Nontraumatic osteonecrosis of the femoral head (non-ONFH) is a disorder that can lead to femoral head collapse and the need for total hip replacement. Various head-preserving procedures have been used for this disease to avert the need for total hip replacement. These include various vascularised and nonvascularised bone grafting procedures. We examined the effect of bone-grafting through a window at the femoral head-neck junction known as the "light bulb" approach for the treatment of osteonecrosis of the femoral head with a combination of demineralised bone matrix (DBM) and auto-iliac bone. The study included 110 patients (138 hips; 41 females, 69 males; mean age 32.36 years, range 17-54 years) with stage IIA-IIIA nontraumatic avascular necrosis of the femoral head according to the system of the ARCO (Association Research Circulation Osseous). The bone grafting procedure is called "light bulb" procedure in which the diseased bone was replaced by a bone graft substitute (combination of DBM and auto-iliac bone).The outcome was determined by the changes in the Harris hip score, by progression in radiographic stages, and by the need for hip replacement. The mean follow-up was 25.37 months (range 7-42 months). All data were processed by a statistics analysis including Cox risk model analysis and Kaplan-Meier survival analysis. Pre- and postoperative evaluations showed that the mean Harris hip score increased from 62 to 79. Clinically, 94 of 138 hips (68%) were successful at the latest follow-up, and radiological improvement was noted in 100% of patients in stage IIA, 76.67% of patients in stage IIB and 50.96% of patients in stage IIC and IIIA cases. Excellent and good results according to the Harris score were obtained in 100% of cases in stage IIA, 93.33% in stage IIB and 59.62% in stages IIIA and IIC stage, with a survivorship of 85% in stages IIA and IIB and 60% in stage IIIA and IIC cases. Cox risk model analysis showed that the clinical success rate correlated with both pre-operation stage and the necrotic area of the femoral head. The complications included ectopic ossification, lateral femoral cutaneous nerve lesion and joint infection. This procedure may be effective at avoiding or forestalling the need for total hip replacement in young patients with early to intermediate stages of osteonecrosis of the femoral head. Therefore, it may be the treatment of choice particularly in nontraumatic osteonecrosis of the femoral head of pre-collapse stage with small and middle area (<30%, or the depth of collapse <2 mm).

The concentrated autologous bone marrow containing mononuclear cells implantation relieves hip pain, prevents the progression of osteonecrosis. Therefore, it may be the treatment of choice particularly in stages I-II nontraumatic osteonecrosis of the femoral head.

BackgroundThe minimally invasive Oxford unicompartmental knee arthroplasty (UKA) is a demanding procedure but has many advantages compared with total knee arthroplasty (TKA). The aim of this observational study was to investigate the learning curve of one experienced surgeon introducing minimally invasive Oxford phase 3 UKA into his routine clinical practice.MethodsThe first 50 consecutive cases of minimally invasive Oxford phase 3 UKA performed by one surgeon were evaluated to determine whether there was an association between outcomes and the cumulative number of cases performed, indicating the presence of learning curve. The cohort was divided into two groups: group A comprised the first 25 cases and group B cases 26–50. Duration of surgery, blood loss, Hospital for Special Surgery score, range of motion, complications, and the radiographical position of the implant were compared between the groups. The cumulative summation test for learning curve (LC-CUSUM) was then used to further analyze the learning curve.ResultsThe mean age and follow-up were 64.4 years and 50.9 months, respectively. The duration of surgery and blood loss were significantly more favorable in group B. The length of incision gradually reduced from 9.7 ± 1.3 to 8.5 ± 1.1 cm. Failures were identified in nine patients (18%). Two revisions and two dislocations were encountered in group A; one revision was performed 4 years after surgery for a patient in group B because of a fracture. One case of lateral compartment osteoarthritis was identified in group A. Two patients in each group reported continuing unexplained pains. CUSUM analysis showed that failure rates diminished rapidly after 16 cases and reached an acceptable rate after 29 cases.ConclusionsMinimally invasive Oxford phase 3 UKA for anteromedial osteoarthritis is a demanding procedure, but satisfactory outcomes can be achieved after approximately 25 cases.

BackgroundThe aim of this prospective study was to evaluate the effectiveness of extracorporeal shock wave therapy (ESWT) in normalizing the symptoms and imaging features of primary bone marrow edema syndrome (BMES) of the knee.MethodsThis study compared the outcomes of ESWT (Group A) (n = 20) and intravenously applied prostacyclin and bisphosphonate (Group B) (n = 20) in the treatment of BMES of the knee in our department between 2011 and 2013. The Visual Analog Scale for pain (VAS, 100 mm), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), the SF-36 scores and MRI scans as well as plain radiographs were obtained before and after therapy between two groups.ResultsCompared with Group B, we found greater improvement in VAS, the WOMAC Osteoarthritis Index and SF-36 score at 1, 3 and 6 months post-treatment in Group A (P < 0.05). Furthermore, MRI scans showed a higher incidence of distinct reduction and complete regression of bone marrow edema at 6 months in Group A (95 vs. 65 %; P = 0.018). The MRI at 1 year follow-up showed complete regression in all patients in Group A. However, two cases in Group B continued to normalize over the subsequent follow-up period.ConclusionsESWT can produce rapid pain relief and functional improvement. It may be an effective, reliable, and non-invasive technique for rapid treatment of BMES of the knee.Trial registrationResearch Registry UIN 528, September 03, 2015.

Acetabular labral injury is closely correlated with femoro-acetabular impingement. Impingement tests and MRA have high sensitivity and accuracy in clinical diagnosis of labral tears. Arthroscopic debridement, repair and osteoplasty for labral tears results in a good early outcome.