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IntroductionAvascular necrosis of femoral head (ANFH) is a progressive disease that often leads to hip joint dysfunction and even disability in young patients. Although the standard treatment, which is core decompression, has the advantage of minimal invasion, the efficacy is variable. Recent studies have shown that implantation of bone marrow containing osteogenic precursors into necrotic lesion of ANFH may be promising for the treatment of ANFH.MethodsA prospective, double-blinded, randomized controlled trial was conducted to examine the effect of bone-marrow buffy coat (BBC) grafting combined with core decompression for the treatment of ANFH. Forty-five patients (53 hips) with Ficat stage I to III ANFH were recruited. The hips were allocated to the control group (core decompression + autologous bone graft) or treatment group (core decompression + autologous bone graft with BBC). Both patients and assessors were blinded to the treatment options. The clinical symptoms and disease progression were assessed as the primary and secondary outcomes.ResultsAt the final follow-up (24 months), there was a significant relief in pain (P <0.05) and clinical joint symptoms as measured by the Lequesne index (P <0.05) and Western Ontario and McMaster Universities Arthritis Index (P <0.05) in the treatment group. In addition, 33.3% of the hips in the control group have deteriorated to the next stage after 24 months post-procedure, whereas only 8% in the treatment group had further deterioration (P <0.05). More importantly, the non-progression rates for stage I/II hips were 100% in the treatment group and 66.7% in the control group.ConclusionImplantation of the autologous BBC grafting combined with core decompression is effective to prevent further progression for the early stages of ANFH.Trial registrationClinicalTrials.gov identifier NCT01613612. Registered 13 December 2011.

Many studies indicate that lead (Pb) and cadmium (Cd) exposure may alter bone development through both direct and indirect mechanisms, increasing the risk of osteoporosis later in life. The aim of this study was to investigate the association between Pb and Cd exposure, physical growth, and bone and calcium metabolism in children of an electronic waste (e-waste) processing area. We recruited 246 children (3-8 years) in a kindergarten located in Guiyu, China. Blood lead levels (BLLs) and blood cadmium levels (BCLs) of recruited children were measured as biomarkers for exposure. Serum calcium, osteocalcin, bone alkaline phosphatase, and urinary deoxypyridinoline were used as biomarkers for bone and calcium metabolism. Physical indexes such as height, weight, and head and chest circumference were also measured. The mean values of BLLs and BCLs obtained were 7.30 μg/dL and 0.69 μg/L, respectively. The average of BCLs increased with age. In multiple linear regression analysis, BLLs were negatively correlated with both height and weight, and positively correlated with bone resorption biomarkers. Neither bone nor calcium metabolic biomarkers showed significant correlation with cadmium. Childhood lead exposure affected both physical development and increased bone resorption of children in Guiyu. Primitive e-waste recycling may threaten the health of children with elevated BLL which may eventually cause adult osteoporosis.

Summary Obesity-related osteoarthritis (OA) is a complex, multifactorial condition that can cause significant impact on patients’ quality of life. Whilst chronic inflammation, adipocytokines and metabolic factors are considered to be important pathogenic factors in obesity related OA, there has been limited investigation into the biomechanical impact of obesity on OA development. This review aims to demonstrate that mechanical factors are the major pathological cause of obesity-related OA. The effect of obesity on pathological changes to the osteochondral unit and surrounding connective tissues in OA is summarized, as well as the impact of obesity-related excessive and abnormal joint loading, concomitant joint malalignment and muscle weakness. An integrated therapeutic strategy based on this multi-factorial presentation is presented, to assist in the management of obesity related OA. The translational potential of this article Despite the high prevalence of obesity-related OA, there is no specific guideline available for obesity-related OA management. In this review, we demonstrated the pathological changes of obesity-related OA and summarized the impact of biomechanical factors by proposing a hypothetical model of obesity-related OA change. Therapeutic strategies based on adjusting abnormal mechanical effects are presented to assist in the management of obesity-related OA.