APPLICATION OF AN UMBRELLA-SHAPED MEMORY ALLOY FEMORAL HEAD SUPPORT DEVICE FOR MINIMALLY INVASIVE TREATMENT OF AVASCULAR NECROSIS OF FEMORAL HEAD_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DUDongpeng , XINGJuan ,  JIANGWenxiong , PANQi , MENGYongzhi , MAMing , FANXinjian

Department of Orthopaedics, the First Hospital of Chinese PLA, Orthopaedic Center of Lanzhou Military Command, Lanzhou Gansu, 730030, P. R. China;

Corresponding author：

JIANGWenxiong, Email: 13919121061@163.com

Keywords：

Avascular necrosis of femoral head; Umbrella-shaped memory alloy femoral head support device; Minimally invasive treatment

DOI：

10.7507/1002-1892.20140096

Video：

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Objective To investigate the technique and short-term effectiveness of the umbrella-shaped memory alloy femoral head support device (umbrella-shaped support device for short) for the treatment of avascular necrosis of femoral head (ANFH). Methods The umbrella-shaped support device was fabricated with Ni-Ti alloy, and its biomechanics characteristics were tested by three-dimensional finite element analysis with pro/mechanica software. Between October 2009 and December 2012, 10 patients (18 hips) with ANFH were treated. There were 7 males (12 hips) and 3 females (6 hips), aged 21-53 years (mean, 40.6 years). The disease duration was 1-5 years (mean, 3.3 years). According to Ficat staged criteria, 10 hips were rated as stage Ⅱ, 6 hips as stage Ⅲ, and 2 hips as stage IV. Microtrauma methods were used to erase the necrotic tissue of the femoral head, and the umbrella-shaped support device, autogenous iliac bone graft, and artificial bone were implanted to support the collapsed femoral head. Results Three-dimensional finite element analysis showed that the largest stress of umbrella-shaped support device was 1 500 MPa and the largest displacement was 1.75 mm. Operation was successfully completed in the other 10 patients (17 hips) except 1 failure hip (total hip arthroplasty was performed after 6 months). The average follow-up period was 19.7 months (range, 15-26 months). At last follow-up, the results were excellent in 5 hips, good in 9 hips, fair in 2 hips, and poor in 1 hip; the excellent and good rate was 82.35%. The Ficat stage had no change when compared with preoperative stages. Conclusion The advantages of the umbrella-shaped support device for the treatment of ANFH are to thoroughly remove the sequestrum, to rebuild blood circulation of the femoral head, to increase the machinery supporting of subchondral bone in weight-bearing area of femoral head, and to decrease the localized stress, and it has good short-term effectiveness, but long-term effectiveness needs further observation.

Citation： DUDongpeng, XINGJuan, JIANGWenxiong, PANQi, MENGYongzhi, MAMing, FANXinjian. APPLICATION OF AN UMBRELLA-SHAPED MEMORY ALLOY FEMORAL HEAD SUPPORT DEVICE FOR MINIMALLY INVASIVE TREATMENT OF AVASCULAR NECROSIS OF FEMORAL HEAD. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(4): 423-427. doi: 10.7507/1002-1892.20140096 Copy

1.	Civinini R, De Biase P, Carulli C, et al. The use of an injectable calcium sulphate/calcium phosphate bioceramic in the treatment of osteonecrosis of the femoral head. Int Orthop, 2012, 36(8):1583-1588.
2.	Park SS, Kim HK. Subchondral fracture after ischemic osteonecrosis of the immature femoral head in piglet model. J Pediatr Orthop B, 2011, 20(4):227-231.
3.	Erken HY, Ofluoglu O, Aktas M, et al. Effect of pentoxifylline on histopathological changes in steroid-induced osteonecrosis of femoral head:experimental study in chicken. Int Orthop, 2012, 36(7):1523-1528.
4.	Tanzer M, Bobyn JD, Krygier JJ, et al. Histopathologic retrieval analysis of clinically failed porous tantalum osteonecrosis implants. J Bone Joint Surg (Am), 2008, 90(6):1282-1289.
5.	Floerkemeier T, Lutz A, Nackenhorst U, et al. Core decompression and osteonecrosis intervention rod in osteonecrosis of the femoral head:clinical outcome and finite element analysis. Int Orthop, 2011, 35(10):1461-1466.
6.	Stronach BM, Duke JN, Rozensweig SD, et al. Subtrochanteric femur fracture after core decompression and placement of a tantalum strut for osteonecrosis of the femoral head. J Arthroplasty, 2010, 25(7):1168. e5-7.
7.	Floerkemeier T, Thorey F, Daentzer D, et al. Clinical and radiological outcome of the treatment of osteonecrosis of the femoral head using the osteonecrosis intervention implant. Int Orthop, 2011, 35(4):489-495.
8.	Jones LC, Hungerford DS. Osteonecrosis:etiology, diagnosis and treatment. Curr Opin Rheumatol, 2004, 16(4):443-449.
9.	Gao YS, Zhang CQ. Cytotherapy of osteonecrosis of the femoral head:a mini review. Int Orthop, 2010, 34(6):779-782.
10.	Brown TD, Way ME, Ferguson AB Jr. Mechanical characteristics of bone in femoral capital aseptic necrosis. Clin Orthop Relat Res, 1981, (156):240-247.
11.	Razik F, Alexopoulos AS, El-Osta B, et al. Time to internal fixation of femoral neck fractures in patients under sixty years-does this matter in the development of osteonecrosis of femoral head? Int Orthop, 2012, 36(10):2127-2132.
12.	Wang BL, Sun W, Shi ZC, et al. Treatment of nontraumatic osteonecrosis of the femoral head using bone impaction grafting through a femoral neck window. Int Orthop, 2010, 34(5):635-639.
13.	佟刚, 赵鉴非, 戴军, 等. 多孔重建钽棒内固定治疗早期股骨头坏死疗效观察与分析. 中国骨与关节损伤杂志, 2012, 27(10):882-884.
14.	Yoshioka T, Mishima H, Akaogi H, et al. Concentrated autologous bone marrow aspirate transplantation treatment for corticosteroid-induced osteonecrosis of the femoral head in systemic lupus erythematosus. Int Orthop, 2011, 35(6):823-829.
15.	梅荣成, 杨述华, 杨操, 等. 钛合金支撑架结合自体骨和DBM 治疗股骨头坏死. 中国矫形外科杂志, 2006, 14(7):509-511.
16.	Liu G, Wang J, Yang S, et al. Effect of a porous tantalum rod on early and intermediate stages of necrosis of the femoral head. Biomed Mater, 2010, 5(6):065003.
17.	Varitimidis SE, Dimitroulias AP, Karachalios TS, et al. Outcome after tantalum rod implantation for treatment of femoral head osteonecrosis:26 hips followed for an average of 3 years. Acta Orthop, 2009, 80(1):20-25.
18.	王岩, 赵德伟, 王继芳, 等. 镍-钛记忆合金网球治疗成人股骨头缺血性坏死初步报告. 中华外科杂志, 1998, 36(10):579-581.
19.	Amstutz HC, Le Duff MJ. Cementing the metaphseal stem in metal-on-metal resurfacing:when and why. Clin Orthop Relat Res, 2009, 467(1):79-83.
20.	Radcliffe IA, Taylor M. Investigation into the affect of cementing techniques on load transfer in the resurfaced femoral head:a multi-femur finite element analysis. Clin Biomech (Bristol, Avon), 2007, 22(4):422-430.
21.	McLardy-Smith P, Steffen RT, Pandit H, et al. Metal-on-metal hip resurfacing:America, where are you? Orthopedics, 2006, 29(9):795-796.
22.	Ueo T, Tsutsumi S, Yamauro T, et al. Biomechanical aspects of the development of aseptic necrosis of the femoral head. Arch Orthop Trauma Surg, 1985, 104(3):145-152.
23.	Kim YM, Lee SH, Lee FY, et al. Morphologic and biomechanical study of avascular necrosis of the femoral head. Orhopedics, 1991, 14(10):1111-1116.
24.	王金熙, 董天华, 陈贤志, 等. 实验性股骨头缺血性坏死修复过程的生物力学研究. 中华外科杂志, 1993, 31(6):374-377, T041.
25.	胡彤宇, 李建衡. 死骨刮除打压植骨治疗股骨头坏死的临床分析. 河北医药, 2007, 29(12):1331-1332.
26.	王红建, 姜星明, 李卫国, 等. 头颈部开窗个体化病灶清除打压植骨治疗股骨头缺血性坏死体会. 河南外科学杂志, 2011, 17(3):5-7.

1. Civinini R, De Biase P, Carulli C, et al. The use of an injectable calcium sulphate/calcium phosphate bioceramic in the treatment of osteonecrosis of the femoral head. Int Orthop, 2012, 36(8):1583-1588.
2. Park SS, Kim HK. Subchondral fracture after ischemic osteonecrosis of the immature femoral head in piglet model. J Pediatr Orthop B, 2011, 20(4):227-231.
3. Erken HY, Ofluoglu O, Aktas M, et al. Effect of pentoxifylline on histopathological changes in steroid-induced osteonecrosis of femoral head:experimental study in chicken. Int Orthop, 2012, 36(7):1523-1528.
4. Tanzer M, Bobyn JD, Krygier JJ, et al. Histopathologic retrieval analysis of clinically failed porous tantalum osteonecrosis implants. J Bone Joint Surg (Am), 2008, 90(6):1282-1289.
5. Floerkemeier T, Lutz A, Nackenhorst U, et al. Core decompression and osteonecrosis intervention rod in osteonecrosis of the femoral head:clinical outcome and finite element analysis. Int Orthop, 2011, 35(10):1461-1466.
6. Stronach BM, Duke JN, Rozensweig SD, et al. Subtrochanteric femur fracture after core decompression and placement of a tantalum strut for osteonecrosis of the femoral head. J Arthroplasty, 2010, 25(7):1168. e5-7.
7. Floerkemeier T, Thorey F, Daentzer D, et al. Clinical and radiological outcome of the treatment of osteonecrosis of the femoral head using the osteonecrosis intervention implant. Int Orthop, 2011, 35(4):489-495.
8. Jones LC, Hungerford DS. Osteonecrosis:etiology, diagnosis and treatment. Curr Opin Rheumatol, 2004, 16(4):443-449.
9. Gao YS, Zhang CQ. Cytotherapy of osteonecrosis of the femoral head:a mini review. Int Orthop, 2010, 34(6):779-782.
10. Brown TD, Way ME, Ferguson AB Jr. Mechanical characteristics of bone in femoral capital aseptic necrosis. Clin Orthop Relat Res, 1981, (156):240-247.
11. Razik F, Alexopoulos AS, El-Osta B, et al. Time to internal fixation of femoral neck fractures in patients under sixty years-does this matter in the development of osteonecrosis of femoral head? Int Orthop, 2012, 36(10):2127-2132.
12. Wang BL, Sun W, Shi ZC, et al. Treatment of nontraumatic osteonecrosis of the femoral head using bone impaction grafting through a femoral neck window. Int Orthop, 2010, 34(5):635-639.
13. 佟刚, 赵鉴非, 戴军, 等. 多孔重建钽棒内固定治疗早期股骨头坏死疗效观察与分析. 中国骨与关节损伤杂志, 2012, 27(10):882-884.
14. Yoshioka T, Mishima H, Akaogi H, et al. Concentrated autologous bone marrow aspirate transplantation treatment for corticosteroid-induced osteonecrosis of the femoral head in systemic lupus erythematosus. Int Orthop, 2011, 35(6):823-829.
15. 梅荣成, 杨述华, 杨操, 等. 钛合金支撑架结合自体骨和DBM 治疗股骨头坏死. 中国矫形外科杂志, 2006, 14(7):509-511.
16. Liu G, Wang J, Yang S, et al. Effect of a porous tantalum rod on early and intermediate stages of necrosis of the femoral head. Biomed Mater, 2010, 5(6):065003.
17. Varitimidis SE, Dimitroulias AP, Karachalios TS, et al. Outcome after tantalum rod implantation for treatment of femoral head osteonecrosis:26 hips followed for an average of 3 years. Acta Orthop, 2009, 80(1):20-25.
18. 王岩, 赵德伟, 王继芳, 等. 镍-钛记忆合金网球治疗成人股骨头缺血性坏死初步报告. 中华外科杂志, 1998, 36(10):579-581.
19. Amstutz HC, Le Duff MJ. Cementing the metaphseal stem in metal-on-metal resurfacing:when and why. Clin Orthop Relat Res, 2009, 467(1):79-83.
20. Radcliffe IA, Taylor M. Investigation into the affect of cementing techniques on load transfer in the resurfaced femoral head:a multi-femur finite element analysis. Clin Biomech (Bristol, Avon), 2007, 22(4):422-430.
21. McLardy-Smith P, Steffen RT, Pandit H, et al. Metal-on-metal hip resurfacing:America, where are you? Orthopedics, 2006, 29(9):795-796.
22. Ueo T, Tsutsumi S, Yamauro T, et al. Biomechanical aspects of the development of aseptic necrosis of the femoral head. Arch Orthop Trauma Surg, 1985, 104(3):145-152.
23. Kim YM, Lee SH, Lee FY, et al. Morphologic and biomechanical study of avascular necrosis of the femoral head. Orhopedics, 1991, 14(10):1111-1116.
24. 王金熙, 董天华, 陈贤志, 等. 实验性股骨头缺血性坏死修复过程的生物力学研究. 中华外科杂志, 1993, 31(6):374-377, T041.
25. 胡彤宇, 李建衡. 死骨刮除打压植骨治疗股骨头坏死的临床分析. 河北医药, 2007, 29(12):1331-1332.
26. 王红建, 姜星明, 李卫国, 等. 头颈部开窗个体化病灶清除打压植骨治疗股骨头缺血性坏死体会. 河南外科学杂志, 2011, 17(3):5-7.

Chinese Journal of Reparative and Reconstructive Surgery

APPLICATION OF AN UMBRELLA-SHAPED MEMORY ALLOY FEMORAL HEAD SUPPORT DEVICE FOR MINIMALLY INVASIVE TREATMENT OF AVASCULAR NECROSIS OF FEMORAL HEAD

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