Efficacy of alendronate in the treatment of avascular necrosis of the hip

Desai, Mohan M; Sonone, Sandeep; Bhasme, Virendra K

doi:10.1093/rheumatology/kei003

Cited by 18 publications

(4 citation statements)

References 6 publications

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“…The benefits of non‐operative treatment methods are controversially discussed in literature. Restricted weight bearing and treatment with pharmacological agents, such as lipid‐lowering drugs, vasodilators, anticoagulants and bisphosphonates, may be useful in the early stages of AVN (Agarwala et al ., , ; Desai et al ., ; Disch et al ., ; Lai et al ., ; Meizer et al ., ; Mont et al ., ). However, in a review of 21 studies, 819 non‐operatively treated hips with AVN demonstrated a success rate of only 23% (Mont et al ., ).…”

Section: Introductionmentioning

confidence: 99%

Advanced core decompression, a new treatment option of avascular necrosis of the femoral head - a first follow-up

Landgraeber

Theysohn

Claßen

et al. 2012

J Tissue Eng Regen Med

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Aseptic necrosis of the femoral head (AVN) leads to destruction of the affected hip joint, predominantly in younger patients. Advanced core decompression (ACD) is a new technique that may allow better removal of the necrotic tissue by using a new percutaneous expandable reamer. A further modification is the refilling of the drill hole and the defect with an injectable, hard-setting, composite calcium sulphate (CaSO₄)-calcium phosphate (CaPO₄) bone graft substitute. Compression tests were performed on seven pairs of femoral cadaver bones. One femur of each pair was treated with ACD, while the opposite side remained untreated. Clinically, the postoperative outcome of 27 hips in 23 patients was performed by physical examination 6 weeks after ACD and at average follow-up of 9.69 months, and compared with the preoperative results. MRI was used to assess the removal of the necrotic tissue, any possible progression of AVN and evaluation of collapse. In the biomechanical analysis, the applied maximum compression force that caused the fracture did not significantly differ from the untreated opposite side. The overall results of postoperative physical examinations were significantly better than preoperatively. Five hips (18.5%) were converted to a total hip replacement. The follow-up MRIs of the other patients showed no progression of the necrotic area. The first follow-up results of ACD have been encouraging for the early stages of aseptic necrosis of the femoral head. In our opinion, an assured advantage is the high stability of the femoral neck after ACD, which allows quick rehabilitation.

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Section: Introductionmentioning

confidence: 99%

Advanced core decompression, a new treatment option of avascular necrosis of the femoral head - a first follow-up

Landgraeber

Theysohn

Claßen

et al. 2012

J Tissue Eng Regen Med

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“…They include restricted weight-bearing [11], lipid-lowering agents [12,13], anticoagulants [14], vasodilators [15,16], bisphosphonates [17-19], shock-wave therapy [20], and application of pulsed electromagnetic fields [21,22]. The results of joint-preserving procedures are, however, less satisfactory than the results with total hip arthroplasty.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a pig femoral head osteonecrosis model

et al. 2010

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BackgroundA 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.MethodsAvascular 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.ResultsAn 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.ConclusionOptical 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 pathogenetic alterations in the necrotic femoral head. Our pig model can be used for further femoral head osteonecrosis studies.

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“…It has been suggested that these precipitations might positively impact necrosis and angiogenesis and multiple studies demonstrated its therapeutic potential on AVNFH 13) . Specifically, it was reported that ESWT may improve function of and pain around affected parts and reduce the severity of osteonecrosis 21 22) . In line with these studies, the present work demonstrated that significant relief of pain was achieved by therapy over time.…”

Section: Discussionmentioning

confidence: 99%

“…There are several non-invasive therapies for the treatment of AVNFH in addition to ESWT; in one report, Desai et al 22) show that alendronate may suppress osteoclasts to delay bone resorption hence preventing the early collapse of femoral heads. In another study, Levin et al 27) demonstrated that hyperbaric oxygen reduces the ranges of femoral head necrosis in rats.…”

Section: Discussionmentioning

confidence: 99%

Osteonecrosis of Femoral Head Treated with Extracorporeal Shock Wave Therapy: Analysis of Short-term Clinical Outcomes of Treatment with Radiologic Staging

et al. 2015

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PurposeTo evaluate clinical results of extracorporeal shock wave therapy (ESWT) with radiographic staging on patients with avascular necrosis of femoral head (AVNFH).Materials and MethodsWe evaluated 24 patients diagnosed with AVNFH (32 hip joints) who were treated with ESWT from 1993 to 2012. Average follow-up period was 27 months, and the average age of patients was 47.8 years. The Association Research Circulation Osseous (ARCO) system was used to grade radiographic stage prior to treatment. For this study patients were divided into two groups based on their ARCO stage, group 1 (ARCO stages I and II) and group 2 (ARCO stage III). Comparative analyses were done between the two groups using the visual analogue scale (VAS) score and the Harris hip score (HHS) at pre-treatment and 3, 6, 12, and 24 months after treatment. Failure was defined when radiographic stage progressed or arthroplasty surgery was needed due to clinical exacerbation.ResultsBoth groups showed clinical improvements with VAS scoring at final follow-up (group 1: median 7 to 1.5, P<0.001; group 2: mean 7 to 4, P=0.056). Using HHS, group 1 showed a significant improvement (from 65.5 to 95 [P<0.001]), while no significance was observed for group 2 (P=0.280). At final follow-up, 3 hips from group 1 and one hip from group 2 showed radiographic improvement; however, two patients underwent total hip arthroplasty due to persistent pain and dysfunction.ConclusionESWT can be considered as an interventional option before surgical treatment in patients with not only early stage AVNFH but also with mid stage.

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Efficacy of alendronate in the treatment of avascular necrosis of the hip

Cited by 18 publications

References 6 publications

Advanced core decompression, a new treatment option of avascular necrosis of the femoral head - a first follow-up

Advanced core decompression, a new treatment option of avascular necrosis of the femoral head - a first follow-up

Evaluation of a pig femoral head osteonecrosis model

Osteonecrosis of Femoral Head Treated with Extracorporeal Shock Wave Therapy: Analysis of Short-term Clinical Outcomes of Treatment with Radiologic Staging

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