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Glucocorticoids-induced osteonecrosis of femoral head (GIONFH) is difficult to treat due to the pathophysiology remains uncertain. Core decompression and bone grafting are regarded as effective measures for treating early GIONFH. Furthermore, commonly used bone graft materials at nowadays are still unsatisfactory. We generated a novel calcium polyphosphate (CPP) composite scaffold, which contains Li and VEGF-loaded gelatin microspheres (LiCPP/GMs/VEGF). The LiCPP/GMs/VEGF scaffold also demonstrated a porosity of 70.5% ± 2.3% with interconnected porous structures, and pore sizes of 100–200 μm and compressive strength of 3.7 MPa. Additionally, bone marrow mesenchymal stem cells (BMSCs) were seeded on scaffolds in vitro. Further characterization showed that the LiCPP/GMs/VEGF scaffolds were biocompatible and enhanced osteogenesis and angiogenesis in vitro. Using a rabbit model of GIONFH, LiCPP/GMs/VEGF scaffolds were implanted into the bone tunnels of core decompression in the femoral head for 12 weeks. Radiographic, histological analysis and western blot analysis demonstrated that the LiCPP/GMs/VEGF scaffolds exhibited good biocompatibility, and osteogenic and angiogenic activity in vivo. Besides, the osteogenic and angiogenic factors were increased along with VEGF release and the activation of factors in Wnt signal pathway. In conclusion, the LiCPP/GMs/VEGF scaffold has an effect on improving the osteogenesis and angiogenesis, which benefited to repair the GIONFH.

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BackgroundTotal hip arthroplasty for adult patients with a history of infection of the hip in childhood could be a more technically demanding procedure due to complicated anatomy and the possibility of reinfection. Here, we conducted a mid-term analysis of clinical outcomes in such patients after primary cementless total hip arthroplasty (THA).MethodsWe reviewed 101 patients (101 hips; 51 men; mean age, 52.3 years) who underwent cementless THA between 2008 and 2015, at a mean of 24 years (range, 11–43) since the resolution of childhood hip infection. Patients were followed up for a mean of 6.1 years (range, 2.1–9.6). Clinical outcomes and quality of life after THA were assessed at final follow-up.ResultsNo cases of infection were reported during the follow-up, and patients showed significant improvement in Harris Hip Score, for which the mean score increased from 48.5 to 90 points; the modified Merle d’Aubigne and Postel (MAP) Hip Score; the Hip Dysfunction and Osteoarthritis Outcome Score; the SF-12; and mean limb length discrepancy, which decreased from 3.4 to 1.1 cm. During follow-up, four cases of prosthesis dislocation, three of transient sciatic paralysis, seven of femoral fracture, five of heterotopic ossification, and 19 of osteolysis were recorded. Revision surgery was performed for two patients, one for isolated loosening of the acetabular component and another for loosening of the femoral stem.ConclusionCementless THA can effectively treat patients with a quiescent period of infection of the hip of more than 10 years, resulting in good functional outcomes and fewer complications. Risk of infection recurrence after THA in these patients seems extremely low.