing, nonunion and avascular necorsis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Y C; Lee, S H; Lee, Y C; Whang, I S; Kim, H S [National Medical Center, Seoul (Korea, Republic of)

    1981-09-15

    Complications of non-union and avascular necrosis during fracture healing process are the most important problems. Early detection of the evidence of non-union and avascular necrosis and follow-up study of fracture healing process will reduce complications and sequellae in fracture patients. Femoral neck and tibial shaft are the most important fracture sites where non-union and/or avascular necorsis are frequently developed. Osteomedullography was performed in 30 cases of fracture, 21 femoral neck, 8 tibial shafts and 1 talar neck, in the Department of Radiology of national Medical Center during the period form August 1977 to March 1981. The following results were obtained: 1. 16 patients of femoral neck fracture were performed osteomedullography one. Non-union showing no crossing vein through the fracture site was noted in 12 cases from 16 patients. 4 cases from the 12 patients of non-union showed decreased viability but 2 case revealed good viability of the femoral head. 1 case from 4 case of good union of fracture showed no evidence of viability of the femoral head. 2. More than twice of osteomedullography were performed in 5 cases of femoral neck fracture, and crossing vein was not appeared in 4 cases at 3 weeks after fracture. 3 cases showed crossing veins at 6 weeks, and 1 case revealed evidence of avascular necrosis of the femoral head at 9 weeks. 3. In 8 cases of tibial shaft fracture, 4 cases were non-union. Another 4 cases revealed intraosseous veins crossing in fracture site or additional Kaski's osteomedullographic signs, indicating bony union. 4. One talar neck fracture showed bony union with decreased viability of the bony on 12 months after fracture. 5. Osteomedullography is considered as very important study for the early diagnosis of the fracture healing, non-union and avascular necrosis.

  6. Osteomedullography: for early diagnosis of the fracture healing, nonunion and avascular necrosis

    International Nuclear Information System (INIS)

    Kim, Y. C.; Lee, S. H.; Lee, Y. C.; Whang, I. S.; Kim, H. S.

    1981-01-01

    Complications of non-union and avascular necrosis during fracture healing process are the most important problem. Early detection of the evidence of non-union and avascular necrosis and follow-up study of fracture healing process will reduce complications and sequellae in fracture patients. Femoral neck and tibial shaft are the most important fracture sites where non-union and/or avascular necrosis are frequently developed. Osteomedullography was performed in 30 cases of fracture, 21 femoral neck, 8 tibial shafts and 1 talar neck, in the Department of Radiology of National Medical Center during the period from August 1977 to March 1981. The following results were obtained: 1. 16 patients of femoral neck fracture were performed osteomedullography once. Non-union showing no crossing vein through the fracture site was noted in 12 cases from 16 patients. 4 cases from the 12 patients of non-union showed decreased viability but 2 case revealed good viability of the femoral head. 1 case from 4 cases of good union of fracture showed no evidence of viability of the femoral head. 2. More than twice of osteomedullography were performed in 5 cases of femoral neck fracture, and crossing vein was not appeared in 4 cases at 3 weeks after fracture. 3 cases showed crossing veins at 6 weeks, and 1 case revealed evidence of avascular necrosis of the femoral head at 9 weeks. 3. In 8 cases of tibial shaft fracture, 4 cases were non-union. Another 4 cases revealed intraosseous veins crossing in fracture site or additional Kaski's osteomedullographic signs, indicating bony union. 4. One talar neck fracture showed bony union with decreased viability of the body on 12 month after fracture. 5. Osteomedullography is considered as very important study for the early diagnosis of the fracture healing, non-union and avascular necrosis

  7. Osteomedullography: for early diagnosis of the fracture healing, nonunion and avascular necrosis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Y C; Lee, S H; Lee, Y C; Whang, I S; Kim, H S [National Medical Center, Seoul (Korea, Republic of)

    1981-12-15

    Complications of non-union and avascular necrosis during fracture healing process are the most important problem. Early detection of the evidence of non-union and avascular necrosis and follow-up study of fracture healing process will reduce complications and sequellae in fracture patients. Femoral neck and tibial shaft are the most important fracture sites where non-union and/or avascular necrosis are frequently developed. Osteomedullography was performed in 30 cases of fracture, 21 femoral neck, 8 tibial shafts and 1 talar neck, in the Department of Radiology of National Medical Center during the period from August 1977 to March 1981. The following results were obtained: 1. 16 patients of femoral neck fracture were performed osteomedullography once. Non-union showing no crossing vein through the fracture site was noted in 12 cases from 16 patients. 4 cases from the 12 patients of non-union showed decreased viability but 2 case revealed good viability of the femoral head. 1 case from 4 cases of good union of fracture showed no evidence of viability of the femoral head. 2. More than twice of osteomedullography were performed in 5 cases of femoral neck fracture, and crossing vein was not appeared in 4 cases at 3 weeks after fracture. 3 cases showed crossing veins at 6 weeks, and 1 case revealed evidence of avascular necrosis of the femoral head at 9 weeks. 3. In 8 cases of tibial shaft fracture, 4 cases were non-union. Another 4 cases revealed intraosseous veins crossing in fracture site or additional Kaski's osteomedullographic signs, indicating bony union. 4. One talar neck fracture showed bony union with decreased viability of the body on 12 month after fracture. 5. Osteomedullography is considered as very important study for the early diagnosis of the fracture healing, non-union and avascular necrosis.

  8. A case of systemic lupus erythematosus presenting as bilateral avascular necrosis of femur.

    Science.gov (United States)

    Adikari, Madura; Gunawardane, Aloka; Illangantilaka, Sachithra; Atukorale, Himantha; Rubasinghe, Jeevanie

    2016-08-05

    Avascular necrosis occur as a result of diverse etiology. Chronic inflammatory conditions such as systemic lupus erythematosus considered as a recognize cause. Many cases were reported in systemic lupus erythematosus after treating with corticosteroids. We report a case of a corticosteroid naïve patient presented as bilateral avascular necrosis of femoral head and later progressed to a case of systemic lupus erythematosus. A 26 year old lady presented with right sided hip pain and diagnosed as avascular necrosis of the femoral head. After 6 months she presented a similar pain in left hip, which revealed avascular necrosis of left femoral head as well. A probable cause for her clinical presentation could not be found after extensive clinical and laboratory evaluation. Patient reported high erythrocyte sedimentation rate persistently, and over the next few years progressed as a case of systemic lupus erythematosus. Above case illustrated avascular necrosis could be an early musculoskeletal manifestation of systemic lupus erythematosus even in the absence of corticosteroid administration.

  9. Early detection by sup(99m)Tc-Sn-pyrophosphate scintigraphy of femoral head necrosis following medial femoral neck fractures

    International Nuclear Information System (INIS)

    Greiff, J.; Lanng, S.; Hoeilund-Carlsen, P.F.; Karle, A.K.; Uhrenholdt, A.

    1980-01-01

    A selected series of 24 patients with displaced medial femoral neck fracture, treated with closed reduction and osteosynthesis with cancellous bone screws (ASIF), were investigated. During an observation period of 6 to 26 months, serial hip joint scintigraphies were performed and compared with serial X-ray examinations. At the first scintigraphic examination performed on average 5-6 weeks after the fracture, two separate investigators found a decreased amount of activity or no activity in the femoral head of 10 and 8 patients, respectively. At the second scintigraphic examination performed on average 11.1 weeks after the fracture both investigators found no activity or a decreased amount of activity in 8 patients. This figure declined to 7 during the following period, because one patient with decreased activity was recorded as having normal activity 15 months after the fracture. These 7 patients all developed radiological signs of femoral head collapse on average 16.3 months after the fracture (range 5-26 months), whereas their scintigrams displayed decreased or absent tracer uptake on average 1.2 months after the fracture (P<0.01). None of the patients with initially normal or increased uptake later showed decreased or absent uptake during the study and none developed radiological collapse. It may be concluded that absent or decreased uptake of sup(99m)Tc-Sn-pyrophosphate in the femoral head following medial femoral neck fracture indicates femoral head necrosis and a high risk of late segmental collapse, whereas normal or increased uptake implying preserved blood supply means that late segmental collapse will probably never develop. (author)

  10. Ideal femoral head size in total hip arthroplasty balances stability and volumetric wear.

    Science.gov (United States)

    Cross, Michael B; Nam, Denis; Mayman, David J

    2012-10-01

    Over the last several years, a trend towards increasing femoral head size in total hip arthroplasty to improve stability and impingement free range of motion has been observed. The specific questions we sought to answer in our review were: (1) What are the potential advantages and disadvantages of metal-on-metal, ceramic-on-ceramic, and metal-on-polyethylene bearings? (2) What is effect that femoral head size has on joint kinematics? (3) What is the effect that large femoral heads have on bearing surface wear? A PubMed search and a review of 2012 Orthopaedic Research Society abstracts was performed and articles were chosen that directly answered components of the specific aims and that reported outcomes with contemporary implant designs or materials. A review of the literature suggests that increasing femoral head size decreases the risk of postoperative dislocation and improves impingement free range of motion; however, volumetric wear increases with large femoral heads on polyethylene and increases corrosion of the stem in large metal-on-metal modular total hip arthroplasty (THA); however, the risk of potentially developing osteolysis or adverse reactions to metal debris respectively is still unknown. Further, the effect of large femoral heads with ceramic-on-ceramic THA is unclear, due to limited availability and published data. Surgeons must balance the benefits of larger head size with the increased risk of volumetric wear when determining the appropriate head size for a given patient.

  11. [Ex vivo microCT analysis of possible microfractures of the femoral head during implantation of a cementless hip resurfacing femoral component].

    Science.gov (United States)

    Lerch, M; Olender, G; von der Höh, N; Thorey, F; von Lewinski, G; Meyer-Lindenberg, A; Windhagen, H; Hurschler, C

    2009-01-01

    Microfractures of the femoral head during implantation of the femoral components are suspected to be a cause of fractures at the implant/neck junction which represent a common failure mode in hip resurfacing arthroplasty. Callus formation observed in femoral head retrievals suggests the occurrence of microfractures inside the femoral head, which might be inadvertently caused by the surgeon during implantation. The aim of this biomechanical study was to analyse whether or not the implantation of a cementless femoral component hip resurfacing system causes microfractures in the femoral head. After the preparation of 20 paired human cadaveric femoral heads, the cementless femoral component ESKA Typ BS (ESKA Implants GmbH & Co., Lübeck) was implanted on 9 specimens with an impaction device that generates 4.5 kN impaction force. On 9 specimens the femoral component was implanted by hand. One head was used as a fracture model, 1 specimen served as control without manipulation. The femoral component used for impaction was equipped with hinges to enable its removal without further interfering with the bone stock. Specimens were scanned with a microCT device before and after impaction and the microCT datasets before and after impaction were compared to identify possible microfractures. Twenty strikes per hand or with the impaction device provided sufficient implant seating. Neither the macroscopic examination nor the 2-dimensional microCT analysis revealed any fractures of the femoral heads after impaction. At least macroscopically and in the 2-dimensional microCT analysis, implantation of the cementless hip resurfacing femoral component ESKA Typ BS with 4.5 kN or by hand does not seem to cause fractures of the femoral head. Georg Thieme Verlag KG Stuttgart, New York.

  12. Case report: AVN of the femoral head five year follow-up of the combination of ipsilateral femoral neck and sub-trochanteric fracture.

    Science.gov (United States)

    Zhang, Wei; Zhu, Feng; Dong, Hanqing; Xu, Yaozeng

    2016-04-01

    To our knowledge, the type of combination of ipsilateral femoral neck and sub-trochanteric fracture is rare. And the long term follow-up is seldom been reported. A 60 year old woman suffered from a traffic accident. We gave her the intramedullary nail treatment for the combination of ipsilateral femoral neck and sub-trochanteric fracture, and the fracture indeed cured after one year and there is no clue of necrosis of the femoral head, but after 5 years, there is an evidence of necrosis of the femoral head. Combination of ipsilateral femoral neck and sub-trochanteric fracture should be kept in mind. Patients with this unusual fracture should be kept under surveillance for longer than might be thought currently to be necessary for there is a possibility of necrosis of the femoral head, even a nondisplaced femoral neck fracture.

  13. Is Assessment of Femoral Head Perfusion During Modified Dunn for Unstable Slipped Capital Femoral Epiphysis an Accurate Indicator of Osteonecrosis?

    Science.gov (United States)

    Novais, Eduardo N; Sink, Ernest L; Kestel, Lauryn A; Carry, Patrick M; Abdo, João C M; Heare, Travis C

    2016-08-01

    The modified Dunn procedure, which is an open subcapital realignment through a surgical dislocation approach, has gained popularity for the treatment of unstable slipped capital femoral epiphysis (SCFE). Intraoperative monitoring of the femoral head perfusion has been recommended as a method of predicting osteonecrosis; however, the accuracy of this assessment has not been well documented. We asked (1) whether intraoperative assessment of femoral head perfusion would help identify hips at risk of developing osteonecrosis; (2) whether one of the four methods of assessment of femoral head perfusion is more accurate (highest area under the curve) at identifying hips at risk of osteonecrosis; and (3) whether specific clinical features would be associated with osteonecrosis occurrence after a modified Dunn procedure for unstable SCFE. Between 2007 and 2014, we performed 29 modified Dunn procedures for unstable SCFE (16 boys, 11 girls; median age, 13 years; range, 8-17 years); two were lost to followup before 1 year. During this period, six patients with unstable SCFE were treated by other procedures. All patients undergoing modified Dunn underwent assessment of epiphyseal perfusion by the presence of active bleeding and/or by intracranial pressure (ICP) monitoring. In the initial five patients perfusion was recorded once, either before dissection of the retinacular flap or after fixation by one of the two methods. In the remaining 22 patients (81%), perfusion was systematically assessed before dissection of the retinacular flap and after fixation by both methods. Minimum followup was 1 year (median, 2.5 years; range, 1-8 years) because osteonecrosis typically develops within the first year after surgery. Patients were assessed for osteonecrosis by the presence of femoral head collapse at radiographs obtained every 3 months during the first year after surgery. Seven (26%) of the 27 patients developed osteonecrosis. Measures of diagnostic accuracy including sensitivity

  14. Optimising femoral-head osteochondral allograft transplantation in a preclinical model

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    Brett D. Crist

    2016-04-01

    Conclusion: These data provide initial translational and clinical evidence for large osteochondral allografts as a potential option for functional resurfacing of full-thickness cartilage defects of the femoral head.

  15. Microstructure analysis and wear behavior of titanium cermet femoral head with hard TiC layer.

    Science.gov (United States)

    Luo, Yong; Ge, Shirong; Liu, Hongtao; Jin, Zhongmin

    2009-12-11

    Titanium cermet was successfully synthesized and formed a thin gradient titanium carbide coating on the surface of Ti6Al4V alloy by using a novel sequential carburization under high temperature, while the titanium cermet femoral head was produced. The titanium cermet phase and surface topography were characterized with X-ray diffraction (XRD) and backscattered electron imaging (BSE). And then the wear behavior of titanium cermet femoral head was investigated by using CUMT II artificial joint hip simulator. The surface characterization indicates that carbon effectively diffused into the titanium alloys and formed a hard TiC layer on the Ti6Al4V alloys surface with a micro-porous structure. The artificial hip joint experimental results show that titanium cermet femoral head could not only improve the wear resistance of artificial femoral head, but also decrease the wear of UHMWPE joint cup. In addition, the carburized titanium alloy femoral head could effectively control the UHMWPE debris distribution, and increase the size of UHMWPE debris. All of the results suggest that titanium cermet is a prospective femoral head material in artificial joint.

  16. Evaluation of instability after transtrochanteric anterior rotational osteotomy for nontraumatic osteonecrosis of the femoral head

    International Nuclear Information System (INIS)

    Hiranuma, Yasunari; Atsumi, Takashi; Kajiwara, Toshihisa; Tamaoki, Satoshi; Asakura, Yasuhiro

    2009-01-01

    Transtrochanteric anterior rotational osteotomy results in improvement of joint congruity and prevention of progressive collapse and osteoarthritic changes in patients with femoral head osteonecrosis. However, this procedure remains controversial for patients with extensive collapse due to potential osteoarthritis caused by postoperative instability. The purpose of this study was to evaluate hip instability after osteotomy and determine the relation between instability and radiological and clinical outcomes. In all, 27 hips of 24 patients that were followed up for a mean period of 3.8 years were included. Instability was defined as more than 1 mm translation of the femoral head in transverse computed tomography scans obtained at 0 deg and 45 deg flexion of the hip joint. Hips were divided into instability and stability groups. Eleven hips (40%) developed instability after surgery. Osteophytes on the femoral head in 10 hips of the instability group and 2 hips of the stability group had increased in size at follow-up. There was a significant relation between postoperative instability and osteophyte formation. Joint space narrowing was not seen in any of the cases. There was no significant difference between the groups in either the postoperative intact ratio of the femoral head or the Japanese Orthopaedic Association hip score. Neither instability nor osteophyte formation on the femoral head after transtrochanteric anterior rotational osteotomy correlated with progressive osteoarthritic changes or clinical outcome in the presence of an adequate femoral head intact ratio facing the weight-bearing area. (author)

  17. Large diameter femoral heads impose significant alterations on the strains developed on femoral component and bone: a finite element analysis.

    Science.gov (United States)

    Theodorou, E G; Provatidis, C G; Babis, G C; Georgiou, C S; Megas, P D

    2011-01-01

    Total Hip Arthroplasty aims at fully recreating a functional hip joint. Over the past years modular implant systems have become common practice and are widely used, due to the surgical options they provide. In addition Big Femoral Heads have also been implemented in the process, providing more flexibility for the surgeon. The current study aims at investigating the effects that femoral heads of bigger diameter may impose on the mechanical behavior of the bone-implant assembly. Using data acquired by Computed Tomographies and a Coordinate Measurement Machine, a cadaveric femur and a Profemur-E modular stem were fully digitized, leading to a three dimensional finite element model in ANSYS Workbench. Strains and stresses were then calculated, focusing on areas of clinical interest, based on Gruen zones: the calcar and the corresponding below the greater trochanter area in the proximal femur, the stem tip region and a profile line along linea aspera. The performed finite elements analysis revealed that the use of large diameter heads produces significant changes in strain development within the bone volume, especially in the lateral side. The application of Frost's law in bone remodeling, validated the hypothesis that for all diameters normal bone growth occurs. However, in the calcar area lower strain values were recorded, when comparing with the reference model featuring a 28mm femoral head. Along line aspera and for the stem tip area, higher values were recorded. Finally, stresses calculated on the modular neck revealed increased values, but without reaching the yield strength of the titanium alloy used.

  18. Middle-term follow-up results of Pipkin type IV femoral head fracture patients treated by reconstruction plate and bioabsorbable screws

    Directory of Open Access Journals (Sweden)

    Shan-Xi Wang

    2018-06-01

    Full Text Available Purpose: To investigate the mid-term curative effects of the treatment of Pipkin type IV femoral head fractures using a reconstruction plate and bioabsorbable screws and provide the evidence for clinical practice. Methods: From February 2010 to September 2014, 21 patients with Pipkin type IV femoral head fractures were treated surgically. There were 13 males and 8 females with an average age of 41.1 years (range, 20–65 years. The causes of the fractures included traffic accidents (13 cases, falls from a height (four cases, heavy lifting injuries (three cases, and sport injury (one case. All patients were followed up with radiography and three-dimensional reconstruction computed tomography and other checks and any complications were actively managed. Closed reduction of fracture-dislocation of the hip was attempted under general anesthesia using the Kocher-Langenbeck approach. Femoral head fractures were treated with internal fixation or excision based on the size of the fracture fragments, whereas acetabular fractures were fixed with a reconstruction plate and screws following anatomic reduction. Results: The incisions healed by primary intention in all patients after surgery, without any infection, deep venous thrombosis, or other complications. All 21 patients were followed up for 36–76 months, with an average follow-up duration of 49 months. Postoperative imaging data showed that all dislocations and fractures were anatomically reduced, and bony union of the fractures was achieved. Heterotopic ossification was found in four patients, post-traumatic osteoarthritis in three, and avascular necrosis of the femoral head in two. At the final follow-up, the assessment of hip joint function according to the Thompson-Epstein scoring scale was excellent in 10 cases, good in six cases, fair in three cases, and poor in two cases. The rate of excellent and good functional outcomes was 76.1%. Conclusion: The mid-term curative effects of a

  19. Cortisol inhibits mTOR signaling in avascular necrosis of the femoral head.

    Science.gov (United States)

    Liao, Yun; Su, Rui; Zhang, Ping; Yuan, Bo; Li, Ling

    2017-10-18

    ANFH is a major health problem, to which long lasting and definitive treatments are lacking. The aim of this study is to study RNA alterations attributed to cortisol-induced ANFH. Rat models were stratified into three groups: in vitro group (n = 20) for molecular biological assays, control group (n = 3), and ANFH group induced using lipopolysaccharide and dexamethasone (n = 3). Bone marrow-derived endothelial progenitor cells (BM-EPCs) were extracted from the rats. An RNA expression array was performed on BM-EPCs, and enriched genes were subject to pathway analysis. In vitro studies following findings of array results were also performed using the isolated BM-EPCs. Significant alterations in mammalian target of rapamycin (mTOR) and HIF signaling pathways were identified in BM-EPCs of ANFH. By applying cortisol and dexamethasone to BM-EPCs, significant changes in mTOR and HIF elements were identified. The alteration of HIF pathways appeared to be downstream of mTOR signaling. Glucocorticoid receptor (GR) expression was related to glucocorticoid-dependent mRNA expression of mTOR/HIF genes. mTOR-dependent angiogenesis but not anabolism was the target of GR in ANFH. Inhibition of mTOR signaling also induced apoptosis of BM-EPCs via CHOP-dependent DR5 induction in response to GR stimulation. Decreased mTOR signaling in response to GR stimulation leading to downregulated HIF pathway as well as increased apoptosis could be the pathophysiology.

  20. Bipolar hip arthroplasty for avascular necrosis of femoral head in young adults

    Directory of Open Access Journals (Sweden)

    Baldev Dudani

    2015-01-01

    Conclusion: Bipolar hip arthroplasty (BHA using tight fitting cup and acetabular reaming in AVN hip has a low incidence of groin pain, acetabular erosion and revision in midterm followup. Good outcome and mid term survival can be achieved irrespective of the Ficat Stage.

  1. 'Femoral head necrosis' in metabolic and hormonal osteopathies

    Energy Technology Data Exchange (ETDEWEB)

    Heuck, F.H.W.; Treugut, H.

    1984-07-01

    The pathogenesis of bone necrosis is discussed with special attention and with respect to metabolic, hormonal, and vascular factors. The influence of statics and dynamics of the hip joint bones for the development of aseptic necrosis are discussed. 45 patients with ''idiopathic femoral head necroses'' were observed, including 6 cases of renal osteopathy following renal transplantation and immune suppression therapy, 14 cases of long term corticoid therapy, and 11 cases of liver diseases of different genesis. The femoral head necrosis understood as complication of an osteopathy. In our patients there were 31 males and 14 females - which means higher involvement of males. Plain radiological findings and CT-findings of changes of the femoral heat structure in different stages of the disease are described. Early diagnosis of metabolic and hormonal osteopathies is demanded for a joint keeping therapy of the beginning femoral head necrosis. 90 refs.

  2. Diagnostic methods in ischemic necrosis of the femoral head. Metodos de diagnostico en la necrosis isquemica de la cabeza femoral

    Energy Technology Data Exchange (ETDEWEB)

    Parra Blanco, J.A.; Pagola Serrano, M.A.; Delgado Macias, M.T. (Hospital Universitario Marques de Valdecilla, Santander (Spain))

    1994-01-01

    Ischemic necrosis of the femoral head (INFH) must be diagnosed at an early stage of development, when therapeutic approaches such as forage biopsy or osteotomy can prevent or slow the normal progression of the disease to arthrosis. In this article, on the basis of the pathological changes that characterize process, we review the advantages and limitations of the principal diagnostic techniques (table I) currently employed in the study of INFH. (Author)

  3. Avascular Necrosis of Bone following Chemotherapy in Cancer Patients with Coagulopathy: Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Hui-Ching Hsu

    2018-03-01

    Full Text Available We report 2 cases of patients with solid tumors and coagulopathy who experienced avascular necrosis (AVN of the bone following chemotherapy. Both cases exhibited nontraumatic bilateral AVN of the femoral heads, and one also showed bilateral AVN of the humeral heads. One case had multiple thromboembolic complications, including pulmonary obstructive syndrome and paraneoplastic pain. The other showed multiple paraneoplastic syndromes, with hypercalcemia and thrombocytosis. Groin pain and claudication of the lower extremities developed and persisted. Both patients eventually received bilateral hip arthroplasty due to AVN of both femoral heads.

  4. Femoroacetabular impingement: bone marrow oedema associated with fibrocystic change of the femoral head and neck junction

    Energy Technology Data Exchange (ETDEWEB)

    James, S.L.J. [Department of Radiology, RNOH Stanmore, Stanmore, Middlesex (United Kingdom) and Department of Radiology, Royal Orthopaedic Hospital, Birmingham (United Kingdom)]. E-mail: jamesslj@email.com; Connell, D.A. [Department of Radiology, RNOH Stanmore, Stanmore, Middlesex (United Kingdom); O' Donnell, P. [Department of Radiology, RNOH Stanmore, Stanmore, Middlesex (United Kingdom); Saifuddin, A. [Department of Radiology, RNOH Stanmore, Stanmore, Middlesex (United Kingdom)

    2007-05-15

    Aim: To describe the association of bone marrow oedema adjacent to areas of fibrocystic change at the femoral head and neck junction in patients with femoroacetabular impingement. Materials and methods: The clinical and imaging findings in six patients with bone marrow oedema adjacent to an area of fibrocystic change at the femoral head and neck junction are presented. There were five males and one female (age range 19-42 years, mean age 34.5 years). Three patients were referred with a clinical suspicion of femoroacetabular impingement, two with suspected osteoid osteoma and one with a clinical diagnosis of sciatica. The volume of bone marrow oedema (grade 1: 0-25%, grade 2: 26-50%, grade 3: 51-75% and grade 4: 76-100% of the femoral neck width), presence of labral and articular cartilage abnormality, joint effusion, and femoral head and neck morphology were recorded. Results: Magnetic resonance imaging (MRI) identified fibrocystic change in the anterolateral aspect of the femoral head and neck junction in all cases (mean size 9 mm, range 5-14 mm, three multilocular and three unilocular cysts). The volume of oedema was variable (one grade 1, two grade 2, one grade 3 and two grade 4). All patients had abnormality of the anterosuperior labrum with five patients demonstrating chondral loss. An abnormal femoral head and neck junction was identified in five patients. Conclusion: The radiological finding of fibrocystic change at the anterosuperior femoral neck with or without bone marrow oedema should prompt the search for femoroacetabular impingement. Bone marrow oedema may rarely be identified adjacent to these areas of cystic change and should be considered in the differential diagnosis of bone marrow oedema in the femoral neck.

  5. Femoroacetabular impingement: bone marrow oedema associated with fibrocystic change of the femoral head and neck junction

    International Nuclear Information System (INIS)

    James, S.L.J.; Connell, D.A.; O'Donnell, P.; Saifuddin, A.

    2007-01-01

    Aim: To describe the association of bone marrow oedema adjacent to areas of fibrocystic change at the femoral head and neck junction in patients with femoroacetabular impingement. Materials and methods: The clinical and imaging findings in six patients with bone marrow oedema adjacent to an area of fibrocystic change at the femoral head and neck junction are presented. There were five males and one female (age range 19-42 years, mean age 34.5 years). Three patients were referred with a clinical suspicion of femoroacetabular impingement, two with suspected osteoid osteoma and one with a clinical diagnosis of sciatica. The volume of bone marrow oedema (grade 1: 0-25%, grade 2: 26-50%, grade 3: 51-75% and grade 4: 76-100% of the femoral neck width), presence of labral and articular cartilage abnormality, joint effusion, and femoral head and neck morphology were recorded. Results: Magnetic resonance imaging (MRI) identified fibrocystic change in the anterolateral aspect of the femoral head and neck junction in all cases (mean size 9 mm, range 5-14 mm, three multilocular and three unilocular cysts). The volume of oedema was variable (one grade 1, two grade 2, one grade 3 and two grade 4). All patients had abnormality of the anterosuperior labrum with five patients demonstrating chondral loss. An abnormal femoral head and neck junction was identified in five patients. Conclusion: The radiological finding of fibrocystic change at the anterosuperior femoral neck with or without bone marrow oedema should prompt the search for femoroacetabular impingement. Bone marrow oedema may rarely be identified adjacent to these areas of cystic change and should be considered in the differential diagnosis of bone marrow oedema in the femoral neck

  6. Pigmented Villonodular Synovitis Causing Osteonecrosis of the Femoral Head: A Case Report

    Directory of Open Access Journals (Sweden)

    Tomohiro Mimura

    2013-01-01

    Full Text Available We report a case of a 27-year-old man with pigmented villonodular synovitis of the hip joint with coincident osteonecrosis of the femoral head. According to our review of the English-language literature, no detailed report of osteonecrosis of the femoral head complicated with pigmented villonodular synovitis has been published. Preoperative X-ray images showed joint narrowing and severe multiple bone erosions at the acetabulum and femoral neck. Magnetic resonance imaging revealed a low-intensity band attributable to osteonecrosis of the femoral head and massive diffuse pigmented villonodular synovitis lesions. Comparison of a three-dimensional computed tomographic image of this patient with an angiographic image of a normal individual demonstrated proximity of the pigmented villonodular synovitis-induced bone erosions to the medial and lateral femoral circumflex arteries and retinacular arteries, suggesting likely the compromise of the latter by the former. We propose that the massive pigmented villonodular synovitis may have contributed to the pathogenesis of osteonecrosis of the femoral head in this patient. We performed open synovectomy and total hip arthroplasty. No operative complications occurred, and no recurrence of the pigmented villonodular synovitis was detected for 3 years after the operation.

  7. Bone marrow scintigraphy in the diagnosis of post-traumatic avascular necrosis of bone

    International Nuclear Information System (INIS)

    Tawn, D.J.; Watt, I.

    1989-01-01

    A series of 19 patients, suspected of developing avascular necrosis of bone following fracture, were entered into a pilot study comparing the use of bone marrow scintigraphy with conventional skeletal scintigraphy. Two-phase bone scintigraphy, using 600 MBq of 99 Tc m -HMDP, and perfusion and late-phase nanocolloid scintigraphy, using 370 MBq of 99 Tc m -nanocolloid, were performed on each patient. Photon deficiency at the site of interest was taken to indicate avascularity. The perfusion phase of both methods was found to be unhelpful. Agreement between methods was obtained in 18 patients (95%). Six patients had abnormal nanocolloid scans, one of which was normal on the conventional bone scintigram. The remaining 13 patients had no evidence to suggest avascularity in either method. Three patients with abnormal scans have had hip replacement survey following which avascularity of the femoral head was confirmed. (author)

  8. Bone marrow scintigraphy in the diagnosis of post-traumatic avascular necrosis of bone

    Energy Technology Data Exchange (ETDEWEB)

    Tawn, D J; Watt, I [Bristol Royal Infirmary (UK)

    1989-09-01

    A series of 19 patients, suspected of developing avascular necrosis of bone following fracture, were entered into a pilot study comparing the use of bone marrow scintigraphy with conventional skeletal scintigraphy. Two-phase bone scintigraphy, using 600 MBq of {sup 99}Tc{sup m}-HMDP, and perfusion and late-phase nanocolloid scintigraphy, using 370 MBq of {sup 99}Tc{sup m}-nanocolloid, were performed on each patient. Photon deficiency at the site of interest was taken to indicate avascularity. The perfusion phase of both methods was found to be unhelpful. Agreement between methods was obtained in 18 patients (95%). Six patients had abnormal nanocolloid scans, one of which was normal on the conventional bone scintigram. The remaining 13 patients had no evidence to suggest avascularity in either method. Three patients with abnormal scans have had hip replacement survey following which avascularity of the femoral head was confirmed. (author).

  9. [Experimental study on vascular bundle implantation combined with cellular transplantation in treating rabbit femoral head necrosis].

    Science.gov (United States)

    Chen, Shuang-Tao; Zhang, Wei-Ping; Liu, Chang-An; Wang, Jun-Jiang; Song, Heng-Yi; Chai, Zhi-wen

    2013-03-01

    To discuss the feasibility of vascular bundle implantation combined with allogeneic bone marrow stromal cells (BMSCs) transplantation in treating rabbit femoral head osteonecrosis and bone defect, in order to explore a new method for the treatment of femoral head necrosis. Thirty-six New Zealand rabbits were randomly divided into three groups,with 12 rabbits in each group. Bilateral femoral heads of the rabbits were studied in the experiment. The models were made by liquid nitrogen frozen, and the femoral heads were drilled to cause bone defect. Group A was the control group,group B was stem cells transplantaion group of allograft marrow stromal,and group C was stem cells transplantation group of allograft marrow stromal combined with vascular bundle implantation. Three rabbits of each group were sacrificed respectively at 2, 4, 8, 12 weeks after operation. All specimens of the femoral heads were sliced for HE staining. Furthermore ,vascular density and the percentage of new bone trabecula of femoral head coronary section in defect area were measured and analyzed statistically. In group C,new bone trabecula and original micrangium formed at the 2nd week after operation; new bone trabecula was lamellar and interlaced with abundant micrangium at the 8th week;at the 12th week,the broadened,coarsened bone trabecula lined up regularly,and the mature bone trabecula and new marrow were visible. At the 2nd week after operation,there was no statistical significance in the percentage of new bone trabecula of femoral head coronary section in defect area between group B and C. While at 4, 8, 12 week after operation, vascular density and the percentage of new bone trabecula of femoral head coronary section in defect area of group C was higher than that of group B. Allogeneic bone marrow stromal cells cultured in vivo can form new bone trabecula, and can be applied to allotransplant. Vascular bundle implanted into the bone defect area of femoral head necrosis could improve blood

  10. Bone Circulatory Disturbances in the Development of Spontaneous Bacterial Chondronecrosis with Osteomyelitis: A Translational Model for the Pathogenesis of Femoral Head Necrosis

    Directory of Open Access Journals (Sweden)

    Robert F. Wideman

    2013-01-01

    Full Text Available This review provides a comprehensive overview of the vascularization of the avian growth plate and its subsequent role in the pathogenesis of bacterial chondronecrosis with osteomyelitis (BCO, femoral head necrosis. BCO sporadically causes high incidences of lameness in rapidly growing broiler (meat-type chickens. BCO is believed to be initiated by micro-trauma to poorly mineralized columns of cartilage cells in the proximal growth plates of the leg bones, followed by colonization by hematogenously distributed opportunistic bacteria. Inadequate blood flow to the growth plate, vascular occlusion, and structural limitations of the microvasculature all have been implicated in the pathogenesis of BCO. Treatment strategies have been difficult to investigate because under normal conditions the incidence of BCO typically is low and sporadic. Rearing broilers on wire flooring triggers the spontaneous development of high incidences of lameness attributable to pathognomonic BCO lesions. Wire flooring imposes persistent footing instability and is thought to accelerate the development of BCO by amplifying the torque and shear stress imposed on susceptible leg joints. Wire flooring per se also constitutes a significant chronic stressor that promotes bacterial proliferation attributed to stress-mediated immunosuppression. Indeed, dexamethasone-mediated immunosuppression causes broilers to develop lameness primarily associated with avascular necrosis and BCO. Prophylactic probiotic administration consistently reduces the incidence of lameness in broilers reared on wire flooring, presumably by reducing bacterial translocation from the gastrointestinal tract that likely contributes to hematogenous infection of the leg bones. The pathogenesis of BCO in broilers is directly relevant to osteomyelitis in growing children, as well as to avascular femoral head necrosis in adults. Our new model for reliably triggering spontaneous osteomyelitis in large numbers of

  11. Correlation between baseline femoral neck marrow status and the development of femoral head osteonecrosis in corticosteroid-treated patients: A longitudinal study by MR imaging

    International Nuclear Information System (INIS)

    Vande Berg, Bruno C.; Gilon, Raphael; Malghem, Jacques; Lecouvet, Frederic; Depresseux, Genevieve; Houssiau, Frederic A.

    2006-01-01

    Objective: To test the hypothesis that the development of corticosteroid (CS)-associated femoral head osteonecrosis (ON) is influenced by baseline femoral neck marrow status. Patients and methods: The population consisted of 20 untreated patients with a newly diagnosed rheumatic disease in whom a standardized CS regimen was planned. Before CS treatment, baseline femoral neck marrow status was determined by magnetic resonance (MR) imaging on T1-weighted images (proportion of surface area of femoral neck and intertrochanteric area occupied by fatty marrow; index of marrow conversion [IMC]) and on a quantitative MR sequence (bulk T1 values of femoral head and neck). The presence of ON was assessed by coronal T1-weighted MR images of the hips at 6 and 12 months. Results: None of the patients suffered from ON at baseline. Four patients (20%) developed bilateral femoral head ON at 6 months. The mean percentage of fat marrow in the femoral neck before treatment was significantly higher in ON-positive than in ON-negative patients (p = 0.0025). The mean baseline femoral neck IMC value, which parallels the degree of red to yellow marrow conversion, was higher in ON-positive than in ON-negative patients (p = 0.089). The mean baseline bulk T1 value of the femoral neck (but not of the femoral head), which inversely correlates with the amount of fat marrow, was significantly shorter in ON-positive than in ON-negative patients (p = 0.0298). Conclusion: The development of CS-associated femoral head ON is correlated with a high fat content in the proximal femur before CS therapy

  12. Using a calliper to restore the centre of the femoral head during total hip replacement.

    Science.gov (United States)

    Hill, J C; Archbold, H A P; Diamond, O J; Orr, J F; Jaramaz, B; Beverland, D E

    2012-11-01

    Restoration of leg length and offset is an important goal in total hip replacement. This paper reports a calliper-based technique to help achieve these goals by restoring the location of the centre of the femoral head. This was validated first by using a co-ordinate measuring machine to see how closely the calliper technique could record and restore the centre of the femoral head when simulating hip replacement on Sawbone femur, and secondly by using CT in patients undergoing hip replacement. Results from the co-ordinate measuring machine showed that the centre of the femoral head was predicted by the calliper to within 4.3 mm for offset (mean 1.6 (95% confidence interval (CI) 0.4 to 2.8)) and 2.4 mm for vertical height (mean -0.6 (95% CI -1.4 to 0.2)). The CT scans showed that offset and vertical height were restored to within 8 mm (mean -1 (95% CI -2.1 to 0.6)) and -14 mm (mean 4 (95% CI 1.8 to 4.3)), respectively. Accurate assessment and restoration of the centre of the femoral head is feasible with a calliper. It is quick, inexpensive, simple to use and can be applied to any design of femoral component.

  13. Hyperlipidaemia - a risk factor for femoral head osteonecrosis (Legg-Calvè-Perthes-Like disease in children with AIDS: case report

    Directory of Open Access Journals (Sweden)

    Paula Aguiar de Aragão

    Full Text Available Although treatment of children infected with HIV with protease inhibitors has improved the survival of these patients, various adverse side effects have been reported, including metabolic abnormalities, such as hyperlipidaemia. We describe a case of hip osteonecrosis in an adolescent with AIDS who was being treated with protease inhibitors. There is a possible relation with hyperlipidemia. F.M.G., white, 11 years old, AIDS A2, started to receive AZT and DDI when he was 7 years old. In April 1999, the patient had a significant increase in viral load and so the antiretroviral therapy was switched to d4T, 3TC and Ritonavir. Triglyceride plasma levels reached 460mg/dl after this switch and were always above the reference value. In December 1999, the patient complained of pain in the right hip. On physical examination, he had limited movement of this joint. Magnetic resonance imaging of the right hip showed flattening, deformity and fragmentation of the femoral head, compatible with osteonecrosis. Few cases of femoral head osteonecrosis have been associated with HIV infection, in the absence of the classic risk factors for osteonecrosis. Metabolic risk factors include hypertriglyceridaemia. The immunological disorders that occur in the HIV infection may predispose the patient to avascular osteonecrosis and metabolic disorders, particularly hypertriglyceridemia, while the use of protease inhibitors, may be considered an additional risk factor for osteonecrosis. Given the importance of premature diagnosis and to avoid complications of osteonecrosis, we recommend evaluation of musculoskeletal symptoms in children receiving protease inhibitors.

  14. Radiostereometric analysis comparison of wear of highly cross-linked polyethylene against 36- vs 28-mm femoral heads.

    Science.gov (United States)

    Bragdon, Charles R; Greene, Meridith E; Freiberg, Andrew A; Harris, William H; Malchau, Henrik

    2007-09-01

    This study used radiostereometric analysis (RSA) to compare the femoral head penetration of 28- vs 36-mm-diameter femoral heads into highly cross-linked polyethylene in 2 groups of total hip arthroplasty patients. Thirty patients were enrolled in this RSA study using highly cross-linked polyethylene (Longevity, Zimmer Inc, Warsaw, Idaho) against either 28- or 36-mm-diameter cobalt chrome femoral heads. At 3-year follow-up, there was no significant difference in the total average femoral head penetration, including both creep and wear, using 3 methods of RSA measurement between the 2 groups. Importantly, after bedding-in, there was no further significant increase in the amount of femoral head penetration (ie, wear) with either head size between years 1 and 3. There were no radiographic signs of lysis or radiolucencies at a minimum 3-year follow-up.

  15. Aseptic necrosis of the femoral head after pregnancy: a case report.

    Science.gov (United States)

    Nassar, Kawtar; Rachidi, Wafae; Janani, Saadia; Mkinsi, Ouafa

    2016-01-01

    A documented case of beginning aseptic necrosis of the femoral head associated with pregnancy together with a review of the literature about this rare complication of pregnancy is presented. The known risk factors of osteonecrosis are; steroid use, alcoholism, organ transplantation, especially after kidney transplant or bone marrow transplantation bone, systemic lupus erythematosus, dyslipidemia especially hypertriglyceridemia, dysbaric decompression sickness, drepanocytosis and Gaucher's disease. Among the less established factors, we mention procoagulations abnormalities, HIV infection, chemotherapy. We report a case of osteonecrosis of femoral head after pregnancy.

  16. Histopathology of femoral head donations: a retrospective review of 6161 cases.

    Science.gov (United States)

    Mackie, Katherine E; Zhou, Ziqiang; Robbins, Peter; Bulsara, Max; Zheng, Ming H

    2011-08-17

    Although total hip arthroplasty is one of the most common orthopaedic surgical procedures, it remains unclear whether histopathological examination of the excised femoral head adds to the quality of patient care. We propose that assessment of femoral heads resected during total hip arthroplasty and donated for allograft use may provide a profile of femoral head pathology that benefits total hip arthroplasty patients and bone donors. We retrospectively analyzed the histological findings reported for 6161 femoral heads donated for allograft use between 1993 and 2006. Specimens obtained during total hip arthroplasty and specimens donated at death were reviewed. Follow-up investigations that resulted from abnormal histopathological findings were also reviewed. The Western Australian Cancer Registry was used to determine whether patients with a suspected neoplasm were subsequently diagnosed with such a disease. A retrospective review of the histopathological findings was conducted to evaluate and reclassify all previous observations of abnormalities. One hundred and five femoral heads demonstrated abnormal or reactive histopathological features not reported prior to surgery and were rejected for allograft use. A reactive lymphocytic infiltrate, most likely due to osteoarthritis, was the most commonly identified feature (forty-five cases). Other features observed in twenty-seven cases were also most likely due to the presence of severe osteoarthritis. Ten femoral heads demonstrated plasmacytosis, which may have been related to osteoarthritis. Two patients were diagnosed with Paget's disease, and two, with rheumatoid arthritis. Nineteen patients had a suspected neoplasm. Of these nineteen, eight cases of non-Hodgkin's lymphoma or chronic lymphocytic leukemia and one case of myelodysplastic syndrome were confirmed on further investigation. One subsequently confirmed malignancy was detected per 770 femoral heads examined. Our findings indicate that, even with a detailed

  17. Trunnion Failure of the Recalled Low Friction Ion Treatment Cobalt Chromium Alloy Femoral Head.

    Science.gov (United States)

    Urish, Kenneth L; Hamlin, Brian R; Plakseychuk, Anton Y; Levison, Timothy J; Higgs, Genymphas B; Kurtz, Steven M; DiGioia, Anthony M

    2017-09-01

    Gross trunnion failure (GTF) is a rare complication in total hip arthroplasty (THA) reported across a range of manufacturers. Specific lots of the Stryker low friction ion treatment (LFIT) anatomic cobalt chromium alloy (CoCr) V40 femoral head were recalled in August 2016. In part, the recall was based out of concerns for disassociation of the femoral head from the stem and GTF. We report on 28 patients (30 implants) with either GTF (n = 18) or head-neck taper corrosion (n = 12) of the LFIT CoCr femoral head and the Accolade titanium-molybdenum-zirconium-iron alloy femoral stems. All these cases were associated with adverse local tissue reactions requiring revision of the THA. In our series, a conservative estimate of the incidence of failure was 4.7% (n = 636 total implanted) at 8.0 ± 1.4 years from the index procedure. Failures were associated with a high-offset 127° femoral stem neck angle and increased neck lengths; 43.3% (13 of 30) of the observed failures included implant sizes outside the voluntary recall (27.8% [5 of 18] of the GTF and 75.0% [8 of 12] of the taper corrosion cases). Serum cobalt and chromium levels were elevated (cobalt: 8.4 ± 7.0 μg/mL; chromium: 3.4 ± 3.3 μ/L; cobalt/chromium ratio: 3.7). The metal artifact reduction sequence magnetic resonance imaging demonstrated large cystic fluid collections typical with adverse local tissue reactions. During revision, a pseudotumor was observed in all cases. Pathology suggested a chronic inflammatory response. Impending GTF could be diagnosed based on aspiration of black synovial fluid and an oblique femoral head as compared with the neck taper on radiographs. In our series of the recalled LFIT CoCr femoral head, the risk of impending GTF or head-neck taper corrosion should be considered as a potential diagnosis in a painful LFIT femoral head and Accolade titanium-molybdenum-zirconium-iron alloy THA with unknown etiology. Almost half of the failures we observed included sizes outside of the

  18. Percutaneous Osteoplasty for the Management of a Femoral Head Metastasis: a Case Report

    International Nuclear Information System (INIS)

    Wang, Wei Guo; Wu, Chun Gen; Gu, Yi Feng; Li, Ming Hua

    2009-01-01

    Percutaneous osteoplasty (POP) as a technical extension of percutaneous vertebroplasty (PVP) has been used to treat malignant disease that affects the skeletal system. POP has demonstrated good outcome for pain relief and functional improvement. Few studies have reported on the efficiency of POP to treat malignancies located in the femoral head. We designed a pilot study with the use of POP to treat intractable pain caused by a femoral head metastatic tumor in a 43-year-old man. During the follow-up period, the patient experienced sustained pain relief and improvement of quality of life that persisted for more than three months

  19. Percutaneous Osteoplasty for the Management of a Femoral Head Metastasis: a Case Report

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    Wang, Wei Guo; Wu, Chun Gen; Gu, Yi Feng; Li, Ming Hua [The Sixth People' s Hospital, Shanghai (China)

    2009-12-15

    Percutaneous osteoplasty (POP) as a technical extension of percutaneous vertebroplasty (PVP) has been used to treat malignant disease that affects the skeletal system. POP has demonstrated good outcome for pain relief and functional improvement. Few studies have reported on the efficiency of POP to treat malignancies located in the femoral head. We designed a pilot study with the use of POP to treat intractable pain caused by a femoral head metastatic tumor in a 43-year-old man. During the follow-up period, the patient experienced sustained pain relief and improvement of quality of life that persisted for more than three months.

  20. Bone marrow edema of the femoral head and transient osteoporosis of the hip

    International Nuclear Information System (INIS)

    Berg, Bruno C. van de; Lecouvet, Frederic E.; Koutaissoff, Sophie; Simoni, Paolo; Malghem, Jacques

    2008-01-01

    The current article of this issue aims at defining the generic term of bone marrow edema of the femoral head as seen at MR imaging. It must be kept in mind that this syndrome should be regarded, not as a specific diagnosis, but rather as a sign of an ongoing abnormal process that involves the femoral head and/or the hip joint. We aim at emphasizing the role of the radiologists in making a specific diagnosis, starting from a non-specific finding on T1-weighted images and by focusing on ancillary findings on T2-weighted SE or fat-saturated proton-density weighted MR images

  1. Three-dimensional display of femoral head cartilage thickness maps from MR images

    International Nuclear Information System (INIS)

    Rubin, R.A.; Dolecki, M.; Rubash, H.E.; Thaete, F.L.; Hernden, J.H.

    1990-01-01

    This paper reports on the development of methods for three-dimensional display and analysis of the articular cartilage of the hip from MR images. Cadaveric femoral head specimens were images with three-dimensional GRASS MR imaging. Data were analyzed on a SUN workstation with original software, the ANALYZE package from Richard Robb's Biomedical Research Group at the Mayo Clinic, and SUN's Voxvu program. The articular cartilage was isolated by manually segmenting images. An original computer ray tracing method measured the cartilage thickness radially and produced movies of a rotating femoral head, displaying brightness proportional to cartilage thickness

  2. Comparing return to sport activities after short metaphyseal femoral arthroplasty with resurfacing and big femoral head arthroplasties.

    Science.gov (United States)

    Karampinas, Panagiotis K; Papadelis, Eustratios G; Vlamis, John A; Basiliadis, Hlias; Pneumaticos, Spiros G

    2017-07-01

    Young patients feel that maintaining sport activities after total hip arthroplasty constitutes an important part of their quality of life. The majority of hip surgeons allow patients to return to low-impact activities, but significant caution is advised to taking part in high-impact activities. The purpose of this study is to compare and evaluate the post-operative return to daily living habits and sport activities following short-metaphyseal hip and high functional total hip arthroplasties (resurfacing and big femoral head arthroplasties). In a study design, 48 patients (55 hips) were enrolled in three different comparative groups, one with the short-metaphyseal arthroplasties, a second with high functional resurfacing arthroplasties and a third of big femoral head arthroplasties. Each patient experienced a clinical examination and evaluated with Harris Hip Score, WOMAC, Sf-36, UCLA activity score, satisfaction VAS, anteroposterior and lateral X-rays of the hip and were followed in an outpatient setting for 2 years. Statistical analysis revealed no notable differences between the three groups regarding their demographic data however significant differences have been found between preoperative and postoperative clinical scores of each group. Also, we fail to reveal any significant differences when comparing data of all three groups at the final 2 years postoperative control regarding their clinical scores. The overall outcome of all three groups was similar, all the patients were satisfied and returned to previous level of sport activities. Short metaphyseal hip arthroplasties in young patients intending to return to previous and even high impact sport activities, similar to high functional resurfacing, big femoral head arthroplasties. Short stems with hard on hard bearing surfaces might become an alternative to standard stems and hip resurfacing.

  3. MRI Evaluation of Post Core Decompression Changes in Avascular Necrosis of Hip.

    Science.gov (United States)

    Nori, Madhavi; Marupaka, Sravan Kumar; Alluri, Swathi; Md, Naseeruddin; Irfan, Kazi Amir; Jampala, Venkateshwarlu; Apsingi, Sunil; Eachempati, Krishna Kiran

    2015-12-01

    Avascular necrosis of hip typically presents in young patients. Core decompression in precollapse stage provides pain relief and preservation of femoral head. The results of core decompression vary considerably despite early diagnosis. The role of MRI in monitoring patients post surgically has not been clearly defined. To study pre and post core decompression MRI changes in avascular necrosis of hip. This is a contiguous observational cohort of 40 hips treated by core decompression for precollapse avascular necrosis of femoral head, who had a baseline MRI performed before surgery. Core decompression of the femoral head was performed within 4 weeks. Follow up radiograph and MRI scans were done at six months. Harris hip score preoperatively, 1 month and 6 months after the surgery was noted. Success in this study was defined as postoperative increase in Harris hip score (HHS) by 20 points and no additional femoral collapse. End point of clinical adverse outcome as defined by fall in Harris hip score was conversion or intention to convert to total hip replacement (THR). MRI parameters in the follow up scan were compared to the preoperative MRI. Effect of core decompression on bone marrow oedema and femoral head collapse was noted. Results were analysed using SPSS software version. Harris hip score improved from 57 to 80 in all patients initially. Six hips had a fall in Harris hip score to mean value of 34.1 during follow up (9 to 12 months) and underwent total hip replacement. MRI predictors of positive outcome are lesions with grade A extent, Grade A & B location. Bone marrow oedema with lesions less than 50% involvement, medial and central location. Careful selection of patients by MR criteria for core decompression provides satisfactory outcome in precollapse stage of avascular necrosis of hip.

  4. Effects of traction on the blood circulation of femoral head: DSA study on a canine model

    International Nuclear Information System (INIS)

    Yang Xiujun; Xiao Jian; Ren Qile; Fu Shiping; Li Wei; Xiao Xiangsheng

    2010-01-01

    Objective: To study the influence of traction on the blood circulation of femur head and its evaluation by DSA. Methods: Using micro-catheter, transfemoral selective femoral circumflex arteriography in 22 healthy dogs was performed in unilateral hip before (Group A, n=22) and immediately (Group B, n=22), 30 (Group D, n=22), 60 (Group E, n=20), 90 (Group F, n=10), 120 (Group G, n= 10) minutes during 2 kg skin hip traction, and immediately after traction removal (Group H, I, J, L and O) , and 30 minutes after traction removal with 60, 90 and 120 minutes continuous traction (Group K, M and P) , and 60 minutes after traction removal with 90 and 120 minutes continuous traction (Group N and Q). DSA was also performed immediately during 4 kg weight traction before continuous traction in 12 hips (Group C). Blood circulation of the femoral head was evaluated mainly by observing its perfusion and time of circulation. Femur head perfusion was assessed as good scoring 3, poor scoring 2 and extremely poor scoring 1. Femur head circulation time was assessed as normal scoring 3, prolonged scoring 2 and remarkably prolonged scoring 1. Analysis of variance was employed for analysis of the angiographic findings between different groups. Results: Good femoral head perfusion in Group A to Q was 22, 0, 0, 0, 0, 0, 0, 22, 22, 1, 18, 0, 0, 8, 0, 0 and 1 hips respectively, poor one was 0, 22, 8, 22, 15, 4, 1, 0, 0, 15, 2, 4, 6, 2, 1, 3 and 8 hips, respectively, extremely poor one was 0, 0, 4, 0, 5, 6, 9, 0, 0, 4, 0, 6, 4, 0, 9, 7 and 1 hips, respectively; and normal femoral head blood circulation time was 22, 0, 0, 0, 0, 0, 0, 22, 22, 1, 18, 0, 0, 8, 0, 0 and 1 hips, respectively, prolonged one was 0, 22, 9, 22, 15, 4, 2, 0, 0, 15, 2, 5, 7, 2, 2, 4 and 8 hips, respectively, remarkably prolonged one was 0, 0, 3, 0, 5, 6, 8, 0, 0, 4, 0, 5, 3, 0, 8, 6 and 1 hips, respectively. F value of femoral head perfusion among group A and B,group B and C, group B, D, E, F and G, Group H, I, J, L and O

  5. Bilateral insufficiency fracture of the femoral head and neck in a case of oncogenic osteomalacia.

    Science.gov (United States)

    Chouhan, V; Agrawal, K; Vinothkumar, T K; Mathesul, A

    2010-07-01

    We describe a case of oncogenic osteomalacia in an adult male who presented with low back pain and bilateral hip pain. Extensive investigations had failed to find a cause. A plain pelvic radiograph showed Looser's zones in both femoral necks. MRI confirmed the presence of insufficiency fractures bilaterally in the femoral head and neck. Biochemical investigations confirmed osteomalacia which was unresponsive to treatment with vitamin D and calcium. A persistently low serum phosphate level suggested a diagnosis of hypophosphataemic osteomalacia. The level of fibroblast growth factor-23 was highly raised, indicating the cause as oncogenic osteomalacia. This was confirmed on positron-emission tomography, MRI and excision of a benign fibrous histiocytoma following a rapid recovery. The diagnosis of oncogenic osteomalacia may be delayed due to the non-specific presenting symptoms. Subchondral insufficiency fractures of the femoral head may be missed unless specifically looked for.

  6. Aseptic necrosis of the femoral head after pregnancy: a case report

    OpenAIRE

    Nassar, Kawtar; Rachidi, Wafae; Janani, Saadia; Mkinsi, Ouafa

    2016-01-01

    A documented case of beginning aseptic necrosis of the femoral head associated with pregnancy together with a review of the literature about this rare complication of pregnancy is presented. The known risk factors of osteonecrosis are; steroid use, alcoholism, organ transplantation, especially after kidney transplant or bone marrow transplantation bone, systemic lupus erythematosus, dyslipidemia especially hypertriglyceridemia, dysbaric decompression sickness, drepanocytosis and Gaucher's dis...

  7. Bone apatite composition of necrotic trabecular bone in the femoral head of immature piglets.

    Science.gov (United States)

    Aruwajoye, Olumide O; Kim, Harry K W; Aswath, Pranesh B

    2015-04-01

    Ischemic osteonecrosis of the femoral head (IOFH) can lead to excessive resorption of the trabecular bone and collapse of the femoral head as a structure. A well-known mineral component to trabecular bone is hydroxyapatite, which can be present in many forms due to ionic substitution, thus altering chemical composition. Unfortunately, very little is known about the chemical changes to bone apatite following IOFH. We hypothesized that the apatite composition changes in necrotic bone possibly contribute to increased osteoclast resorption and structural collapse of the femoral head. The purpose of this study was to assess the macroscopic and local phosphate composition of actively resorbed necrotic trabecular bone to isolate differences between areas of increased osteoclast resorption and normal bone formation. A piglet model of IOFH was used. Scanning electron microscopy (SEM), histology, X-ray absorbance near edge structure (XANES), and Raman spectroscopy were performed on femoral heads to characterize normal and necrotic trabecular bone. Backscattered SEM, micro-computed tomography and histology showed deformity and active resorption of necrotic bone compared to normal. XANES and Raman spectroscopy obtained from actively resorbed necrotic bone and normal bone showed increased carbonate-to-phosphate content in the necrotic bone. The changes in the apatite composition due to carbonate substitution may play a role in the increased resorption of necrotic bone due to its increase in solubility. Indeed, a better understanding of the apatite composition of necrotic bone could shed light on osteoclast activity and potentially improve therapeutic treatments that target excessive resorption of bone.

  8. A biomechanical evaluation of proximal femoral nail antirotation with respect to helical blade position in femoral head: A cadaveric study

    Directory of Open Access Journals (Sweden)

    Jin-Ho Hwang

    2012-01-01

    Full Text Available Objective: Despite new developments in the management of osteoporotic fractures, complications like screw cutout are still found in the fixation of proximal femur fractures even with biomechanically proven better implants like proximal femoral nail antirotation (PFNA. The purpose of this cadaveric study was to investigate the biomechanical stability of this device in relation to two common positions (center-center and inferior-center of the helical blade in the femoral head in unstable trochanteric fractures. Materials and Methods: Eight pairs of human cadaveric femurs were used; in one group [center-center (C-C group], the helical blade of PFNA was fixed randomly in central position both in anteroposterior and lateral view, whereas in the other group it was fixed in inferior one-third position in anteroposterior and in central position in lateral view [inferior-center (I-C group]. Unstable intertrochanteric fracture was created and each specimen was loaded cyclically till load to failure Results: Angular and rotational displacements were significantly higher within the C-C group compared to the I-C group in both unloaded and loaded condition. Loading to failure was higher in the I-C group compared to the C-C group. No statistical significance was found for this parameter. Correlations between tip apex distance, cyclic loading which lead to femoral head displacement, and ultimate load to failure showed a significant positive relationship. Conclusion: The I-C group was superior to the C-C group and provided better biomechanical stability for angular and rotational displacement. This study would be a stimulus for further experimental studies with larger number specimens and complex loading protocols at multicentres.

  9. Marrow pattern in the proximal femoral metaphysis of patients with osteonecrosis of femoral head and normal subjects: comparison on MR images

    International Nuclear Information System (INIS)

    Chun, Ho Jong; Park, Jeong Mi; Kim, Jee Young; Lim, Gye Yeon; Yang, Po Song; Kim, Euy Neyong; Kim, Choon Yul; Shinn, Kyung Sub

    1996-01-01

    To predict early risk of osteonecrosis of the femoral head by comparison of the bone marrow pattern of the proximal femoral metaphysis(PFM) in normal subjects and patients with osteonecrosis of the femoral head on T1-weighted magnetic resonance(MR) images. The authors retrospectively reviewed T1(TR 525/TE 25 msec) weighted coronal MR images of 67 hips with osteonecrosis and 65 normal hips in 39 patients with osteonecrosis of the femoral head and in 27 normal subjects. On the basis of bright signal intensity of fat, the proportion of remaining hematopoietic marrow in PFM was subdivided into 4 grades (0 to 3) by two radiologists. No evidence of remaining hematopoietic marrow was assigned grade 0, and grades 1, 2 and 3 represented scanty, moderate, and prominent hematopoietic marrow, respectively. Grades 0 and 1 were collectively defined as 'predominantly fatty', grades 2 and 3 as 'predominantly hematopoietic'. The frequency of the predominantly fatty marrow in PFM was analyzed in relation to three age groups (<25, 25-50, 50<) and both sexes. The overall frequency of predominantly fatty marrow in PFM was higher in hips with osteonecrosis than in normal hips (p<0.001). Especially in the male population under the age of 50, the frequency was apparently higher in hips with osteonecrosis, compared with normal hips (p<0.0001). However, the male population aged over 50 or female population showed no statistically significant difference in our series. In proximal femoral metaphysis with osteonecrosis of the femoral head, fatty marrow conversion occurs apparently earlier than in normal subject. T1-weighted MR imaging could therefore be useful in predicting early risk of osteonecrosis of the femoral head because of early fatty marrow conversion of the proximal femoral metaphysis

  10. Gd-DTPA-enhanced MR imaging of avascular necrosis of the hip

    International Nuclear Information System (INIS)

    Van de Berg, B.; Malghem, J.; Noel, H.; Maldague, B.

    1990-01-01

    This paper evaluates the interest of Gd-DTPA-enhanced MR imaging in the diagnosis of avascular necrosis (AVN) of the hip. MR imaging of 10 patients with various stages of AVN of the femoral head (14 abnormal hips) was performed (1.5-T Gyroscan). T1-weighted images before and after contrast injection and T2-weighted images were obtained in two planes. MR images were compared with pathologic findings in six femoral head specimens (total hip replacement). In the early stages of AVN (Mitchell classes A and B), a peripheral band of contrast-enhanced tissue appears on T1-weighted images after Gd-DTPA injection, mimicking the double line seen on T2-weighted images. In later stages (class C and D), the sequestrated segments, appearing hypointense on T1-weighted images, usually show a significant signal intensity enhancement after Gd-DTPA injection. The truly avascular areas may be limited to a band of thickened subchondral bone

  11. Factors affecting the aluminium content of human femoral head and neck.

    Science.gov (United States)

    Zioła-Frankowska, Anetta; Dąbrowski, Mikołaj; Kubaszewski, Łukasz; Rogala, Piotr; Frankowski, Marcin

    2015-11-01

    Tissues for the study were obtained intraoperatively during hip replacement procedures from 96 patients. In all the cases, the indication for this treatment was primary or secondary degenerative changes in the hip joint. The subject of the study was the head and neck of the femur, resected in situ. Aluminium concentrations measured in femoral head and neck samples from patients aged between 25 and 91 were varied. Statistical methods were applied to determine the variations in relation to the parameters from the background survey. Significant differences in the aluminium content of femoral head samples were observed between patients under and over 60 years of age. Based on the results, it was confirmed that the aluminium accumulates in bones over a lifetime. The study showed that the content of aluminium in the head and neck of the femur depends on the factors such as: type of medicines taken, contact with chemicals at work, differences in body anatomy and sex. The study on the levels of aluminium in bones and the factors affecting its concentration is a valuable source of information for further research on the role of aluminium in bone diseases. Based on the investigations, it was found that the GF-AAS technique is the best analytical tool for routine analysis of aluminium in complex matrix samples. The use of femoral heads in the investigations was approved by the Bioethics Committee of the University of Medical Sciences in Poznań (Poland). Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Wear and creep of highly crosslinked polyethylene against cobalt chrome and ceramic femoral heads.

    Science.gov (United States)

    Galvin, A L; Jennings, L M; Tipper, J L; Ingham, E; Fisher, J

    2010-10-01

    The wear and creep characteristics of highly crosslinked ultrahigh-molecular-weight polyethylene (UHMWPE) articulating against large-diameter (36mm) ceramic and cobalt chrome femoral heads have been investigated in a physiological anatomical hip joint simulator for 10 million cycles. The crosslinked UHMWPE/ceramic combination showed higher volume deformation due to creep plus wear during the first 2 million cycles, and a steady-state wear rate 40 per cent lower than that of the crosslinked UHMWPE/cobalt chrome combination. Wear particles were isolated and characterized from the hip simulator lubricants. The wear particles were similar in size and morphology for both head materials. The particle isolation methodology used could not detect a statistically significant difference between the particles produced by the cobalt chrome and alumina ceramic femoral heads.

  13. Multi-element determination in cancellous bone of human femoral head by PIXE

    International Nuclear Information System (INIS)

    Yuanxun Zhang; Yongping Zhang; Yongpeng Tong; Shijing Qiu; Xiaotao Wu; Kerong Dai

    1996-01-01

    Proton Induced X-ray Emission (PIXE) method is used for the determination of elemental concentrations in cancellous bone of human femoral head from five autopsies and seven patients with femoral neck broken. The specimen preparation and experimental procedure are described in detail. Using the t test, the results show that the concentrations of P, Ca, Fe, Cu, Sr in control group are higher than those in patient group, but the concentrations of S, K, Zn, Mn are not significantly different. The physiological functions of metallic elements in human bone are also discussed. (author). 19 refs., 1 fig., 4 tabs

  14. Long Term Survivorship of a Severely Notched Femoral Stem after Replacing the Fractured Ceramic head with a Cobalt-Chromium Head.

    Science.gov (United States)

    Panagopoulos, Andreas; Tatani, Irini; Megas, Panagiotis

    2016-01-01

    Although ceramic head fracture occurs infrequently today, in the event of a fracture, the resulting revision surgery can prove very challenging, since the ceramic particles lodge into the surrounding soft tissue and can cause rapid implant failure. A case of long term survivorship of a severed notched femoral stem after replacing the fractured femoral head with a cobalt-chromium one is reported in a 40-year old woman with hip dysplasia who underwent an uncomplicated total hip arthroplasty. The incident of ceramic femoral head fracture occurred 14 months postoperatively without reporting any significant trauma. Intraoperative findings at revision were a multifragmented femoral head and a damaged polyethylene insert along with diffuse metallosis and excessive wear of the cone of the stem. Both the stem and the acetabular component were stable. After removal of ceramic fragments, metallotic tissue excision and careful lavage of the joint, the inlay was replaced by a similar one and a cobalt-chromium femoral head was placed to the existing notched taper of the firmly incorporated stem. At the 13 th year follow up examination, the patient had no pain, used no walking aids, and had normal activity with no signs of wearing or loosening in the plain x-rays. Despite current recommendations of using ceramic femoral heads in cases of fracture or to revise the severely damaged stems we were able to provide a long term survivorship up to 13 years postoperatively of a cobalt-chromium femoral head applied to a severe damaged stem.

  15. Nonunion of the femoral neck: possibilities and limitations of the various treatment modalities

    NARCIS (Netherlands)

    Raaymakers, Ernst L. F. B.; Marti, René K.

    2008-01-01

    Nowadays in cases of nonunions of the femoral neck, the surgeon is tempted to perform prosthetic replacement of the hip, more so if there is also evidence of avascular necrosis of the head of femur. This provides rapid pain relief and allows early mobilization. However, long-term results of hip

  16. Case report: multifocal subchondral stress fractures of the femoral heads and tibial condyles in a young military recruit.

    Science.gov (United States)

    Yoon, Pil Whan; Yoo, Jeong Joon; Yoon, Kang Sup; Kim, Hee Joong

    2012-03-01

    Subchondral stress fractures of the femoral head may be either of the insufficiency-type with poor quality bone or the fatigue-type with normal quality bone but subject to high repetitive stresses. Unlike osteonecrosis, multiple site involvement rarely has been reported for subchondral stress fractures. We describe a case of multifocal subchondral stress fractures involving femoral heads and medial tibial condyles bilaterally within 2 weeks. A 27-year-old military recruit began having left knee pain after 2 weeks of basic training, without any injury. Subsequently, right knee, right hip, and left hip pain developed sequentially within 2 weeks. The diagnosis of multifocal subchondral stress fracture was confirmed by plain radiographs and MR images. Nonoperative treatment of the subchondral stress fractures of both medial tibial condyles and the left uncollapsed femoral head resulted in resolution of symptoms. The collapsed right femoral head was treated with a fibular strut allograft to restore congruity and healed without further collapse. There has been one case report in which an insufficiency-type subchondral stress fracture of the femoral head and medial femoral condyle occurred within a 2-year interval. Because the incidence of bilateral subchondral stress fractures of the femoral head is low and multifocal involvement has not been reported, multifocal subchondral stress fractures can be confused with multifocal osteonecrosis. Our case shows that subchondral stress fractures can occur in multiple sites almost simultaneously.

  17. Femoral head and neck excision arthroplasty in a leopard tortoise (Stigmochelys pardalis).

    Science.gov (United States)

    Naylor, Adam D

    2013-12-01

    Cases of femoral head and neck excision arthroplasty are infrequently reported in reptiles, and details of surgical technique and clinical outcome in chelonia are lacking. An adult female leopard tortoise (Stigmochelys pardalis) was presented with chronic non-weight-bearing lameness of the left hind limb. Examination and radiography were consistent with coxofemoral luxation, and as a result of the chronic presentation, surgical intervention was recommended. A cranial approach to the joint via the prefemoral fossa afforded good surgical exposure. A depressed lytic acetabular lesion was noted during the procedure, postulated to be a result of abnormal wear from the luxated femoral head. A fiberglass prop was used during recovery to allow extension of the limb without full weight-bearing. Lameness persisted postoperatively, but limb usage significantly improved.

  18. The study of the hemodynamics in femoral heads by positron emission tomography

    International Nuclear Information System (INIS)

    Iwanami, Hisako

    1998-01-01

    Evaluation of the hemodynamics in bone tissue is important for clarifying the pathogenesis and pathology of necrotic disease. However, there is no established method of non-invasive quantitative measurement of the blood flow in bone tissue. In addition, the blood volume representing the vascular bed volume is difficult to measure and remains unclear. To evaluate the applicability of positron emission tomography (PET) to the measurement of the blood flow and blood volume in bone tissue, we measured the blood flow and blood volume in the femoral head and evaluated age-associated hemodynamic changes in healthy adult males. The subjects were 16 healthy adult males (31 hip joints) and 1 male (2 hip joints) with trauma who underwent unilateral prosthetic replacement of the femoral head. Their age ranged from 20 to 78 years (mean, 42 years). The blood flow was measured by the dynamic study method using H 2 15 O while the blood volume was measured by the steady state method using C 15 O. The blood flow was 1.68-6.47 ml/min./100 g (mean±SD, 3.49±1.28), and the blood volume was 1.67-6.03 ml/100 ml (mean±SD, 2.99±1.25). With age the blood flow significantly decreased (p<0.01), and the blood volume significantly increased (p<0.05). Our results showed that the blood flow and blood volume in bone tissue can be measured in vivo by PET. Both the blood flow and blood volume in the femoral head considerably differed among individuals. The age-related changes in the femoral head may result from decreased trabecular bone with age and its replacement by blood. Though additional cases should be evaluated, PET is adequately applicable to experimental and clinical studies in orthopedic surgery. (author)

  19. Osteonecrosis of the femoral head in sickle cell disease: prevalence, comorbidities, and surgical outcomes in California

    OpenAIRE

    Adesina, Oyebimpe; Brunson, Ann; Keegan, Theresa H. M.; Wun, Ted

    2017-01-01

    Osteonecrosis of the femoral head (ONFH) is a prevalent complication of sickle cell disease (SCD) that has not been well described in population-based cohort studies. Using California's Office of Statewide Planning and Development discharge databases (1991-2013), we estimated the cumulative incidence of ONFH after accounting for the competing risk of death and used a multivariable Cox proportional hazards regression to identify factors associated with ONFH diagnosis. We also calculated rates ...

  20. The influence of early radiolucent lines appearing on femoral head penetration into HXLPE cemented sockets.

    Science.gov (United States)

    Morita, Daigo; Seki, Taisuke; Higuchi, Yoshitoshi; Takegami, Yasuhiko; Amano, Takafumi; Ishiguro, Naoki

    2018-04-01

    This study investigates differences in femoral head penetration between highly cross-linked polyethylene (HXLPE) cemented sockets both with and without radiolucent lines (RLLs) in the early postoperative phase and at 5 years follow-up. There were 35 patients (37 hips), mean age of 66.8 years, who underwent total hip arthroplasty (THA) using highly HXLPE cemented sockets. They were divided into 2 groups based on postoperative the early appearance of RLLs. Femoral head penetrations on both anteroposterior- and Lauenstein-view radiographs were evaluated, and the mean polyethylene (PE) wear rate was calculated based on femoral head penetrations between 2 and 5 years. Femoral head penetrations in the proximal direction were 0.075 mm and 0.150 mm in the RLL and non-RLL groups at 1 year postoperatively ( p = 0.019). At 5 years measured penetration was 0.107 mm and 0.125 mm in the RLL and non-RLL groups, respectively ( p = 0.320). The mean PE wear rates in anteroposterior-view were 0.008 mm/year and 0.003 mm/year in the RLL and non-RLL groups ( p = 0.390) and those in Lauenstein-view were 0.010 mm/year and 0.005 mm/year, respectively ( p = 0.239). In the RLL group, the PE bedding-in was less compared with those in the non-RLL group. Additionally, the mean PE wear rate in the RLL group tended to be higher than that in the non-RLL group. The distribution of stress loading through the cement may differ according to whether early RLLs appear.

  1. Differences in Femoral Head Penetration Between Highly Cross-Linked Polyethylene Cemented Sockets and Uncemented Liners.

    Science.gov (United States)

    Morita, Daigo; Seki, Taisuke; Higuchi, Yoshitoshi; Takegami, Yasuhiko; Ishiguro, Naoki

    2017-12-01

    This study aimed at investigating differences in femoral head penetration between highly cross-linked polyethylene (HXLPE) cemented sockets and uncemented liners during 5 years postoperatively. Ninety-six patients (106 hips) with a mean age of 64.4 (range, 35-83) years underwent total hip arthroplasty using a HXLPE cemented socket or liner and were respectively divided into cemented (35 patients [37 hips]) and uncemented (61 patients [69 hips]) groups. Femoral head penetrations were evaluated on both anteroposterior (AP)-view and Lauenstein-view radiographs, and mean polyethylene (PE) wear rates were calculated based on femoral head penetration from 2 to 5 years. Multivariate analyses were performed to assess risk factors for PE wear. At 5 years postoperatively, the cemented and uncemented groups exhibited proximal direction femoral head penetrations of 0.103 mm and 0.124 mm (P = .226) and anterior direction penetrations of 0.090 mm and 0.151 mm (P = .002), respectively. The corresponding mean PE wear rates were 0.004 mm/y and 0.009 mm/y in the AP-view (P = .286) and 0.005 mm/y and 0.012 mm/y in the Lauenstein-view (P = .168), respectively. Left-side operation and high activity were independent risk factors for PE wear on AP-view. When HXLPE was used, all mean PE wear rates were very low and those of cemented sockets and uncemented liners were very similar. PE particle theory suggests that the occurrence of osteolysis and related aseptic loosening might consequently decrease. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Significance of radiological diagnosis in complex investigation of necroses of femoral head ossification centers. Pt. 2

    Energy Technology Data Exchange (ETDEWEB)

    Siegling, C.W.; Endert, G.; Ritter, H.; Schumann, E.

    1984-07-01

    101 scintigraphic investigations and 42 angiograms show that the vascular tamponade is the decisive factor for the beginning of necrosis of the femoral head ossification center. Plain films, scintigraphy and angiography give information of the duration of the disease. Extent and localisation of the circulatory disturbance are important for the prognosis of the disease. From stage classification and prognostic factors the conclusions for therapy can be drawn.

  3. Determination of the vitality of the femoral head with sup(99m)Tc-Sn-pyrophosphate scintigraphy

    International Nuclear Information System (INIS)

    Greiff, J.

    1980-01-01

    A series of 14 patients who for various reasons were scheduled for total hip replacement were investigated. sup(99m)Tc-Sn-pyrophosphate scintigraphy and tetracycline labelling of the bone structure was performed prior to surgery, and subsequently the femoral heads were submitted to histological evaluation on decalcified as well as non-decalcified slides. The evaluation of the scintigraphs was performed by a specialist in nuclear medicine and the histological slides were evaluated by a pathologist, in the both cases without the radiological findings or the clinical history. The scintigraphic evaluations of the vitality of the femoral head were in all cases verified by the histological examination, whereas the radiological findings in three cases failed to demonstrate that a femoral head necrosis actually was present. From this study it can be concluded that sup(99m)Tc-Sn-pyrophosphate scintigraphy is an excellent method of assessing bone vitality in the femoral head. (author)

  4. Diagnostics of femoral head status in humans using laser spectroscopy - In vitro studies.

    Science.gov (United States)

    Lin, Huiying; Li, Wansha; Zhang, Hao; Chen, Peng; Chen, Delong; He, Wei; Svanberg, Sune; Svanberg, Katarina

    2017-10-01

    Osteonecrosis of the femoral head (ONFH), a recalcitrant and disabling disease, is caused by inadequate or fully disrupted blood supply to the affected segment of the subchondral bone. Theoretically, there will develop gas-filled pores during the bone decay process due to lacking blood supply. Unfortunately, the relationship between the gas-filled pores and ONFH is still unclear. Here, we have introduced diode laser absorption spectroscopy to detect oxygen and water vapor signals in the femoral heads from hip replacement in 19 patients. Five samples are affected by osteoarthritis (OA) and the others are related to ONFH. Oxygen and water vapor signals could be obtained, demonstrating the presence of gas-filled pores in both the OA and ONFH groups while the measurement results showed no significant difference. A study of gas exchange was also performed on one excised bone sample to study how these gas pores communicate with the ambient air. The results suggested that the obtained oxygen signals inside the bone samples originate from the invasion of ambient air, which is not expected in vivo. In conclusion, the ability to detect the gas signal of laser absorption spectroscopy shows the potential for the medical application of assessing the human femoral head in vivo. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

  5. Transient peripartum osteoporosis of the femoral head in first and third pregnancy.

    Science.gov (United States)

    Truszczyńska, Aleksandra; Walczak, Piotr; Rapała, Kazimierz

    2012-01-01

    The aim of this article was to present transient peripartum femoral head osteoporosis. This very rare condition occurred twice in our patient-a woman in her 30s. The cases described in the literature were mostly unilateral, with bilateral hip involvement noted much less frequently. In our patient, transient osteoporosis occurred in the third trimester of her first pregnancy in the right hip, her second pregnancy was uncomplicated, and in the third trimester of the patient's third pregnancy, osteoporotic changes were noted in the left hip joint. The patient breastfed her first and third babies only 3 wk each. She breastfed her second baby for 4 mo. The diagnostic workup was based on the clinical examination and radiographic/magnetic resonance imaging, which revealed bone marrow edema, and the dual-energy X-ray absorptiometry scans. The treatment consisted in core decompression of the femoral head (foragé), unloading of the hip using crutches as well as administration of calcitonin and calcium supplements. Complete recovery of the femoral heads was achieved. The follow-up time was 7 yr. Copyright © 2012 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

  6. Hip Dislocation Increases Roughness of Oxidized Zirconium Femoral Heads in Total Hip Arthroplasty: An Analysis of 59 Retrievals

    Science.gov (United States)

    Moussa, Mohamed E.; Esposito, Christina I.; Elpers, Marcella E.; Wright, Timothy M.; Padgett, Douglas E.

    2014-01-01

    The aims of this study were to assess damage on the surface of retrieved oxidized zirconium metal (OxZr) femoral heads, to measure surface roughness of scratches, and to evaluate the extent of surface effacement using scanning electron microscopy (SEM). Ceramic zirconia-toughened alumina (ZTA) heads were analyzed for comparison. OxZr femoral heads explanted for recurrent dislocation had the most severe damage (p<0.001). The median surface roughness of damaged OxZr femoral heads was 1.49μm, compared to 0.084μm for damaged ZTA heads and 0.052μm for undamaged OxZr (p<0.001). This may be of clinical concern because increased surface roughness has the potential to increase the wear of polyethylene liners articulating against these OxZr heads in THA. PMID:25443362

  7. A comparative study of radionuclide bone scan, X-ray and MRI on early femoral head necrosis in adults

    International Nuclear Information System (INIS)

    Liu Jihua; Ji Qinglian; Xu Aide; Zuo Shuyao; Gao Zhenhua

    2004-01-01

    Objective: To summarize radionuclide bone scan signs in the early femoral head necrosis (FHN) in adults, to compare them with MRI and X-ray findings and to discuss the pathological basis of radionuclide bone scan findings from the view of MRI. Methods: Forty cases (63 hips) with early FHN in adult patients proved by follow-up studies or pathology were analyzed. All patients underwent radionuclide bone scan, MRI and X-ray examination within a period of less than 7 d separately. Results: 1) Radionuclide bone scan manifestations of the early FHN corresponding to different MRI signs included: focally decreased uptake of radioisotope, focally increased uptake, atypical or typical doughnut sign, mildly increased uptake in the superior part of femoral head with band-like region of obviously increased uptake in inferior part of femoral head or femoral neck, and diffused increase of uptake in the whole head. 2) In 40 cases (63 hips), there was statistical difference in diagnosis early FHN in adults not only between radionuclide bone scan and X-ray but also between MRI and X-ray in sensitivity (P 0.05). Conclusions: 1) The atypical or typical doughnut sign and mildly increased uptake in the superior part of femoral head with band-like region of obviously increased uptake in inferior part of femoral head or neck are specific signs for diagnosing early FHN. 2) For sensitivity, radionuclide bone scan and MRI are equally superior to X-ray. (authors)

  8. Osteonecrosis of femoral head: Treatment by core decompression and vascular pedicle grafting

    Directory of Open Access Journals (Sweden)

    Babhulkar Sudhir

    2009-01-01

    Full Text Available Background: Femoral head-preserving core decompression and bone grafting have shown excellent result in preventing collapse. The use of vascularized grafts have shown better clinical results. The vascular pedicle bone graft is an easy to perform operation and does not require special equipment. We analyzed and report a series of patients of osteonecrosis of femoral head treated by core decompression and vascular pedicle grafting of part of iliac crest based on deep circumflex iliac vessels. Materials and Methods: The article comprises of the retrospective study of 31 patients of osteonecrosis of femoral head in stage II and III treated with core decompression and vascular pedicle grafting by using part of iliac crest with deep circumflex iliac vessels from January 1990 to December 2005. The young patients with a mean age 32 years (18-52 years with a minimum follow-up of five years were included for analysis. Sixteen patients had osteonecrosis following alcohol abuse, 12 patients following corticosteroid consumption, 3 patients had idiopathic osteonecrosis. Nine patients were stage IIB, and 22 patients were stage IIIC according to ARCO′s system. The core decompression and vascular pedicle grafting was performed by anterior approach by using part of iliac crest with deep circumflex iliac vessels. Results: Digital subtraction arteriography performed in 9 patients at the end of 12 weeks showed the patency of deep circumflex artery in all cases, and bone scan performed in 6 other patients showed high uptake in the grafted area of the femoral head proving the efficacy of the operative procedure. Out of 31 patients, only one patient progressed to collapse and total joint replacement was advised. At the final follow up period of 5-8 years, Harris Hip Score improved mean ± SD of 28.2 ± 6.4 ( p < 0.05. Forty-eight percent of patients had an improvement in Harris Hip Score of more that 28 points. Conclusion: The core decompression and vascular pedicle

  9. Sequential radionuclide bone imaging in avascular pediatric hip conditions

    International Nuclear Information System (INIS)

    Minikel, J.; Sty, J.; Simons, G.

    1983-01-01

    Radionuclide bone imaging was performed on six patients with various hip conditions. Initial bone images revealed diminished uptake of isotope /sup 99m/Tc-MDP in the capital femoral epiphysis. Following therapeutic intervention, repeat bone scans revealed normal uptake of /sup 99m/Tc-MDP in the capital femoral epiphysis. Subsequent radiographs revealed that avascular necrosis had not occurred. There are two types of avascularity: the potentially reversible, and the irreversible. Attempts should be made toward early recognition of the potentially reversible avascular insult. With early recognition, surgical reconstruction prior to osteophyte death may result in revascularization. If this can be accomplished, avascular necrosis can be avoided

  10. Clinical and radiographic outcomes of femoral head fractures: excision vs. fixation of fragment in Pipkin type I: what is the optimal choice for femoral head fracture?

    Science.gov (United States)

    Park, Kyung-Soon; Lee, Keun-Bae; Na, Bo-Ram; Yoon, Taek-Rim

    2015-07-01

    In this work, we present relatively long-term results of femoral head fractures with a specific focus on Pipkin type I fractures. Fifty-nine femoral head fractures were treated according to modified Pipkin's classification as follows: type I, small fragment distal to the fovea centralis (FC); type II, large fragment distal to the FC; type III, large fragment proximal to the FC; type IV, comminuted fracture. There were 15 cases of type I, 28 of type II, 9 of type III, and 7 of type IV fractures. Conservative treatment with skeletal traction was performed in 4 type II cases, excision of the fragment in 15 type I and 10 type II cases, fixation of the fragment in 14 type II and all 9 type III cases, and total hip replacement in all 7 type IV cases. The overall clinical and radiographic outcomes were evaluated using previously published criteria, focusing on the results in Pipkin type I fractures with relatively large fragments. Based on Epstein criteria, in type II fractures, excellent or good clinical results were seen in 6 of 10 patients (60.0 %) treated by excision of the fragment and 12 of 14 patients (85.7 %) treated by internal fixation (p = 0.05). Also, excellent or good radiologic results were seen in 4 of 10 (40.0 %) patients treated by excision of the fragment and 12 of 14 (85.7 %) patients treated by internal fixation (p = 0.03). Even in Pipkin type I fractures, if the fragment is large (modified Pipkin type II), early reduction and internal fixation can produce good results.

  11. Distinct focal lesions of the femoral head: imaging features suggesting an atypical and minimal form of bone necrosis

    International Nuclear Information System (INIS)

    Theodorou, Daphne J.; Theodorou, Stavroula J.; Resnick, Donald; Haghighi, Parviz

    2002-01-01

    Heading AbstractObjective. To document the imaging findings observed in patients with an unusual pattern of abnormality of the femoral head, most likely representing osteonecrosis.Design and patients. The imaging findings in 11 patients (10 men, 1 woman; age range 32-55 years) with a distinct lesion of the femoral head were reviewed with particular attention to the morphologic appearance, location, and extent of the lesion(s) in the proximal femur.Results. The 16 lesions identified in these patients extended to the subchondral area. Articular collapse was not evident in any hip. Radiography and CT showed areas of mixed bone sclerosis and osteolysis surrounded by sclerotic margins. On MR imaging, the signal intensity characteristics of the osseous lesion(s) were most commonly similar to those of fluid. Histopathologic findings, available in two hips, were typical of osteonecrosis. There was evidence of correlation of the site of the lesion with the known general distribution and anastomoses of arteries supplying the femoral head.Conclusion. A distinct, focal lesion of the femoral head is believed to represent an atypical form of bone necrosis. Its restriction to a small portion of the femoral head may relate to localized vascular anatomy. Recognition of the quite characteristic imaging findings can prevent misdiagnosis and may have implications for the prediction of the natural course of the disease. (orig.)

  12. [Short-term curative effects of Tantalum rod treatment in early avascular necrosis].

    Science.gov (United States)

    Ye, Fu-Sheng; Ni, Zhe-Ji; Chu, Xiao-Bing; He, Bang-Jian; Li, Ju; Tong, Pei-Jian

    2013-08-01

    To explore the recent clinical curative effect of Tantalum rod in treating the early avascular necrosis. From January 2008 to November 2008, the 25 patients (39 hips) with early avascular necrosis accepted tantalum rod placement and included 9 males (11 hips) and 16 females (28 hips) with an average age of 37 years old ranging from 18 to 74 years old. Four patients (6 hips) caused by Alcoholic, 6 patients (8 hips) by hormone, 2 cases (2 hips) by traumatic, 13 cases (23 hips) by idiopathic. Steinberg preoperative stage involved 7 hips in period I, 24 hips in period II, 8 hips in period III. Curative effect analysis included preoperative and postoperative Harris score, radiographic changes and hip replacement for follow-up to accept the end of the femoral head survival rate. All patients were followed up for 6 to 47 months (averaged 37.4 months). All 12 hips imaging appeard progress,including tantalum rod exit in 1 hip, hip hemiarthroplasty collapse in 3 hips, the area increased to avascular necrosis in 8 hips. Six hips accepted total hip replacement, including imaging progress in 5 hips (41.7%, 5/12), no imaging progress in 1 hip (3.7%,1/27). All hips' Kaplan-Meier survival curves showed 6-month survival rate was (97.4 +/- 2.5)% after tantalum stick insertion, 1-year survival rate was (94.7 +/- 3.6), and 2-year survival rate was (88.6 +/- 5.4)%, 3-year survival rate was (72.5 +/- 11.2). It is effective for treatment of avascular necrosis of femoral head in Steinberg I and II by Tantalum rod, and it can effectively relieve femoral head replacement time.

  13. Characterization of an Ex vivo Femoral Head Model Assessed by Markers of Bone and Cartilage Turnover

    Science.gov (United States)

    Madsen, Suzi Hoegh; Goettrup, Anne Sofie; Thomsen, Gedske; Christensen, Søren Tvorup; Schultz, Nikolaj; Henriksen, Kim; Bay-Jensen, Anne-Christine; Karsdal, Morten Asser

    2011-01-01

    Objective: The pathophysiology of osteoarthritis involves the whole joint and is characterized by cartilage degradation and altered subchondral bone turnover. At present, there is a need for biological models that allow investigation of the interactions between the key cellular players in bone/cartilage: osteoblasts, osteoclasts, and chondrocytes. Methods: Femoral heads from 3-, 6-, 9-, and 12-week-old female mice were isolated and cultured for 10 days in serum-free media in the absence or presence of IGF-I (100 nM) (anabolic stimulation) or OSM (10 ng/mL) + TNF-α (20 ng/mL) (catabolic stimulation). Histology on femoral heads before and after culture was performed, and the growth plate size was examined to evaluate the effects on cell metabolism. The conditioned medium was examined for biochemical markers of bone and cartilage degradation/formation. Results: Each age group represented a unique system regarding the interest of bone or cartilage metabolism. Stimulation over 10 days with OSM + TNF-α resulted in depletion of proteoglycans from the cartilage surface in all ages. Furthermore, OSM + TNF-α decreased growth plate size, whereas IGF-I increased the size. Measurements from the conditioned media showed that OSM + TNF-α increased the number of osteoclasts by approximately 80% and induced bone and cartilage degradation by approximately 1200% and approximately 2600%, respectively. Stimulation with IGF-I decreased the osteoclast number and increased cartilage formation by approximately 30%. Conclusion: Biochemical markers and histology together showed that the catabolic stimulation induced degradation and the anabolic stimulation induced formation in the femoral heads. We propose that we have established an explant whole-tissue model for investigating cell-cell interactions, reflecting parts of the processes in the pathogenesis of joint degenerative diseases. PMID:26069585

  14. Successful disinfection of femoral head bone graft using high hydrostatic pressure.

    Science.gov (United States)

    van de Sande, Michiel A J; Bovée, Judith V M G; van Domselaar, Mark; van Wijk, Marja J; Sanders, Ingrid; Kuijper, Ed

    2017-12-20

    The current standard for sterilization of potentially infected bone graft by gamma irradiation and thermal or chemical inactivation potentially deteriorates the biomechanical properties of the graft. We performed an in vitro experiment to evaluate the use of high hydrostatic pressure (HHP); which is widely used as a disinfection process in the food processing industry, to sterilize bone grafts. Four femoral heads were divided into five parts each, of which 16 were contaminated (in duplicate) with 10 5 -10 7  CFU/ml of Staphylococcus epidermidis, Bacillus cereus, or Pseudomonas aeruginosa or Candida albicans, respectively. Of each duplicate, one sample was untreated and stored similarly as the treated sample. The remaining four parts were included as sterile control and non-infected control. The 16 parts underwent HHP at the high-pressure value of 600 MPa. After HHP, serial dilutions were made and cultured on selective media and into enrichment media to recover low amounts of microorganism and spores. Three additional complete femoral heads were treated with 0, 300 and 600 MPa HHP respectively for histological evaluation. None of the negative-control bone fragments contained microorganisms. The measured colony counts in the positive-control samples correlated excellent with the expected colony count. None of the HHP treated bone fragments grew on culture plates or enrichment media. Histological examination of three untreated femoral heads showed that the bone structure remained unchanged after HHP. Sterilizing bone grafts by high hydrostatic pressure was successful and is a promising technique with the possible advantage of retaining biomechanical properties of bone tissue.

  15. Do oxidized zirconium femoral heads reduce polyethylene wear in cemented THAs? A blinded randomized clinical trial.

    Science.gov (United States)

    Zaoui, Amine; Hage, Samer El; Langlois, Jean; Scemama, Caroline; Courpied, Jean Pierre; Hamadouche, Moussa

    2015-12-01

    Charnley low-friction torque total hip arthroplasty (THA) remains the gold standard in THA. The main cause for failure is wear of the socket. Highly crosslinked polyethylene (HXLPE) has been associated with reduced wear rates. Also, oxidized zirconium has shown in vitro reduced wear rates. However, to our knowledge, there are no data comparing oxidized zirconium femoral heads with metal heads against HXLPE or ultrahigh-molecular-weight polyethylene (UHMWPE) when 22.25-mm bearings were used, which was the same size that performed so well in Charnley-type THAs. We hypothesized that after a minimal 4-year followup (1) use of HXLPE would result in lower radiographic wear than UHMWPE when articulating with a stainless steel head or with an oxidized zirconium head; (2) use of oxidized zirconium would result in lower radiographic wear than stainless steel when articulating with UHMWPE and HXLPE; and (3) there would be no difference in terms of Merle d'Aubigné scores between the bearing couple combinations. One hundred patients were randomized to receive cemented THA with either oxidized zirconium or a stainless steel femoral head. UHMWPE was used in the first 50 patients, whereas HXLPE was used in the next 50 patients. There were 25 patients in each of the four bearing couple combinations. All other parameters were identical in both groups. Complete followup was available in 86 of these patients. Femoral head penetration was measured using a validated computer-assisted method dedicated to all-polyethylene sockets. Clinical results were compared between the groups using the Merle d'Aubigné score. In the UHMWPE series, the median steady-state penetration rate from 1 year onward was 0.03 mm/year (range, 0.003-0.25 mm/year) in the oxidized zirconium group versus 0.11 mm/year (range, 0.03-0.29 mm/year) in the metal group (difference of medians 0.08, p zirconium group versus 0.05 mm/year (range, -0.39 to 0.11 mm/year) in the metal group (difference of medians 0.03, p

  16. Development of detection method of early stage nontraumatic osteo-necrosis of the femoral head by dynamic MRI

    International Nuclear Information System (INIS)

    Morita, Fuminori; Ikehira, Hiroo; Kitahara, Hiroshi; Terada, Tomoko; Nakano, Yoshitada; Ishii, Teruyuki; Iida, Tetsu; Ikenouchi, Sumio; Moriya, Hideshige

    1999-01-01

    The early detection methods of nontraumatic osteo-necrosis of the femoral head were demonstrated with the dynamic or static enhancement MR imaging method using gadolinium-DTPA (Gd-DTPA). Even if with these methods we could not detect stage 0 of nontraumatic osteo-necrosis, but these pathological change should be induced at 0 stage in the patients who were medicated high-dose corticosteroids. The authors designed the big ROI (region of interest) dynamic MR imaging method to brake this diagnostic difficulty for 0 stage of femoral, and evaluated the efficacy of this technology with normal and femoral nontraumatic osteo-necrosis patients volunteer. (author)

  17. Starclose SE® hemostasis after 6F direct antegrade superficial femoral artery access distal to the femoral head for peripheral endovascular procedures in obese patients.

    Science.gov (United States)

    Spiliopoulos, Stavros; Kitrou, Panagiotis; Christeas, Nikolaos; Karnabatidis, Dimitris

    2016-01-01

    Direct superficial femoral artery (SFA) antegrade puncture is a valid alternative to common femoral artery (CFA) access for peripheral vascular interventions. Data investigating vascular closure device (VCD) hemostasis of distant SFA 6F access are limited. We aimed to investigate the safety and effectiveness of the Starclose SE® VCD for hemostasis, following direct 6F antegrade SFA access distal to the femoral head. This prospective, single-center study included patients who were not suitable for CFA puncture and were scheduled to undergo peripheral endovascular interventions using direct antegrade SFA 6F access, at least 2 cm below the inferior edge of femoral head. Hemostasis was obtained with the Starclose SE® VCD (Abbott Laboratories). Primary endpoints were successful hemostasis rate and periprocedural (30-day) major complication rate. Secondary endpoint was the rate of minor complications. Clinical and Doppler ultrasound follow-up was performed at discharge and at one month. Between September 2014 and August 2015, a total of 30 patients (21 male; 70.0%) with a mean body mass index of 41.2 kg/m2 were enrolled. Mean age was 72±9 years (range, 67-88 years). Most patients suffered from critical limb ischemia (87.1%) and diabetes (61.3%). Calcifications were present in eight cases (26.6%). Reason for direct SFA puncture was obesity (100%). Successful hemostasis was achieved in 100% of the cases. No major complications were noted after one-month follow-up. Minor complications included two <5 cm hematomas (6.6%) not necessitating treatment. In this prospective study, Starclose SE® VCD was safe and effective for hemostasis of antegrade direct SFA puncture. Uncomplicated hemostasis was achieved even in cases of puncturing 2 to 7 cm below the inferior edge of the femoral head.

  18. MR-based three-dimensional presentation of cartilage thickness in the femoral head

    International Nuclear Information System (INIS)

    Nakanishi, Katsuyuki; Tanaka, Hisashi; Nakamura, Hironobu; Sato, Yoshinobu; Kubota, Tetsuya; Tamura, Shinichi; Ueguchi, Takashi

    2001-01-01

    The purpose of our study was to visualize the hyaline cartilage of the femoral head and to evaluate the distribution of the thickness by three-dimensional reconstruction of MRI data. The MRI was performed in 10 normal volunteers, 1 patient with osteonecrosis and 4 with advanced osteoarthritis. A fast 3D spoiled gradient-recalled acquisition in the steady state pulse sequence (TR 22 ms/TE 5.6 ms/no. of excitations 2) with fat suppression was used for data collection. Coronal and sagittal images were obtained with 3-mm effective slice thickness, 16-cm field of view (FOV) and 256 x 192 matrix. The MR images were reconstructed in three dimensions for evaluating the distribution of the cartilage thickness. In all normal volunteers, 1 patient with osteonecrosis and three advanced osteoarthritis, 3D reconstruction was successful, but in 1 case of osteoarthritis, 3D reconstruction failed because of the narrow joint space. In normal volunteers, the cartilage thickness is thickest in the central portion around the ligamentum teres (mean 2.8 mm). The medial portion and the lateral portion are almost of the same thickness (medial 1.3 mm, lateral 1.1 mm). In 3 cases of osteoarthritis, the cartilage became thinner in the lateral portions (<0.6 mm), but was unchanged in the central and medial portions. Three-dimensional reconstruction of MRI data is useful for evaluating the distribution of the cartilage thickness of the femoral head objectively. (orig.)

  19. Femoral head shape differences during development may identify hips at risk of degeneration.

    Science.gov (United States)

    Vanden Berg-Foels, Wendy S; Schwager, Steven J; Todhunter, Rory J; Reeves, Anthony P

    2011-12-01

    Developmental dysplasia of the hip (DDH) is a common cause of elevated contact stress and early onset osteoarthritis (OA). We hypothesized that adaptation to focal loading during postnatal development would result in signature changes to the shape of the femoral head secondary center of ossification (SCO). SCO shape was evaluated in a canine model of DDH at ages 14 and 32 weeks. The evolving 3D morphology of the SCO was captured using serial quantitative computed tomography. A discrete medial representation shape model was fit to each SCO and served as the basis for quantitative thickness and bending measurements. Shape measurements were tested for associations with hip subluxation and degeneration. At 32 weeks, the SCO was thinner (flatter) in the perifoveal region, the site of focal loading; a greater bend to the SCO was present lateral to the site of thinning; SCO thinning and bending were associated with less femoral head coverage and with a higher probability of degeneration. Shape changes were not detected at 14 weeks. Measurement and visualization of SCO shape changes due to altered loading may provide a basis for identifying hips at risk of early onset OA and a tool for surgical planning of hip restructuring.

  20. The comparative study of CT and MRI on femoral head necrosis

    International Nuclear Information System (INIS)

    Lin Yunliang; Liu Xianghua; Wu Shiqiang; Zeng Kangnian

    2008-01-01

    Objective: To compare the imaging features of CT and MRI in the femoral head necrosis as well as their pathological basis. Methods: 18 cases (30 hips) with femoral head necrosis proved by follow-up studies or pathology were analyzed, including 3 cases of pathological data. Results: The blurred high-density sclerotic line on CT in 28 hips were corresponded to 'line-like signs' on MRI, whereas, the other two hips without blurred high-density sclerosis line appeared 'line-like signs' on MRI. The normal area surrounded by the high-density line on CT in 26 hips were corresponded to fat-like signal area in 12 hips and mixed signal area in 14 hips on MRI. The other 4 hips with blurred bony trabeculum surrounded by the high-density line on CT showed mixed signal intensity on MRI. Conclusion: The high-density sclerotic line on CT corresponds to 'line-like sign' on MRI, which was considered as reactive interface between necrotic and viable region, was a specific signs to diagnose FHN. Compared with CT, MRI can accurately reflect pathological process during different repaired stages. (authors)

  1. MR-based three-dimensional presentation of cartilage thickness in the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Nakanishi, Katsuyuki [Dept. of Radiology, Osaka Seamen' s Insurance Hospital (Japan); Tanaka, Hisashi; Nakamura, Hironobu [Osaka Univ. (Japan). Dept. of Radiology; Sugano, Nobuhiko [Dept. of Orthopedic Surgery, Osaka University Medical School (Japan); Sato, Yoshinobu; Kubota, Tetsuya; Tamura, Shinichi [Div. of Functional Imaging, Osaka University Medical School (Japan); Ueguchi, Takashi [Dept. of Radiology, Osaka University Medical Hospital (Japan)

    2001-11-01

    The purpose of our study was to visualize the hyaline cartilage of the femoral head and to evaluate the distribution of the thickness by three-dimensional reconstruction of MRI data. The MRI was performed in 10 normal volunteers, 1 patient with osteonecrosis and 4 with advanced osteoarthritis. A fast 3D spoiled gradient-recalled acquisition in the steady state pulse sequence (TR 22 ms/TE 5.6 ms/no. of excitations 2) with fat suppression was used for data collection. Coronal and sagittal images were obtained with 3-mm effective slice thickness, 16-cm field of view (FOV) and 256 x 192 matrix. The MR images were reconstructed in three dimensions for evaluating the distribution of the cartilage thickness. In all normal volunteers, 1 patient with osteonecrosis and three advanced osteoarthritis, 3D reconstruction was successful, but in 1 case of osteoarthritis, 3D reconstruction failed because of the narrow joint space. In normal volunteers, the cartilage thickness is thickest in the central portion around the ligamentum teres (mean 2.8 mm). The medial portion and the lateral portion are almost of the same thickness (medial 1.3 mm, lateral 1.1 mm). In 3 cases of osteoarthritis, the cartilage became thinner in the lateral portions (<0.6 mm), but was unchanged in the central and medial portions. Three-dimensional reconstruction of MRI data is useful for evaluating the distribution of the cartilage thickness of the femoral head objectively. (orig.)

  2. Necrosis of the femoral head after /sup 60/Co radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Maruno, H; Kawai, K [Kobe Univ. (Japan). School of Medicine

    1978-10-01

    A patient (50-year-old woman) received 10500 rad of skin dose and 630 rad of tumor dose for treatment of cervical cancer 15 years ago. The depth dose at the hip-joint was 3590 rad at the right hip-joint and 4315 rad at the left. Hip-joint pain occurred about 15 years after the irradiation, and one more year later she could not walk because of severe pain. X-ray films revealed great bone destruction at the both hip-joints as well as necrosis of the femoral head and arthropathy. The same findings were seen at the ilium, ischium, and pubis. Histologically, the synovial membrane was highly thick, fibrotic, and cicatricial. Obstructive changes were observed also in the small arteries. A severe narrowing or obstruction was observed in the Harversian canal at the bone cortex. The femoral head at the whole area was necrotic. The trabeculae were entirely thinned and were partially thickened by appositional bone formation. This new bone was also necrotic. Edematous fibrous-fatty tissues predominated the bone marrow. There was no proliferation of fibrous cell or new bone formation at the sites other than the margin.

  3. Common site of subchondral insufficiency fractures of the femoral head based on three-dimensional magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Iwasaki, Kenyu; Yamamoto, Takuaki; Motomura, Goro; Karasuyama, Kazuyuki; Sonoda, Kazuhiko; Kubo, Yusuke; Iwamoto, Yukihide [Kyushu University, Department of Orthopaedic Surgery Graduate School of Medical Sciences, Higashi-ku, Fukuoka (Japan)

    2016-01-15

    The objective of this study was to investigate the common sites of subchondral insufficiency fractures of the femoral head (SIF) based on three-dimensional (3-D) reconstruction of MR images. In 33 hips of 31 consecutive patients diagnosed with SIF, 3-D reconstruction of the bone, fracture, and acetabular edge was performed using MR images. These 3-D images were used to measure the fractured areas and clarify the positional relationship between the fracture and degree of acetabular coverage. The fractured area in the anterior portion was significantly larger than in the posterior area. In 11 cases, the fractures contacted the acetabular edge and were distributed on the lateral portion. The indices of acetabular coverage (center-edge angle and acetabular head index) in these cases were less than the normal range. In the remaining 22 cases, the fractures were apart from the acetabular edge and distributed on the mediolateral centerline of the femoral head. The majority of these cases had normal acetabular coverage. The common site of SIF is the anterior portion. In addition, two types of SIF are proposed: (1) Lateral type: the contact stress between the acetabular edge and lateral portion of the femoral head causes SIF based on the insufficient acetabular coverage, and (2) Central type: the contact stress between the acetabular surface and the mediolateral center of the femoral head causes SIF independent from the insufficiency of acetabular coverage. These findings may be useful for considering the treatment and prevention of SIF. (orig.)

  4. Normal radiological unossified hip joint space and femoral head size development during growth in 675 children and adolescents.

    Science.gov (United States)

    Wegener, Veronika; Jorysz, Gabriele; Arnoldi, Andreas; Utzschneider, Sandra; Wegener, Bernd; Jansson, Volkmar; Heimkes, Bernhard

    2017-03-01

    Evaluation of hip joint space width during child growth is important to aid in the early diagnosis of hip pathology in children. We established reference values for hip joint space and femoral head size for each age. Hip joint space development during growth was retrospectively investigated medial and cranial in 1350 hip joints of children using standard anteroposterior supine plain pelvic radiographs. Maximum capital femoral epiphysis diameter and femoral radii were further more investigated. Hip joint space values show a slow decline during growth. Joint space was statistically significantly (p < 0.006) larger in boys than girls. Our hip joint space measurements on supine subjects seem slightly larger than those reported by Hughes on standing subjects. Evaluation of the femoral head diameter and the radii showed a size curve quite parallel to the known body growth charts. Radii medial and perpendicular to the physis are not statistically significantly different. We recommend to compare measurements of hip joint space at two locations to age dependent charts using the same imaging technique. During growth, a divergence in femoral head size from the expected values or loss of the spherical shape should raise the question of hip disorder. Clin. Anat. 30:267-275, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  5. Femoral Head Bone Loss Following Short and Long-Duration Spaceflight

    Science.gov (United States)

    Blaber, Elizabeth A.; Cheng-Campbell, Margareth A.; Almeida, Eduardo A. C.

    2016-01-01

    Exposure to mechanical unloading during spaceflight is known to have significant effects on the musculoskeletal system. Our ongoing studies with the mouse bone model have identified the failure of normal stem cell-based tissue regeneration, in addition to tissue degeneration, as a significant concern for long-duration spaceflight, especially in the mesenchymal and hematopoietic tissue lineages. The 30-day BionM1 and the 37-day Rodent Research 1 (RR1) missions enabled the possibility of studying these effects in long-duration microgravity experiments. We hypothesized that the inhibition of stem cell-based tissue regeneration in short-duration spaceflight would continue during long-duration spaceflight and furthermore would result in significant tissue alterations. MicroCT analysis of BionM1 femurs revealed 31 decrease in bone volume ratio, a 14 decrease in trabecular thickness, and a 20 decrease in trabecular number in the femoral head of space-flown mice. Furthermore, high-resolution MicroCT and immunohistochemical analysis of spaceflight tissues revealed a severe disruption of the epiphyseal boundary, resulting in endochondral ossification of the femoral head and perforation of articular cartilage by bone. This suggests that spaceflight in microgravity may cause rapid induction of an aging-like phenotype with signs of osteoarthritic disease in the hip joint. However, mice from RR1 exhibited significant bone loss in the femoral head but did not exhibit the severe aging and disease-like phenotype observed during BionM1. This may be due to increased physical activity in the RH hardware. Immunohistochemical analysis of the epiphyseal plate and investigation of cellular proliferation and differentiation pathways within the marrow compartment and whole bone tissue is currently being conducted to determine alterations in stem cell-based tissue regeneration between these experiments. Our results show that the observed inhibition of stem cell-based tissue regeneration

  6. Increased Dickkopf-1 expression accelerates bone cell apoptosis in femoral head osteonecrosis.

    Science.gov (United States)

    Ko, Jih-Yang; Wang, Feng-Sheng; Wang, Ching-Jen; Wong, To; Chou, Wen-Yi; Tseng, Shin-Ling

    2010-03-01

    Intensive bone cell apoptosis contributes to osteonecrosis of femoral head (ONFH). Dickkopf-1 (DKK1) reportedly mediates various types of skeletal disorders. This study investigated whether DKK1 was linked to the occurrence of ONFH. Thirty-nine patients with various stages of ONFH were recruited. Bone specimens were harvested from 34 ONFH patients underwent hip arthroplasty, and from 10 femoral neck fracture patients. Bad, Bcl2 TNFalpha, DKK1, Wnt3a, LRP5, and Axin1 expressions were analyzed by quantitative RT-PCR and ELISA. Apoptotic cells were assayed using terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end-labelling (TUNEL). Primary bone-marrow mesenchymal cells were treated with DKK1 RNA interference and recombinant DKK1 protein. ONFH patients with the histories of being administrated corticosteroids and excessive alcohol consumption had significantly higher Bad and DKK1 mRNA expressions in bone tissue and DKK1 abundances in serum than femoral neck fracture patients. Bone cells adjacent to osteonecrotic bone displayed strong DKK1 immunoreactivity and TUNEL staining. Increased DKK1 expression in bone tissue and serum correlated with Bad expression and TUNEL staining. Serum DKK1 abundance correlated with the severity of ONFH. The DKK1 RNA interference and recombinant DKK1 protein regulated Bad expression and apoptosis of primary bone-marrow mesenchymal cells. Knock down of DKK1 reduced dexamethasone-induced apoptosis of mesenchymal cells. Taken together, promoted DKK1 expression was associated with bone cell apoptosis in the occurrence of ONFH patients with the histories of corticosteroid and alcohol intake and progression of ONFH. DKK1 expression in injured tissue provides new insight into ONFH pathogenesis.

  7. Efficacy analysis of tomosynthesis in the diagnosis of the femoral head osteochondropathy (Legg-Calvé-Perthes disease

    Directory of Open Access Journals (Sweden)

    A. Yu. Vasil'ev

    2017-01-01

    Full Text Available Background: Despite the fact that the prevalence of the femoral head osteochondropathy is 2.9% of all bone and muscle disorders and 25% of the disorders of the hip joint, this problem demands special attention, while late diagnosis could lead to disability of the patient.Aim: To compare and clarify X-ray symptomatology of Legg-Calvé-Perthes disease found by standard digital radiography and by tomosynthesis.Materials and methods: Eighty six patients aged from 5 to 12 years with the femoral head osteochondropathy were allocated into two groups: 43  patients from the group  1 were assessed by standard two-plane digital radiography (frontal and Lauenstein projections, whereas 43  patients from the group  2 were assessed by direct plane tomosynthesis only. The investigations were performed with the X-ray machine FDR AcSelerate  200 (Fujifilm, Japan with the function of tomosynthesis. Radiographic symptoms of the disease were assessed in the subgroups that were identified depending on the disease stage: 24 patients had stage I, 20 – stage II, 20 – stage III, and 22 – stages IV and V.Results: Standard radiography could not detect any bone abnormalities in any patient with stage I of Legg-Calvé-Perthes disease (n1 = 12, 100%; however, by means of tomosynthesis, all patients from this subgroup (n2 = 12, 100% had minimally increased density on the affected side. In 9  (75% patients, tomosynthesis showed cystiform remodeling of trabecular structure in subchondral parts of the femoral head of the affected hip, and in 2 (17% patients, flattening of the inner epiphysis pole was visualized. At stage II of the disease standard radiography showed femoral head compression with widening of the joint space in 8 (80% patients, absence of subchondral lucency in 6 (60%, and increased density of the femoral head in 4 (40%. In all these patients (n2 = 10, 100% tomosynthesis showed signs of intra-articular effusion, in 6 (60% cases there were

  8. Femoral neck fractures complicating gaucher disease in children

    Energy Technology Data Exchange (ETDEWEB)

    Goldman, A.B.; Jacobs, B.

    1984-09-01

    In normal children, fractures of the femoral neck are uncommon and accompany severe trauma and multiple injuries elsewhere in the skeleton. In children with Gaucher disease, a rare hereditary disorder of lipid metabolism, midcervical or basicervical fractures can occur with minor or no trauma and without other injury to the skeleton. Three children with Gaucher disease who developed pathologic fractures of the femoral neck are described. In all three, the fractures occurred between five and nine years of age, and the fracture lines passed through areas of abnormal bone characterized by poorly defined patches of increased and decreased density and cortical thinning along the medial femoral necks. In the affected hips, there was no evidence of avascular necrosis of the femoral heads at the time of injury. One child's fracture was preceeded by multiple bone 'crisis' localized to the proximal femora.

  9. Femoral neck fractures complicating gaucher disease in children

    International Nuclear Information System (INIS)

    Goldman, A.B.; Jacobs, B.

    1984-01-01

    In normal children, fractures of the femoral neck are uncommon and accompany severe trauma and multiple injuries elsewhere in the skeleton. In children with Gaucher disease, a rare hereditary disorder of lipid metabolism, midcervical or basicervical fractures can occur with minor or no trauma and without other injury to the skeleton. Three children with Gaucher disease who developed pathologic fractures of the femoral neck are described. In all three, the fractures occurred between five and nine years of age, and the fracture lines passed through areas of abnormal bone characterized by poorly defined patches of increased and decreased density and cortical thinning along the medial femoral necks. In the affected hips, there was no evidence of avascular necrosis of the femoral heads at the time of injury. One child's fracture was preceeded by multiple bone 'crisis' localized to the proximal femora. (orig.)

  10. Femoral neck fractures complicating gaucher disease in children

    Energy Technology Data Exchange (ETDEWEB)

    Goldman, A B; Jacobs, B

    1984-09-01

    In normal children, fractures of the femoral neck are uncommon and accompany severe trauma and multiple injuries elsewhere in the skeleton. In children with Gaucher disease, a rare hereditary disorder of lipid metabolism, midcervical or basicervical fractures can occur with minor or no trauma and without other injury to the skeleton. Three children with Gaucher disease who developed pathologic fractures of the femoral neck are described. In all three, the fractures occurred between five and nine years of age, and the fracture lines passed through areas of abnormal bone characterized by poorly defined patches of increased and decreased density and cortical thinning along the medial femoral necks. In the affected hips, there was no evidence of avascular necrosis of the femoral heads at the time of injury. One child's fracture was preceeded by multiple bone 'crisis' localized to the proximal femora.

  11. Late results after intertrochanteric varus angulation in aseptic femoral head necrosis in adults

    International Nuclear Information System (INIS)

    Schneider, E.; Ahrendt, J.; Niethard, F.U.; Blaesius, K.

    1989-01-01

    25 patients suffering from femoral head necrosis in 30 hip joints were radiologically studied for an average of 11.6 years following intertrochanteric varus angulation osteotomy. Preoperatively only stages 2 and 3 according to Meyers were seen. The follow-up results could be distributed into 4 groups. At best the osteonecrosis was reconstructed within 6 to 9 years while the trabeculae started to become rearranged within 2 to 4 years. At worst, rapid destruction in absence of bony reaction was observed. The ability of the bone outside the osteonecrosis to react to changed circumstances following angulation osteotomy correlates with long-term results. This may indicate a general osteopathy even outside the necrotic area. (orig.) [de

  12. Subchondral insufficiency fracture of the femoral head in a patient with alkaptonuria

    Energy Technology Data Exchange (ETDEWEB)

    Hamada, Takahiro; Shida, Jun-ichi; Inokuchi, Akihiko; Arizono, Takeshi [Kyushu Central Hospital, Department of Orthopaedic Surgery, Fukuoka-city (Japan); Yamamoto, Takuaki [Kyushu University, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Fukuoka-city (Japan)

    2014-06-15

    We report a patient with alkaptonuria accompanied by bilateral rapidly destructive arthrosis of the hip. The destruction of the left hip joint with its severe functional impairment necessitated total hip arthroplasty (THA). The outcome was satisfactory. Both magnetic resonance imaging (MRI) and pathologic findings were compatible with a subchondral insufficiency fracture. A year and half later, during a follow-up visit, the patient complained of right coxalgia. Radiography showed that the right femoral head had already disappeared, requiring THA of the right hip. Although there have been a few reports of rapid destructive hip osteoarthritis associated with ochronotic arthropathy, the pathogenesis of the destructive change is not clear. Subchondral insufficiency fracture was diagnosed on MR imaging and pathologically confirmed in our patient with alkaptonuria, suggesting that subchondral insufficiency fracture is one of the causes of ochronotic hip destruction. (orig.)

  13. Subchondral insufficiency fracture of the femoral head in a patient with alkaptonuria

    International Nuclear Information System (INIS)

    Hamada, Takahiro; Shida, Jun-ichi; Inokuchi, Akihiko; Arizono, Takeshi; Yamamoto, Takuaki

    2014-01-01

    We report a patient with alkaptonuria accompanied by bilateral rapidly destructive arthrosis of the hip. The destruction of the left hip joint with its severe functional impairment necessitated total hip arthroplasty (THA). The outcome was satisfactory. Both magnetic resonance imaging (MRI) and pathologic findings were compatible with a subchondral insufficiency fracture. A year and half later, during a follow-up visit, the patient complained of right coxalgia. Radiography showed that the right femoral head had already disappeared, requiring THA of the right hip. Although there have been a few reports of rapid destructive hip osteoarthritis associated with ochronotic arthropathy, the pathogenesis of the destructive change is not clear. Subchondral insufficiency fracture was diagnosed on MR imaging and pathologically confirmed in our patient with alkaptonuria, suggesting that subchondral insufficiency fracture is one of the causes of ochronotic hip destruction. (orig.)

  14. Subchondral insufficiency fracture of the femoral head in a patient with alkaptonuria.

    Science.gov (United States)

    Hamada, Takahiro; Yamamoto, Takuaki; Shida, Jun-ichi; Inokuchi, Akihiko; Arizono, Takeshi

    2014-06-01

    We report a patient with alkaptonuria accompanied by bilateral rapidly destructive arthrosis of the hip. The destruction of the left hip joint with its severe functional impairment necessitated total hip arthroplasty (THA). The outcome was satisfactory. Both magnetic resonance imaging (MRI) and pathologic findings were compatible with a subchondral insufficiency fracture. A year and half later, during a follow-up visit, the patient complained of right coxalgia. Radiography showed that the right femoral head had already disappeared, requiring THA of the right hip. Although there have been a few reports of rapid destructive hip osteoarthritis associated with ochronotic arthropathy, the pathogenesis of the destructive change is not clear. Subchondral insufficiency fracture was diagnosed on MR imaging and pathologically confirmed in our patient with alkaptonuria, suggesting that subchondral insufficiency fracture is one of the causes of ochronotic hip destruction.

  15. The usefulness of 3D quantitative analysis with using MRI for measuring osteonecrosis of the femoral head

    International Nuclear Information System (INIS)

    Hwang, Ji Young; Lee, Sun Wha; Park, Youn Soo

    2006-01-01

    We wanted to evaluate the usefulness of MRI 3D quantitative analysis for measuring osteonecrosis of the femoral head in comparison with MRI 2D quantitative analysis and quantitative analysis of the specimen. For 3 months at our hospital, 14 femoral head specimens with osteonecrosis were obtained after total hip arthroplasty. The patients preoperative MRIs were retrospectively reviewed for quantitative analysis of the size of the necrosis. Each necrotic fraction of the femoral head was measured by 2D quantitative analysis with using mid-coronal and mid-sagittal MRIs, and by 3D quantitative analysis with using serial continuous coronal MRIs and 3D reconstruction software. The necrotic fraction of the specimen was physically measured by the fluid displacement method. The necrotic fraction according to MRI 2D or 3D quantitative analysis was compared with that of the specimen by using Spearman's correlation test. On the correlative analysis, the necrotic fraction by MRI 2D quantitative analysis and quantitative analysis of the specimen showed moderate correlation (r = 0.657); on the other hand, the necrotic fraction by MRI 3D quantitative analysis and quantitative analysis of the specimen demonstrated a strong correlation (r = 0.952) (ρ < 0.05). MRI 3D quantitative analysis was more accurate than 2D quantitative analysis using MRI for measuring osteonecrosis of the femoral head. Therefore, it may be useful for predicting the clinical outcome and deciding the proper treatment option

  16. Patient-specific core decompression surgery for early-stage ischemic necrosis of the femoral head.

    Directory of Open Access Journals (Sweden)

    Wei Wang

    Full Text Available Core decompression is an efficient treatment for early stage ischemic necrosis of the femoral head. In conventional procedures, the pre-operative X-ray only shows one plane of the ischemic area, which often results in inaccurate drilling. This paper introduces a new method that uses computer-assisted technology and rapid prototyping to enhance drilling accuracy during core decompression surgeries and presents a validation study of cadaveric tests.Twelve cadaveric human femurs were used to simulate early-stage ischemic necrosis. The core decompression target at the anterolateral femoral head was simulated using an embedded glass ball (target. Three positioning Kirschner wires were drilled into the top and bottom of the large rotor. The specimen was then subjected to computed tomography (CT. A CT image of the specimen was imported into the Mimics software to construct a three-dimensional model including the target. The best core decompression channel was then designed using the 3D model. A navigational template for the specimen was designed using the Pro/E software and manufactured by rapid prototyping technology to guide the drilling channel. The specimen-specific navigation template was installed on the specimen using positioning Kirschner wires. Drilling was performed using a guide needle through the guiding hole on the templates. The distance between the end point of the guide needle and the target was measured to validate the patient-specific surgical accuracy.The average distance between the tip of the guide needle drilled through the guiding template and the target was 1.92±0.071 mm.Core decompression using a computer-rapid prototyping template is a reliable and accurate technique that could provide a new method of precision decompression for early-stage ischemic necrosis.

  17. The therapeutic effect of negative pressure in treating femoral head necrosis in rabbits.

    Science.gov (United States)

    Zhang, Yin-gang; Wang, Xuezhi; Yang, Zhi; Zhang, Hong; Liu, Miao; Qiu, Yushen; Guo, Xiong

    2013-01-01

    Because negative pressure can stimulate vascular proliferation, improve blood circulation and promote osteogenic differentiation of bone marrow stromal cells, we investigated the therapeutic effect of negative pressure on femoral head necrosis (FHN) in a rabbit model. Animals were divided into four groups (n = 60/group): [1] model control, [2] core decompression, [3] negative pressure and [4] normal control groups. Histological investigation revealed that at 4 and 8 weeks postoperatively, improvements were observed in trabecular bone shape, empty lacunae and numbers of bone marrow hematopoietic cells and fat cells in the negative pressure group compared to the core decompression group. At week 8, there were no significant differences between the negative pressure and normal control groups. Immunohistochemistry staining revealed higher expression of vascular endothelial growth factor (VEGF) and bone morphogenetic protein-2 (BMP-2) in the femoral heads in the negative pressure group compared with the core decompression group. Transmission electron microscopy revealed that cell organelles were further developed in the negative pressure group compared with the core decompression group. Microvascular ink staining revealed an increased number of bone marrow ink-stained blood vessels, a thicker vascular lumen and increased microvascular density in the negative pressure group relative to the core decompression group. Real-time polymerase chain reaction revealed that expression levels of both VEGF and BMP-2 were higher in the negative pressure group compared with the core decompression group. In summary, negative pressure has a therapeutic effect on FHN. This effect is superior to core decompression, indicating that negative pressure is a potentially valuable method for treating early FHN.

  18. Fat-suppressed T2-weighted MRI appearance of subchondral insufficiency fracture of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Sonoda, Kazuhiko; Yamamoto, Takuaki; Motomura, Goro; Karasuyama, Kazuyuki; Kubo, Yusuke; Iwamoto, Yukihide [Kyushu University, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Higashi-ku, Fukuoka (Japan)

    2016-11-15

    Our aims were to investigate the imaging appearance of subchondral insufficiency fracture (SIF) of the femoral head based on fat-suppressed T2-weighted MRI, and evaluate its correlation with the clinical outcomes following conservative treatment. We retrospectively evaluated 40 hips in 37 patients with SIF of the femoral head (12 males and 25 females; mean age 55.8 years, range 22-78 years). MRI examinations were performed within 3 months after the onset of hip pain. Using fat-suppressed T2-weighted imaging, we evaluated the hips for the intensity of the subchondral bone (corresponding to the area superior to the low intensity band on T1-weighted images) as well as bone marrow edema, joint effusion, and presence of the band lesion. We then correlated the intensity of the subchondral bone with clinical outcomes. The hips were classified into three types based on subchondral intensity on fat-suppressed T2-weighted images: type 1 (21 hips) showed high intensity, type 2 (eight hips) showed heterogeneous intensity, and type 3 (11 hips) showed low intensity. The mean period between pain onset and MRI examination was significantly longer for type 2 hips than for type 1. Healing rates were 86 % for type 1, 75 % for type 2, and 18 % for type 3. SIF cases were classified into three types based on subchondral intensity on fat-suppressed T2-weighted imaging performed within 3 months after pain onset. Type 3 SIF tended to be intractable to conservative treatment compared to type 1 and type 2. (orig.)

  19. Subchondral Insufficiency Fracture of the Femoral Head in a Pregnant Woman with Pre-existing Anorexia Nervosa.

    Science.gov (United States)

    Kasahara, Kyoko; Mimura, Tomohiro; Moritani, Suzuko; Kawasaki, Taku; Imai, Shinji; Tsuji, Shunichiro; Kimura, Fuminori; Murakami, Takashi

    2018-05-01

    Subchondral insufficiency fracture (SIF) is a fragility fracture secondary to osteoporosis that leads to collapse of the femoral head with no evidence of osteonecrosis. SIF of the femoral head has been reported in adults of varying ages and both sexes, but it has never been reported to occur in pregnant women. Herein, we describe a 40-year-old primiparous patient with pre-existing anorexia nervosa who developed SIF of the femoral head in the third trimester. At 29 weeks of gestation, the patient complained of sudden pain on walking in both hips. Despite the bed rest, her hip pain increased; consequently, cesarean section was performed at 36 weeks. After delivery, plain radiographs showed that the left femoral head was collapsed. Dual-energy X-ray absorptiometry indicated that the patient was osteoporotic. The magnetic resonance imaging (MRI) of her hips showed the findings that were compatible with SIF. Her left hip pain worsened during follow-up, and a radiograph showed progressive collapse of the left femoral head. The patient then underwent left bipolar hip arthroplasty 18 months after delivery, and she was diagnosed with SIF histopathologically. This is the first report of SIF in a pregnant woman that may reflect pregnancy-associated osteoporosis. SIF in pregnancy might be overlooked or misdiagnosed because the MRI findings have several overlaps with those of other hip disorders. Precise diagnosis of SIF in pregnancy may contribute to a better outcome by avoiding early arthroplasty in young women and appropriate evaluation of the osteopenic status of the patient.

  20. The role of acetabulum geometry and femoral head-neck ratio in the development of osteoarthritis in young men

    DEFF Research Database (Denmark)

    Halle, B; Halle, D M; Torfing, T

    2007-01-01

    and the consequence of acetabular retroversion on standardized x-rays. Men aged 26-55 years who earlier had a total hip arthroplasty were included in the case group. This group was compared to a control-group of men treated as trauma patients. The study indicates that acetabular dysplasia and retroversion......We studied the role of acetabulum geometry and head neck ratio in the development of osteoarthritis of the hip in young men. Contrary to previous studies we evaluated the significance of the anterior, posterior and total coverage of the femoral head, the influence of the femoral neck...... and a relative decreased head neck ratio are associated with osteoarthritis of the hip in young men....

  1. A Case of Acute Prosthesis Migration after Femoral Head Replacement due to Osteomalacia by FGF23-Induced Tumor

    Directory of Open Access Journals (Sweden)

    Shinya Hayashi

    2012-01-01

    Full Text Available Fibroblast growth factor 23 (FGF23 was recently identified as an important factor involved in the development of hypophosphatemic rickets and osteomalacia. We experienced a rare case of acute prosthesis migration after hemihip arthroplasty due to FGF23-induced tumor. The patient underwent femoral head replacement because of femoral neck fracture, but prosthesis migration was occurred at 1 week after operation. The patient took various examinations, and FGF23-induced tumor was found in his right wrist. The tumor was resected, and he underwent total hip arthroplasty 8 month later. Finally, he was able to obtain free gait without pain.

  2. Detection of avascular necrosis in adults by single photon emission computed tomography

    International Nuclear Information System (INIS)

    Collier, B.D.; Johnston, R.P.; Carrera, G.; Isitman, A.T.; Hellman, R.S.; Zielonka, J.S.

    1984-01-01

    Twenty-one adult patients with the clinical diagnosis of avascular necrosis (AVN) of the femoral head were examined with planar bone scintigraphy (high resolution collimator) and single photon emission computed tomography (SPECT). The duration of hip pain ranged from 1 day to 18 months. Risk factors (including steroids, renal transplantation, alcoholism, and trauma) were present in 17 cases. A final diagnosis of AVN (20 hips), osteochondral facture, or stress fracture, was established for 17 patients. The 4 remaining patients, who were radiographically normal and did not complain of pain 3 months later, were thought to have no significant bone pathology. SPECT and planar bone scintigraphy were reported as positive for AVN only if a photopenic bony defect could be identified. In particular, uniformly increased activity throughout the femoral head was not considered to be diagnostic of AVN. The authors conclude that by identifying a photopenic defect which is not evident on planar bone scintigraphy, SPECT can contribute to accurate diagnosis of AVN

  3. MR imaging of the hip in avascular necrosis: Radiologic-pathologic correlation

    International Nuclear Information System (INIS)

    Kang, H.S.; Lee, S.H.; Lee, Y.S.; Cho, Z.H.; Han, M.C.; Kim, C.W.

    1987-01-01

    MR imaging is the most sensitive modality for diagnosing avascular necrosis (AVN), but there is no established explanation for the change of signal intensity of the osteonecrotic segment. Ten surgically removed femoral heads with AVN underwent MR imaging at 2.0 T. A combination of high gradient strength (0.1 m T/cm) and small radio frequency coil (8 cm in diameter) was used to obtain images with effective thickness of 2.0 mm and pixel dimensions as small as 200 μm. MR images were correlated with high-resolution CT and histologic findings. This paper illustrates how MR images the histologic findings of AVN

  4. Avascular necrosis of the hips with increased activity on 68Ga-DOTATATE PET/CT

    Science.gov (United States)

    Papadakis, Georgios Z.; Millo, Corina; Karantanas, Apostolos H.; Bagci, Ulas; Patronas, Nicholas J.

    2016-01-01

    Prolonged exposure to cortisol is one of the major causes of avascular bone necrosis (AVN). We report on a case of a woman with Cushing’s syndrome attributed to ectopic ACTH secreting tumor who was evaluated with whole body PET/CT study using 68Ga-DOTATATE. The scan showed increased activity by both femoral heads, corresponding to the margins of bilateral AVN seen on MRI. The presented data suggests AVN-induced reactive inflammatory alterations adjacent to the necrotic segment of the bone which can be effectively targeted using radiolabeled somatostatin (SST) analogues. PMID:28033218

  5. The comparison of 5-field conformal radiotherapy techniques for the treatment of prostate cancer: The best for femoral head sparing

    International Nuclear Information System (INIS)

    Zare, Mahkameh; Lashkari, Marzieh; Ghalehtaki, Reza; Ghasemi, Arash; Dehghan Manshadi, Hamidreza; Mir, Ali; Noorollahi, Somayeh; Alamolhoda, Mahboobeh

    2016-01-01

    External radiotherapy is a standard treatment procedure for localized prostate cancer. Given the relatively high long term survival treatment complications have been brought in center of attention. In this planning study, between 2012 and 2014, CT simulation data of 90 consecutive high-risk prostate cancer patients were collected. In the first phase, all were planned for whole pelvis irradiation up to 46Gy in 23 daily fractions. In the second phase, only the prostate gland was the target of radiation. Next, the subjects were divided randomly into three groups and each received a unique 5field conformal radiation plan including Plan A (Gantry angle: 0, 60, 120, 240, and 300), Plan B (Gantry angles: 0, 90, 120, 240, and 270) and Plan C (Gantry angles: 0, 60, 90, 270, and 300). The total dose was 70Gy. For each patient, the rectum, bladder, and both femoral heads were contoured as the at risk organs (OAR). From dose volume histograms, the proportional dose of PTV V100, the bladder and rectum V80 and V90 and femoral head V50 and V100 were calculated in all subjects and compared across plans. A statistically significant difference in the femoral head V50 and V100 was found between our studied 5field plans so that in Plan A (beam angles: 0, 60, 120, 240 and 300) less dose was received by both heads of femur. This study suggests that 5 field treatment planning including an anterior, two anterior oblique and two posterior oblique portals to be more proper for 3D conformal radiotherapy in order to spare femoral head with acceptable PTV coverage, and bladder and rectal doses.

  6. High-energy extracorporeal shock wave therapy for nontraumatic osteonecrosis of the femoral head.

    Science.gov (United States)

    Xie, Kai; Mao, Yuanqing; Qu, Xinhua; Dai, Kerong; Jia, Qingwei; Zhu, Zhenan; Yan, Mengning

    2018-02-02

    Nontraumatic osteonecrosis of the femoral head (ONFH) is treated with a series of methods. High-energy extracorporeal shock wave therapy (ESWT) is an option with promising mid-term outcomes. The objective of this study was to determine the long-term outcomes of ESWT for ONFH. Fifty-three hips in 39 consecutive patients were treated with ESWT in our hospital between January 2005 and July 2006. Forty-four hips in 31 patients with stage I-III nontraumatic ONFH, according to the Association Research Circulation Osseous (ARCO) system, were reviewed in the current retrospective study. The visual analog pain scale (VAS), Harris hip score, radiography, and magnetic resonance imaging were used to estimate treatment results. The progression of ONFH was evaluated by imaging examination and clinical outcomes. The results were classified as clinical success (no progression of hip symptoms) and imaging success (no progression of stage or substage on radiography and MRI). The mean follow-up duration was 130.6 months (range, 121 to 138 months). The mean VAS decreased from 3.8 before ESWT to 2.2 points at the 10-year follow-up (p < 0.001). The mean Harris hip score improved from 77.4 before ESWT to 86.9 points at the 10-year follow-up. The clinical success rates were 87.5% in ARCO stage I patients, 71.4% in ARCO stage II patients, and 75.0% in ARCO stage III patients. Imaging success was observed in all stage I hips, 64.3% of stage II hips, and 12.5% of stage III hips. Seventeen hips showed progression of the ARCO stage/substage on imaging examination. Eight hips showed femoral head collapse at the 10-year follow-up. Four hips in ARCO stage III and one hip in ARCO stage II were treated with total hip arthroplasty during the follow-up. Three were performed 1 year after ESWT, one at 2 years, and one at 5 years. The results of the current study indicated that ESWT is an effective treatment method for nontraumatic ONFH, resulting in pain relief and function restoration

  7. Modified Pauwels' intertrochanteric osteotomy in neglected femoral neck fractures in children: a report of 10 cases followed for a minimum of 5 years.

    Science.gov (United States)

    Magu, Narender Kumar; Singh, Roop; Sharma, Ashwini Kumar; Ummat, Vikas

    2007-04-01

    To evaluate the role of a modified Pauwels' intertrochanteric osteotomy (MPIO) in neglected femoral neck fractures in children. Prospective study with retrospective analysis. Tertiary care Postgraduate Institute of Medical Sciences. Ten children (8 males, 2 females) with an average age of 10.2 years with neglected femoral neck fractures were seen from 1990 to 1998. A femoral neck fracture was considered neglected when no proper medical treatment was instituted for at least 1 month following the fracture. Nonunion was accompanied by coxa vara and resorption of the femoral neck in 9 patients; a 10th patient had a neglected femoral neck fracture for 1 month without coxa vara. Three patients at time of presentation with Delbet Type II displaced fractures with associated nonunion and coxa vara (2 with Ratliff Type III and 1 with Type I) also had avascular necrosis using plain radiographic criteria of increased density. Modified Pauwels' intertrochanteric osteotomy. The children were immobilized in a hip spica for 6-10 weeks postoperatively and weightbearing was started after hip spica removal. Fracture healing, neck-shaft angle, avascular necrosis, and functional outcome. Patients were followed for an average of 8.2 years (range 5-12 years). All patients had union of their fracture within an average of 16.6 weeks (12-20 weeks) and of the osteotomy site within 8.2 weeks (7-9 weeks). Radiologic signs of avascular necrosis disappeared completely in the 3 patients who presented with avascular necrosis. In 1 patient with a preoperatively viable femoral head, radiologic signs of Ratliff Type I avascular necrosis appeared between 60 and 98 weeks. This radiologic finding became normal again, indicating viability of the femoral head somewhere between 98 to 205 weeks of follow-up. Postoperatively, an average of 135-degree neck-shaft angle was achieved (range 125-160 degrees). The average preoperative neck-shaft angle was 104.4 degrees (range 92-120 degrees) and on the normal hip

  8. Laser Doppler flowmetry for bone blood flow measurement: correlation with microsphere estimates and evaluation of the effect of intracapsular pressure on femoral head blood flow

    International Nuclear Information System (INIS)

    Swiontkowski, M.F.; Tepic, S.; Perren, S.M.; Moor, R.; Ganz, R.; Rahn, B.A.

    1986-01-01

    Laser Doppler flowmetry (LDF) was used to measure bone blood flow in the rabbit femoral condyles. To correlate the LDF output signal blood cell flux to in vivo blood flow, simultaneous measurements using LDF and 85 Sr-labeled microspheres were made in an adult rabbit model. There was no correlation between the two methods for blood flow in the femoral condyles and the correlation between the two methods for blood flow in the femoral head does not achieve statistical significance. An LDF signal of 0.4 V was approximately equal to a microsphere measured flow rate of 0.4 ml blood/g bone/min. The strength of the correlation in the latter case may have been affected by (a) large arteriovenous shunts, (b) inadequate mixing of the microspheres with a left ventricular injection, and (c) insufficient numbers of microspheres present in the bone samples. When LDF was used to evaluate the effect of elevated intracapsular pressure on femoral head blood flow in skeletally mature rabbits, femoral head subchondral bone blood flow declined with increasing intracapsular pressure from a baseline value of 0.343 +/- 0.036 to a value of 0.127 +/- 0.27 at 120 cm of water pressure. The decline in femoral head blood flow was statistically significant at pressures of 40 cm of water or higher (p less than 0.001), and evaluation of sections of the proximal femora made from preterminal disulphine blue injections confirmed these findings. Intracapsular tamponade has an adverse effect on femoral head blood flow beginning well below central venous pressure and should be considered in the pathophysiology of posttraumatic and nontraumatic necrosis of the femoral head. Laser Doppler flowmetry was easy to use and appears to be a reproducible technique for evaluating femoral head blood flow, offering distinct advantages over the microsphere technique for measuring bone blood flow

  9. Histologic findings of femoral heads from patients with Gaucher disease treated with enzyme replacement.

    Science.gov (United States)

    Lebel, Ehud; Elstein, Deborah; Peleg, Ariel; Reinus, Constantine; Zimran, Ari; Amir, Gail

    2013-07-01

    To assess correlations of patient demographics, including enzyme replacement therapy (ERT) with bone histology, to facilitate decisions of whether and when to perform hip replacement surgery in patients with Gaucher disease. We examined the histology of surgically removed femoral heads and categorized findings by the presence or extent of osteonecrosis, Gaucher cell (GC) infiltration, and bone regeneration qualifiers using a tripartite histology-based scoring system. Twenty-two patients with 26 bone specimens were evaluated. Seventeen patients (77%) were splenectomized, 16 (73%) received ERT, and 12 (55%) had the putatively milder genotype (N370S/N370S), with the rest putatively at increased risk for skeletal disease (N370S/other). The 3 histology subscores were applicable to all specimens. Osteonecrotic bone was seen in 19 of 26 (73%); osteoarthritis was seen in all cartilage specimens. Gaucher cell infiltration was not correlated with demographics or disease severity. A trend was noted between reduced GC infiltration and ERT (ρ = 0.407), but regeneration qualifiers were not correlated with ERT or other features. Histologic findings of GC infiltration and bone regeneration qualifiers did not correlate with demographics or with exposure to ERT. Most specimens unexpectedly showed good regenerative responses to osteonecrosis despite heavy GC infiltration.

  10. Subchondral insufficiency fractures of the femoral head: associated imaging findings and predictors of clinical progression

    Energy Technology Data Exchange (ETDEWEB)

    Hackney, Lauren A.; Joseph, Gabby B.; Link, Thomas M. [University of California, San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Lee, Min Hee [University of California, San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea, Republic of); Vail, Thomas P. [University of California, Department of Orthopaedic Surgery, San Francisco, CA (United States)

    2016-06-15

    To characterize the morphology and imaging findings of femoral head subchondral insufficiency fractures (SIF), and to investigate clinical outcomes in relation to imaging findings. Fifty-one patients with hip/pelvis magnetic resonance (MR) images and typical SIF characteristics were identified and reviewed by two radiologists. Thirty-five patients had follow-up documentation allowing assessment of clinical outcome. Subgroup comparisons were performed using regression models adjusted for age and body mass index. SIF were frequently associated with cartilage loss (35/47, 74.5 %), effusion (33/42, 78.6 %), synovitis (29/44, 66 %), and bone marrow oedema pattern (BMEP) (average cross-sectional area 885.7 ± 730.2 mm{sup 2}). Total hip arthroplasty (THA) was required in 16/35 patients, at an average of 6 months post-MRI. Compared to the THA cohort, the non-THA group had significantly (p < 0.05) smaller overlying cartilage defect size (10 mm vs. 29 mm), smaller band length ratio and fracture diameters, and greater incidence of parallel fracture morphology (p < 0.05). Male gender and increased age were significantly associated with progression, p < 0.05. SIF were associated with synovitis, cartilage loss, effusion, and BMEP. Male gender and increased age had a significant association with progression to THA, as did band length ratio, fracture diameter, cartilage defect size, and fracture deformity/morphology. (orig.)

  11. Gene Expression Changes in Femoral Head Necrosis of Human Bone Tissue

    Directory of Open Access Journals (Sweden)

    Bernadett Balla

    2011-01-01

    Full Text Available Osteonecrosis of the femoral head (ONFH is the result of an interruption of the local circulation and the injury of vascular supply of bone. Multiple factors have been implicated in the development of the disease. However the mechanism of ischemia and necrosis in non-traumatic ONFH is not clear. The aim of our investigation was to identify genes that are differently expressed in ONFH vs. non-ONFH human bone and to describe the relationships between these genes using multivariate data analysis. Six bone tissue samples from ONFH male patients and 8 bone tissue samples from non-ONFH men were examined. The expression differences of selected 117 genes were analyzed by TaqMan probe-based quantitative real-time RT-PCR system. The significance test indicated marked differences in the expression of nine genes between ONFH and non-ONFH individuals. These altered genes code for collagen molecules, an extracellular matrix digesting metalloproteinase, a transcription factor, an adhesion molecule, and a growth factor. Canonical variates analysis demonstrated that ONFH and non-ONFH bone tissues can be distinguished by the multiple expression profile analysis of numerous genes controlled via canonical TGFB pathway as well as genes coding for extracellular matrix composing collagen type molecules. The markedly altered gene expression profile observed in the ONFH of human bone tissue may provide further insight into the pathogenetic process of osteonecrotic degeneration of bone.

  12. Age-related changes in the hemodynamics of the femoral head as evaluated by early phase of bone scintigraphy

    International Nuclear Information System (INIS)

    Hamaguchi, Hiroyuki; Fujioka, Mikihiro; Takahashi, Kenji A.

    2006-01-01

    The femoral head is reported to be in a markedly hypoemic state as compared with other tissues even under normal conditions, and it is therefore necessary to understand its hemodynamics to investigate the pathogenesis of hip disorders. It is known that aspects of intraosseous hemodynamics including blood flow and blood pool can be evaluated soon after radioisotope administration. In this study, hemodynamic changes in the femoral head according to gender and age were examined by investigating accumulation of radioisotope in the tissue during the early phase of bone scintigraphy. The subjects of this study consisted of 58 joints of 31 men and 75 joints of 41 women, whose ages ranged from 15 to 87 years (average age: 67.9 years). Images of bone scintigraphy were obtained for 15 to 20 minutes at 5 minutes and at 3 hours after radioisotope administration. The ratio of accumulation in the femoral head to that in the diaphysis (head-to-diaphysis ratio, HD ratio) was calculated. HD ratios obtained 15-20 minutes later ranged from 0.01 to 7.35 (1.88±0.91, mean±SD). HD ratios decreased with age, and a significant inverse correlation was observed between age and HD ratio, demonstrating a correlation coefficient of -0.27 (p=0.001). The HD ratio among men was 0.01-3.57 (1.66±0.71), while that among women was 0.53-7.35 (2.05±1.01), and a significant difference was observed in HD ratio between men and women (p=0.02). There was a significant difference in HD ratios between men and women in their teens to forties (p=0.03), while no significant differences was observed in the other age groups. HD ratios obtained 3 hours later ranged from 0.44 to 6.32 (1.95±0.79, mean±SD), and no significant correlation was observed between age and HD ratio, demonstrating a correlation coefficient of -0.14. The present study demonstrated that blood flow and blood pool of the femoral head decrease with aging particularly in women. This hemodynamic deterioration of the femoral head caused by aging

  13. A comparative assessment of the value of imaging methods in diagnostic of osteonecrosis of the femoral head in adults

    International Nuclear Information System (INIS)

    Peshev, A.; Mlachkova, D.; Mlachkov, N.

    2006-01-01

    Full text: The aim of the presentation is to study the possibilities of contemporary methods for early diagnosis of osteonecrosis of the femoral head in adults with a view to make a suitable diagnostic protocol. 156 hip joints were examined. A conventional radiography was performed in all, CT - in 112, bone scan - in 123, MRI - in 42. The findings of the imaging methods were compared. The results of imaging methods were put together with the extension of the clinical complaints. The findings of conventional radiography were classified according to Ficat and Arlet, CT findings were classified according to Magit. The size and location of the necrotic area as a prognostic factor was evaluated. MRI was the most sensitive method in the early stages of necrosis of femoral head, followed by bone scan and CT. Conventional radiography is suitable for late stages of osteonecrosis. On the basis of our investigations we propose a diagnostic protocol for early diagnosis of osteonecrosis of the femoral head in adults

  14. Anterior approach versus posterior approach for Pipkin I and II femoral head fractures: A systemic review and meta-analysis.

    Science.gov (United States)

    Wang, Chen-guang; Li, Yao-min; Zhang, Hua-feng; Li, Hui; Li, Zhi-jun

    2016-03-01

    We performed a meta-analysis, pooling the results from controlled clinical trials to compare the efficiency of anterior and posterior surgical approaches to Pipkin I and II fractures of the femoral head. Potential academic articles were identified from the Cochrane Library, Medline (1966-2015.5), PubMed (1966-2015.5), Embase (1980-2015.5) and ScienceDirect (1966-2015.5) databases. Gray studies were identified from the references of the included literature. Pooling of the data was performed and analyzed by RevMan software, version 5.1. Five case-control trials (CCTs) met the inclusion criteria. There were significant differences in the incidence of heterotopic ossification (HO) between the approaches, but no significant differences were found between the two groups regarding functional outcomes of the hip, general postoperative complications, osteonecrosis of the femoral head or post-traumatic arthritis. The present meta-analysis indicated that the posterior approach decreased the risk of heterotopic ossification compared with the anterior approach for the treatment of Pipkin I and II femoral head fractures. No other complications were related to anterior and posterior approaches. Future high-quality randomized, controlled trials (RCTs) are needed to determine the optimal surgical approach and to predict other postoperative complications. III. Copyright © 2016 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  15. MRI study of avascular necrosis of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Simizu, Koh; Suguro, Toru; Tsuchiya, Akihiro; Moriya, Hideshige; Nishikawa, Satoru; Arimizu, Noboru [Chiba Univ. (Japan). School of Medicine

    1990-10-01

    Magnetic resonance (MR) images of 70 joints were reviewed in 38 patients with avascular necrosis of the knee or hip joint, whose ages ranged from 19 to 62 years with an average of 41 years. According to causes, steroid induced avascular necrosis was the commonest, accounting for 87% of cases. The remainer of the cases were alcoholic avascular necrosis (8%) and idiopathic avascular necrosis (5%). Steroid induced avascular necrosis was greatly different from idiopathic avascular necrosis in view of clinical manifestations, common sites, and complications of femur head necrosis. Idiopathic avascular necrosis was common in the central part of internal condyle and was confined to one joint. Steroid induced avascular necrosis was common in the posterior part of external condyle and was frequently associated with multiple necroses of the diaphysis. Seventy five percent of the cases were associated with avascular necrosis of the knee. The diagnostic accuracy of the other imaging modalities in avascular necrosis was low (33% for plain roentgenography and 50% for RI examination). Thus, MR was the imaging procedure of choice for detecting avascular necrotic lesions. (N.K.).

  16. MRI study of avascular necrosis of the knee

    International Nuclear Information System (INIS)

    Simizu, Koh; Suguro, Toru; Tsuchiya, Akihiro; Moriya, Hideshige; Nishikawa, Satoru; Arimizu, Noboru

    1990-01-01

    Magnetic resonance (MR) images of 70 joints were reviewed in 38 patients with avascular necrosis of the knee or hip joint, whose ages ranged from 19 to 62 years with an average of 41 years. According to causes, steroid induced avascular necrosis was the commonest, accounting for 87% of cases. The remainer of the cases were alcoholic avascular necrosis (8%) and idiopathic avascular necrosis (5%). Steroid induced avascular necrosis was greatly different from idiopathic avascular necrosis in view of clinical manifestations, common sites, and complications of femur head necrosis. Idiopathic avascular necrosis was common in the central part of internal condyle and was confined to one joint. Steroid induced avascular necrosis was common in the posterior part of external condyle and was frequently associated with multiple necroses of the diaphysis. Seventy five percent of the cases were associated with avascular necrosis of the knee. The diagnostic accuracy of the other imaging modalities in avascular necrosis was low (33% for plain roentgenography and 50% for RI examination). Thus, MR was the imaging procedure of choice for detecting avascular necrotic lesions. (N.K.)

  17. The Protective Effect of Cordycepin On Alcohol-Induced Osteonecrosis of the Femoral Head

    Directory of Open Access Journals (Sweden)

    Yi-Xuan Chen

    2017-08-01

    Full Text Available Background: Alcohol abuse is known to be a leading risk factor for atraumatic osteonecrosis of the femoral head (ONFH, in which the suppression of osteogenesis plays a critical role. Cordycepin benefits bone metabolism; however, there has been no study to determine its effect on osteonecrosis. Methods: Human bone mesenchymal stem cells (hBMSCs were identified by multi-lineage differentiation. Alkaline phosphatase (ALP activity, RT-PCR, western blots, immunofluorescent assay and Alizarin red staining of BMSCs were evaluated. A rat model of alcohol-induced ONFH was established to investigate the protective role of cordycepin against ethanol. Hematoxylin & eosin (H&E staining and micro-computerized tomography (micro-CT were performed to observe ONFH. Apoptosis was assessed by TdT-mediated dUTP nick end labeling (TUNEL. Immunohistochemical staining was carried out to detect OCN and COL1. Results: Ethanol significantly suppressed ALP activity, decreased gene expression of OCN and BMP2, lowered levels of RUNX2 protein, and reduced immunofluorescence staining of OCN and COL1 and calcium formation of hBMSCs. However, these inhibitory effects were attenuated by cordycepin co-treatment at concentrations of 1 and 10 µg/mL Moreover, it was revealed that the osteo-protective effect of cordycepin was associated with modulation of the Wnt/β-catenin pathway. In vivo, by micro-CT, TUNEL and immunohistochemical staining of OCN and COL1, we found that cordycepin administration prevented alcohol-induced ONFH. Conclusion: Cordycepin treatment to enhance osteogenesis may be considered a potential therapeutic approach to prevent the development of alcohol-induced ONFH.

  18. Avascular necrosis of bone in severe acute respiratory syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Hong, N. E-mail: hongnan@bjmu.edu.cn; Du, X.K

    2004-07-01

    AIM: To report the incidence of avascular osteonecrosis (AVN) in severe acute respiratory syndrome (SARS) patients. MATERIALS AND METHODS: Sixty-seven SARS patients who had large joint pain between March 2003 and May 2003 underwent both plain radiographs and magnetic resonance imaging (MRI) examination on the same day. All patients received steroids and ribavirin treatment. All plain radiographs and MR images were analysed by two experienced musculoskeletal radiologists. Any abnormalities, location, extent, morphology, the number, size and signal intensity of lesions were evaluated. RESULTS: Twenty-eight patients were identified with AVN, The mean time to diagnosis of AVN was 119 days after the onset of SARS, or 116 days after steroid use. Three patients had early bilateral AVN of the femoral head, four patients of one femoral head, five patients of the bilateral hips and knees, four patients of the ipsilateral hip and knees, 10 patients of the knee(s), one patient of the right proximal fibula, and one patient of the knees and talus. Results of hip, knee and ankle plain radiographs were negative. CONCLUSION: AVN can occur in the patients with SARS. AVN had a strong association with steroid use. More studies are required to confirm whether the virus itself can also lead to AVN.

  19. Avascular necrosis of bone in severe acute respiratory syndrome

    International Nuclear Information System (INIS)

    Hong, N.; Du, X.K.

    2004-01-01

    AIM: To report the incidence of avascular osteonecrosis (AVN) in severe acute respiratory syndrome (SARS) patients. MATERIALS AND METHODS: Sixty-seven SARS patients who had large joint pain between March 2003 and May 2003 underwent both plain radiographs and magnetic resonance imaging (MRI) examination on the same day. All patients received steroids and ribavirin treatment. All plain radiographs and MR images were analysed by two experienced musculoskeletal radiologists. Any abnormalities, location, extent, morphology, the number, size and signal intensity of lesions were evaluated. RESULTS: Twenty-eight patients were identified with AVN, The mean time to diagnosis of AVN was 119 days after the onset of SARS, or 116 days after steroid use. Three patients had early bilateral AVN of the femoral head, four patients of one femoral head, five patients of the bilateral hips and knees, four patients of the ipsilateral hip and knees, 10 patients of the knee(s), one patient of the right proximal fibula, and one patient of the knees and talus. Results of hip, knee and ankle plain radiographs were negative. CONCLUSION: AVN can occur in the patients with SARS. AVN had a strong association with steroid use. More studies are required to confirm whether the virus itself can also lead to AVN

  20. The effect of core decompression on local expression of BMP-2, PPAR-γ and bone regeneration in the steroid-induced femoral head osteonecrosis

    Directory of Open Access Journals (Sweden)

    Wang Wei

    2012-08-01

    Full Text Available Abstract Background To investigate the efficacy of the sole core decompression surgery for the treatment of steroid-induced femoral head osteonecrosis. Methods The model was established by administration of steroids in combination with horse serum. The rabbits with bilateral femoral head osteonecrosis were randomly selected to do the one side of core decompression. The other side was used as the sham. Quantitative RT-PCR and western blot techniques were used to measure the local expression of BMP-2 and PPAR-γ. Bone tissues from control and operation groups were histologically analyzed by H&E staining. The comparisons of the local expression of BMP-2 and PPAR-γ and the bone regeneration were further analyzed between different groups at each time point. Results The expression of BMP-2 in the osteonecrosis femoral head with or without decompression was significantly lower than that in normal animals. BMP-2 expression both showed the decreasing trend with the increased post-operation time. No significant difference of BMP-2 expression occurred between femoral head osteonecrosis with and without decompression. The PPAR-γ expression in the femoral head osteonecrosis with and without core decompression both was significantly higher than that in control. Its expression pattern showed a significantly increased trend with increased the post-operation time. However, there was no significant difference of PPAR-γ expression between the femoral head osteonecrosis with and without decompression at each time point. Histopathological analysis revealed that new trabecular bone and a large number of osteoblasts were observed in the steroid-induced femoral head osteonecrosis with lateral decompression at 8 weeks after surgery, but there still existed trabecular bone fractures and bone necrosis. Conclusions Although decompression takes partial effect in promoting bone regeneration in the early treatment of femoral head osteonecrosis, such an effect does not

  1. Corrosion at the head-neck interface of current designs of modular femoral components: essential questions and answers relating to corrosion in modular head-neck junctions.

    Science.gov (United States)

    Osman, K; Panagiotidou, A P; Khan, M; Blunn, G; Haddad, F S

    2016-05-01

    There is increasing global awareness of adverse reactions to metal debris and elevated serum metal ion concentrations following the use of second generation metal-on-metal total hip arthroplasties. The high incidence of these complications can be largely attributed to corrosion at the head-neck interface. Severe corrosion of the taper is identified most commonly in association with larger diameter femoral heads. However, there is emerging evidence of varying levels of corrosion observed in retrieved components with smaller diameter femoral heads. This same mechanism of galvanic and mechanically-assisted crevice corrosion has been observed in metal-on-polyethylene and ceramic components, suggesting an inherent biomechanical problem with current designs of the head-neck interface. We provide a review of the fundamental questions and answers clinicians and researchers must understand regarding corrosion of the taper, and its relevance to current orthopaedic practice. Cite this article: Bone Joint J 2016;98-B:579-84. ©2016 The British Editorial Society of Bone & Joint Surgery.

  2. Assessment of bone quality in the isolated femoral head for intracapsular fractures of the femoral head. Analysis of bone architecture using micro-CT and pQCT, and comparison with extracapsular fractures

    International Nuclear Information System (INIS)

    Sando, Masaru

    2003-01-01

    Block sections were prepared from the five locations, central portion, superior portion, inferior portion, anterior portion, and posterior portion, of the region around the fracture of the femoral head isolated from 21 patients (16 patients with intracapsular fracture, 5 patients with extracapsular fracture). Cancellous bone microstructure, cortical bone thickness, and bone density were evaluated and analyzed for differences in the mechanism from which intracapsular versus extracapsular fracture and fragility developed. The method of evaluating the bone architecture differed from conventional bone histomorphometry of hard tissues and involved non-invasive micro-CT measurements, while the bone density was measured by peripheral quantitative computed topography (pQCT). The results indicate that in comparison to patients with extracapsular fractures, patients with intracapsular fractures showed significant decreases in the trabecular thickness of superior and posterior portions in the cancellous bone. The cortical bone thickness was significantly decreased in the superior portion. Bone density was significantly decreased in the superior portion, while in the extracapsular fracture group density tended to be lower in the inferior, anterior, and posterior portions, although this was not statistically significant. Although there have been previous studies on the bone quality of the femoral head isolated from intracapsular fracture of the femoral head, most reports are of two-dimensional analysis of coronal sections. As far as we are aware, there have been no previous reports comparing individual locations to extracapsular fractures. In view of the various reports that bone density is lower in the extracapsular fracture compared to the intracapsular fracture, we speculate that extracapsular fracture results from the effects of external forces on decreased bone density, while in the intracapsular fracture type, thinning of the superior portion of the cortical bone creates

  3. Superimposition of maximal stress and necrosis areas at the top of the femoral head in hip aseptic osteonecrosis.

    Science.gov (United States)

    Escudier, J-C; Ollivier, M; Donnez, M; Parratte, S; Lafforgue, P; Argenson, J-N

    2018-05-01

    Recent reports described possible mechanical factors in the development and aggravation of osteonecrosis of the femoral head (OFH), but these have yet to be confirmed on dedicated mechanical study. We therefore developed a 3D finite element model based on in-vivo data from patients with incipient OFH, with a view to determining whether the necrosis area was superimposed on the maximal stress area on the femoral head. The location of the necrosis area is determined by stress on the femoral head. All patients from the rheumatology department with early stage OFH in our center were investigated. Analysis of CT scans showed stress distribution on the head by 3D finite elements models, enabling determination of necrosis volume within the maximal stress area and of the percentage intersection of necrosis within the stress area (%I n/s: necrosis volume in stress area divided by total stress area volume and multiplied by 100) and of stress within the necrosis area (%I s/n: stress volume in necrosis area divided by total necrosis area volume and multiplied by 100). Nineteen of the 161 patients assessed retrospectively for the period between 2006 and 2015 had incipient unilateral OFH, 10 of whom (4 right, 6 left) had CT scans of sufficient quality for inclusion. Mean age was 52 years (range, 37-81 years). Mean maximal stress was 1.63MPa, mean maximal exported stress volume was 2,236.9 mm 3 and mean necrosis volume 6,291.1 mm 3 . Mean %I n/s was 83% and mean %I s/n 35%, with no significant differences according to gender, age, side or stress volume. There was a strong inverse correlation between necrosis volume and %I s/n (R 2 =-0.92) and a strong direct correlation between exported stress volume and %I s/n (R 2 =0.55). %I s/n was greater in small necrosis (stress area on the femoral head. The present results need confirmation by larger-scale studies. We consider it essential to take account of these mechanical parameters to reduce failure rates in conservative treatment of

  4. Transfer of metallic debris from the metal surface of an acetabular cup to artificial femoral heads by scraping: comparison between alumina and cobalt-chrome heads.

    Science.gov (United States)

    Chang, Chong Bum; Yoo, Jeong Joon; Song, Won Seok; Kim, Deug Joong; Koo, Kyung-Hoi; Kim, Hee Joong

    2008-04-01

    We aimed to investigate the transfer of metal to both ceramic (alumina) and metal (cobalt-chrome) heads that were scraped by a titanium alloy surface under different load conditions. The ceramic and metal heads for total hip arthroplasties were scraped by an acetabular metal shell under various loads using a creep tester. Microstructural changes in the scraped area were visualized with a scanning electron microscope, and chemical element changes were assessed using an energy dispersive X-ray spectrometry. Changes in the roughness of the scraped surface were evaluated by a three-dimensional surface profiling system. Metal transfer to the ceramic and metal heads began to be detectable at a 10 kg load, which could be exerted by one-handed force. The surface roughness values significantly increased with increasing test loads in both heads. When the contact force increased, scratching of the head surface occurred in addition to the transfer of metal. The results documented that metallic debris was transferred from the titanium alloy acetabular shell to both ceramic and metal heads by minor scraping. This study suggests that the greatest possible effort should be made to protect femoral heads, regardless of material, from contact with metallic surfaces during total hip arthroplasty.

  5. Detection of acute avascular necrosis with dynamic contrast-enhanced MR imaging

    International Nuclear Information System (INIS)

    Nadel, S.N.; Richardson, W.J.; Martinez, S.; Rizk, W.S.; Malizos, K.; Debatin, J.F.

    1991-01-01

    Early detection of avascular necrosis (AVN) may allow earlier intervention and lead to improved treatment success. This paper is designed to compare standard and dynamic contrast-enhanced MR imaging in the detection of acute AVN. A previously described animal model of AVN was used. Five anesthetized dogs underwent right femoral head devascularization, including placement of a supercooling coil around the femoral neck. Within 3 hours the dogs were imaged in a 1.5-T Signa magnet. Standard T1-weighted, T2-weighted, and STIR images were obtained through both hips. A DiGrass sequence with 30 sequential 3.2-second T1-weighted images was used, and 0.2 mmol/kg gadoteridol was injected intravenously at the start of the sequence at 2 mL/sec with an automated injector. Following imaging, oxytetracycline was given intravenously. After 3 days the dogs were killed, and their femoral heads were extracted, coronally sectioned, and analyzed for fluorescence. T1-weighted, T2-weighted, and STIR sequences showed no marrow abnormalities on either the normal or the operated-on side. With contrast material injection, all normal areas and the unoperated portion the femoral neck and diaphysis enhanced markedly 4-9 seconds following the bolus

  6. Analysis of slipped capital femoral epiphysis

    International Nuclear Information System (INIS)

    Magid, D.; Fishman, E.K.; Sponseller, P.D.; Griffin, P.P.

    1988-01-01

    CT with multiplanar reconstruction (CT/MPR) was used to assess 25 adolescents with known or suspected slipped capital femoral epiphysis (SCFE). CT/MPR localizes the epiphysis in three planes, establishing its relationship to the acetabulum and the metaphyseal neck. MPR facilitates measurements of head-neck angles, residusal head-neck contact, and relative retrovision. CT/MPR may establish the true age of the epiphyseal failure and can reveal subtle SCFE in the face of normal plain films. Patients often present with confusing histories; clues to the true age of failure include subtle signs of healing, remodeling, or new bone buttressing. Characterization of acute versus chronic conditions influences preoperative planning. Postoperatively, CT/MPR confirms early results and follows epiphyseal fusion and remodelling. It also detects complications, such as pin or graft migration avascular necrosis (AVN), or chondrolysis

  7. Femoral head retroposition as a potential compensatory mechanism in patients with a severe mismatch between pelvic incidence and lumbar lordosis.

    Science.gov (United States)

    Cheng, Xiaofei; Zhang, Kai; Sun, Xiaojiang; Zhao, Changqing; Li, Hua; Zhao, Jie

    2017-12-01

    Severe mismatch between pelvic incidence (PI) and lumbar lordosis (LL) leads to extra anterior displacement of the gravity line. The objective of this study is to investigate whether femoral head retroposition is a separate compensatory mechanism responsible for the extra anterior displacement. Based on the values of PI and LL, 94 patients were divided into the PI-LL match group (PI-LL ≤ 0°), the mild PI-LL mismatch group (20°> PI-LL >0°), and the severe PI-LL mismatch group (PI-LL ≥ 20°). A series of parameters including PI, LL, PI-LL, thoracic kyphosis (TK), pelvic tilt (PT), sacral slope (SS), knee flexion angle (KFA), tibial obliquity angle (TOA), sagittal vertical axis (SVA), S1 overhang, femoral head shift (FHS), and pelvic shift (PS) were measured and compared among the three groups. The severe PI-LL mismatch group exhibited significantly greater PI, PI-LL, PT, KFA, SVA, PS, and FHS, and less LL and TK, compared with the control and mild PI-LL mismatch group. The mild PI-LL mismatch group had significantly greater PI-LL, PT, KFA, TOA, and S1 overhang, and less LL and SS than the control group. SS, TOA, and S1 overhang in the severe PI-LL mismatch group differed significantly from that in the control group, but did not differ significantly from that in the mild PI-LL mismatch group. Femoral head retroposition is an entirely separate compensatory mechanism and, in this study, participated in the compensation for the anterior displacement of the gravity line induced by extra-sagittal spinal malalignment in patients with severe PI-LL mismatch.

  8. Relative volume measured with magnetic resonance imaging is an articular collapse predictor in hematological pediatric patients with femoral head osteonecrosis.

    Science.gov (United States)

    Ippolito, Davide; Masetto, Alessandro; Talei Franzesi, Cammillo; Bonaffini, Pietro A; Casiraghi, Alessandra; Sironi, Sandro

    2016-08-28

    To assess the potential value of femoral head (FH) volume measurements to predict joint collapse, as compared to articular surface involvement, in post-treatment osteonecrosis (ON) in pediatric patients affected by lymphoproliferative diseases. Considering 114 young patients with lymphoproliferative diseases undergone a lower-limbs magnetic resonance imaging (MRI) examination between November 2006 and August 2012 for a suspected post-treatment ON, we finally considered a total of 13 cases (7 males, mean age 15.2 ± 4.8 years), which developed a FH ON lesions (n = 23). The MRI protocol included coronal short tau inversion recovery and T1-weighted sequences, from the hips to the ankles. During the follow-up (elapsed time: 9.2 ± 2 mo), 13/23 FH articular surface (FHS) developed articular deformity. The first MRI studies with diagnosis of ON were retrospectively analyzed, measuring FH volume (FHV), FHS, ON volume (ONV) and the articular surface involved by ON (ONS). The relative involvement of FHS, in terms of volume [relative volume (RV): ONV/FHV] and articular surface [relative surface (RS): ONS/FHS], was then calculated. By using receiver operating characteristic curve analysis (threshold of 23% of volume involvement), RV predicted articular deformity in 13/13 FHS [sensitivity 100%, specificity 90%, accuracy 95%, positive predictive value (PPV) 93%, negative predictive value (NPV) 100%]. Considering a threshold of 50% of articular involvement, RS predicted articular deformity in 10/13 femoral heads (sensitivity 77%, specificity 100%, accuracy 87%, PPV 100%, NPV 77%). RV might be a more reliable parameter than RS in predicting FH deformity and could represent a potential complementary diagnostic tool in the follow-up of femoral heads ON lesions.

  9. Modified porous tantalum rod technique for the treatment of femoral head osteonecrosis.

    Science.gov (United States)

    Pakos, Emilios E; Megas, Panayiotis; Paschos, Nikolaos K; Syggelos, Spyridon A; Kouzelis, Antonios; Georgiadis, Georgios; Xenakis, Theodoros A

    2015-11-18

    To study a modified porous tantalum technique for the treatment of osteonecrosis of the femoral head. The porous tantalum rod was combined with endoscopy, curettage, autologous bone grafting and use of bone marrow aspirates from iliac crest aspiration in 49 patients (58 hips) with a mean age of 38 years. The majority of the patients had idiopathic osteonecrosis, followed by corticosteroid-induced osteonecrosis. Thirty-eight hips were of Steinberg stage II disease and 20 hips were of stage III disease. Patients were followed for 5 years and were evaluated clinically with the Merle D'Aubigne and Postel score and radiologically. The primary outcome of the study was survival based on the conversion to total hip arthroplasty (THA). Secondary outcomes included deterioration of the osteonecrosis to a higher disease stage at 5 years compared to the preoperative period and identification of factors that were associated with survival. The Kaplan-Meier survival analysis was performed to evaluate the survivorship of the prosthesis, and the Fisher exact test was performed to test associations between various parameters with survival. No patient developed any serious intraoperative or postoperative complication including implant loosening or migration and donor site morbidity. During the 5-year follow up, 1 patient died, 7 patients had disease progression and 4 hips were converted to THA. The 5-year survival based on conversion to THA was 93.1% and the respective rate based on disease progression was 87.9%. Stage II disease was associated with statistically significant better survival rates compared to stage III disease (P = 0.04). The comparison between idiopathic and non-idiopathic osteonecrosis and between steroid-induced and non-steroid-induced osteonecrosis did not showed any statistically significant difference in survival rates. The clinical evaluation revealed statistically significantly improved Merle d'Aubigne scores at 12 mo postoperatively compared to the

  10. A rare case of avascular necrosis in sickle cell trait: a case report.

    Science.gov (United States)

    Sanders, William J

    2018-01-01

    Sickle cell trait is usually an asymptomatic presentation of a patient with slightly different hemoglobin molecule makeup than normal. It is similar to a more serious disease, sickle cell disease, in which a person's hemoglobin is mutated in such a way that causes their red blood cells to easily change shape in certain environmental and internal states; this causes red blood cells to adhere to the walls and occlude the lumen of the arteries in which they travel, leading to downstream effects secondary to ischemia. Sickle cell trait does not have these ischemic effects, usually. In this case, a young African American female patient presents to the clinic with severe right hip pain. Her past medical history includes sickle cell trait and asthma. She has not been symptomatic of her asthma for years and is not on therapy for it. The pain has lasted for several months and has not improved with anti-inflammatory medication. There is severe pain with internal and external rotation of the hip. The neurovascularity of the lower extremities is intact bilaterally. MRI of the femur shows stage 2 or 3 avascular necrosis of the femoral head, while X-rays of the femur are unremarkable. Non weight-bearing for several weeks was unsuccessful; shortly thereafter, the patient underwent core decompression of the right femoral head as well as starting bisphosphonates. The patient improved temporarily but regressed shortly thereafter. Her avascular necrosis worsened radiographically over the next several months. At this point, the only other option would be to do a total hip arthroplasty, but the patient may need several more throughout her lifetime due to the lifespan of the artificial replacement. There have only been scarce reports of avascular necrosis in patients with sickle cell trait. This manuscript presents such a case and includes the trials and tribulations associated with its management.

  11. Is the rotation of the femoral head a potential initiation for cutting out? A theoretical and experimental approach.

    Science.gov (United States)

    Lenich, Andreas; Bachmeier, Samuel; Prantl, Lukas; Nerlich, Michael; Hammer, Jochen; Mayr, Edgar; Al-Munajjed, Amir Andreas; Füchtmeier, Bernd

    2011-04-22

    Since cut-out still remains one of the major clinical challenges in the field of osteoporotic proximal femur fractures, remarkable developments have been made in improving treatment concepts. However, the mechanics of these complications have not been fully understood.We hypothesize using the experimental data and a theoretical model that a previous rotation of the femoral head due to de-central implant positioning can initiate a cut-out. In this investigation we analysed our experimental data using two common screws (DHS/Gamma 3) and helical blades (PFN A/TFN) for the fixation of femur fractures in a simple theoretical model applying typical gait pattern on de-central positioned implants. In previous tests during a forced implant rotation by a biomechanical testing machine in a human femoral head the two screws showed failure symptoms (2-6Nm) at the same magnitude as torques acting in the hip during daily activities with de-central implant positioning, while the helical blades showed a better stability (10-20Nm).To calculate the torque of the head around the implant only the force and the leverarm is needed (N [Nm] = F [N] * × [m]). The force F is a product of the mass M [kg] multiplied by the acceleration g [m/s2]. The leverarm is the distance between the center of the head of femur and the implant center on a horizontal line. Using 50% of 75 kg body weight a torque of 0.37Nm for the 1 mm decentralized position and 1.1Nm for the 3 mm decentralized position of the implant was calculated. At 250% BW, appropriate to a normal step, torques of 1.8Nm (1 mm) and 5.5Nm (3 mm) have been calculated.Comparing of the experimental and theoretical results shows that both screws fail in the same magnitude as torques occur in a more than 3 mm de-central positioned implant. We conclude the center-center position in the head of femur of any kind of lag screw or blade is to be achieved to minimize rotation of the femoral head and to prevent further mechanical complications.

  12. The Role of (99m)Tc-Annexin V Apoptosis Scintigraphy in Visualizing Early Stage Glucocorticoid-Induced Femoral Head Osteonecrosis in the Rabbit.

    Science.gov (United States)

    Wang, Xiaolong; Liu, Yu; Wang, Xuemei; Liu, Rui; Li, Jianbo; Zhang, Guoliang; Li, Qiang; Wang, Lei; Bai, Zhigang; Zhao, Jianmin

    2016-01-01

    To validate the ability of (99m)Tc-Annexin V to visualize early stage of glucocorticoid-induced femoral head necrosis by comparing with (99m)Tc-MDP bone scanning. Femoral head necrosis was induced in adult New Zealand white rabbits by intramuscular injection of methylprednisolone. (99m)Tc-Annexin scintigraphy and (99m)Tc-MDP scans were performed before and 5, 6, and 8 weeks after methylprednisolone administration. Rabbits were sacrificed at various time points and conducted for TUNEL and H&E staining. All methylprednisolone treated animals developed femoral head necrosis; at 8 weeks postinjection, destruction of bone structure was evident in H&E staining, and apoptosis was confirmed by the TUNEL assay. This was matched by (99m)Tc-Annexin V images, which showed a significant increase in signal over baseline. Serial (99m)Tc-Annexin V scans revealed that increased (99m)Tc-Annexin V uptake could be observed in 5 weeks. In contrast, there was no effect on (99m)Tc-MDP signal until 8 weeks. The TUNEL assay revealed that bone cell apoptosis occurred at 5 weeks. (99m)Tc-Annexin V is superior to (99m)Tc-MDP for the early detection of glucocorticoid-induced femoral head necrosis in the rabbit and may be a better strategy for the early detection of glucocorticoid-induced femoral head necrosis in patients.

  13. Use of concentrated bone marrow aspirate and platelet rich plasma during minimally invasive decompression of the femoral head in the treatment of osteonecrosis.

    Science.gov (United States)

    Martin, John R; Houdek, Matthew T; Sierra, Rafael J

    2013-06-01

    The aim of this paper is to describe our surgical procedure for the treatment of osteonecrosis of the femoral head using a minimally invasive technique. We have limited the use of this procedure for patients with pre-collapse osteonecrosis of the femoral head (Ficat Stage I or II). To treat osteonecrosis of the femoral head at our institution we currently use a combination of outpatient, minimally invasive iliac crest bone marrow aspirations and blood draw combined with decompressions of the femoral head. Following the decompression of the femoral head, adult mesenchymal stem cells obtained from the iliac crest and platelet rich plasma are injected into the area of osteonecrosis. Patients are then discharged from the hospital using crutches to assist with ambulation. This novel technique was utilized on 77 hips. Sixteen hips (21%) progressed to further stages of osteonecrosis, ultimately requiring total hip replacement. Significant pain relief was reported in 86% of patients (n=60), while the rest of patients reported little or no pain relief. There were no significant complications in any patient. We found that the use of a minimally invasive decompression augmented with concentrated bone marrow and platelet rich plasma resulted in significant pain relief and halted the progression of disease in a majority of patients.

  14. Review of a single contemporary femoral neck fracture fixation method in young patients.

    LENUS (Irish Health Repository)

    Henari, Shwan

    2011-03-01

    An intracapsular femoral neck fracture in a young patient is a rare and difficult injury to manage. The occurrence of complications following fixation is multifactorial. Initial displacement and timing and accuracy of reduction are the key factors affecting outcome. The severities of the trauma to the hip and the impact of the intracapsular hematoma also play a role, the importance of which remains poorly understood. The purpose of this study was to evaluate the high incidence of femoral neck fractures treated in our institution over a 7-month period, to record the long-term outcome of these patients, all of whom were treated with contemporary methods of internal fixation, and to highlight the reasons for this injury being termed an "orthopedic emergency" and its differences from the same injury in the elderly population. We performed a retrospective analysis of 12 cases of intracapsular femur neck fracture in patients younger than 50 years treated over 7 months in a regional trauma center. All patients underwent satisfactory reduction and fixation. Nine of the 12 patients had a good outcome at a mean follow-up of 29 months. One patient developed a nonunion of the femoral head requiring total hip arthroplasty, one developed avascular necrosis of the femoral head, and one developed partial avascular necrosis. This compares favorably with other studies.

  15. Increased frequency of white matter lesions in patients with osteonecrosis (WMLeOn) of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Hadjigeorgiou, Georgios M. E-mail: gmhadji@med.uth.gr; Karantanas, Apostolos H.; Zibis, Aristidis; Dardiotis, Efthimios; Aggelakis, Konstantinos; Papadimitriou, Alexandros; Malizos, Konstantinos

    2004-06-01

    White matter lesions (WML) are commonly seen in cerebral MR imaging in normal and demented elderly people or young people suffering from migraine. We present data showing that WML are detected in an unexpectedly high frequency (56.9%) in patients with non-traumatic osteonecrosis of the femoral head compared to age and sex-matched controls. We designated the coexistence of WML and osteonecrosis as white matter lesions in osteonecrosis (WMLeON). We examined the possible association of WMLeON with hyperlipidaemia and other risk factors for WML or osteonecrosis of the femoral head. The frequency of history of corticosteroid treatment was statistically lower in patients with WMLeON (58.6%) compared to those without it (90.1%) (P=0.03). We found no association of WMLeON with diabetes, stroke, hyperlipidaemia, migraine, smoking, alcohol consumption, hypertension, atrial fibrillation, or systemic lupus erythematosus. Although, the clinical significance of WMLeON is still unknown, this finding supports, at least, the hypothesis that non-traumatic osteonecrosis is indeed a multisystem disorder rather than a disease of human skeleton.

  16. Bisphosphonate-modified gold nanoparticles: a useful vehicle to study the treatment of osteonecrosis of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Fanord, Fedena; Fairbairn, Korie; Bhethanabotla, Venkat; Gupta, Vinay K [Department of Chemical and Biomedical Engineering, University of South Florida, 4202 E. Fowler Avenue, ENB 118, Tampa, FL 33620 (United States); Kim, Harry [Shriners Hospitals for Children, 12502 USF Pine Drive, Tampa, FL 33612 (United States); Garces, Amanda, E-mail: vkgupta@usf.edu [Lisa Muma Weitz Microscopy and Cell Imaging, Department of Pathology and Cell Biology, University of South Florida, 12901 Bruce B Downs Boulevard, Tampa, FL 33612 (United States)

    2011-01-21

    Legg-Calve-Perthes disease (LCPD) is a juvenile form of osteonecrosis of the femoral head that presents in children aged 2-14 years. To date, there is no effective medical therapy for treating LCPD largely due to an inability to modulate the repair process, including the predominance of bo