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Ann R Coll Surg Engl 2021 Apr 29. Epub 2021 Apr 29.

Southampton University Hospitals NHS Trust, UK.

Introduction: Autologous stem cell progenitor implantation into necrotic lesions of the femoral head has previously been described as a potential treatment for avascular necrosis (AVN), on the basis that there is a reduced number of functioning stem cells in the marrow within the necrotic segment. We present a case series of patients with AVN that underwent core decompression with autologous stem cell implantation using a new device.

Methods: The records and imaging of patients with AVN of the femoral head treated by a single surgeon were retrospectively reviewed. Read More

Bone 2021 Jul 16;148:115961. Epub 2021 Apr 16.

Ribeirão Preto Medical School, USP Ribeirão Preto, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Campus Universitário s/n - Monte Alegre, Ribeirão Preto, SP, Brazil; Ribeirão Preto Medical School Musculoskeletal Imaging Research Laboratory, Brazil; Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, MO, United States.

Objective: To evaluate the association between bone changes due to vaso-occlusive events in sickle cell disease (SCD) revealed by conventional MRI sequences and the fat fraction obtained using a 6-point DIXON technique (FFdix), in an attempt to use quantitative data as a biomarker for bone complications.

Methods: Cross-sectional study, with 48 SCD patients, 26-homozygous (HbSS), and 22-compound heterozygous (HbSC). Forty-eight healthy individuals paired by age, weight, and sex with SCD patients. Read More

Ther Adv Musculoskelet Dis 2021 29;13:1759720X211002677. Epub 2021 Mar 29.

Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, NO 600, Yishan Road, Xuhui district, Shanghai 200233, China.

Background: Osteonecrosis of the femoral head (ONFH) remains a major cause of disability in patients with systemic lupus erythematosus (SLE) and seriously impairs quality of life. This study aimed to investigate associations between glucocorticoids (GCs), antiphospholipid antibodies (aPLs), and ONFH in patients with SLE.

Methods: We conducted a multicentre cohort study on patients with SLE and used a directed acyclic graph-based analysis strategy. Read More

Mymensingh Med J 2021 Apr;30(2):323-328

Dr Mohammad Tariqul Alam, Assistant Professor, Paediatric Orthopaedics, Mymensingh Medical College (MMC), Mymensingh, Bangladesh; E-mail:

Cellular death of bone due to impairment of the blood supply leading to collapse resulting in pain, and loss of joint function is known as avascular necrosis (AVN). The head of femur is the most common bone affected by avascular necrosis followed by talus and scaphoid. We evaluate the results of core decompression with non-vascularized fibular graft in avascular necrosis of femoral head. Read More

J Orthop Res 2021 Mar 31. Epub 2021 Mar 31.

Center for Excellence in Hip, Scottish Rite for Children, Dallas, Texas, USA.

This study investigated the sensitivity of T1ρ and T2 relaxation time mapping to detect acute ischemic injury to the secondary ossification center (SOC) and epiphyseal cartilage of the femoral head in a piglet model of Legg-Calvé-Perthes disease. Six piglets underwent surgery to induce global right femoral head ischemia and were euthanized 48 h later. Fresh operated and contralateral-control femoral heads were imaged ex vivo with T1, T2, and T1ρ mapping using a 9. Read More

PLoS One 2021 18;16(3):e0248701. Epub 2021 Mar 18.

Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.

Purpose: The purpose of this study was to identify imaging risk factors on contrast-enhanced hip MRI after closed reduction of developmental dysplasia of the hip (DDH) that could predict future development of avascular necrosis (AVN) of the femoral head.

Materials And Methods: Fifty-eight infants (F: M = 53: 5, aged 3-18 months) who underwent immediate postoperative contrast-enhanced hip MRI after closed reduction of DDH were included in this study. Quality of reduction (concentric vs eccentric reduction with or without obstacles), abduction angle of the hip, presence of ossific nucleus, and pattern of contrast enhancement of the femoral head were retrospectively evaluated on MRI. Read More

Klin Lab Diagn 2021 Mar;66(2):104-109

Federal Budgetary State Institution «National Medical Research Center» Traumatology and Orthopedics «named after academician G.A. Ilizarov of the Ministry of Health of Russia».

The increase in the number of patients with hip pathologies among children of different ages makes the diagnosis and treatment of these diseases one of the most actually existing problems in modern orthopedics. The aim of the work was to determine the features of the lipid peroxidation system - antioxidant protection and hemogram indices in children with various forms of hip joint pathology. The results of a preoperative examination of 47 patients aged 6-15 years (average age 10. Read More

Clin Sports Med 2021 Apr 5;40(2):385-398. Epub 2021 Feb 5.

Department of Orthopaedics, San Antonio Military Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA. Electronic address:

This article provides concise and up-to-date information on the most common hip pathologies that affect adolescent athletes. We cover the evaluation and treatment of avulsion injuries, stress fractures, slipped capital femoral epiphysis (SCFE), femoroacetabular impingement, developmental dysplasia of the hip, Legg-Calve-Perthes disease, and coxa saltans focusing on minimizing advanced imaging and using conservative therapy when applicable. Although this is not an all-encompassing list of disorders, it is key to understand these hip pathologies because these injuries occur commonly and can also have detrimental complications if not diagnosed and addressed early, especially SCFE and femoral neck stress fractures. Read More

Bone Rep 2021 Jun 18;14:100756. Epub 2021 Feb 18.

Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Centre, Nijmegen, the Netherlands.

Avascular necrosis of the femoral head is a well-known complication of treatment with high dosage glucocorticoids and has been described in a few patients with Cushing's syndrome. In this case report, we describe the, to our knowledge, first case of a patient with endogenous Cushing's syndrome with a bone infarction located in the distal femur. In patients with Cushing's syndrome and bone pain, the diagnosis of bone infarction should be considered as it can occur as a rare complication of hypercortisolism. Read More

Bone Joint J 2021 Mar;103-B(3):589-596

Leeds Children's Hospital, Leeds, UK.

Aims: Osteonecrosis (ON) can cause considerable morbidity in young people who undergo treatment for acute lymphoblastic leukaemia (ALL). The aims of this study were to determine the operations undertaken for ON in this population in the UK, along with the timing of these operations and any sequential procedures that are used in different joints. We also explored the outcomes of those patients treated by core decompression (CD), and compared this with conservative management, in both the pre- or post-collapse stages of ON. Read More

J Orthop Case Rep 2020 Jul;10(4):42-44

Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan.

Introduction: Subcapital fractures following internal fixation of an intertrochanteric fracture are relatively rare. It has been reported that these fractures are caused by improper placement of implants, osteoporosis, and any trauma episode. We report a rare case of subcapsular fracture possibly caused by whole femoral head necrosis following intertrochanteric fracture treatment. Read More

Arch Orthop Trauma Surg 2021 Feb 21. Epub 2021 Feb 21.

Department of Orthopaedic Surgery, Gachon University Gil Medical Center, Incheon, Republic of Korea.

Introduction: Several studies investigated the posttraumatic osteonecrosis of the femoral head (ONFH) after femoral neck fracture (FNF). However, no study has investigated the hidden ONFH after FNF, which is missed by simple radiographs, using magnetic resonance imaging (MRI).

Materials And Methods: This retrospective study involved 58 consecutive patients who underwent implant removal surgery after internal fixation due to FNF. Read More

Acta Chir Orthop Traumatol Cech 2020 ;87(6):381-386

Ortopedická klinika, Fakultní nemocnice Hradec Králové.

PURPOSE OF THE STUDY The purpose of the retrospective study was to analyse the success rate and safety of overhead traction in treating decentered hip joints. In patients treated strictly non-operatively, i.e. Read More

AJR Am J Roentgenol 2021 04 3;216(4):1014-1021. Epub 2021 Feb 3.

Department of Pathology, University of Utah, University of Utah Hospital, Salt Lake City, UT.

The purpose of this study was to assess the utility of radiography in diagnosing osteonecrosis of the femoral head with pathologic examination as the reference standard. Radiography and pathology reports of 253 consecutive femoral head resections were reviewed. A subset of 128 cases in which the diagnosis of osteonecrosis was made or suggested radiographically or pathologically were reviewed to evaluate for factors that might influence correlation. Read More

Medicine (Baltimore) 2021 Jan;100(4):e23616

Department of Orthopaedic Surgery, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, Zhejiang, People's Republic of China.

Rationale: Pediatric femoral shaft combined with ipsilateral femoral neck fractures are very rare but challenging injuries fraught with the development of avascular necrosis, coxa vara, and leg length discrepancy. Majority of the previous reports indicated the neck femur fracture was fixed with cannulated screws or/and pins, femoral shaft fracture was stabilized with a plate and screws. However, we used cannulated screws combined with elastic stable intramedullary nails to minimally invasive procedures treat this type of injury and achieved good follow-up results. Read More

J Clin Imaging Sci 2021 12;11. Epub 2021 Jan 12.

Department of Radiology, Princess Margaret Hospital, Hong Kong.

Magnetic resonance imaging (MRI) is a commonly used imaging modality to detect early avascular necrosis (AVN). When MRI is inconclusive, bone scan is helpful in detecting AVN during early phase of the disease. As newer nuclear medicine equipment, such as single photon emission computed tomography/computed tomography (SPECT/CT) and positron emission tomography, are emerging in medical science, the role of these imaging modalities in AVN of femoral head is re-evaluated. Read More

Surg Radiol Anat 2021 Jan 23. Epub 2021 Jan 23.

Department of Orthopaedic Surgery, Peking University Third Hospital, NO. 49 North Gardon Road, Haidian District, Beijing, China.

Purpose: The application of the anatomical parameters of the contralateral hip joint to guide the preoperative template of the affected side relies on the bilateral hip symmetry. We investigated the bilateral hip symmetry and range of anatomical variations by measurement and comparison of bilateral hip anatomical parameters.

Methods: This study included 224 patients (448 hips) who were diagnosed with osteoarthritis (OA) and avascular necrosis (AVN) of the femur head, and underwent bilateral primary total hip arthroplasty (THA) in our hospital from January 2012 to August 2020. Read More

Oper Orthop Traumatol 2021 Feb 21;33(1):36-45. Epub 2021 Jan 21.

Abteilung Kinderorthopädie, Kinderchirurgische Universitätsklinik, Inselspital Bern, Freiburgstr., 3010, Bern, Schweiz.

Objective: Transgluteal approach for anatomical reduction of femoral neck fractures (extra-intraarticular) in children under preservation of the blood supply of the femoral head.

Indications: Femoral neck fractures AO 31-M/2.1 I‑III; 31-M/3. Read More

Oper Orthop Traumatol 2021 Feb 19;33(1):23-35. Epub 2021 Jan 19.

Kindertraumatologie, BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau am Staffelsee, Deutschland.

Objective: Anatomic reduction and stable fixation of pediatric femoral neck fractures.

Indications: All unstable and displaced femoral neck fractures (AO classification 31-E/1.1, 31-E/1. Read More

JBJS Case Connect 2020 12 24;10(4):e20.00104. Epub 2020 Dec 24.

Department of Orthopaedic Surgery, KU-Wichita, Wichita, Kansas.

Case: We describe a case of posterior hip dislocation in a 13-year-old boy after a contact football injury with attempted closed reduction resulting in complete separation of the epiphysis from the femoral neck metaphysis with associated femoral head fracture and posterior dislocation of the femoral head. Treatment was emergently performed with a greater trochanteric osteotomy, open reduction internal fixation using cannulated screws, and additional small diameter drill holes in the femoral head to promote blood flow. The patient did well postoperatively and at over 4 years follow-up had no evidence of avascular necrosis and returned to full athletics participation. Read More

J Arthroplasty 2021 02;36(2):e12-e13

Stanford University Medical Center Outpatient Center, Redwood City, CA.

J Arthroplasty 2021 02;36(2):e11

Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Int Orthop 2021 03 11;45(3):585-591. Epub 2021 Jan 11.

Research and treatment center of hip injury diseases, Medical Center of Hip, Luoyang Orthopedic Hospital of Henan Province, Orthopedics Hospital of Henan Province, No. 82, South Qiming Road, Luoyang, 471002, China.

Purpose: To investigate the clinical efficacy and safety of two different bone graft materials in the minimally invasive treatment of early and middle stage femoral head necrosis.

Methods: A total of 36 patients (39 hips) with avascular necrosis of the femoral head were divided into autologous iliac bone group (ABG) and bioceramics bone group (BBG). Both groups were treated with minimally invasive thick channel decompression to remove dead bone of femoral head. Read More

Oper Orthop Traumatol 2021 Feb 6;33(1):15-22. Epub 2021 Jan 6.

Kinderorthopädie, Olgahospital, Klinikum Stuttgart, Kriegsbergstr. 62, 70174, Stuttgart, Deutschland.

Objective: Illustration of surgical treatment of all types of femoral neck fractures other than type AO 31-E/2.1 (Delbet type IB) through the lateral approach INDICATIONS: Femoral neck fractures: a) transcervical (type AO 31-E/1.1) or Delbet type IA, respectively; b) medial femoral neck fracture (type AO 31-M/3. Read More

Ir J Med Sci 2021 Jan 6. Epub 2021 Jan 6.

Radiology Department, Third Hospital of Hebei Medical University, Shijiazhuang, China.

Background: To explore the clinical significance of digital tomographic fusion imaging in the diagnosis of avascular disease of the femoral head in adults.

Methods: Eighty-two adult patients with avascular necrosis of the femoral head confirmed by MRI in the department of orthopedics of our hospital were studied retrospectively. The related signs of adult avascular necrosis of the femoral head were diagnosed by digital tomographic fusion imaging, and the detection rates of digital X-ray (DR) and digital tomosynthesis (DTS) were compared to clarify the clinical value of digital tomographic fusion imaging in the diagnosis of adult avascular necrosis of the femoral head. Read More

BMC Musculoskelet Disord 2020 Dec 12;21(1):841. Epub 2020 Dec 12.

Institute of Orthopedics of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.

Background: Our study aimed to investigate the clinical outcomes and survival rates following porous tantalum rod surgery (PTRS) and conversion total hip arthroplasty (THA) subsequent to failed PTRS.

Methods: A total of 38 subjects (40 hips) with osteonecrosis of the femoral head (ONFH) were included in this retrospective study between January 2008 and December 2011. All subjects were evaluated before surgery by using the Association Research Circulation Osseous (ARCO) classification system, the Japan Investigation Committee (JIC) classification and the Harris hip score (HHS). Read More

J Arthroplasty 2021 04 19;36(4):1352-1360. Epub 2020 Oct 19.

Division of Orthopaedics, Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN.

Background: Osteonecrosis of the femoral head (ONFH) is a potentially severe toxicity associated with glucocorticoid treatment for pediatric hematologic malignancy. We examined clinical outcomes of THA in adolescents and young adults treated for hematologic malignancies who developed advanced ONFH.

Methods: In a single-institution cohort, we retrospectively reviewed medical records and imaging for perioperative complications, reoperations, functional assessment at last follow-up, and radiological outcomes. Read More

Hip Int 2020 Dec;30(2_suppl):3-12

Reconstructive Orthopaedic Surgery Innovative Techniques - Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.

Introduction: Avascular necrosis of femoral head (AVN) is 1 of the main factors causing disability in young adults. Hip prosthesis can be considered an effective treatment of the painful symptoms but it is a major surgical intervention for this type of population. Thus, a large space should be left to therapeutic alternatives such as regenerative medicine. Read More

J Biol Regul Homeost Agents 2020 Jul-Aug;34(4 Suppl. 3):285-287. Congress of the Italian Orthopaedic Research Society

IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.

Bilateral secondary osteoarthritis of the hip may affect also young patients following bilateral hip diseases such as slipped capital femoral epiphysis and developmental hip dysplasia. We report the case of an 18- year old male with a previous diagnosis of Legg-Calvé-Perthes disease who underwent a bilateral total hip arthroplasty through minimally invasive direct anterior approach, with optimal results at 1-year follow up. Read More

BMJ Case Rep 2020 Nov 30;13(11). Epub 2020 Nov 30.

Orthopedisch Centrum Oost Nederland OCON, Hengelo, The Netherlands

A fracture through the neck of the femoral stem in total hip arthroplasty is extremely rare. We report a neck fracture of a cementless Zweymüller stem, one of the most implanted stems worldwide. According to our knowledge, this is the first thorough case description of a neck fracture of a cementless Zweymüller stem. Read More