Joint-preserving procedures for osteonecrosis of the femoral head

Atilla, Bülent; Bakırcıoğlu, Sancar; Shope, Alexander J.; Parvızı, Javad

doi:10.1302/2058-5241.4.180073

Cited by 61 publications

(44 citation statements)

References 85 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The AI-based nomogram using hybrid variables may potentially assist in decision making during clinical follow-up as patients with early-stage ONFH may benefit from timely interventions ( 44 ). Although the definitive method of treatment for traumatic ONFH remains controversial, certain early interventions have been widely used during post-operative clinical follow-up.…”

Section: Discussionmentioning

confidence: 99%

Deep Learning Improves Osteonecrosis Prediction of Femoral Head After Internal Fixation Using Hybrid Patient and Radiograph Variables

et al. 2020

View full text Add to dashboard Cite

Femoral neck fractures (FNFs) are a great public health problem that leads to a high incidence of death and dysfunction. Osteonecrosis of the femoral head (ONFH) after internal fixation of FNF is a frequently reported complication and a major cause for reoperation. Early intervention can prevent osteonecrosis aggravation at the preliminary stage. However, at present, failure to diagnose asymptomatic ONFH after FNF fixation hinders effective intervention at early stages. The primary objective of this study was to develop a predictive model for postoperative ONFH using deep learning (DL) methods developed using plain X-ray radiographs and hybrid patient variables. A two-center retrospective study of patients who underwent closed reduction and cannulated screw fixation was performed. We trained a convolutional neural network (CNN) model using postoperative pelvic radiographs and the output regressive radiograph variables. A less experienced orthopedic doctor, and an experienced orthopedic doctor also evaluated and diagnosed the patients using postoperative pelvic radiographs. Hybrid nomograms were developed based on patient and radiograph variables to determine predictive performance. A total of 238 patients, including 95 ONFH patients and 143 non-ONFH patients, were included. A CNN model was trained using postoperative radiographs and output radiograph variables. The accuracy of the validation set was 0.873 for the CNN model, and the algorithm achieved an area under the curve (AUC) value of 0.912 for the prediction. The diagnostic and predictive ability of the algorithm was superior to that of the two doctors, based on the postoperative X-rays. The addition of DL-based radiograph variables to the clinical nomogram improved predictive performance, resulting in an AUC of 0.948 (95% CI, 0.920-0.976) and better calibration. The decision curve analysis showed that adding the DL increased the clinical usefulness of the nomogram compared with a clinical approach alone. In conclusion, we constructed a DL facilitated nomogram that incorporated a hybrid of radiograph and patient variables, which can be used to improve the prediction of preoperative osteonecrosis of the femoral head after internal fixation.

show abstract

Section: Discussionmentioning

confidence: 99%

Deep Learning Improves Osteonecrosis Prediction of Femoral Head After Internal Fixation Using Hybrid Patient and Radiograph Variables

et al. 2020

View full text Add to dashboard Cite

show abstract

“… [26] It usually takes 3 to 4 different tunnel bores. [11] When finished, the pin would be removed, followed by a sterile dressing. This treatment would be done only once.…”

Section: Methods and Analysismentioning

confidence: 99%

“…Early identification and treatment of patients with acute pain in the hip and groin area could be helpful in improving the diagnosis. [ 10 11 ] In recent years, extensive research to investigate hip preservation methods related to ONFH has been done; however, there is still limited evidence on this disease. [ 3 4 ]…”

Section: Introductionmentioning

confidence: 99%

“…Despite extensive research on the treatments for the early-stage femoral head necrosis, such as CD with/without graft, bone-marrow implantation, bone grafting with/without vascularization, growth-factor-based treatment, mesenchymal stem cells, and proximal femoral osteotomies, there is still little evidence of treatment in stage I patients, and the optimal joint protection method is still unknown. [11] The clinical efficacy of a monotherapy may be very limited. Based on previous research and clinical practice, we hypothesized:…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Extracorporeal shockwave therapy combined with multiple drilling and intramedullary drug injection for treating early-stage Femur Head Necrosis

Chen

et al. 2020

Medicine

View full text Add to dashboard Cite

Background: Early diagnosis and treatment of the osteonecrosis of the femoral head (ONFH), a refractory disease, is imperative to prevent femoral head collapse; however, the existing solutions remain controversial. This study assessed the safety and efficacy of extracorporeal shock wave therapy (ESWT) combined with multiple drilling and intramedullary drug injection, a novel cocktail therapy, as a randomized controlled trial (RCT) model to postulate an alternative therapy for patients with early-stage ONFH. Methods: Femoral head necrosis patients aged 20 to 60 years with stage ARCO I-II were recruited. One hundred twenty eligible participants were randomized into four groups in a 1:1:1:1 ratio: extracorporeal shock wave therapy combined with multiple drilling and intramedullary drug injection (group EMI), extracorporeal shock wave therapy (group E), multiple drilling combined with intramedullary drug injection (group MI), and multiple drilling (“positive” control group; group M). The primary outcomes included effective rate, subchondral collapse rate of the femoral head, lesion size, and grade of bone marrow edema. Secondary outcomes included the Harris Hip Score and the visual analog scale. All outcomes were measured at the screening visit (baseline) and at the planned time intervals during treatment and follow-up, and the efficacy was statistically analyzed according to the intention-to-treat sub-populations and per-protocol sub-populations. Objectives: To examine the clinical efficacy of ESWT combined with multiple drilling and intramedullary drug injection to provide a safe and more effective method for treating early-stage ONFH. Trial registration number: ChiCTR1900020888; Pre-results.

show abstract

“…Core decompression treatment is a modern treatment strategy, which is much better than any conservative treatment. Core decompression treatment gave satisfactory results of 63.5 % at initial stages of FHN while conventional treatment methods gave only 22.7 % of results [11,12] . Still, the advantages associated with the core decompression method have been ignored [13,14] .…”

Section: Femoral Head Osteonecrosis Treatment Without Using Cellsmentioning

confidence: 97%

Bone Regeneration Therapy of Atraumatic Necrosis of Femoral Head

Zhao¹

2020

pharmaceutical-sciences

View full text Add to dashboard Cite

Zhao et al.: Bone regeneration therapy of femoral head Femoral head necrosis is a mobility disorder and till now no satisfactory solution has been reported. The principal contributing factor in the pathogenesis of the disease is insufficient blood supply to the femoral head resulting in necrosis of the femoral head. Various preventive measures required to treat femoral head necrosis include revascularization, adequate supply of osteogenic cells and establishing enough strength to avoid collapse. Among all, cell transplantation therapy is considered the most favourable treatment strategy for femoral head necrosis. However, the results merely depend on the etiology and the clinical stage of femoral head necrosis. Thus, it is better to make a treatment plan according to the epidemiology, disease status and stage. The main objective of this communication is to study the treatment of femoral head necrosis with cell replacement therapy and also its effects by focusing on the disease stages.

show abstract

Joint-preserving procedures for osteonecrosis of the femoral head

Cited by 61 publications

References 85 publications

Deep Learning Improves Osteonecrosis Prediction of Femoral Head After Internal Fixation Using Hybrid Patient and Radiograph Variables

Deep Learning Improves Osteonecrosis Prediction of Femoral Head After Internal Fixation Using Hybrid Patient and Radiograph Variables

Extracorporeal shockwave therapy combined with multiple drilling and intramedullary drug injection for treating early-stage Femur Head Necrosis

Bone Regeneration Therapy of Atraumatic Necrosis of Femoral Head

Contact Info

Product

Resources

About