Which Factors Influence Preservation of the Osteonecrotic Femoral Head?

Lieberman, Jay R.; Engstrom, Stephen M.; Meneghini, R. Michael; SooHoo, Nelson F.

doi:10.1007/s11999-011-2050-4

Cited by 144 publications

(122 citation statements)

References 56 publications

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“…However, all of them were based on MRI of the hip joints and/or plain radiographs. [6][7][8][9][10][11] Owing to the difference in lesion location, heterogeneous morphology and irregular border, we think the percentage or the angle of necrotic areas that were measured from the centre plane of the femoral head or the maximum lesion plane only partially reflected the lesion size. With the development of computer software, we can now distinguish and delineate the lesion border on MR and CT images, calculate the necrotic lesion volume as well as the percentage of the femoral head with necrosis.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have found that lesion size and location are important factors of femoral head collapse. [6][7][8][9] Although there were several methods introduced to identify the lesion location and measure the lesion size, all of them were based on MR images and/or X-ray plain films. 8,9,13,14 So far, no study has reported the feasibility and accuracy of using CT to measure the size of ONFH lesions.…”

Section: Discussionmentioning

confidence: 99%

“…6 Therefore, being able to accurately predict the risk of femoral head collapse according to the disease severity and to take appropriate therapeutic measures are critical to preserve the hip joint and improve the prognosis of ONFH. 7 Studies have shown that the size and location of necrotic lesions are major factors associated with femoral head collapse. [6][7][8][9] Although various approaches have been reported to illustrate the lesion location and size, all were based on MRI and/or radiographs.…”

Section: Advances In Knowledgementioning

confidence: 99%

“…[6][7][8][9] Although various approaches have been reported to illustrate the lesion location and size, all were based on MRI and/or radiographs. [6][7][8][9][10][11] As a main imaging modality for diagnosis of ONFH, CT can clearly display ONFH that is in Association Research Circulation Osseous (ARCO) stage II or above. Multislice CT can achieve isotropic resolution.…”

Section: Advances In Knowledgementioning

confidence: 99%

“…7 Studies have shown that the size and location of necrotic lesions are major factors associated with femoral head collapse.…”

mentioning

confidence: 99%

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Osteonecrosis of the femoral head: using CT, MRI and gross specimen to characterize the location, shape and size of the lesion

Hu¹,

Huang²,

Wei³

et al. 2015

BJR

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of the femoral head: using CT, MRI and gross specimen to characterize the location, shape and size of the lesion. Br J Radiol 2015;88:20140508. FULL PAPER Osteonecrosis of the femoral head: using CT, MRI and gross specimen to characterize the location, shape and size of the lesion The results were compared with findings from coronal sectional gross specimens. Two radiologists independently measured the volume of necrotic lesions from CT and MR images using computer software, and the results were averaged. The volume of specimens' necrotic lesion was measured using the water displacement method.Results: There was a high degree of consistency between CT, MRI and the coronal sectional gross specimen on the location, shape and spatial structure of lesions.Differences of the lesion volume measured from CT and MR images were not statistically significant between two radiologists. The necrotic lesion volumes measured from CT and MR images and gross specimens were 22.07 6 5. Osteonecrosis of the femoral head (ONFH) is a common disease of the hip joint. If untreated, 80% of patients with ONFH will suffer the collapse of femoral head articular surface in a few years of disease progression.1 Once the femoral head collapses, osteoarthritis becomes inevitable and function of the hip joint will be seriously affected, which eventually will lead to artificial joint replacement. 2,3Although hip replacement is an effective approach to relieve pain and improve hip function in the short term, its long-term performance remains unsatisfactory.4,5 Furthermore, non-traumatic ONFH typically occurs in young adults and involves both hips. On the other hand, not all ONFH will progress to femoral head collapse.6 Therefore, being able to accurately predict the risk of femoral head collapse according to the disease severity and to take appropriate therapeutic measures are critical to preserve the hip joint and improve the prognosis of ONFH. 7 Studies have shown that the size and location of necrotic lesions are major factors associated with femoral head collapse.6-9 Although various approaches have been reported to illustrate the lesion location and size, all were based on MRI and/or radiographs.6-11 As a main imaging modality for diagnosis of ONFH, CT can clearly display ONFH that is in Association Research Circulation Osseous (ARCO) stage II or above. Multislice CT can achieve isotropic resolution. Volume data acquired from axial scans can be used to reconstruct in any direction to observe lesions. But so far, there has been no study that reports the feasibility and accuracy of using CT to measure the size of ONFH lesions. We hypothesized that CT and MRI could achieve highly consistent results in illustrating the size, shape and location of ONFH lesions in ARCO stage II and above, and both methods can be used to assess the risk of necrotic femoral head collapse.The objectives of this study are (1) to investigate the accuracy of using CT to capture the size, location, shape and spatial structural relationship of the necrotic lesion by com...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Advances In Knowledgementioning

confidence: 99%

Section: Advances In Knowledgementioning

confidence: 99%

“…7 Studies have shown that the size and location of necrotic lesions are major factors associated with femoral head collapse.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Osteonecrosis of the femoral head: using CT, MRI and gross specimen to characterize the location, shape and size of the lesion

Hu¹,

Huang²,

Wei³

et al. 2015

BJR

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Bone tissue engineering for treating osteonecrosis of the femoral head

Bian

et al. 2023

Exploration

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Osteonecrosis of the femoral head (ONFH) is a devastating and complicated disease with an unclear etiology. Femoral head-preserving surgeries have been devoted to delaying and hindering the collapse of the femoral head since their introduction in the last century. However, the isolated femoral head-preserving surgeries cannot prevent the natural progression of ONFH, and the combination of autogenous or allogeneic bone grafting often leads to many undesired complications. To tackle this dilemma, bone tissue engineering has been widely developed to compensate for the deficiencies of these surgeries. During the last decades, great progress has been made in ingenious bone tissue engineering for ONFH treatment. Herein, we comprehensively summarize the state-of-the-art progress made in bone tissue engineering for ONFH treatment. The definition, classification, etiology, diagnosis, and current treatments of ONFH are first described. Then, the recent progress in the development of various bone-repairing biomaterials, including bioceramics, natural polymers, synthetic polymers, and metals, for treating ONFH is presented. Thereafter, regenerative therapies for ONFH treatment are also discussed. Finally, we give some personal insights on the current challenges of these therapeutic strategies in the clinic and the future development of bone tissue engineering for ONFH treatment. K E Y WO R D S biomaterials, bone tissue engineering, osteonecrosis of the femoral head, regenerative therapy  Yixin Bian and Tingting Hu contributed equally to this work.

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Preclinical models for studying corticosteroid‐induced osteonecrosis of the femoral head

Tsubosaka,

Maruyama,

Lui

et al. 2023

J Biomed Mater Res

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Nontraumatic osteonecrosis of the femoral head (ONFH) is a refractory condition that commonly results in femoral head collapse and degenerative arthritis of the hip. In the early stages, surgical procedures for hip preservation, including core decompression (CD), have been developed to prevent progressive collapse of the femoral head. Optimization of bone regeneration and biological augmentation may further enhance the therapeutic efficacy of CD for ONFH. Thus, combining CD with cell‐based therapy has recently been proposed. In fact, patients treated with cell‐based therapy using autologous bone marrow concentrate demonstrate improved survivorship of the femoral head, compared with conventional CD alone. Preclinical research studies to investigate adjunctive therapies for CD often utilize the rabbit model of corticosteroid‐induced ONFH. Mesenchymal stem cells (MSCs) are known to promote osteogenesis and angiogenesis, and decrease inflammation in bone. Local drug delivery systems have the potential to achieve targeted therapeutic effects by precisely controlling the drug release rate. Scaffolds can provide an osteoconductive structural framework to facilitate the repair of osteonecrotic bone tissue. We focused on the combination of both cell‐based and scaffold‐based therapies for bone tissue regeneration in ONFH. We hypothesized that combining CD and osteoconductive scaffolds would provide mechanical strength and structural cell guidance; and that combining CD and genetically modified (GM) MSCs to express relevant cytokines, chemokines, and growth factors would promote bone tissue repair. We developed GM MSCs that overexpress the anti‐inflammatory, pro‐reconstructive cytokines platelet‐derived growth factor‐BB to provide MSCs with additional benefits and investigated the efficacy of combinations of these GM MSCs and scaffolds for treatment of ONFH in skeletally mature male New Zealand white rabbits. In the future, the long‐term safety, efficacy, durability, and cost‐effectiveness of these and other biological and mechanical treatments must be demonstrated for the patients affected by ONFH.

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Which Factors Influence Preservation of the Osteonecrotic Femoral Head?

Cited by 144 publications

References 56 publications

Osteonecrosis of the femoral head: using CT, MRI and gross specimen to characterize the location, shape and size of the lesion

Osteonecrosis of the femoral head: using CT, MRI and gross specimen to characterize the location, shape and size of the lesion

Bone tissue engineering for treating osteonecrosis of the femoral head

Preclinical models for studying corticosteroid‐induced osteonecrosis of the femoral head

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