The injury and dysfunction of the femoral head microvascular endothelial cells are associated with the pathogenesis of glucocorticoid‐induced osteonecrosis of the femoral head (ONFH). Reports indicate that icariin (ICA) can enhance vascular roles and also inhibit endothelial cell dysfunction. However, it still remains unclear whether ICA can promote angiogenesis in glucocorticoid‐induced ONFH. In this study, we investigate this hypothesis through in vitro and in vivo experiments. Results showed that 0.1 mg/mL hydrocortisone significantly suppressed bone microvascular endothelial cells (BMECs) proliferation while ICA at 10−5 mol/L reversed this inhibition. ICA significantly promoted BMECs migration, tube formation, the angiogenesis‐related cytokines expression and the activation of Akt. Furthermore, ICA enhanced Bcl‐2 expression but diminished Bax expression. According to in vivo results, rats with ICA treatment exhibited a lower ratio of empty lacunae, higher volume of blood vessels and more CD31‐positive cells. This study revealed that ICA promotes angiogenesis of BMECs in vitro and improves femoral head blood vessel volume of rats treated with glucocorticoid, suggesting the efficacy of ICA in the prevention of glucocorticoid‐induced ONFH.
BackgroundThe aim of this study was to compare clinical and radiological outcomes between a short femoral cementless stem and a conventional femoral cementless stem in total hip arthroplasty in patients 70 years and older.MethodsFrom December 2011 and July 2013, we retrospectively reviewed 50 patients (55 hips) 70 years and older treated with a short femoral cementless stem and 53 patients (58 hips) 70 years and older treated with a conventional femoral cementless stem. Their mean age was 74 ± 13.2 years and 75 ± 10.4 years, respectively. The mean follow-up was 40 ± 3.6 months and 42 ± 5.2 month, respectively. They were pre- and postoperatively evaluated by the clinical and radiological examination.ResultsThere was no difference in terms of average operative time, average estimated blood loss, and average hemoglobin at discharge between the short stem and the conventional stem. No patients with the short stem had intra-operative fracture, but five patients with the conventional stem had intra-operative fracture. At final follow-up, there was no statistically significant difference in Harris Hip Score, and radiographic review level between two stems. No hip with the short stem had thigh pain, but six hips with the conventional stem had thigh pain at the final follow-up. No component was revised for aseptic loosening in either group.ConclusionsOur study demonstrated that both short cementless stem and conventional cementless stem provided stable fixation and achieved a satisfactory result in patients 70 years and older and the short cementless stem had a low incidence of thigh pain and intra-operative fracture.
Osteocyte apoptosis is the main manifestation of steroid-induced avascular necrosis of the femoral head (SANFH). STAT1 and caspase 3 participate in the process of apoptosis and STAT1 upregulates the expression of caspase 3. We examined the relationship between the STAT1-caspase 3 pathway and apoptosis in SANFH. All specimens were divided into four groups: the negative control group, Ficat I-II group, Ficat III group, and Ficat IV-V group, and examined histologically, with a TUNEL assay, immunohistochemically, with a caspase 3 activity assay, with ELISAs of STAT1 and phospo-STAT1 (p-STAT1), with a western blotting analysis of p-STAT1 and with real-time RT-PCR. The proportion of empty lacunae increased significantly with the development of SANFH. The proportion of TUNEL-positive cells and immunohistochemical analysis of caspase 3 also increased significantly, although the Ficat I-II group did not differ significantly from the negative control group. Immunohistochemical analysis of STAT1 and p-STAT1, caspase 3 activity all showed significant differences among the groups. An ELISA and a western blotting analysis of p-STAT1 showed significant differences among the groups. An ELISA of STAT1, real-time RT-PCR analysis of caspase 3 and STAT1 all showed significant differences among the groups except between the Ficat I-II and negative control groups. The correlation analysis showed strong positive relationships between the proportion of empty lacunae and the proportion of TUNEL-positive cells between caspase 3 activity and the proportion of TUNEL-positive cells and between the levels of p-STAT1 protein and caspase 3 mRNA. The apoptotic process in SANFH develops with the upregulated expression of caspase 3 via the expression and activation of STAT1. The STATI-caspase 3 pathway plays a critical role in the development of SANFH.
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