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Introduction: HIV is widely prevalent in all regions of the world. The use of antiretroviral drugs has dramatically reduced the mortality rate of HIV-related diseases, but correspondingly increased the incidence of chronic complications in HIV-positive people. Related studies have found that the incidence of osteonecrosis of the femoral head is higher in HIV-positive people, but the co-occurrence of femoral head necrosis, acetabular necrosis and hip joint dislocation in HIV-positive patients is rare. Methods: We report a 50-year-old man with a 15-month history of progressively worsening right hip pain with movement restriction. According to the CT findings of the other hospital, the patient was admitted to the hospital with femoral head necrosis. After the admission, the relevant X-ray, CT and MRI examinations showed that the right femoral head collapsed and deformed, with the surrounding bone sclerosis, bone fragments, loose body of the joint, right hip subluxation, acetabular marginal osteogeny, and local microcystic degeneration. The left femoral head was in good shape, and cystic degeneration can be seen under the articular surface. The patient was finally diagnosed with femoral head necrosis and acetabular necrosis combined with hip subluxation. Results: The pain of the patient was significantly relieved after the operation, and the patient was discharged from the hospital one week after the start of treatment to continue rehabilitation training. During the follow-up one month after the operation, the self-reported pain disappeared completely, and the limitation of activity was significantly improved. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical value of whole Eucommia capsules in the postoperative application of cannulated screw fixation for Garden Ⅲ-Ⅳ femoral neck fractures. Methods A prospective study was conducted on 110 patients with Garden Ⅲ-Ⅳ femoral neck fractures who received cannulated screw fixation from June 2020 to June 2022. The patients were randomly divided into two groups, each with 55 patients: the observation group received whole Eucommia capsules postoperatively, while the control group received conventional treatment for 6 months. Postoperative evaluations included reduction grade, incidences of internal fixation failure, fracture nonunion, and femoral head necrosis. Harris scores were assessed before and after treatment, and serum levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and cysteine-aspartic acid protease-3 (Caspase-3) were measured. Results Four patients (2 due to non-compliance with medication, 2 lost to follow-up) withdrew from the observation group, and four patients (1 due to non-compliance with medication, 3 lost to follow-up) withdrew from the control group. There were no statistically significant differences between the two groups in reduction grade, internal fixation failure rate, or fracture nonunion rate (P＞0.05). Significant differences were observed in Harris scores and femoral head necrosis rates (P＜0.05), with the observation group showing higher Harris scores and lower femoral head necrosis rates than the control group. After treatment, the observation group showed increased levels of VEGF and bFGF and decreased levels of Caspase-3 compared to pre-treatment (P＜0.05), while the control group showed no significant changes in serum indicators (P＞0.05). Conclusion Postoperative treatment with whole Eucommia capsules after cannulated screw fixation for Garden Ⅲ-Ⅳ femoral neck fractures is beneficial for improving joint function and preventing femoral head necrosis. The mechanism may be related to the upregulation of VEGF and bFGF and the downregulation of Caspase-3. [ABSTRACT FROM AUTHOR]

The pathogenesis of orthopedic diseases is intimately linked to blood stasis, frequently arising from damage to primary and secondary blood channels. This disruption can lead to "blood leaving the meridians" or Qi stagnation, resulting in blood stasis syndrome. Taohong Siwu Decoction (THSWD) is a renowned classical Chinese medicinal formula extensively used to promote blood circulation and mitigate blood stasis. Clinical studies have demonstrated its significant therapeutic effects on various orthopedic conditions, particularly its anti-inflammatory and analgesic properties, as well as its efficacy in preventing deep vein thrombosis post-surgery. Despite these findings, research on THSWD remains fragmented, and its interdisciplinary impact is limited. This review aims to provide a comprehensive evaluation of the efficacy and pharmacological mechanisms of THSWD in treating common orthopedic diseases. Additionally, we employ bibliometric analysis to explore research trends and hotspots related to THSWD. We hope this review will enhance the recognition and application of THSWD in orthopedic treatments and guide future research into its pharmacological mechanisms. [ABSTRACT FROM AUTHOR]

Abstract Introduction HIV is widely prevalent in all regions of the world. The use of antiretroviral drugs has dramatically reduced the mortality rate of HIV-related diseases, but correspondingly increased the incidence of chronic complications in HIV-positive people. Related studies have found that the incidence of osteonecrosis of the femoral head is higher in HIV-positive people, but the co-occurrence of femoral head necrosis, acetabular necrosis and hip joint dislocation in HIV-positive patients is rare. Methods We report a 50-year-old man with a 15-month history of progressively worsening right hip pain with movement restriction. According to the CT findings of the other hospital, the patient was admitted to the hospital with femoral head necrosis. After the admission, the relevant X-ray, CT and MRI examinations showed that the right femoral head collapsed and deformed, with the surrounding bone sclerosis, bone fragments, loose body of the joint, right hip subluxation, acetabular marginal osteogeny, and local microcystic degeneration. The left femoral head was in good shape, and cystic degeneration can be seen under the articular surface. The patient was finally diagnosed with femoral head necrosis and acetabular necrosis combined with hip subluxation. Results The pain of the patient was significantly relieved after the operation, and the patient was discharged from the hospital one week after the start of treatment to continue rehabilitation training. During the follow-up one month after the operation, the self-reported pain disappeared completely, and the limitation of activity was significantly improved.

BACKGROUND: The gluteus medius not only abducts the hip joint, but also plays an important role in limiting the external movement of the femoral head. At present, there is a lack of research on the correlation between gluteus medius status and non-traumatic femoral head necrosis. OBJECTIVE: To investigate the relationship between the gluteus medius width ratio and the medial space ratio of the hip joint and the progression of nontraumatic femoral head necrosis, and to explore the effect of gluteus medius atrophy on the surface and necrotic zone stress of the femoral head necrosis through finite element analysis. METHODS: Retrospective analysis of unilateral non-traumatic femoral head necrosis patients admitted to Third Affiliated Hospital of Guangzhou University of Chinese Medicine was performed. All patients were followed up for an average of more than 2 years. They were divided into a collapsed group and a noncollapsed group based on whether there was collapse of the femoral head during the follow-up. Medial space ratio, gluteus medius width ratio, Sharp angle, gluteus medius length ratio, and gluteus medius activation angle were measured and calculated. The differences in these indicators were compared between the two groups. At the first visit and follow-up at 3, 6, 12, and 24 months, the medial space ratio and gluteus medius width ratio were measured and calculated to explore the changes of these two indicators in the course of non-traumatic femoral head necrosis. In addition, using three-dimensional finite element analysis, a Japanese Investigation Committee classification C1 type femoral head necrosis model was constructed based on CT data. At the same time, based on MRI data, a model of the gluteus medius muscle was constructed and divided into a gluteus medius muscle atrophy group (gluteus medius width ratio: 74%- 76%) and a gluteus medius muscle normal group (gluteus medius width ratio: 94%-96%). Each group constructed 10 models, with 6 degrees of freedom of the distal femur constrained to zero. 600 N pressures were applied along the Z-axis to the upper surface of the sacrum. The stress distribution, maximum stress values on the surface and necrotic area of the femoral head, and the maximum displacement of the necrotic area were compared between two groups of models. RESULTS AND CONCLUSION: (1) A total of 153 patients (67 males and 86 females) with 153 hips were included in this study. (2) At the 24-hour follow-up, the medial space ratio of the collapsed group was significantly higher than that of the non-collapsed group (P < 0.05). The gluteus medius width ratio of the collapsed group was significantly lower than that of the non-collapsed group (P < 0.05). There was no statistically significant difference in Sharp angle, gluteus medius activation angle, and gluteus medius length ratio between the two groups (P > 0.05). (3) Since the follow-up time exceeded 3 months, the gluteus medius width ratio of the collapsed group was lower than that of the non-collapsed group (P < 0.05). Since the follow-up time exceeded 12 months, the medial space ratio of the collapsed group was higher than that of the non-collapsed group (P < 0.05). (4) Pearson correlation analysis showed a significant positive correlation between follow-up time and medial space ratio in the collapsed group (P < 0.05), and a significant negative correlation between follow-up time and gluteus medius width ratio (P < 0.05). The regression coefficient of gluteus medius width ratio was larger than that of medial space ratio. (5) The group with middle gluteal muscle atrophy showed significant stress concentration on the surface of the femoral head, and the stress zone was significantly located on the outside. The maximum stress on the surface of the femoral head in the group with middle gluteal muscle atrophy was significantly greater than that in the group with normal middle gluteal muscle (P < 0.05). There was significant stress concentration in the necrotic area of the middle gluteal muscle atrophy group, and the maximum stress was located at the edge of the necrotic area. The maximum stress and maximum displacement in the necrotic area of the middle gluteal muscle atrophy group were significantly greater than those of the normal group (P < 0.05). (6) It is indicated that gluteus medius width ratio is an effective indicator for evaluating changes in gluteal muscle atrophy. In the progression of non-traumatic femoral head necrosis, atrophy of the gluteus medius muscle first occurs, followed by widening of the medial hip joint space. The mechanical mechanism may be that the atrophy of the gluteus medius muscle affects the stability of the hip joint, leading to external displacement of the femoral head, and increasing stress and displacement on the surface and necrotic area of the femoral head. [ABSTRACT FROM AUTHOR]

BACKGROUND: Exosomes are vesicle-like structures secreted by cells into extracellular compartments in the form of cytosol, which contain a large amount of microRNAs with important intercellular communication roles. MicroRNAs in exosomes rely on exosome transport and are able to enter target cells to exert important biological regulatory effects. In common bone and joint diseases, abnormal or damaged bone metabolism releases a large number of exosomes, while some exosome-derived microRNAs also promote the progression of osteoarthritis. Therefore, exosome-derived microRNAs are closely related to the skeletal system and are important for the development as well as diagnosis and treatment of many osteoarticular diseases. OBJECTIVE: To review the research progress of exosome-derived microRNAs in bone metabolism and bone and joint diseases. METHODS: Using “exosomes, extracellular vesicle, microRNA, miRNA, bone, bone diseases, bone formation, bone regeneration, bone resorption, bone destruction” as Chinese and English search terms, articles were searched on CNKI, Metasys, and PubMed databases. Finally, 86 articles were included for summarization. RESULTS AND CONCLUSION: Exosome-derived microRNAs can regulate bone metabolism by affecting bone formation and bone resorption, and are closely related to the development of bone and joint diseases such as fracture healing, osteoporosis, osteoarthritis, rheumatoid arthritis, osteonecrosis of the femoral head, and osteosarcoma. Exosome-derived microRNAs will be an effective means of diagnosis and treatment of certain bone and joint diseases in the future. However, the current research on exosome-derived microRNAs in osteoarthritic diseases is limited, and more explorations and researches are still needed to diagnose and treat osteoarthritic diseases using exosome-derived microRNAs. [ABSTRACT FROM AUTHOR]

Abstract Femoral head necrosis (FHN) is a serious complication after femoral neck fractures (FNF), often linked to sclerosis around screw paths. Our study aimed to uncover the proteomic and metabolomic underpinnings of FHN and sclerosis using integrated proteomics and metabolomics analyses. We identified differentially expressed proteins (DEPs) and metabolites (DEMs) among three groups: patients with FNF (Group A), sclerosis (Group B), and FHN (Group C). Using the Kyoto Encyclopedia of Genes and Genomes and Gene Ontology enrichment analyses, we examined the roles of these proteins and metabolites. Our findings highlight the significant differences across the groups, with 218 DEPs and 44 DEMs identified between the sclerosis and FNF groups, 247 DEPs and 31 DEMs between the FHN and sclerosis groups, and a stark 682 DEPs and 94 DEMs between the FHN and FNF groups. Activities related to carbonate dehydratase and hydrolase were similar in the FHN and sclerosis groups, whereas extracellular region and lysosome were prevalent in the FHN and FNF groups. Our study also emphasized the involvement of the PI3K-Akt pathway in sclerosis and FHN. Moreover, the key metabolic pathways were implicated in glycerophospholipid metabolism and retrograde endocannabinoid signaling. Using western blotting, we confirmed the pivotal role of specific genes/proteins such as ITGB5, TNXB, CA II, and CA III in sclerosis and acid phosphatase 5 and cathepsin K in FHN. This comprehensive analyses elucidates the molecular mechanisms behind sclerosis and FHN and suggests potential biomarkers and therapeutic targets, paving the way for improved treatment strategies. Further validation of the findings is necessary to strengthen the robustness and reliability of the results.

BACKGROUND: The appearance of the crescent sign in femoral head necrosis is a “turning point” in the progression of the disease, and repairing and stabilizing the bone-cartilage interface is particularly important in preventing further progression and collapse of the femoral head. Tissue engineering offers potential advantages in the simultaneous repair and integration of the bone-cartilage interface. OBJECTIVE: To review potentially suitable techniques addressing the subchondral separation in femoral head necrosis. METHODS: Relevant articles from January 1970 to April 2023 were searched in PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) using English search terms “femoral head necrosis, avascular necrosis of femoral head, osteonecrosis of femoral head” and Chinese search terms “femoral head necrosis, subchondral bone, cartilage, integration of cartilage and subchondral bone”. A total of 114 articles were included for review and analysis. RESULTS AND CONCLUSION: (1) Structural defects, ischemic and hypoxic environment, inflammatory factors, and stress concentration may cause subchondral separation in osteonecrosis of the femoral head. Subchondral bone collapse and failure of hip-preserving surgery may be associated. Integration of tissue engineering scaffolds with the bone-cartilage interface is one potential approach for treating subchondral separation in osteonecrosis of the femoral head. (2) Current literature suggests that multiphase scaffolds, gradient scaffolds, and composite materials have shown improvements in promoting cell adhesion, proliferation, and deposition of bone and cartilage matrix. These advancements aid in the integration of scaffolds with the bone-cartilage interface and have implications for the treatment of subchondral separation in osteonecrosis of the femoral head. (3) Surface modifications of scaffolds can enhance interface integration efficiency, but they have their advantages and disadvantages. Scaffolds providing different environments can induce differentiation of mesenchymal stem cells and facilitate integration between different interfaces. (4) Future scaffolds for subchondral separation in osteonecrosis of the femoral head are expected to be composite materials with gradient and differentiated biomimetic structures. Surface modifications and stem cell loading can promote integration between the bone-cartilage interface and scaffolds for therapeutic purposes, but further experimental verification is still needed. Challenges include synchronizing scaffold degradation rate with repair progress and ensuring stability between different interfaces. [ABSTRACT FROM AUTHOR]

Femoral head necrosis (FHN) is a serious complication after femoral neck fractures (FNF), often linked to sclerosis around screw paths. Our study aimed to uncover the proteomic and metabolomic underpinnings of FHN and sclerosis using integrated proteomics and metabolomics analyses. We identified differentially expressed proteins (DEPs) and metabolites (DEMs) among three groups: patients with FNF (Group A), sclerosis (Group B), and FHN (Group C). Using the Kyoto Encyclopedia of Genes and Genomes and Gene Ontology enrichment analyses, we examined the roles of these proteins and metabolites. Our findings highlight the significant differences across the groups, with 218 DEPs and 44 DEMs identified between the sclerosis and FNF groups, 247 DEPs and 31 DEMs between the FHN and sclerosis groups, and a stark 682 DEPs and 94 DEMs between the FHN and FNF groups. Activities related to carbonate dehydratase and hydrolase were similar in the FHN and sclerosis groups, whereas extracellular region and lysosome were prevalent in the FHN and FNF groups. Our study also emphasized the involvement of the PI3K-Akt pathway in sclerosis and FHN. Moreover, the key metabolic pathways were implicated in glycerophospholipid metabolism and retrograde endocannabinoid signaling. Using western blotting, we confirmed the pivotal role of specific genes/proteins such as ITGB5, TNXB, CA II, and CA III in sclerosis and acid phosphatase 5 and cathepsin K in FHN. This comprehensive analyses elucidates the molecular mechanisms behind sclerosis and FHN and suggests potential biomarkers and therapeutic targets, paving the way for improved treatment strategies. Further validation of the findings is necessary to strengthen the robustness and reliability of the results. [ABSTRACT FROM AUTHOR]

Purpose: To determine the effect of alendronate sodium combined with radial shock wave on hemorheology and degree of pain in patients with femoral head necrosis. Methods: The study comprised 188 patients with femoral head necrosis treated in Taizhou People's Hospital, China from June 2020 to June 2022. They were divided into control group (CG, n = 96) and study group (SG, n = 92). Control group was given radial shock wave therapy once in 30 days, while the study group was given alendronate sodium orally (10 mg/daily) for 3 months, as well as radial shock wave therapy. Hemorheology indices (plasma viscosity (PV), low-cut reduced viscosity (LRV), high-cut reduced viscosity (HRV)); degree of pain (McGill Pain Questionnaire (MPQ)), joint muscle strength, and clinical efficacy in both groups were compared. Results: The SG had significantly lower levels of PV, LRV and HRV, and lesser MPQ scores at 1 month (T1) and 2 months post-treatment (T2) than CG (p < 0.05). The post-treatment levels of PV, LRV, HRV, and MPQ scores at T1 stage in the two groups were significantly lower than the pre-treatment (T0) scores (p < 0.001). The scores of PV, LRV, HRV, and MPQ at T2 in both groups were significantly lower than the corresponding T1 scores (p < 0.05). Higher numbers of cases with grade 4 and grade 5 joint muscle strength were seen in SG than in CG at T2. Treatment efficacy/effectiveness in SG was significantly higher than in CG (p < 0.05). Conclusion: Alendronate sodium combination with radial shock wave, produces significant improvement in femoral head necrosis, mitigates symptoms and enhances joint muscle strength of patients. Future studies with larger sample sizes will be necessary to validate the outcome of this study. [ABSTRACT FROM AUTHOR]

Leg health is a significant economic and welfare concern for the poultry industry. Current methods of detection rely on visual assessment of the legs and gait scores and bone scoring during necropsy for full characterization. Additionally, the current scoring of femurs only examines the external surface of the femoral head. Through the use of the dual-energy X-ray absorptiometry (DXA) imaging system, we show the presence of a necrotic region in the femurs that would otherwise be considered healthy based on the current evaluation procedures. Importantly, these lesions were present in almost 60% (22 of 37) of femurs that scored normal for femoral head necrosis (FHN). Additionally, these femurs showed greater bone mineral content (BMC) relative to weight compared to their counterparts with no lucent lesions (6.95% ± 0.20% vs. 6.26% ± 0.25; p = 0.038). Identification of these lesions presents both a challenge and an opportunity. These subclinical lesions are likely to be missed in routine scoring procedures for FHN and can inadvertently impact the characterization of the disease and genetic selection programs. Furthermore, this imaging system can be used for in vivo, ex vivo, and embryonic (egg) studies and, therefore, constitutes a potential non-invasive method for early detection of bone lesions in chickens and other avian species. [ABSTRACT FROM AUTHOR]

ABSTRACT: Femoral head necrosis (FHN) in broilers is a common leg disorder in intensive poultry farming, giving rise to poor animal health and welfare. Abnormal mechanical stress in the hip joint is a risk factor for FHN, and articular cartilage is attracting increasing attention as a cushion and lubrication structure for the joint. In the present study, broilers aged 3 to 4 wk with FHN were divided into femoral head separation (FHS) and femoral head separation with growth plate lacerations (FHSL) groups, with normal broilers as control. The features of the hip joint, bone, and cartilage were assessed in FHN progression using devices including computed tomography (CT), atomic force microscope (AFM), and transmission electron microscopy (TEM). Broilers with FHN demonstrated decreased bone mechanical properties, narrow joint space, and thickened femoral head stellate structures. Notably, abnormal cartilage morphology was observed in FHN-affected broilers, characterized by increased cartilage thickness and rough cartilage surfaces. In addition, as FHN developed, cartilage surface friction and friction coefficient dramatically increased, while cartilage modulus and stiffness decreased. The ultramicro-damage occurred in chondrocytes and the extracellular matrix (ECM) of cartilage. Cell disintegration, abnormal mitochondrial accumulation, and oxidative stress damage were observed in chondrocytes. A notable decline in cartilage collagen content was observed in ECM during the initial stages of FHN, accompanied by a pronounced reduction in collagen fiber diameter and proteoglycan content as FHN progressed. Furthermore, the noticeable loosening of the collagen fiber structure and the appearance of type I collagen were noted in cartilage. In conclusion, there was a progressive decrease in bone quality and multifaceted damage of cartilage in the femoral head, which was closely linked to the severity of FHN in broilers.

Abstract Necrosis of the femoral head is the main complication in femoral neck fracture patients with triangle cannulated screw fixation. Instant postoperative fixation instability is a main reason for the higher risk of femoral head necrosis. Biomechanical studies have shown that cross screw fixation can effectively optimize fixation stability in patients with proximal humerus fractures and pedicle screw fixation, but whether this method can also effectively optimize the fixation stability of femoral neck fractures and reduce the corresponding risk of femoral head necrosis has yet to be identified. In this study, a retrospective review of imaging data in femoral neck fracture patients was performed. The cross angle between the femoral neck and the caudal cannulated screw was reported; if the angle between the screw and the transverse plane increased, it was recorded as positive; otherwise, it was recorded as negative. Angle values and their corresponding absolute values were compared in patients with and without femoral head necrosis. Regression analysis identified potential risk factors for femoral head necrosis. Moreover, the biomechanical effect of the screw–femoral neck angle on fixation stability was also verified by numerical mechanical simulations. Clinical review presented significantly larger positive angle values in patients with femoral head necrosis, which was also proven to be an independent risk factor for this complication. Moreover, fixation stability progressively deteriorated with increasing angle between the caudal screw and the transverse plane. Therefore, increasing the angle between the caudal screw and the transverse plane may aggravate the risk of femoral head necrosis by deteriorating the fixation stability in patients with femoral neck fracture.

This retrospective study investigates the effectiveness of a nursing intervention based on Orem's self-care model of nursing with elderly patients with femoral head necrosis who underwent total hip arthroplasty. Postoperative outcomes in the intervention and control groups were assessed by the visual analog scale (VAS), Barthel index, and Harris Hip Score (HHS). Participants in the intervention group had significantly better outcomes in terms of VAS, Barthel index, and HHS. The occurrence of pneumonia was significantly different between the groups. Those who underwent Orem's self-care model of nursing intervention were highly satisfied with their status postoperatively compared with the control group. [ABSTRACT FROM AUTHOR]

Necrosis of the femoral head is the main complication in femoral neck fracture patients with triangle cannulated screw fixation. Instant postoperative fixation instability is a main reason for the higher risk of femoral head necrosis. Biomechanical studies have shown that cross screw fixation can effectively optimize fixation stability in patients with proximal humerus fractures and pedicle screw fixation, but whether this method can also effectively optimize the fixation stability of femoral neck fractures and reduce the corresponding risk of femoral head necrosis has yet to be identified. In this study, a retrospective review of imaging data in femoral neck fracture patients was performed. The cross angle between the femoral neck and the caudal cannulated screw was reported; if the angle between the screw and the transverse plane increased, it was recorded as positive; otherwise, it was recorded as negative. Angle values and their corresponding absolute values were compared in patients with and without femoral head necrosis. Regression analysis identified potential risk factors for femoral head necrosis. Moreover, the biomechanical effect of the screw–femoral neck angle on fixation stability was also verified by numerical mechanical simulations. Clinical review presented significantly larger positive angle values in patients with femoral head necrosis, which was also proven to be an independent risk factor for this complication. Moreover, fixation stability progressively deteriorated with increasing angle between the caudal screw and the transverse plane. Therefore, increasing the angle between the caudal screw and the transverse plane may aggravate the risk of femoral head necrosis by deteriorating the fixation stability in patients with femoral neck fracture. [ABSTRACT FROM AUTHOR]

Introduction: Avascular necrosis of the femoral head (ANFH) is one of the most complicated bone disorders; management remains challenging. We evaluated the effect of lncRNA-MALAT1 suppression on ANFH rats. Material and methods: Dexamethasone was injected intravenously at 0.5 mg/kg daily for 30 days to induce ANFH; an lncRNA-MALAT1 inhibitor group received the inhibitor for the entire 30 days. LncRNA-MALAT1 suppression was evaluated by measuring blood hexosamine and hydroxyproline levels, and that of circulating endothelial progenitor cells (EPCs). Changes in femoral head bone ultrastructure were assessed via transmission electron microscopy and magnetic resonance imaging (MRI). We used reverse transcription polymerase chain reaction (RT-PCR) and Western blotting to measure gene and protein expression levels in femoral head tissue. Results: The blood hexosamine level rose and that of hydroxyproline fell in the LncRNA-MALAT1 inhibitor group compared to the ANFH group. LncRNA- MALAT1 suppression increased the level of circulating EPCs. Ultrastructural changes in the femoral bone head were alleviated by the lncRNA- MALAT1 inhibitor. LncRNA-MALAT1 suppression lowered the levels of AMPK, mTOR, and Beclin-1 in rat tissue homogenates. Conclusions: LncRNA-MALAT1 suppression attenuated dexamethasone-induced femoral head necrosis by regulating AMPK/mTOR/Beclin-1 signaling. [ABSTRACT FROM AUTHOR]

BACKGROUND: After the internal fixation of cannulated screws in femoral neck fractures, because the affected limb is often unable to bear weight in the short term and the implants with high stiffness have a stress shielding effect on the fracture end, it is easy to cause osteoporosis of the affected limb and changes in the biomechanical distribution of the proximal femur, the incidence of osteonecrosis of the femoral head is high after surgery. At present, few studies have been conducted on the biomechanical effects of osteoporosis at the proximal end of the femur occurring after femoral neck fracture surgery on femoral neck fracture treated with cannulated screws. OBJECTIVE: Using finite element analysis, to investigate the biomechanical effects of osteoporosis occurring after femoral neck fracture surgery on femoral neck fracture treated with cannulated screws and explore the role of biomechanical factors in osteonecrosis of the femoral head. METHODS: Based on the obtained CT scan data of the femur in a patient with a femoral neck fracture, a proximal femoral model for internal fixation for femoral neck fracture was established by Mimics 19.0, 3-Matic, UG 11.0, Hypermesh 14.0, and Abaqus software. One finite element model of the proximal femur without osteoporosis and three finite element models of the proximal femur with osteoporosis were analyzed using Abaqus software. The stress, contact pressure, displacement peak and cloud map under different components of the four models were measured and analyzed, and the internal stress changes and distribution of the femoral head were compared and analyzed. RESULTS AND CONCLUSION: The stresses and contact pressures of the femoral head and lower anterior cannulated screws varied more with the degree of osteoporosis. The peak displacement of the four models increased slowly with the degree of osteoporosis. By one-way analysis of variance, there was no significant effect of the degree of osteoporosis on the peak stress, contact pressure, and displacement of the different components. The internal stress distribution of the femoral head changed with the degree of osteoporosis. Changes in the biomechanical environment of the proximal femur have an important impact on osteonecrosis of the femoral head. [ABSTRACT FROM AUTHOR]

Leg health is a significant economic and welfare concern for the poultry industry. Current methods of detection rely on visual assessment of the legs and gait scores and bone scoring during necropsy for full characterization. Additionally, the current scoring of femurs only examines the external surface of the femoral head. Through the use of the dual-energy X-ray absorptiometry (DXA) imaging system, we show the presence of a necrotic region in the femurs that would otherwise be considered healthy based on the current evaluation procedures. Importantly, these lesions were present in almost 60% (22 of 37) of femurs that scored normal for femoral head necrosis (FHN). Additionally, these femurs showed greater bone mineral content (BMC) relative to weight compared to their counterparts with no lucent lesions (6.95% ± 0.20% vs. 6.26% ± 0.25; p = 0.038). Identification of these lesions presents both a challenge and an opportunity. These subclinical lesions are likely to be missed in routine scoring procedures for FHN and can inadvertently impact the characterization of the disease and genetic selection programs. Furthermore, this imaging system can be used for in vivo, ex vivo, and embryonic (egg) studies and, therefore, constitutes a potential non-invasive method for early detection of bone lesions in chickens and other avian species.

Abstract Background Regenerative techniques combined with core decompression (CD) are commonly used to treat osteonecrosis of the femoral head (ONFH). However, no consensus exists on regeneration therapy combined with CD that performs optimally. Therefore, we evaluated six regenerative therapies combined with CD treatment using a Bayesian network meta-analysis (NMA). Methods We searched PubMed, Embase, Cochrane Library, and Web of Science databases. Six common regeneration techniques were categorized into the following groups with CD as the control group: (1) autologous bone graft (ABG), (2) autologous bone graft combined with bone marrow aspirate concentrate (ABG + BMAC), (3) bone marrow aspirate concentrate (BMAC), (4) free vascular autologous bone graft (FVBG), (5) expanded mesenchymal stem cells (MSCs), and (6) platelet-rich plasma (PRP). The conversion rate to total hip arthroplasty (THA) and progression rate to femoral head necrosis were compared among the six treatments. Result A total of 17 literature were included in this study. In the NMA, two of the six treatment strategies demonstrated higher response in preventing the progression of ONFH than CD: MSCs (odds ratio [OR]: 0.098, 95% confidence interval [CI]: 0.0087–0.87) and BMAC (OR: 0.27, 95% CI: 0.073–0.73). Additionally, two of the six treatment strategies were effective techniques in preventing the conversion of ONFH to THA: MSCs (OR: 0.062, 95% CI: 0.0038–0.40) and BMAC (OR: 0.32, 95% CI: 0.1–0.074). No significant difference was found among FVBG, PRP, ABG + BMAC, ABG, and CD in preventing ONFH progression and conversion to THA (P > 0.05). Conclusions Our NMA found that MSCs and BMAC were effective in preventing ONFH progression and conversion to THA among the six regenerative therapies. According to the surface under the cumulative ranking value, MSCs ranked first, followed by BMAC. Additionally, based on our NMA results, MSCs and BMAC following CD may be necessary to prevent ONFH progression and conversion to THA. Therefore, these findings provide evidence for the use of regenerative therapy for ONFH.

Background: Regenerative techniques combined with core decompression (CD) are commonly used to treat osteonecrosis of the femoral head (ONFH). However, no consensus exists on regeneration therapy combined with CD that performs optimally. Therefore, we evaluated six regenerative therapies combined with CD treatment using a Bayesian network meta-analysis (NMA). Methods: We searched PubMed, Embase, Cochrane Library, and Web of Science databases. Six common regeneration techniques were categorized into the following groups with CD as the control group: (1) autologous bone graft (ABG), (2) autologous bone graft combined with bone marrow aspirate concentrate (ABG + BMAC), (3) bone marrow aspirate concentrate (BMAC), (4) free vascular autologous bone graft (FVBG), (5) expanded mesenchymal stem cells (MSCs), and (6) platelet-rich plasma (PRP). The conversion rate to total hip arthroplasty (THA) and progression rate to femoral head necrosis were compared among the six treatments. Result: A total of 17 literature were included in this study. In the NMA, two of the six treatment strategies demonstrated higher response in preventing the progression of ONFH than CD: MSCs (odds ratio [OR]: 0.098, 95% confidence interval [CI]: 0.0087–0.87) and BMAC (OR: 0.27, 95% CI: 0.073–0.73). Additionally, two of the six treatment strategies were effective techniques in preventing the conversion of ONFH to THA: MSCs (OR: 0.062, 95% CI: 0.0038–0.40) and BMAC (OR: 0.32, 95% CI: 0.1–0.074). No significant difference was found among FVBG, PRP, ABG + BMAC, ABG, and CD in preventing ONFH progression and conversion to THA (P > 0.05). Conclusions: Our NMA found that MSCs and BMAC were effective in preventing ONFH progression and conversion to THA among the six regenerative therapies. According to the surface under the cumulative ranking value, MSCs ranked first, followed by BMAC. Additionally, based on our NMA results, MSCs and BMAC following CD may be necessary to prevent ONFH progression and conversion to THA. Therefore, these findings provide evidence for the use of regenerative therapy for ONFH. [ABSTRACT FROM AUTHOR]

BACKGROUND: At present, digital subtraction angiography is used in the clinical observation of blood supply of femoral head necrosis, and the patency of the nutrient blood vessels of the femoral head is evaluated by observing the in and out of the contrast agent. Although digital subtraction angiography can visually observe the feeding vessels of the femoral head, it cannot quantify the perfusion. In addition, the collapse of the femoral head is closely related to the prognosis of the disease, but there are few studies on the changes in blood supply in the femoral head during the peri-collapse period. OBJECTIVE: To compare the differences in microcirculation perfusion in different regions and different stages of femoral head necrosis, summarize the changes in microcirculation perfusion characteristics of femoral head necrosis, and observe the effect of dynamic contrast-enhanced magnetic resonance imaging in evaluating the microcirculation perfusion of the femoral head. METHODS: From February 16 to September 1, 2022, a total of 37 patients (69 hips) who visited a doctor for femoral head necrosis were retrospectively collected, including 29 males and 8 females; the age was (35.35±12.19) years (range 18-65 years). The patient’s bilateral femoral head and proximal femur were scanned by dynamic contrast-enhanced magnetic resonance imaging, and gadoteric acid meglumine was intravenously injected during the scanning. After scanning, Geniq software was used to post-process the data to obtain femoral head microcirculation perfusion parameters. Regions of interest were drawn at the necrotic zone, repair reaction zone, and greater trochanter, and time-signal intensity curves of the regions of interest were obtained and classified. Paired t-tests were used to evaluate differences between necrotic area, repair reaction area, and greater trochanter perfusion parameters, as well as differences in femoral head perfusion in different stages of necrosis. Differences in necrotic area, repair reaction area and greater trochanter time-intensity curve classification were evaluated using the χ2 test. RESULTS AND CONCLUSION: (1) Comparing the perfusion parameters in different regions, the peak value of enhanced signal intensity, area under the curve, maximum slope, volume transfer constant, and the median volume fraction of extravascular extracellular space in the necrotic region were lower than those of the greater trochanter, and the differences were statistically significant (P < 0.05). There was no statistically significant difference in the volume rate constant (P > 0.05). (2) The signal peak value, area under the curve, maximum slope, volume transfer constant, rate transfer constant, and the median ratio of extravascular to extracellular space in the repair reaction area were higher than those in the necrotic area and the greater trochanter, and the differences were statistically significant (P < 0.05). (3) The median signal peak value and maximum slope of the necrotic area in ARCO stage II were greater than those in ARCO stage III, and the difference was statistically significant (P < 0.05). There were no significant differences in area under the curve, rate transfer constant, volume transfer constant and the median ratio of extravascular to extracellular space (P > 0.05). (4) The signal peak value, area under the curve, maximum slope, volume transfer constant, rate transfer constant, and ratio of extravascular to extracellular space in the repair reaction zone of the ARCO Stage II were lower than those of the ARCO Stage III, and the difference was statistically significant (P < 0.05). (5) It is concluded that the microcirculation perfusion velocity, blood flow and capillary permeability in the necrotic area of the femoral head were significantly reduced, while the microcirculation perfusion velocity, blood flow and vascular permeability in the repair reaction area were significantly improved compared with those in the normal area. With the occurrence of collapse, the perfusion velocity and blood flow were further reduced, and the perfusion in the repair reaction zone was enhanced. [ABSTRACT FROM AUTHOR]

BACKGROUND: For many years, the choice of internal fixation for femoral neck fractures in young adults has been controversial. No matter what treatment is chosen, the goal is the anatomical reduction and stable internal fixation. Although there are many internal fixation methods for the treatment of femoral neck fractures in young adults, the therapeutic effects have their advantages and disadvantages, and there is no unified treatment plan at present. OBJECTIVE: To observe the effect of a new type of femoral neck internal fixation system in the treatment of femoral neck fractures. METHODS: From January 2019 to June 2020, the relevant data of 21 patients with femoral neck fractures fixed by femoral neck internal fixation system (observation group) and 32 patients with femoral neck fractures fixed by three hollow nails (control group) were included in this study. The patient age was ≤ 65 years old. All patients had closed fractures. All patients underwent anteroposterior radiography of the affected side before the operation, and all patients underwent a CT plain scan plus three-dimensional reconstruction. Fracture healing and necrosis of the femoral head were evaluated by X-ray film of the hip joint after the operation. MRI examination was performed in some cases when necessary. The hip function was assessed at the last follow-up. RESULTS AND CONCLUSION: (1) All 21 patients in the observation group were followed up for an average of 19 months. The average operation time was 58.09 minutes. The average number of fluoroscopy was 23.19 times. The average intraoperative blood loss was 109.29 mL. The average clinical healing time was 3.86 months. The mean time of complete weight bearing after the operation was 6 months. The complication rate was 14.3%. The excellent and good rate of hip joint function was 85.7%. (2) In the control group, 32 patients were followed up for an average of 18 months. The average operation time was 74.06 minutes. The average number of fluoroscopy was 33.41 times. The average intraoperative blood loss was 81.56 mL. The average clinical healing time was 4.69 months. The mean time of complete weight bearing after the operation was 6.72 months. The complication rate was 28.1%. The rate of excellent and good hip function was 71.9%. (3) The results show that compared with the simple cannulated screw internal fixation, the femoral neck internal fixation system can shorten the operation time and clinical healing time of patients with femoral neck fractures under 65 years old, and reduce the frequency of fluoroscopy. [ABSTRACT FROM AUTHOR]

BACKGROUND: In clinical practice, impacted femoral neck fractures are usually treated with cannulated screw internal fixation. In previous studies, the preoperative posterior tilt of the femoral head has been shown to be associated with internal fixation failure. However, there are few studies on the occurrence of femoral head necrosis after internal fixation and posterior tilt. OBJECTIVE: To investigate the correlation between femoral head necrosis and posterior tilt measured by three-dimensional reconstruction and its risk factors after internal fixation of impacted femoral neck fractures. METHODS: The clinical data of 150 patients with impacted femoral neck fractures admitted to Tianjin Hospital from 2016 to 2020 were retrospectively analyzed. The posterior tilt of the femoral head was measured by a three-dimensional reconstruction technique according to postoperative femoral head necrosis. The patients were divided into the necrosis group and the non-necrosis group. The clinical data were compared between the two groups using single-factor analysis. Risk factors of femoral head necrosis were analyzed by multivariate logistic regression analysis. The predictive value of posterior tilt for postoperative femoral head necrosis was assessed using receiver operating characteristic curves. RESULTS AND CONCLUSION: (1) A total of 150 patients were followed up for 18 to 66 months (mean, 29 months) after surgery, and necrosis occurred in 20 patients (13.3%). (2) Multivariate logistic regression analysis exhibited that reduction quality grade C and posterior tilt were risk factors for femoral head necrosis. (3) Receiver operating characteristic curve analysis revealed the predictive value of posterior tilt measured in three dimensions for postoperative femoral head necrosis, with a cut-off value of 20.74°. (4) The results showed that posterior tilt and reduction quality grade C were risk factors for femur head necrosis after closed reduction and internal fixation in patients with impacted femoral neck fractures. The posterior tilt of the femoral head can be accurately measured by three-dimensional reconstruction technology. Patients with posterior tilt ≥20.74° are more likely to experience postoperative femoral head necrosis. [ABSTRACT FROM AUTHOR]

Steroid‐induced femoral head necrosis (SIFHN) is a serious clinical complication that is caused by prolonged or excessive use of glucocorticoids (GCs). Osteoblast apoptosis and osteogenic differentiation dysfunction caused by GC‐induced oxidative stress and mitochondrial impairment are strongly implicated in SIFHN. Apocynin (APO) is a kind of acetophenone extracted from an herb. In recent years, APO has received much attention for its antiapoptotic and antioxidant properties. This study aimed to investigate whether APO could protect against SIFHN and explore the mechanism. In our study, low‐dose APO had no toxic effects on osteoblasts and restored dexamethasone (Dex)‐treated osteoblasts by improving survival, inhibiting OS and restoring mitochondrial dysfunction. Mechanistically, APO alleviated Dex‐induced osteoblast injury by activating the Nrf2 pathway, and the use of ML385 to block Nrf2 significantly eliminated the protective effect of APO. In addition, APO could reduce the formation of empty lacunae, restore bone mass and promote the expression of Nrf2 in SIFHN rats. In conclusion, APO protects osteoblasts from Dex‐induced oxidative stress and mitochondrial dysfunction through activation of the Nrf2 pathway and may be a beneficial drug for the treatment of SIFHN. [ABSTRACT FROM AUTHOR]

Background: Osteonecrosis of the femoral head is a degenerative condition linked to corticosteroids, alcoholism, or trauma. With its rising prevalence due to increased hormone drug use and its debilitating effects on young to middle-aged individuals, understanding its association with specific laboratory indicators can aid early diagnosis and prevention. Methods: Upon retrospective analysis of the clinical data pertaining to individuals diagnosed with femoral head necrosis, spanning from January 2016 to January 2022, a comprehensive evaluation was conducted within the same time frame. The study aimed to ascertain the presence of femoral head necrosis in a total of 1176 individuals. A total of 1036 healthy patients were recruited randomly, ensuring that their ages matched. The risk variables associated with the utilization of logistic regression analysis and analysis techniques are employed. The patient examines the age distribution within a specific age group. Results: The levels of high-density lipoprotein, low-density lipoprotein A1, lipoprotein B1, total protein, albumin, globulin, and other lipophilic metabolism and coagulation markers exhibited a statistically significant increase compared to the control group. A multifactor logistic regression analysis was conducted to identify potential risk factors associated with femoral head necrosis in patients. Conclusion: Femoral head necrosis is associated with a range of variables including coagulation malfunction, lipid metabolic abnormalities, and inflammation. [ABSTRACT FROM AUTHOR]

Background: Owing to the hampered blood supply, cellular death of bone components results in avascular necrosis of the femoral head. Aims: The present study was conducted to assess the outcomes following treatment of avascular necrosis of femoral head treated with Total Hip Replacement. Materials and methods: 54 subjects with advanced avascular necrosis of femoral head treated with Total Hip Replacement were included in the study. Each hip was postoperatively assessed using the Harris hip scoring system where scores less than 70 were considered poor, 70-79 as fair, 80-89 as good, and 90-100 as excellent scores. Results: In 87.03% (n=47) subjects Harris Hip scoring was excellent, in 7.40% (n=4) subjects, the scoring was good, in 5.55% (n=3) subjects Harris hip scoring was fair, whereas, in 3.70% (n=2) subjects, Harris Hip scoring criteria was poor. The postoperative complications were also assessed in the study subjects following total hip arthroplasty, and the results are shown in Table 3. It was seen that delayed wound healing was seen in 5.55% (n=3) study subjects, posterior dislocation was seen in 3.70% (n=2) study subjects, and limb length discrepancy was also seen in 3.70% (n=2) study subjects Conclusion: The present study concludes that subjects having advanced necrosis of femoral head managed with total hip replacement showed acceptable clinical and functional outcomes with a small incidence of delayed wound healing, posterior dislocation, and limb length discrepancy. [ABSTRACT FROM AUTHOR]

Introduction: Femoral neck fractures are challenging injuries associated with a compromised blood supply to the femoral head, leading to a high risk of avascular necrosis and poor clinical outcomes. This study aimed to investigate the efficacy of femoral head intraosseous vascular anastomosis in the treatment of porcine sub-capital femoral neck fractures. Methods: Ten Landrace pigs were used as experimental animal models. The femoral head was completely removed after femoral neck sub-cephalic fracture. It was fixed on the medial side of the knee joint, and the blood supply to the femoral head was reconstructed by anastomosing the femoral head vessels. One week later, blood flow in the femoral head was observed by borehole, digital subtraction angiography examination, and hematoxylin and eosin staining. Further, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling tests were performed to detect pathological changes in the femoral head. Results: After one-week, digital subtraction angiography of the femoral head revealed a blood circulation rate of 70 %, and the blood seepage rate of the borehole was 80 %. Hematoxylin and eosin staining and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling test results showed that necrosis of bone marrow cells in the experimental group was significantly improved compared to that in the control group. Discussion: This study highlights the potential benefits of femoral head intraosseous vascular anastomosis in the treatment of porcine sub-capital femoral neck fractures. Further research and clinical trials are warranted to validate these findings and to explore the translational potential of this technique in human patients.

Abstract Objective To evaluate the safety and reproducibility of the surgery for unstable slipped capital femoral epiphysis (SCFE) through the modified Dunn technique in a single center cohort from Brazil. Methods We retrospectively analyzed a cohort of patients submitted to this procedure by a single surgeon who was a hip preservation specialist. Demographic data and radiographic angles were evaluated for the relative risk (RR) of avascular necrosis (AVN) using a log-binomial regression model with simple and random effects. Results Among the 30 patients (30 hips) with a mean age of 11.79 years at the time of the operation, there were 17 boys and 18 left hips, which were operated on in a mean of 11.5 days after the slip. The mean follow-up was of 38 months. The preoperative Southwick angle averaged 60.69° against 4.52° postoperatively (p< 0.001). A larger preoperative slip angle was associated with the development of AVN (RR: 1.05; 95% confidence interval [95%CI]: 1.02–1.07; p< 0.01). The overall AVN rate was of 26.7%. Function was good or excellent in 86% of uncomplicated hips, and poor in 87.5% of the partients who developed AVN, as graded by the Harris Hip Score. There was no statistical relationship between epiphyseal bleeding and AVN development (p= 0.82). Conclusion The modified Dunn technique is associated with restoration of the femoral alignment and function after unstable SCFE, when uncomplicated. Moreover, it was shown to be reproducible in our population, with a rate of 26% of femoral head necrosis.

Abstract Background Osteonecrosis of the femoral head is a degenerative condition linked to corticosteroids, alcoholism, or trauma. With its rising prevalence due to increased hormone drug use and its debilitating effects on young to middle-aged individuals, understanding its association with specific laboratory indicators can aid early diagnosis and prevention. Methods Upon retrospective analysis of the clinical data pertaining to individuals diagnosed with femoral head necrosis, spanning from January 2016 to January 2022, a comprehensive evaluation was conducted within the same time frame. The study aimed to ascertain the presence of femoral head necrosis in a total of 1176 individuals. A total of 1036 healthy patients were recruited randomly, ensuring that their ages matched. The risk variables associated with the utilization of logistic regression analysis and analysis techniques are employed. The patient examines the age distribution within a specific age group. Results The levels of high-density lipoprotein, low-density lipoprotein A1, lipoprotein B1, total protein, albumin, globulin, and other lipophilic metabolism and coagulation markers exhibited a statistically significant increase compared to the control group. A multifactor logistic regression analysis was conducted to identify potential risk factors associated with femoral head necrosis in patients. Conclusion Femoral head necrosis is associated with a range of variables including coagulation malfunction, lipid metabolic abnormalities, and inflammation.

For the treatment of an intertrochanteric fracture combined with femoral head necrosis in middle-age patients, it has been controversial whether to perform fracture reduction and fixation first then total hip replacement, or direct total hip replacement. We present a rare case of 53-year-old male patient suffered from bilateral intertrochanteric fracture caused by a road traffic injury. The patient had a history of femoral head necrosis for eight years, and the Harris score was 30. We performed total hip replacement with prolonged biologic shank prostheses for primary repair. One year after the surgery, nearly full range of motion was achieved without instability (active flexion angle of 110°, extension angle of 20°, adduction angle of 40°, abduction angle of 40°, internal rotation angle of 25°, and external rotation angle of 40°). The Harris score was 85. For the middle-aged patient with unstable intertrochanteric fractures and osteonecrosis of the femoral head, we can choose primary repair for concurrent bilateral intertrochanteric fracture and femoral head necrosis with prolonged shank biologic total hip replacement.

BACKGROUND: There are relatively few finite element studies on hip dysplasia, and the influence of the size of hip abduction angle on the biomechanical distribution of the hip joint is not clear. OBJECTIVE: To apply the finite element method to analyze the hip joint stress distribution on the healthy side and the affected side of patients with hip dysplasia under different abduction angles, and to provide solutions for the prevention, treatment and rehabilitation of hip dysplasia METHODS: A patient with left-sided hip dysplasia was selected from the CT scan data of bilateral hip joints, and the hip joint model was established by Mimics software, solidified by Geomagic Wrap software and assembled with cortical bone and cancellous bone by Solidworks software. The Ansys Workbench software was used to load the joint load, and the stress distribution of the hip joint under the condition of single foot landing under different abduction angles was analyzed. RESULTS AND CONCLUSION: (1) The model constructed in this study was consistent with the actual situation. As the hip abduction angle increased, the maximum stress value of the femoral neck in the normal hip part gradually increased and was always located on the medial side of the femoral neck, and the maximum stress value of the femoral head was the smallest when the hip abduction on the healthy side was 15°, and the maximum stress value above the acetabulum was the smallest when the hip abduction was 20°. (2) The maximum stress value in the affected hip of developmental dysplasia of the hip patients was always located above the acetabulum, and the maximum stress value in the acetabulum was minimal when the abduction of the hip was 25°; the maximum stress value in the femoral head was minimal when the hip was abducted at 20°, and the maximum stress value in the femoral neck was minimal when the hip was abducted at 0° and was located posterior to the femoral neck. As the hip abduction angle increased, the maximum stress point in the femoral neck gradually moved towards the medial inferior aspect of the femoral neck. [ABSTRACT FROM AUTHOR]

Introduction: Avascular osteonecrosis of the femoral head (AVN) is a widespread disease affecting mostly young and active people, often exacerbating in progressive stages, ending in joint replacement. The most common joint preserving operative therapy for early stages is core decompression (CD), optional with cancellous bone grafting (CBG). For success it is vital that the necrotic area is hit and the sclerotic rim is broken by drilling into the defect zone to relieve intraosseous pressure. The aim of this study was to investigate if both techniques are precise enough to hit the center of the necrosis and if there is a difference in precision between drilling with small pins (CD) and the trephine (CBG). Patients and methods: 10 patients underwent CD, 12 patients CBG with conventional C-arm imaging. Postoperatively 3D MRI reconstructions of the necrotic area and the drilling channels were compared. The deviation of the drilling channel from the center of the necrotic area was measured. PROMs (HHS, HOOS, EQ-5D, SF-36) were evaluated to compare the clinical success of these procedures. Results: Neither with CD nor with CBG the defect zone was missed. The drilling precision of both procedures did not differ significantly: distance to center 3.58 mm for CD (range 0.0–14.06, SD 4.2) versus 3.91 mm for CBG (range 0.0–15.27, SD 4.7). PROMs showed no significant difference. Conclusion: Concerning the most important difference between the two procedures—the surgical higher demanding technique of CBG—we suggest applying the less invasive technique of CD alone. [ABSTRACT FROM AUTHOR]

Objective: Traumatic hip dislocations are very rare in childhood and adolescence. The aim of this multi-centre study is to analyse the current epidemiology and injury morphology of a large number of traumatic hip dislocations in children. This can provide a better understanding of childhood hip dislocations and contribute to the development of a therapeutic approach in order to prevent long-term impacts. Methodology: This retrospective, anonymised multi-centre study included patients, aged up to 17 years, with acute traumatic hip dislocations and open growth plates. The patients came from 16 German hospitals. Exclusion criteria included insufficient data, a positive history of hip dysplasia, or an association with syndromal, neurological or connective tissue diseases predisposing to hip dislocation. An analysis was carried out on the patients' anthropometric data and scans (X-ray, MRI, CT), which were collected between 1979 and 2021. Gender, age at the time of dislocation, associated fractures, mechanism of injury, initial treatment including time between dislocation and reduction, method of reduction, treatment algorithm following reduction and all documented complications and concomitant injuries were evaluated. Results: Seventy-six patients met the inclusion criteria. There were two age peaks at 4–8 years and 11–15 years. There was an increased incidence of girls in the under-eight age group, who had mild trauma, and in the group of over-eights there were more boys, who had moderate and severe trauma. Dorsal dislocation occurred in 89.9% of cases. Mono-injuries dominated across all age groups. Concomitant injuries rarely occurred before the age of eight; however, they increased with increasing ossification of the acetabulum and appeared as avulsion injuries in 32% of 11–15-year-olds. Of the 76 patients, 4 underwent a spontaneous, 67 a closed and 5 a primary open reduction. A reduction was performed within 6 h on 84% of the children; however, in around 10% of cases a reduction was not performed until after 24 h. Concomitant injuries needing intervention were identified in 34 children following reduction. Complications included nerve irritation in the form of sensitivity disorders (n = 6) as well as avascular necrosis (AVN) of the femoral head in 15.8% of the patients (n = 12). Conclusions: Traumatic hip dislocations are rare in childhood and adolescence and have high complication rates. The most severe complication, femoral head necrosis, occurred in 16% of cases. Minor injuries, especially in younger children, are enough to cause a dislocation. Posterior dislocation was more frequent and primarily occurred as a mono-injury; however, concomitant injuries must be considered with increasing age. Children continue to experience delayed reductions. The length of time until reduction, age and the severity of the concomitant injury play a role in the development of femoral head necrosis; however, this topic requires additional investigation. [ABSTRACT FROM AUTHOR]

Objectives: To determine the diagnostic values of deep changes beyond the subchondral bone in osteonecrosis of the femoral head (ONFH) to distinguish between Association Research Circulation Osseous (ARCO) stages 2 and 3A. Methods: This retrospective study included 124 hips with ONFH of stages 2 (n = 49; 23 females; mean age, 50.7 years) and 3A (n = 75; 20 females; mean age, 53.2 years) from May 2017 to August 2022, who underwent CT (n = 124) and MRI (n = 85). Deep changes beyond subchondral bone were analyzed on CT (bone resorption area and cystic change) and on MRI (bone marrow edema [BME] and joint effusion). Diagnostic performance and multivariate analysis were evaluated for detecting stage 3A. Results: Stage 3A showed more frequent bone resorption area (72.0% vs. 4.1%), cystic change (52.0% vs. 0.0%), BME (93.5% vs. 43.6%), and joint effusion (76.0% vs. 24.5%) than stage 2 (p < 0.001, all). Bone resorption area and cystic change showed low sensitivities (52.0~72.0%) but high specificities (96.0~100.0%), while BME and joint effusion showed high sensitivities (76.0~93.0%) but low specificities (56.0~76.0%) for stage 3A. Predictors were in the order of bone resorption area, cystic change, and joint effusion (odds ratio: 32.952, 26.281, 9.603, respectively), and combined bone resorption area and cystic change had the best predictive value (AUC, 0.900) for stage 3A. Conclusions: Among deep changes, bone resorption area and cystic changes were highly specific and BME and joint effusion were highly sensitive for stage 3A. Combined bone resorption area and cystic change had the best predictive value for predicting ARCO stage 3A. Key Points: • The exact classification between ARCO stage 2 and 3A is essential but it is sometimes difficult to distinguish between ARCO stage 2 and 3A only by subchondral fracture, especially early post-collapse stage with preservation of femoral head contour. • The predictors of stage 3A were in the order of bone resorption area, cystic change, and joint effusion and combined bone resorption area and cystic change had the best predictive value for predicting stage 3A. • Analysis of deep changes beyond the subchondral bone may make it easier to distinguish between ARCO stage 2 and 3A. [ABSTRACT FROM AUTHOR]

Non-traumatic osteonecrosis of the femoral head ( NONFH) is a kind of refractory osteoarthropathy that changes in bone structure and biomechanics, leading to the loss of hip function. It can be divided into two categories: glucocorticoid and alcohol. Bone marrow mesenchymal stem cells ( BMSCs), as the main stem cells to maintain bone homeostasis, have the ability to differentiate into osteoblasts and chondrocytes. It is of great significance to repair and reconstruct NONFH by regulating the differentiation of BMSCs into osteoblasts and chondrocytes. Traditional Chinese medicine has a long history in the treatment of bone erosion and bone impediment under the guidance of overall concept and syndrome differentiation. Traditional Chinese medicine is of great significance in the treatment of NONFH by promoting the differentiation of BMSCs into osteoblasts and chondrocytes and avoiding their differentiation into adipocytes. Based on this, this article reviews the latest research progress of traditional Chinese medicine in regulating the differentiation function of BMSCs in the treatment of NONFH, aiming to provide ideas and references for the in-depth research and clinical prevention and treatment of NONFH. [ABSTRACT FROM AUTHOR]

For the treatment of an intertrochanteric fracture combined with femoral head necrosis in middle-age patients, it has been controversial whether to perform fracture reduction and fixation first then total hip replacement, or direct total hip replacement. We present a rare case of 53-year-old male patient suffered from bilateral intertrochanteric fracture caused by a road traffic injury. The patient had a history of femoral head necrosis for eight years, and the Harris score was 30. We performed total hip replacement with prolonged biologic shank prostheses for primary repair. One year after the surgery, nearly full range of motion was achieved without instability (active flexion angle of 110°, extension angle of 20°, adduction angle of 40°, abduction angle of 40°, internal rotation angle of 25°, and external rotation angle of 40°). The Harris score was 85. For the middle-aged patient with unstable intertrochanteric fractures and osteonecrosis of the femoral head, we can choose primary repair for concurrent bilateral intertrochanteric fracture and femoral head necrosis with prolonged shank biologic total hip replacement. [ABSTRACT FROM AUTHOR]

Abstract Background The incidence of avascular necrosis (AVN) after pediatric femoral neck fracture (PFNF) in the literature varies widely, and the risk factors associated with AVN after PFNF are controversial. Therefore, this study aimed to accurately investigate the incidence of AVN after PFNF and systematically evaluate and meta-classify their risk factors. Methods A comprehensive search was performed of PubMed, Web of Science, and Embase. The pooled rate and 95% confidence interval (CI) were used to assess the incidence of AVN after PFNF, and pooled odds ratio (OR) were calculated to measure the effect sizes. In addition, we performed subgroup, stratified, and publication bias analyses. Results A total of 30 articles were included in our meta-analysis, with 303 AVN cases among 1185 patients. The pooled incidence of AVN after PFNF was 22% (95% CI 18%, 27%). Subgroup analyses indicated Delbet type I–IV fracture incidences with AVN of 45%, 32%, 17%, and 12%, respectively. The incidence of AVN after PFNF in Asia was 19%, lower than in Africa at 36%, Europe at 26%, and North America at 23%. In addition, the larger sample size group and the earlier published literature group showed a higher incidence of necrosis. Stratified analyses showed that patient age and Delbet fracture classification were both important factors affecting AVN after PFNF (OR = 1.61, p = 0.02 and OR = 3.02, p

Lameness or leg weakness is the main cause of poor poultry welfare and serious economic losses in meat-type poultry production worldwide. Disorders related to the legs are often associated with multifactorial aetiology which makes diagnosis and proper treatment difficult. Among the infectious agents, bacteria of genus Staphylococcus are one of the most common causes of bone infections in poultry and are some of the oldest bacterial infections described in poultry. Staphylococci readily infect bones and joints and are associated with bacterial chondronecrosis with osteomyelitis (BCO), spondylitis, arthritis, tendinitis, tenosynovitis, osteomyelitis, turkey osteomyelitis complex (TOC), bumblefoot, dyschondroplasia with osteomyelitis and amyloid arthropathy. Overall, 61 staphylococcal species have been described so far, and 56% of them (34/61) have been isolated from clinical cases in poultry. Although Staphylococcus aureus is the principal cause of poultry staphylococcosis, other Staphylococcus species, such as S. agnetis, S. cohnii, S. epidermidis, S. hyicus, S. simulans, have also been isolated from skeletal lesions. Antimicrobial treatment of staphylococcosis is usually ineffective due to the location and type of lesion, as well as the possible occurrence of multidrug-resistant strains. Increasing demand for antibiotic-free farming has contributed to the use of alternatives to antibiotics. Other prevention methods, such as better management strategies, early feed restriction or use of slow growing broilers should be implemented to avoid rapid growth rate, which is associated with locomotor problems. This review aims to summarise and address current knowledge on skeletal disorders associated with Staphylococcus spp. infection in poultry.

Jie Wang, Yao Zhang, Changsong Zhao, Qiang Zhang Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of ChinaCorrespondence: Qiang Zhang, Email zhangqianggk@sina.comIntroduction: The causes of femoral head necrosis mainly include trauma, corticosteroid, and alcohol, among which Brucella is highly unusual.Patients and Methods: This paper reported three rare cases of femoral head necrosis due to Brucella, summarizing and analyzing the epidemiological history, clinical manifestations, laboratory examinations, imaging findings, individualized therapy, and biopsy results of patients with this disease. A literature review related to brucellosis and femoral head necrosis was conducted.Results: All three patients had an epidemic history of brucellosis. They suffered from hip pain and limitation of movement for months, and femoral head necrosis was confirmed by magnetic resonance imaging (MRI). Pathological Giemsa staining or real-time polymerase chain reaction (real-time PCR) confirmed Brucella melitensis (B. melitensis) as the cause of osteonecrosis. Each patient received individualized therapy according to the degree of osteonecrosis, which was based on anti-brucellosis medications and hip puncture and irrigation decompression. They were followed up for more than two years and rehabilitated well.Conclusion: Brucella infection should always be considered the cause of femoral head necrosis for patients with hip pain, especially for those with an epidemic history; early diagnosis and individual stepwise therapy can prevent the progression of osteonecrosis.Keywords: Brucella, femoral head necrosis, core decompression, total hip arthroplasty, case series

Objective To investigate associations between femoral head necrosis (FHN) and injury to the retinaculum of Weitbrecht in patients with femoral neck fractures who had undergone initial trials of either closed reduction or direct open reduction. Methods This prospective observational study included 110 patients with displaced femoral neck fractures admitted to the Sixth People's Hospital Affiliated to Shanghai Jiaotong University and Shanghai Tongji Hospital between January 2008 and May 2017. Among these, 25 patients underwent initial closed reductions, and 85 patients underwent an open reduction directly. Watson‐Jones anterolateral approach was used during the surgery for injury to the retinaculum of Weitbrecht, and FHN was assessed as a surgical outcome. The severity of injury to the retinaculum of Weitbrecht was evaluated using a scoring system developed by our surgical team. Follow‐up was at least 24 months. Results The initial closed reduction treatment group had significantly higher total scores of injury to the retinaculum of Weitbrecht (6.24 ± 2.20 vs 4.62 ± 2.12, p = 0.009) compared to the open reduction group. High total scores were significantly associated with initial trials of closed reduction treatment, especially for the broken and released injury to the superior and anterior retinacula (both p = 0.01). Twenty‐six patients experienced FHN postoperatively, with mean onset time of 19.42 ± 3.87 months. FHN was significantly associated with the severity of injury to the retinaculum of Weitbrecht (p

Femoral head necrosis (FHN) is a common leg disease in broilers, resulting in economic losses in the poultry industry. The occurrence of FHN is closely related to the decrease in the number of bone marrow mesenchymal stem cells (BMSCs) and the change in differentiation direction. This study aimed to investigate the function of differentiation of BMSCs in the development of FHN. We isolated and cultured BMSCs from spontaneous FHN-affected broilers and normal broilers, assessed the ability of BMSCs into three lineages by multiple staining methods, and found that BMSCs isolated from FHN-affected broilers demonstrated enhanced lipogenic differentiation, activated Notch-RBPJ signaling pathway, and diminished osteogenic and chondrogenic differentiation. The treatment of BMSCs with methylprednisolone (MP) revealed a significant decrease in the expressions of Runx2, BMP2, Col2a1 and Aggrecan, while the expressions of p-Notch1/Notch1, Notch2 and RBPJ were increased significantly. Jagged-1 (JAG-1, Notch activator)/DAPT (γ-secretase inhibitor) could promote/inhibit the osteogenic or chondrogenic ability of MP-treated BMSCs, respectively, whereas the differentiation ability of BMSCs was restored after transfection with si-RBPJ. The above results suggest that the Notch-RBPJ pathway plays important role in FHN progression by modulating the osteogenic and chondrogenic differentiation of BMSCs. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the MRI perfusion changes in patients with risk factors for osteonecrosis and normally appearing femoral heads prior to overt femoral head osteonecrosis. Methods: Fifty-eight patients (105 hips) were prospectively included in this ethics committee–approved study. There were 46 hips with no image anomalies and no risk factors for osteonecrosis of the femoral head (ONFH) risk factors, 38 with ONFH risk factors and no image abnormalities, and 21 with overt ONFH. All patients underwent DCE-MRI. Semi-quantitative (peak enhancement [PE], area under the curve [AUC], time to maximum enhancement [TME]) and quantitative perfusion parameters (volume plasma, KTRANS, and KEP) were calculated. Excessive alcohol consumption, corticosteroid use, and trauma were considered major risk factors for osteonecrosis of the femoral head. Results: Measured at the femoral neck and compared to the healthy hips without OFNH risk factors, PE was significantly lower in the hips of patients with OFNH risk factors. Moreover, the difference was greater in females with risk factors, who presented significantly lower PE values (p = 0.0096). A PE threshold of 1.4% yielded a 92% sensitivity and 54% specificity for the presence of associated ONFH risk factors. The hips with overt OFNH compared to those with normally appearing showed an increase of PE of 45% in the neck (p < 0.014). Various epiphyseal femoral head perfusion parameters (PE, TME, AUC, and Ktrans) presented statistically significant differences in hips with ONFH and those without (p < 0.0001). Conclusion: DCE-MRI can identify perfusion marrow changes related to the presence of ONFH risk factors and adjacent to osteonecrosis areas. Key Points: • Bone marrow perfusion changes may occur prior to overt ONFH and extend beyond the osteonecrosis area to the entire femoral head and neck. • Peak enhancement values were significantly reduced in patients with ONFH risk factors, compared to those without. • The presence of ONFH led to a significant increase in marrow perfusion adjacent to the osteonecrosis area. [ABSTRACT FROM AUTHOR]

BACKGROUND: At present, non-coding RNAs have been proven to play an important role in a variety of orthopedic disease. Therefore, non-coding RNAs may bring new ideas for understanding the etiology, pathogenesis and treatment of this disease. OBJECTIVE: To explore the methods and ideas of early diagnosis and treatment of the femoral head necrosis, review the research progress on non-coding RNAs in the femoral head necrosis, and put forward the existing problems and solutions. METHODS: The keywords of “osteonecrosis of the femoral head, non-coding RNAs, miRNA, lncRNA, circRNA” were used to search articles published between January 2000 and November 2021 on CNKI, Wanfang, VIP, PubMed, and Medline databases. Finally, 67 articles were included. RESULTS AND CONCLUSION: (1) The types of non-coding RNAs are very rich, accounting for about 98% of all transcription products and 90% of the functions of all RNAs. According to their functions, they can be divided into housekeeping non-coding RNAs, such as tRNA, rRNA, and snoRNA and regulatory non-coding RNAs, such as miRNA, lncRNA, circRNA, and siRNA. (2) At present, the research on miRNAs and steroid-induced osteonecrosis of the femoral head is the most popular focus, while the related studies on exosomal lncRNAs and circRNAs and necrosis of the femoral head have not been reported. (3) The expression of most non-coding RNAs is down-regulated in the occurrence of steroid-induced osteonecrosis of the femoral head, and most non-coding RNAs promote the proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells and the generation of osteogenic markers by negatively regulating their related target genes, can also promote the formation of vascular endothelial cells and inhibit the occurrence and progression of avascular necrosis of femoral head. (4) Non-coding RNAs carried by exosomes can also play a role in the femoral head necrosis, but there is little literature at present, and the difference between non-coding RNAs carried by exosomes is not clear at present, which can be gradually improved in future studies. (5) The use of non-coding RNAs analogues and inhibitors can effectively inhibit the occurrence and development of non-traumatic femoral head necrosis, which can provide a new strategy for the early diagnosis and treatment of non-traumatic femoral head necrosis. [ABSTRACT FROM AUTHOR]

Background: Bone grafting is considered a method that can provide mechanical and structural support to the femoral head and prevent the collapse of the femoral head after core decompression (CD). However, there are no consensus guidelines on which bone grafting method is best after CD. The authors assessed the efficacy of various bone grafting modalities and CD through a Bayesian network meta-analysis (NMA). Materials and methods: Ten articles were retrieved from PubMed, ScienceDirect, and Cochrane Library searches. Bone graft modalities are categorized into four, and CD is the control group: (1) CD, (2) autologous bone graft (ABG), (3) biomaterial bone graft (BBG), (4) bone graft combined with bone marrow graft (BG + BM), and (5) free vascular bone graft (FVBG). The rates of conversion to total hip arthroplasty (THA), femoral head necrosis progression rate, and Harris hip score (HHS) improvement were compared among the five treatments. Results: A total of 816 hips were included in the NMA: specifically, 118 hips in CD, 334 in ABG, 133 in BBG, 113 in BG + BM, and 118 in FVBG. The NMA results show no significant differences in preventing conversion to THA and improving HHS in each group. All bone graft methods are better than CD in preventing osteonecrosis of the femoral head (ONFH) progress [ABG: odds ratio (OR) = 0.21, 95% CI: 0.07-0.56; BBG: OR = 0.13, 95% CI: 0.03-0.52; BG + BM: OR = 0.06, 95% CI: 0.01-0.24; FVBG: OR = 0.11, 95% CI: 0.02-0.38]. The rankgrams indicate that BG + BM is the best intervention in preventing conversion to THA (73%), preventing ONFH progress (75%), and improving HHS (57%), followed by the BBG in preventing conversion to THA (54%), improving HHS (38%), and the FVBG in preventing ONFH progress (42%). Conclusions: This finding indicates that bone grafting after CD is necessary to prevent ONFH progression. Moreover, bone grafts combined with bone marrow grafts and BBG seem to be effective treatment methods in ONFH. [ABSTRACT FROM AUTHOR]

BACKGROUND: Femoral head necrosis brings a serious burden to patients and the society. The existing hypotheses cannot fully explain the mechanism of the femoral head necrosis. However, there is no doubt that the dysfunction of bone microcirculation system is its pathological basis. Given the importance of microcirculation during femoral head necrosis, recent studies indicate that bone microvascular endothelial cell injury exerts a crucial effect on the pathogenesis of femoral head necrosis. OBJECTIVE: To analyze the action mechanism of bone microvascular endothelial cells for treatment of femoral head necrosis, and to focus on the prospect of improving microcirculation and promoting osteogenesis based on bone microvascular endothelial cells, so as to treat femoral head necrosis. METHODS: “Necrosis of femoral head; bone microvascular endothelial cells; microcirculation disorder; bone tissue engineering technology; microRNAs” were used as Chinese and English keywords. Totally 220 related articles were obtained by searching on CNKI (China National Knowledge Infrastructure), Wanfang database, and PubMed database. Insufficient timeliness, vague conclusions, and repetitive articles were excluded by reading the titles, abstracts and part of the content. Finally, 63 articles that met the inclusion criteria were included for review. RESULTS AND CONCLUSION: (1) The impaired angiogenesis, abnormal apoptosis, thrombosis and fat embolism caused by the dysfunction of bone microvascular endothelial cells are all involved in the occurrence and development of avascular necrosis of the femoral head. (2) Traditional Chinese medicine, bone tissue engineering technology, transfection-based method, and microRNAs can be employed to prevent and treat avascular necrosis of the femoral head by promoting angiogenesis, suppressing apoptosis and vascular embolism. (3) Combined transplantation of microvascular endothelial cells and bone marrow mesenchymal stem cells is one of the most promising strategies for the treatment of femoral head necrosis, but the optimal ratio between co-grafts and scaffolds with good biocompatibility and cultured cells needs further research. (4) For gene transfection, the transcriptional regulation mechanism of target gene in host cells has not been fully studied. In addition, there are few related clinical trials, and the therapeutic effect needs to be further verified. [ABSTRACT FROM AUTHOR]

Background: The incidence of avascular necrosis (AVN) after pediatric femoral neck fracture (PFNF) in the literature varies widely, and the risk factors associated with AVN after PFNF are controversial. Therefore, this study aimed to accurately investigate the incidence of AVN after PFNF and systematically evaluate and meta-classify their risk factors. Methods: A comprehensive search was performed of PubMed, Web of Science, and Embase. The pooled rate and 95% confidence interval (CI) were used to assess the incidence of AVN after PFNF, and pooled odds ratio (OR) were calculated to measure the effect sizes. In addition, we performed subgroup, stratified, and publication bias analyses. Results: A total of 30 articles were included in our meta-analysis, with 303 AVN cases among 1185 patients. The pooled incidence of AVN after PFNF was 22% (95% CI 18%, 27%). Subgroup analyses indicated Delbet type I–IV fracture incidences with AVN of 45%, 32%, 17%, and 12%, respectively. The incidence of AVN after PFNF in Asia was 19%, lower than in Africa at 36%, Europe at 26%, and North America at 23%. In addition, the larger sample size group and the earlier published literature group showed a higher incidence of necrosis. Stratified analyses showed that patient age and Delbet fracture classification were both important factors affecting AVN after PFNF (OR = 1.61, p = 0.02 and OR = 3.02, p < 0.001, respectively), while the time to treatment was not (OR = 0.9, p = 0.71). Conclusion: The pooled incidence of AVN after PFNF was ~ 22%; furthermore, the available evidence demonstrates that patient age and Delbet type of fracture were important influencing factors of AVN after PFNF. [ABSTRACT FROM AUTHOR]

(1) Background: To evaluate the performance of a deep learning model to automatically segment femoral head necrosis (FHN) based on a standard 2D MRI sequence compared to manual segmentations for 3D quantification of FHN. (2) Methods: Twenty-six patients (thirty hips) with avascular necrosis underwent preoperative MR arthrography including a coronal 2D PD-w sequence and a 3D T1 VIBE sequence. Manual ground truth segmentations of the necrotic and unaffected bone were then performed by an expert reader to train a self-configuring nnU-Net model. Testing of the network performance was performed using a 5-fold cross-validation and Dice coefficients were calculated. In addition, performance across the three segmentations were compared using six parameters: volume of necrosis, volume of unaffected bone, percent of necrotic bone volume, surface of necrotic bone, unaffected femoral head surface, and percent of necrotic femoral head surface area. (3) Results: Comparison between the manual 3D and manual 2D segmentations as well as 2D with the automatic model yielded significant, strong correlations (Rp > 0.9) across all six parameters of necrosis. Dice coefficients between manual- and automated 2D segmentations of necrotic- and unaffected bone were 75 ± 15% and 91 ± 5%, respectively. None of the six parameters of FHN differed between the manual and automated 2D segmentations and showed strong correlations (Rp > 0.9). Necrotic volume and surface area showed significant differences (all p < 0.05) between early and advanced ARCO grading as opposed to the modified Kerboul angle, which was comparable between both groups (p > 0.05). (4) Conclusions: Our deep learning model to automatically segment femoral necrosis based on a routine hip MRI was highly accurate. Coupled with improved quantification for volume and surface area, as opposed to 2D angles, staging and course of treatment can become better tailored to patients with varying degrees of AVN. [ABSTRACT FROM AUTHOR]

Introduction: Atraumatic necrosis of the femoral head (AFHN) is a common disease with an incidence of 5000–7000 middle-aged adults in Germany. There is no uniform consensus in the literature regarding the configuration of the bone in AFHN. The clinical picture of our patients varies from very hard bone, especially in idiopathic findings, and rather soft bone in cortisone-induced necrosis. A better understanding of the underlying process could be decisive for establishing a morphology-dependent approach. The aim of this study is the closer examination of the condition of the bone in the AFHN compared to the primary hip osteo arthritis (PHOA). Materials and methods: The preparations were obtained as part of elective endoprosthetic treatment of the hip joint. Immediately after sample collection, thin-slice CT of the preserved femoral heads was performed to determine the exact density of the bone in the necrosis zone. Reconstruction was done in 0.8–1 mm layers in two directions, coronary and axial, starting from the femoral neck axis. Density of the femoral heads was determined by grey value analysis. The value in Hounsfield units per sample head was averaged from three individual measurements to minimize fluctuations. For biomechanical and histomorphological evaluation, the samples were extracted in the load bearing zone perpendicular to the surface of the femoral head. Group-dependent statistical evaluation was performed using single factor variance analysis (ANOVA). Results: A total of 41 patients with a mean age of 64.44 years were included. The mean bone density of the AFHN samples, at 1.432 g/cm3, was about 7% higher than in the PHOA group with a mean value of 1.350 g/cm3 (p = 0.040). The biomechanical testing in the AFHN group showed a 22% higher—but not significant—mean compressive strength (20.397 MPa) than in the PHOA group (16.733 MPa). On the basis of histological analysis, no differentiation between AFHN and PHOA samples was possible. Conclusions: The present study (NCT, evidence level II) shows that AFHN has a very well detectable higher bone density compared to PHOA. However, neither biomechanical stress tests nor histomorphological evaluation did show any significant difference between the groups. The results allow the conclusion that there is no "soft" necrosis at all in the AFHN group. [ABSTRACT FROM AUTHOR]

Objective: The aim of this meta-analysis was to investigate the impact of intravenous iloprost therapy on pain, function, edema changes, and follow-up surgery in bone marrow edema syndrome of the proximal femur. Methods: A systematic literature search up to May 2022 was performed to find relevant papers that made a statement about the outcome of intravenous iloprost therapy alone. Factors such as the Visual Analog Scale (VAS), Harris Hip Score (HHS), edema reduction, and follow-up interventions were considered. These were compared using Forest plots. Results: In 11 studies, 190 proximal femora with bone marrow edema syndrome that received intravenous iloprost therapy without further therapeutic intravenous or surgical intervention such as core decompression were studied. There was a significant mean improvement in VAS by 3.3 cm (2.07–4.5 cm) (p < 0.001) and HHS by 24.36 points (18.23–30.49) (p < 0.001) 3–6 months after receiving iloprost therapy. Only in 9.3% of cases (1.1–24.3%) did no clinical or radiological improvement occur. Conclusions: It could be shown that the existing publications support intravenous therapy with iloprost in patients with bone marrow edema syndrome and result in good clinical outcomes. [ABSTRACT FROM AUTHOR]

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