The Role of Structural Deterioration and Biomechanical Changes of the Necrotic Lesion in Collapse Mechanism of Osteonecrosis of the Femoral Head

Wang, Peng; Wang, Cheng; Meng, Hui; Liu, Guangbo; Huo, Li; Gao, Jianming; Tian, Hua; Peng, Jiang

doi:10.1111/os.13277

Cited by 17 publications

(26 citation statements)

References 108 publications

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“…ONFH causes the collapse of the femoral head with severe pain and limited mobility[ 24 ]. Hip pain and functional limitations are the typical clinical manifestations of this condition[ 25 ]. Therefore, symptom alleviation and recovery of hip joint function are essential in determining the effectiveness of short-term treatment 1 .…”

Section: Discussionmentioning

confidence: 99%

Effects of individual shock wave therapy vs celecoxib on hip pain caused by femoral head necrosis

Zhu¹,

Yan²,

Xiao³

et al. 2023

World J Clin Cases

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BACKGROUND Celecoxib has been used to treat hip discomfort and functional difficulties associated with osteonecrosis of the femoral head (ONFH), although significant adverse reactions often follow long-term use. Extracorporeal shock wave therapy (ESWT) can delay the progression of ONFH, alleviate the pain and functional limitations it causes, and avoid the adverse effects of celecoxib. AIM To investigate the effects of individual ESWT, a treatment alternative to the use of celecoxib, in alleviating pain and dysfunction caused by ONFH. METHODS This was a randomized, controlled, double-blinded, non-inferiority trial. We examined 80 patients for eligibility in this study; 8 patients were excluded based on inclusion and exclusion criteria. A total of 72 subjects with ONFH were randomly assigned to group A ( n = 36; celecoxib + alendronate + sham-placebo shock wave) or group B ( n = 36; individual focused shock wave [ESWT based on magnetic resonance imaging three-dimensional (MRI-3D) reconstruction] + alendronate). The outcomes were assessed at baseline, at the end of treatment, and at an 8-wk follow-up. The primary outcome measure was treatment efficiency after 2 wk of intervention using the Harris hip score (HHS) (improvement of 10 points or more from the baseline was deemed sufficient). Secondary outcome measures were post-treatment HHS, visual analog scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. RESULTS After treatment, the pain treatment efficiency of group B was greater than that of group A (69% vs 51%; 95%CI: 4.56% to 40.56%), with non-inferiority thresholds of -4.56% and -10%, respectively. Furthermore, the HHS, WOMAC, and VAS scores in group B dramatically improved during the follow-up period as compared to those in group A ( P < 0.001). After therapy, the VAS and WOMAC in group A were significantly improved from the 2 nd to 8 th wk ( P < 0.001), although HHS was only significantly altered at the 2 wk point ( P < 0.001). On the 1 st d and 2 nd wk after treatment, HHS and VAS scores were different between groups, with the difference in HHS lasting until week 4. Neither group had severe complications such as skin ulcer infection or lower limb motor-sensory disturbance. CONCLUSION Individual shock wave therapy (ESWT) based on MRI-3D reconstruction was not inferior to celecoxib in managing hip pain and restrictions associated with ONFH.

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Section: Discussionmentioning

confidence: 99%

Effects of individual shock wave therapy vs celecoxib on hip pain caused by femoral head necrosis

Zhu¹,

Yan²,

Xiao³

et al. 2023

World J Clin Cases

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“…The revised version mainly focused on analysis of CT image findings, because of the sensitivity to various fracture types, which is important for distinguishing ARCO stages 2 and 3 26 . The revised version mentions that fractures in osteonecrosis range from subchondral fracture to fracture in necrotic portion 2,10 . Histologic analysis studies of these various fractures are frequent, 27–31 but CT studies are limited 18 .…”

Section: Discussionmentioning

confidence: 99%

“…Osteonecrosis of the femoral head (ONFH) is a pathologic state that leads to progressive femoral head collapse and subsequent arthritis 1 . Osteonecrosis of the femoral head is either traumatic or nontraumatic; traumatic ONFH is caused by femoral neck fracture, and nontraumatic ONFH has several etiologies including alcohol consumption and excessive glucocorticoid use, which occurs frequently in young and physically active populations 2,3 . For this reason, total hip arthroplasty (THA) has a higher revision rate in nontraumatic ONFH than in traumatic ONFH or primary hip osteoarthritis 4,5 .…”

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confidence: 99%

“…For this reason, total hip arthroplasty (THA) has a higher revision rate in nontraumatic ONFH than in traumatic ONFH or primary hip osteoarthritis 4,5 . To preserve the patients' own hip joint and delay THA, detection of early stage of ONFH is important for a successful joint preservation 2 . Osteonecrosis of the femoral head in the pericollapse stage (from the appearance of subchondral fracture to the early collapse [<2 mm]) can be treated with joint-preserving surgery.…”

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confidence: 99%

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What Is New in Stage 3 of the 2019 Revised Association Research Circulation Osseous Staging System of Osteonecrosis of the Femoral Head: A Relationship to Bone Resorption

Bae,

Lee,

Kim

et al. 2023

J Comput Assist Tomogr

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The aim of the study is to evaluate the stage 3 findings of the 2019 revision of the Association Research Circulation Osseous (ARCO) staging system for osteonecrosis of the femoral head between 3A and 3B and the relationship with bone resorption area. Materials and Methods:We retrospectively enrolled 87 patients with ARCO stage 3 osteonecrosis of the femoral head, divided into stage 3A (n = 73) and 3B (n = 14). The revised stage 3 findings included subchondral fracture, fracture in necrotic portion, and flattening of the femoral head and were compared between stage 3A and 3B. The association between these findings and the causative features of bone resorption area was also evaluated.Results: All stage 3 cases had subchondral fractures. In stage 3A, these fractures were generated by crescent sign (41.1%) and by fibrovascular reparative zone in 58.9%; however, in stage 3B, fibrovascular reparative zone generated 92.9% of these fractures and crescent sign only 7.1% with statistical significance (P = 0.034). Necrotic portion fracture was noted in 36.7% and femoral head flattening was observed in 14.9% of all stage 3. Necrotic portion fracture (92.9% vs 26.0%) and femoral head flattening (71.4% vs 4.1%) were observed more frequently in stage 3B than 3A (P < 0.001). Almost all subchondral fractures by fibrovascular reparative zone (96.4%) and necrotic portion fracture (96.9%), and all femoral head flattening was presented with bone resorption area with expanding areas. Conclusions:The ARCO stage 3 descriptions reflect severity in this order: subchondral fracture, necrotic portion fracture, and femoral head flattening. More severe findings are usually associated with expanding bone resorption areas.

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“…Osteonecrosis of the femoral head (ONFH) is a progressive degenerative disorder of the hip 1 . Trabecular bone within necrotic lesions is thin, dispersed, fractured, and accompanied by release of inflammatory factors and alterations in the microenvironment 2 . ONFH causes a large socioeconomic burden, typically affecting young to middle-aged adults.…”

Section: Introductionmentioning

confidence: 99%

The potential effect of BMSCs with miR‐27a in improving steroid-induced osteonecrosis of the femoral head

Cui

Huang

Zhang

et al. 2022

Sci Rep

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Steroid induced osteonecrosis of the femoral head (ONFH) frequently leads to femoral head collapse and subsequent hip arthritis. This study aimed to investigate the potential therapeutic mechanism of miR‐27a on steroid-induced ONFH. Levels of IL-6, TNF-α, miR-27a, Runx2, PPAR-γ and ApoA5 were first examined in bone marrow tissues from steroid-induced ONFH and controls. Subsequently, we overexpressed or knocked down miR-27a in bone marrow mesenchymal stem cells (BMSCs) and detected cell proliferation, osteogenic differentiation, adipogenic differentiation. In addition, miR-27a mimics and BMSCs were injected into the established steroid-induced ONFH rats, and the osteoprotective effects of both were evaluated. Dual luciferase reporter was used to test the targeting effect of miR-27a-3p and PPARG. miR-27a and Runx2 were lowly expressed in steroid-induced ONFH, PPAR-γ and ApoA5 were highly expressed. Overexpression of miR-27a in BMSCs promoted cell proliferation and osteogenic differentiation, inhibited adipogenic differentiation. Furthermore, increasing miR-27a and BMSCs obviously reduced bone loss in steroid induced ONFH rats. The expressions of Runx2 in BMSCs and steroid-induced ONFH rats was significantly up‐regulated, while IL-6, TNF-α, PPAR-γ and ApoA5 were down‐regulated with miR-27a overexpression. Additionally, PPARG was the target of miR-27a-3p. The results of the present study reveal a role for miR-27a in promoting osteogenesis and may have a synergistic effect with BMSCs.

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The Role of Structural Deterioration and Biomechanical Changes of the Necrotic Lesion in Collapse Mechanism of Osteonecrosis of the Femoral Head

Cited by 17 publications

References 108 publications

Effects of individual shock wave therapy vs celecoxib on hip pain caused by femoral head necrosis

Effects of individual shock wave therapy vs celecoxib on hip pain caused by femoral head necrosis

What Is New in Stage 3 of the 2019 Revised Association Research Circulation Osseous Staging System of Osteonecrosis of the Femoral Head: A Relationship to Bone Resorption

The potential effect of BMSCs with miR‐27a in improving steroid-induced osteonecrosis of the femoral head

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