Osteonecrosis of the femoral head: Part 2— Options for treatment

Parsons, Sarah; Steele, Niall

doi:10.1016/j.cuor.2008.07.009

Cited by 12 publications

(15 citation statements)

References 37 publications

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“…ESWT in ARCO stages I–III may help to prevent progression of the area of avascular necrosis, manage pain, improve the function of hip, 9 – 13 and even completely heal the early lesion. 7 Moreover, ESWT seemed to be more effective than core decompression and nonvascularized fibular grafting, which are two usual treatments for the early stages of osteonecrosis of the femoral head. 5 The exact mechanisms of the ESWT benefits in AVNFH remain unknown, although it is thought that shock waves may cause an increase in neovascularization and the expression of angiogenesis-related growth factors, in addition to bone remodeling and regeneration.…”

Section: Discussionmentioning

confidence: 99%

“… 26 – 28 On the basis of previously mentioned several good effects on clinical symptoms, imaging, and molecular biology in early-stage AVNFH, the authors speculate that ESWT is possible effective for advanced AVNFH. Most of the existing studies on AVNFH used focused shock waves broadcast by electromagnetic 6 or electrohydraulic 5 , 7 , 8 , 11 – 13 shock wave generators, which are generally used in conjunction with general or regional anesthesia and under radiographic guidance. What’s more, the location of some arteries and nerves should be located with an ultrasound Doppler scan to avoid any direct shock wave contact.…”

Section: Discussionmentioning

confidence: 99%

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Radial Extracorporeal Shock Wave Therapy in a Person With Advanced Osteonecrosis of the Femoral Head

Wen

Jiang²,

Zhang³

et al. 2016

American Journal of Physical Medicine &Amp; Rehabilitation

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Radial Extracorporeal Shock Wave Therapy in a Person With Advanced Osteonecrosis of the Femoral Head

Wen

Jiang²,

Zhang³

et al. 2016

American Journal of Physical Medicine &Amp; Rehabilitation

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“…However, it must be noted that the patients in the control group were administrated bisphosphonates, which may reduce the risk of developing ON to some degree. 4 , 26 , 28…”

Section: Discussionmentioning

confidence: 99%

“…However, concerns have been raised due to the potential for core decompression to weaken the cancellous bone within and adjacent to the necrotic zones. 4 With respect to joint replacement surgeries, approximately 10 000 to 20 000 new cases of ON are diagnosed in the United States every year, and it is estimated that 5% to 12% of total hip arthroplasties are performed every year in order to treat this disease. 1 , 2 …”

Section: Introductionmentioning

confidence: 99%

The efficacy of statins in preventing glucocorticoid-related osteonecrosis in animal models

Yang

Liu

et al. 2016

Bone & Joint Research

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ObjectivesThe primary purpose of this meta-analysis was to determine whether statin usage could reduce the risk of glucocorticoid-related osteonecrosis in animal models.MethodsA systematic literature search up to May 2015 was carried out using the PubMed, Ovid, EBM reviews, ISI Web of Science, EBSCO, CBM, CNKI databases with the term and boolean operators: statins and osteonecrosis in all fields. Risk ratio (RR), as the risk estimate of specific outcome, was calculated along with 95% confidence intervals (CI). The methodological quality of individual studies was assessed using a quantitative tool based on the updated Stroke Therapy Academic Industry Roundtable (STAIR) recommendations.ResultsA total of 11 eligible studies were included according to predetermined criteria. The pooled data demonstrated that animals with statin usage, either alone or combined with other treatments, were at a decreased risk of developing glucocorticoid-related osteonecrosis (RR = 2.06, 95% confidence interval (CI) 1.71 to 2.50). Moreover, subgroup analysis revealed that compared with statins alone, statins combined with other treatments significantly decreased the risk of osteonecrosis (RR = 1.23, 95% CI 1.02 to 1.47). However, we could find no significant risk difference for different gender, or for different time points.ConclusionsThe present study suggests that statins combined with other treatments are efficient in preventing the development of glucocorticoid-related osteonecrosis in animals. These results might shed light on clinical practice when glucocorticoids are prescribed, and could be further investigated in high-quality clinical trials.Cite this article: Z. Yang, H. Liu, D. Li, X. Xie, T. Qin, J. Ma, P. Kang. The efficacy of statins in preventing glucocorticoid-related osteonecrosis in animal models: A meta-analysis. Bone Joint Res 2016;5:393–402. DOI: 10.1302/2046-3758.59.2000500.

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“…These methods only work in the early stage, asymptomatic ONFH, but show limited success in preventing disease progression ( Table 2 ) [5] , [20] . Restricted weight bearing cannot be recommended as a routine treatment, however, such therapies may have a role for patients with very limited disease or those not fit for further surgery [21] , [22] . Other conservative treatments, including the use of pharmacological agents (such as lipid-lowering drugs, anticoagulants, vasodilators, traditional Chinese medicines, and bisphosphonates) and various noninvasive biophysical modalities (such as electromagnetic stimulation, extracorporeal shock-wave therapy, and hyperbaric oxygen) are advised for supplemental treatment of this disease [7] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] .…”

Section: Current Treatment Options For Onfhmentioning

confidence: 99%

Review of various treatment options and potential therapies for osteonecrosis of the femoral head

Cao

Guan

Lai

et al. 2016

Journal of Orthopaedic Translation

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SummarySize and location of the lesion, subchondral collapse occurrence, and articular cartilage involvement are general disease progression criteria for direct osteonecrosis of the femoral head (ONFH) classifications. Treatment options for ONFH are usually based on individual factors and lesion characteristics. Although spontaneous repair of ONFH occurs in some cases, untreated ONFH is unlikely to escape the fate of subchondral collapse and usually ends up with total hip arthroplasty. Operations to preserve the femoral head, e.g., core decompression and bone grafting, are usually recommended in younger patients. They are helpful to relieve pain and improve function in the affected femoral head without subchondral collapse, however, poor prognosis after surgical procedures remains the major problem for ONFH. Pharmacological and physical therapies only work in the early stage of ONFH and have also been recommended as a supplement or prevention treatment for osteonecrosis. Following advances in basic science, many new insights focus on bone tissue engineering to optimize therapies and facilitate prognosis of ONFH. In this review, disease classifications, current treatment options, potential therapies, and the relevant translational barriers are reviewed in the context of clinical application and preclinical exploration, which would provide guidance for preferable treatment options and translation into novel therapies.

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Osteonecrosis of the femoral head: Part 2— Options for treatment

Cited by 12 publications

References 37 publications

Radial Extracorporeal Shock Wave Therapy in a Person With Advanced Osteonecrosis of the Femoral Head

Radial Extracorporeal Shock Wave Therapy in a Person With Advanced Osteonecrosis of the Femoral Head

The efficacy of statins in preventing glucocorticoid-related osteonecrosis in animal models

Review of various treatment options and potential therapies for osteonecrosis of the femoral head

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