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It is estimated that 20000 to 30000 new patients are diagnosed with osteonecrosis annually accounting for approximately 10% of the 250000 total hip arthroplasties done annually in the United States. The lack of level 1 evidence in the literature makes it difficult to identify optimal treatment protocols to manage patients with pre-collapse avascular necrosis of the femoral head, and early intervention prior to collapse is critical to successful outcomes in joint preserving procedures. There have been a variety of traumatic and atraumatic factors that have been identified as risk factors for osteonecrosis, but the etiology and pathogenesis still remains unclear. Current osteonecrosis diagnosis is dependent upon plain anteroposterior and frog-leg lateral radiographs of the hip, followed by magnetic resonance imaging (MRI). Generally, the first radiographic changes seen by radiograph will be cystic and sclerotic changes in the femoral head. Although the diagnosis may be made by radiograph, plain radiographs are generally insufficient for early diagnosis, therefore MRI is considered the most accurate benchmark. Treatment options include pharmacologic agents such as bisphosphonates and statins, biophysical treatments, as well as joint-preserving and joint-replacing surgeries. the surgical treatment of osteonecrosis of the femoral head can be divided into two major branches: femoral head sparing procedures (FHSP) and femoral head replacement procedures (FHRP). In general, FHSP are indicated at pre-collapse stages with minimal symptoms whereas FHRP are preferred at post-collapse symptomatic stages. It is difficult to know whether any treatment modality changes the natural history of core decompression since the true natural history of core decompression has not been delineated.
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http://dx.doi.org/10.5312/wjo.v6.i8.590 | DOI Listing |
Sci Rep
March 2025
Jinan Fifth People's Hospital, No. 24297, Jingshi Road, Huaiyin District, Jinan, 250022, Shandong, China.
This study delved into the role of the PI3K/AKT signaling pathway and cuproptosis in steroid-induced osteonecrosis of the femoral head (SIONFH), assessing the therapeutic potential of the PI3K agonist 740Y-P. We analyzed femoral head specimens from SIONFH patients using DIA proteomics, identifying differentially expressed proteins linked to cuproptosis. In vitro, MC3T3-E1 cells treated with dexamethasone (DEX) exhibited hallmarks of cuproptosis, including downregulation of DLAT, PDHB, SLC25A3, and FDX1, increased copper ions, and reduced osteogenic potential, as shown by decreased ALP activity and RUNX2/BMP2 expression.
View Article and Find Full Text PDFJ Biomech
March 2025
Department of Biological Sciences, Graduate School of Science, The University of Tokyo, Tokyo, Japan. Electronic address:
Understanding the transmission of forces through the joints of the lower limb under weight-bearing conditions is critical for assessing the progression of knee and ankle osteoarthritis, as well as for developing effective surgical and preventive strategies. This study presents the first simultaneous quantification of three-dimensional skeletal posture and ground reaction force vectors during quiet standing, utilizing upright computed tomography and a custom-made force plate. We constructed the force plate using two six-axis force sensors, and the coordinate system of the CT was aligned with that of the force plate using metal spheres attached to the edges of the force plate.
View Article and Find Full Text PDFInjury
February 2025
Department of Arthritis, Affiliated Hospital of Shandong Second Medical University, Weifang, 261031, PR China. Electronic address:
Objective: This study aimed to identify the optimal position for the femoral neck system (FNS) device when fixing Pauwels III #NOF, by analyzing the mechanical stability and stress distribution of FNS at different screw placement positions for the fixation of Pauwels III femoral neck fractures.
Methods: We employed finite element analysis to create a 3D model of a Pauwels type III femoral neck fracture. Six models were designed, each with varied FNS screw placement positions.
Pediatr Radiol
March 2025
Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, Liaoning, China.
Background: The Tönnis classification is widely used to quantify the severity of developmental dysplasia of the hip (DDH) based on the epiphyseal ossification center, while the International Hip Dysplasia Institute (IHDI) has proposed an alternative system. However, the pathological morphology associated with these classifications remains inadequately defined.
Objective: This study aimed to elucidate the correlation between the Tönnis classification and the IHDI classification with the pathological morphology of cartilage and soft tissues in DDH.
Eur J Orthop Surg Traumatol
March 2025
Baidya and Banskota Hospital, Patan, Nepal.
Introduction: Traumatic hip dislocations (THD) often result from high-energy trauma and are frequently associated with fractures of the femoral head, shaft, or acetabulum. Effective management, including timely hip relocation, is essential for favorable outcomes. However, limited literature exists on the functional outcomes of THD, especially in resource-limited settings like Nepal.
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