Objective To compare the short-term effectiveness between primary cemented and uncemented total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH) after renal transplantation. Methods The clinical data were retrospectively analyzed from 18 patients (21 hips) with ONFH after renal transplantation undergoing cemented THA in 11 cases (13 hips) (cemented group) and uncemented THA in 7 cases (8 hips) (uncemented group) between February 2005 and February 2012. There was no significant difference in gender, age, disease duration, ONFH stage, preoperative Harris score, and bone density between 2 groups (P gt; 0.05). Postoperative complications were observed in 2 groups; the hip function was assessed based on Harris scores; X-ray film was used to observe the prosthetic situation. Results All the wounds healed by first intention. The patients were followed up 6-77 months (mean, 46 months) in the cemented group, and 4-71 months (mean, 42 months) in the uncemented group. Femoral prosthesis infection occurred in 1 case (1 hip) respectively in each group; hip dislocation, femoral prosthesis loosening, and acetabular prosthesis loosening occurred in 1 case (1 hip) of the cemented group, respectively. At last follow-up, the incidences of postoperative complications and revision rate of the cemented group were 30.7% (4/13) and 23.1% (3/13) respectively, which were significantly higher than those of the uncemented group [12.5% (1/8) and 0 (0/8)] (P=0.047, P=0.040). Harris score was significantly increased to 94.1 ± 3.7 in the uncemented group and 90.0 ± 4.2 in the cemented group, showing significant differences compared with the preoperative scores in 2 groups (P lt; 0.05), but there was no significant difference between 2 groups (t=1.815, P=0.062). Postoperative X-ray films showed that the initial position of the prosthesis was satisfactory. At last follow-up, the bone fixation, fibrous stability, and loosening of the femoral prosthesis and loosening of acetabular prosthesis occurred in 9 hips, 3 hips, 1 hip, and 1 hip of the cemented group, respectively; bone fixation of the femoral prosthesis and stability of acetabular prosthesis were observed in all hips of the uncemented group. There was no heterotopic ossification in 2 groups. Conclusion Uncemented THA after renal transplantation can obtain satisfactory short-term effectiveness, and uncemented THA is better than the cemented THA; however, the middle- and long-term effectivenesses need further observation．
Objective To provide the objective basis for the evaluation of the operative results of vascularized greater trochanter bone flap in treating osteonecrosis of the femoral head (ONFH) by three-dimensional gait analysis. Methods Between March 2006 and March 2007, 35 patients with ONFH were treated with vascularized greater trochanter bone flap, and gait analysis was made by using three-dimensional gait analysis system before operation and at 1, 2 years afteroperation. There were 23 males and 12 females, aged 21-52 years (mean, 35.2 years), including 8 cases of steroid-induced, 7 cases of traumatic, 6 cases of alcohol ic, and 14 cases of idiopathic ONFH. The left side was involved in 15 cases, and right side in 20 cases. According to Association Research Circulation Osseous (ARCO) classification, all patients were diagnosed as having femoral-head necrosis at stage III. Preoperative Harris hip functional score (HHS) was 56.2 ± 5.6. The disease duration was 1.5-18.6 years (mean, 5.2 years). Results All incisions healed at stage I without early postoperative compl ications of deep vein thrombosis and infections of incision. Thirty-five patients were followed up 2-3 years with an average of 2.5 years. At 2 years after operation, the HHS score was 85.8 ± 4.1, showing significant difference when compared with the preoperative score (t=23.200, P=0.000). Before operation, patients showed a hip muscles gait, short gait, reduce pain gait, and the pathological gaits significantly improved at 1 year after operation. At 1 year and 2 years after operation, step frequency, pace, step length and hip flexion, hip extension, knee flexion, ankle flexion were significantly improved (P lt; 0.01). Acceleration-time curves showed that negative wave and spinous wave at acceleration-stance phase of front feet and hind feet in affected l imb were obviously reduced at 1 year and 2 years after operation. Postoperative petronas wave appeared at swing phase; the preoperative situation was three normal phase waves. Conclusion These results suggest that three-dimensional gait analysis before and after vascularized greater trochanter for ONFH can evaluate precisely hip vitodynamics variation.
Objective To compare the efficiency of secondary total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH) after failed internal fixation of femoral neck fracture and the primary THA for non-traumatic ONFH and to evaluate if the two groups have significant difference. Methods From June 2004 to July 2007, 203 cases of ONFH were treated by THA. In group A, 83 patients (83 hips) with ONFH after failed internal fixation included 56 males (56 hips) and 27 females (27 hips) with an average age of 58.3 years (range 45-75 years). According to Ficat classification, there were 61 cases atstage III and 22 cases at stage IV. The Harris score was 37.6 ± 2.0. The disease course was 1-6 years with an average of 2.6 years. In group B, 120 patients (167 hips) with non-traumatic ONFH included 67 males (94 hips) and 53 females (73 hips) with an average age of 52.6 years (range 41-67 years). According to Ficat classification, there were 56 cases (83 hips) at stage III and 64 cases (84 hips) at stage IV. The Harris score was 38.2±1.0. The disease course was 1.5-5.0 years with an average of 2.6 years. There were no significant differences in general data between two groups (P gt; 0.05). Results All 203 cases were followed up for 2 to 5 years (average 3.4 years). There were no significant differences in the operation time of single-hip, the blood loss, the blood transfusion between two groups (P gt; 0.05). Intraoperative fractures occurred in 4 hips (4.8%) of group A and 2 hips (1.2%) of group B, showing significant difference (P lt; 0.05). There were no significant differences (P gt; 0.05) in the incidence of dislocation [3 hips (3.6%) in group A and 1 hip (0.6%) in group B], continuous femoral pain [2 hips (2.4%) in group A and 1 hip (0.6%) in group B] and infection [1 hip (0.6%) in group B] between two groups. There were no significant differences (P gt; 0.05) in acetabular abduction, anteversion, femoral anteversion, and combined anteversion angles as well as the recovery rate of acetabular rotational center between two groups. The Harris scores of groups A and B after 2 years were 79.4 ± 2.1 and 84.2 ± 3.5.There was no significant difference between two groups (P gt; 0.05). The Harris score postoperation had significant differences compared with preoperation (P lt; 0.05). Conclusion Compared to the primary THA to non-traumatic ONFH, secondary THA to ONFH after failed internal fixation has no significant increase in operative difficulty, the postoperative hip function isgood, but the incidence of intraoperative fracture is higher.
Objective To evaluate the short-term cl inical outcomes of metal-on-metal total hi p resurfacing arthroplasty in treating osteonecrosis of the femoral head (ONFH) in young and middle-aged patients and to compare with patients of hip osteoarthritis at the same period. Methods From July 2006 to October 2008, 33 patients (45 hips) with ONFH (ONFH group) and 39 patients (45 hips) with osteoarthritis (osteoarthritis group) were treated with metal-on-metal total hipresurfacing arthroplasty. In ONFH group, there were 18 males (27 hips) and 15 females (18 hips) with an average age of 42.7 years (range 19-58 years), including 22 left hips and 23 right hips. The causes were trauma (4 cases), glucocorticoid (25 cases), drugs (2 cases), alcohol (1 case), and psoriasis (1 case). According to Steinberg classification, there were 10 hips at stage III, 18 hips at stage IV a, 13 hips at stage IV b, and 4 hips at stage IV c. The Harris score was 52.0 ± 4.6. The disease course was 1-12 years. In osteoarthritis group, there were 26 males (30 hips) and 13 females (15 hips) with an average age of 47.1 years (range 42-65 years), including 17 left hips and 28 right hips. The causes were degenerative arthritis (23 cases), trauma (11 cases), and ankylosing spondyl itis (5 cases). The Harris score was 57.0 ± 3.8. The disease course was 3-17 years. There were no significant differences in general data between two groups (P gt; 0.05). Results All incisions achieved heal ing by first intention without compl ications of infection and thrombosis of deep vein of lower extremities. The patients were followed up for 26 months in ONFH group and 28 months in osteoarthritis group. Femoral neck fracture occurred in 1 case of osteoarthritis group after 4 months, who received total hip arthroplasty; no compl ication of prosthesis loosening, dislocation, incision infection, osteonecrosis, and bone absorption occurred in other patients. At last follow-up, the Harris scores were 93.0 ± 5.5 in ONFH group and 94.0 ± 2.4 in osteoarthritis group, showing no significant difference between two groups (P gt; 0.05); but there were significant differences between pre- and post-operation (P lt; 0.01). Conclusion The cl inical short-term outcomes ofmetal-on-metal total hip resurfacing arthroplasty to treat ONFH are satisfactory. It can achieve similar outcomes to that ofosteoarthritis group. More cases and long-term follow-up are needed to investigate long-term cl inical outcomes.
Objective To study the effect of core decompression combining with autologous cortical sustaining bone and cancellous bone graft in treating osteonecrosis of the femoral head (ONFH). Methods From February 2004 to May 2008, 64 patients (77 hi ps) with ONFH were treated with core decompression combining with autologous cortical sustaining bone and cancellous bone graft, including 45 males and 19 females and aging 23 to 60 years with an average age of 43 years. There were 51 cases of unilateral ONFH and 13 cases of bilateral ONFH. ONFH was caused by alcohol in 39 cases(47 hi ps), by steroid in 21 cases (26 hi ps), and by trauma in 4 cases (4 hi ps). The disease course was 1-12 years. The pain time was 2-14 months (average 7 months). All the cases underwent imageology and postoperation pathology examination to confirm the diagnosis of ONFH. According to Association Research Circulation Osseous (ARCO) international classification of osteonecrosis, 17 cases (23 hips) were classified as stage I A, 2 cases (3 hips) as stage I B, 21 cases (24 hips) as stage II A, 2 cases (2 hips) as stage II B, 4 cases (4 hips) as stage II C, and 18 cases (21 hips) as stage III A. The outcome was evaluated both cl inically by Harris score and radiologically by imageology. Results A total of 59 cases (69 hips) were followed up for 12-62 months with an average of 32.1 months. The Harris score was 87.12 ± 8.68 at 12 months after operation, showing significant difference (P lt; 0.05) when compared with the preoperative one (68.38 ± 14.49). The results were excellent in 39 hips, good in 18 hips, fair in 6 hips, and poor in 6 hip; and the excellent and good rate was 82.6%. Radiographic evaluation was 21 hips (30.4%) of grade I, 42 hips (60.9%) of grade II, and 6 hips (8.7%) of grade III. One case had the compl ication of il ium bone donor site, 21 cases had l ittle pain or numbness, and the other cases had no uncomfortable compl ication. Conclusion The method of core decompression combining with autologous cortical sustaining bone and cancellous bone graft can improve the means of bone grafts, prevent the collapse of the femoral head, and is less traumatic than common procedures. Cl inical effects are obvious and effective.
Objective To explore the relationship between alcohol induced osteonecrosis of the femoral head (ONFH) and the single nucleotide polymorphisms (SNP) of methylene tetrahydrofolate reductase (MTHFR) 677 C/T. Methods From July 2005 to May 2008, eighty-nine male patients with alcohol induced ONFH were selected as the patient group, aged from 24 to58 years old (mean 44.3 years old). The time of drinking was about 17 years, 375 mL/day. The imaging evidence showed ONFH with no other history associated to ONFH. Seventy-seven male healthy adults were selected as the control group, aged from 23 to 52 years old (mean 42.7 years old). The time of drinking was about 14 years, 335 mL/day. The imaging evidence showed no ONFH. The 2 mL blood sample was acquired from every subject. DNA was purified from leucocyte at first, then was ampl icated by PCR, the product of PCR was sequenced at last. The SNP of MTHFR 677 C/T was analyzed with SPSS 12.0 software package. Results The TT genotype and T allele frequencies of MTHFR 677 C/T were 27.2% and 52.0% (P gt; 0.05) in the control group, and the distribution of genotype was consistent with Hardy-Weinberg equil ibrium. The genotype frequencies of CC, CT and TT were 23.4% (18 cases), 49.4% (38 cases) and 27.2% (21 cases) in the control group, were 14.6% (13 cases), 36.0% (32 cases) and 49.4% (44 cases) in the patient group; showing statistically significant differences (P lt; 0.05). The allele frequencies of C and T were 48.0% (74) and 52.0% (80) in the control group, and were 32.6% (58) and 67.4% (120) in the patient group; showing statistically significant differences (P lt; 0.05). The frequencies of C, T alleles and TT genotype were higher in the patient group than in the control group, showing statistically significant differences (P lt; 0.05). The odds ratios were 0.523, 1.914 and 2.607, respectively; the 95% confidence interval were 0.335-0.816, 1.226-2.987, 1.359-5.001, respectively. Conclusion The relationship may exist between the SNP of MTHFR 677 C/T and alcohol induced ONFH.
【Abstract】 Objective To explore the midterm efficacy of superelastic cage implantation for the treatment of osteonecrosisof femoral head (ONFH). Methods From July 1996 to January 1998, 54 patients (75 hips) of ONFH were treatedwith superelastic cage and followed up. Among 54 patients, 5 patients were lost to follow up and 3 patients were dead of myocardialinfarction, renal failure and gastric cancer, respectively. Forty-six patients completed follow up including 32 males and14 females, aged from 21 to 61 with an average of 39 years old. Twenty-nine hips were classified as Ficat Stage Ⅱ and 36 as StageⅢ . Harris score was 58.20 ± 13.82. All patients were evaluated both cl inically and radiographically. Results Postoperatively,forty-six patients (65 hips) were followed up for 86 to 125 months with an average of 8 years and 8 months. Harris score was 80.78 ± 18.77. Twenty-nine hips were rated excellent, 21 good, 2 fair and 13 poor．A total of 76.9% of overall cl inical results were rated as good or excellent. Eight hips (12.3%) with the cage broken were turned to total hip replacement. Radiographicevaluation: 16 hips (24.6%) rated as grade Ⅰ , 34 (52.3%) grade Ⅱ and 15 (23.1%) grade Ⅲ . Conclusion Superelastic cage implantation is one of alternative treatments for ONFH at early and midterm stages. However, long-term follow-up is needed to know whether it is able to cure ONFH and whether cages will be broken as time passes by.
Objective To explore the differences between transient osteoporosis of the hi p (TOH) and bone marrow edema (BME) associated with osteonecrosis of the femoral head (ONFH) in terms of cl inical practice and imaging. Methods From January 2006 to February 2008, 5 hips of TOH in 5 cases (1 male and 4 females, aged 29-42 years) and 67 hips of BME associated with ONFH in 63 cases (53 males and 10 females, aged 18-70 years) were analyzed. According to ARCO classification, there were 23 hi ps of stage II, 43 hi ps of stage III, and 1 hi p of stage IV. The induced factors, the degree of pain, the duration of pain and commemorative symptoms were compared. The X-ray, MRI and ECT were also compared. Results There were no differences in induced factors, the degree of pain, joint effusion and ECT between TOH and BME associated with ONFH. TOH had no risk factors, antecedent symptoms and commemorative pain. There were 2 hips with TOH which showed osteopenia on X-ray films. The location of edema was in the superior part or the whole femoral head.A total of 65 hips with BME associated with ONFH had related causes of disease, 10 had antecedent pain and 59 had change of hardening on X-ray films. The X-ray films showed sclerotic area and the edema changes on MRI surrounded the necrotic lesion. The pain just amel iorated when BME disappeared. Conclusion There are differences between TOH and BME associated with ONFH on symptoms, X-ray films and MRI.
Objective To retrospectively analyze the cl inical effect of l ightbulb operation with nano-hydroxyapatite/ collagen in a consecutive series of patients with osteonecrosis of the femoral head (ONFH). Methods From January 2001to July 2005, 26 patients (35 hips) were treated, 16 males and 10 females, aged 19-54 years old (33.5 on average). The course of disease was 12-36 months (18 months on average). Based on the etiology, 15 cases (22 hips) were steroid induced type, 10 (12 hips) were alcohol induced type and the other one (1 hip ) was idiopathic type. According to the system of Association Research Circulation Osseous (ARCO), there were 6 hi ps of stage IIB, 16 hi ps of stage IIC, 9 hi ps of stage IIIA, 3 hi ps of stage IIIB and 1 hip of stage IIIC. The Harris score was 62.2 ± 7.5. All the patients who had undergone l ightbulb operation with nano-hydroxyapatite/collagen were evaluated both cl inically and radiographically. The bone graft mixture rate of nanohydroxyapatite/ collagen and autogenous bone was 1 ∶ 1, and the mixed bone graft was 6 times of the scraped osteonecrosis volume (30-48 mL). Results The incisions of all 26 patients (35 hi ps) obtained heal ing by first intention. The 2 cases, which got lateral femoral cutaneous nerve injury during the operation, recovered 3-6 months after the operation without any treatment. Another 2 cases got heterotopic ossification 3 months after operation, with no special treatment. All the 26 patients (35 hips) were followed up for 2-7 years (3.5 on average). The patients’ bone heal ing began from the 3rd month after operation. The postoperative Harris score was 85.1 ± 16.2, and there was significant difference compared with the preoperative one (P lt; 0.001). There were 15 hips of excellent, 11 of good, 5 of fair, and 4 of poor which received total hip arthroplasty at the end of the follow-up. According to imaging, 5 hips were progressed from preoperative IIC to IIIA, while the other hips were radiologically stable, with no progress of ONFH. Conclusion Lightbulb operation with nano-hydroxyapatite/collagen provides a surgical treatment to treat early ONFH with satisfactory cl inical outcomes. Nano-hydroxyapatite/collagen is beneficial for the repair and reconstruction of ONFH and suitable for femoral-head-preserving operation for the patients with ONFH of stage II.
Objective To investigate the expression levels of osteoprotegerin (OPG) and receptor activator of NF-κB l igand (RANKL) mRNAs in bone tissues of the femoral head of the patients suffering glucocorticoid-induced osteonecrosisof the femoral head (ONFH), and to discuss the relationship between OPG/RANKL and ONFH. Methods Between March2007 and March 2008, bone tissues of the femoral head were collected as the experimental material from 35 patients suffering ONFH (experimental group) and from 21 patients suffering fracture of femoral neck (control group). The ratio of men to women in both groups was 4 ∶ 3, whose age was 41-70 years old (55.34 on average in the experimental group and 55.33 on average in the control group). The experimental group received over 3 weeks’ glucocorticoid treatment or more than 1 week’ s high-dose glucocorticoid treatment in recent 2 years, while the control group never received more than 1 week’s hormone treatment. In the two groups, the microstructure of bone tissues of the femoral head was detected by HE staining and the bone tissue total RNA was extracted, and then the expression levels of OPG mRNA and RANKL mRNA were examined by realtime quantitative PCR (RTQ-PCR) for each sample. Results HE staining: bone trabeculae and bone units were replaced by interrupted bone fragments, which were surrounded by many inflammatory granulation tissues and few osteocytes were seen in bone lacunae in the experimental group. In the control group, bone trabeculae and bone units were made by complete lamellar bones which surrounded blood vessels and osteocytes were seen in lacunae. RTQ-PCR testing: in the experimental group, OPG mRNA and RANKL mRNA were 1.35 ± 0.42 and 4.36 ± 1.35, respectively, while in the control group they were 1.78 ± 0.63 and 3.49 ± 1.02, respectively. The expression level of OPG mRNA in the experimental group was significantly lower than that in the control group, and the expression level of RANKL mRNA of the former was significantly higher than the latter. The OPG mRNA/ RANKL mRNA ratio in the xperiment group (0.34 ± 0.16) was significantly lower than that in the control group (0.54 ± 0.20), and there was significant difference (P lt; 0.05). Conclusion The glucocorticoid-induced ONFH may be related to the expression levels of OPG mRNA/RANKL mRNA in bone tissues.