Treatment for femoral head osteonecrosis has been less successful in late stages of the disease, after progression to collapse. The current authors treated 21 patients (22 hips) with Stage III osteonecrosis by a technique of open reduction and fixation with methylmethacrylate cement (cementation). The followup ranged from 1 to 3 years (average, 1.7 years). Patient progress was followed using preoperative and postoperative Harris hip scores, Western Ontario and McMaster Universities Osteoarthritis Index, and a health status questionnaire (Short Form-36). Patients were staged preoperatively using the Association Research Circulation Osseous international classification system and radiographic evaluation was done intraoperatively and postoperatively. The Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index, and Short Form-36 physical health scores improved significantly from 53.5 to 78.0, 66.0 to 48.1, and 27.0 to 40.0, respectively. The outcome was worse for patients with more advanced disease. Six patients, all with severe disease, had total hip arthroplasty. Cementation is technically simple, enables patients' immediate postoperative pain relief and improvement in mobility, and has the potential to restore and maintain the sphericity of the femoral head after collapse. The high failure rate (27%) at short-term followup, although comparable with other reported techniques, does not support generalized use for Stage III disease. Currently the use of this procedure is restricted to symptomatic, young patients (younger than 40 years), preferably with mild to moderate Stage III disease (degree of head involvement < 30% and degree of collapse < 4 mm).
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http://dx.doi.org/10.1097/01.blo.0000072465.53786.58 | DOI Listing |
Foot Ankle Int
January 2025
Royal National Orthopaedic Hospital NHS Trust, Foot & Ankle Unit, Stanmore, United Kingdom.
Background: Ankle and hindfoot fusion in the presence of large bony defects represents a challenging problem. The purpose of this study was to evaluate outcomes of patients who underwent ankle-hindfoot fusions with impaction bone grafting (IBG) with morselized femoral head allograft to fill large bony void defects.
Methods: This was a 3-center, retrospective review of a consecutive series of 49 patients undergoing ankle or hindfoot fusions with femoral head IBG for filling large bony defects.
Pak J Med Sci
January 2025
Muhammad Ashfaq, MCPS, FCPS, CHPE (JSMU) Pediatric Medicine, National Institute of Child Health Karachi, Pakistan.
Objectives: To determine gender and ethnic distribution of developmental dysplasia of hip in newborns using Graf method for ultrasound. To determine the significance of association between developmental dysplasia of hip with ethnicity in newborns using Graf's method ultrasound.
Method: This analytical cross-sectional observational study was conducted in Karachi from January through June 2022 .
J Clin Orthop Trauma
March 2025
Department of Orthopaedic Surgery, Mercy St. Vincent Medical Center, 2213 Cherry St., Toledo, OH, 43608, USA.
Background: Gravid females with pelvic fractures are rarely encountered by the orthopaedic trauma surgeon. The initial injury can be detrimental to the pregnant patient, but an unnecessary "second hit" from surgery could also contribute to the outcome of the fetus. Understanding the surgical risks for this unique patient population requires knowledge about the negative effects of anesthesia, surgical exposures, and radiation.
View Article and Find Full Text PDFJ Tissue Eng
January 2025
Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China.
Osteonecrosis of the femoral head (ONFH) is a prevalent orthopedic disorder characterized primarily by compromised blood supply. This vascular deficit results in cell apoptosis, trabecular bone loss, and structural collapse of the femoral head at late stage, significantly impairing joint function. While MRI is a highly effective tool for diagnosing ONFH in its early stages, challenges remain due to the limited availability and high cost of MRI, as well as the absence of routine MRI screening in asymptomatic patients.
View Article and Find Full Text PDFBone Res
January 2025
The Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
The death of osteoblasts induced by glucocorticoid (GC)-mediated oxidative stress plays a crucial role in the development of steroid-induced osteonecrosis of the femoral head (SIONFH). Improving bone formation driven by osteoblasts has shown promising outcomes in the prognosis of SIONFH. Isovitexin has demonstrated antioxidant properties, but its therapeutic effects on GC-induced oxidative stress and SIONFH remain unexplored.
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