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BMJ Case Rep 2022 Jun 22;15(6). Epub 2022 Jun 22.

Trauma and Orthopaedics, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK.

Anterior dislocations of the native hip are rare injuries, and normally a result of high energy trauma such as road traffic accidents. Delays in reduction of over 12 hours have been shown to increase the risk of avascular necrosis to the head of the femur significantly. We report the case of an elderly man who sustained an anterior dislocation of his native hip following a fall. Read More

Acta Ortop Bras 2022 15;30(2):e247996. Epub 2022 Apr 15.

Universidade de São Paulo, Medical School, Hospital das Clínicas, Institute of Orthopedics and Traumatology (IOT-HCFMUSP), São Paulo, SP, Brazil.

Many experimental models exist to better understand the necrosis of the femoral head etiology, both in terms of the species variety in which necrosis is induced and in the operative techniques used for treatment.

Objective: This study has two main objectives, the first is to review the literature concerning experimental models of avascular necrosis of the growing femoral head, the second, to demonstrate the experimental pig model's reproducibility using a pilot study.

Methods: This was a bibliographic review to describe the attempts over time to find the best species and technique for induction that would reproduce ischemic necrosis of the growing femoral head in humans. Read More

Acta Orthop Traumatol Turc 2022 May;56(3):187-193

Department of Orthopaedics and Traumatology, İstanbul Bilim University, İstanbul, Turkey.

Objective: This study aimed to establish a feasible conservative treatment algorithm for Legg-Calvè-Perthes Disease (LCPD), clarify its limitations, and evaluate the correlations between radiographical and clinical results.

Methods: Patients diagnosed with LCPD and treated conservatively were evaluated retrospectively; 39 hips from 35 patients were included. The treatment protocol consisted of intermittent manual traction, range of motion exercises, activity limitation, bed rest, NSAID (ibuprofen 100mg/5mL), and ASA (100mg/day) during attack periods. Read More

Adv Orthop 2022 29;2022:8688770. Epub 2022 May 29.

Head of Teaching Department of Orthopaedics and Musculoskeletal Trauma, University of Pavol Jozef Šafárik, Kosice, Slovakia.

Background: Hilgenreiner brace (Hb) was developed to improve hip reduction rate and reduce the incidence of femoral head avascular necrosis (AVN). In children under the age of 18 months with unstable hip joints or a dislocated hip joint, the treatment method involves nonsurgical treatment in most cases.

Objectives: To evaluate the effectiveness and safety of traction, closed reduction, and hip fixation in Hb in patients with severe forms of hip developmental dysplasia (DDH) in follow-up. Read More

N Engl J Med 2022 06;386(23):e62

Taipei Medical University, Taipei, Taiwan.

J Orthop Surg Res 2022 Jun 6;17(1):302. Epub 2022 Jun 6.

Joint Reconstruction Research Centre, Tehran University of Medical Sciences, End of Keshavarz Blvd, Tehran, 1419733141, Iran.

Purpose: At present, concomitant avascular necrosis (AVN) of femoral head and septic arthritis (SA) as a sequel of COVID-19 infection has yet not been documented. By large-scale use of life-saving corticosteroids (CS) in COVID-19 cases, our aim is to warn of the occurrence of hip joint infection in these patients.

Methods: We report a series of five cases in which patients developed septic arthritis concomitant with AVN after being treated for COVID-19 infection. Read More

Acta Chir Orthop Traumatol Cech 2022 ;89(2):134-138

Ortopediatri, Pediatric Orthopedic Academy, Istanbul, Turkey.

PURPOSE OF THE STUDY Radiographs are preferred for understanding the deformity and containment in Legg-Calvé-Perthes disease (LCPD), as well as for treatment planning, but plain radiographs provide only static information and are inadequate for dynamic assessment of the joint. Magnetic resonance imaging (MRI) has been shown to be superior to other diagnostic modalities. The aim of this study was to determine the importance of hip MRI in LCPD treatment decision-making processes between pediatric orthopedic surgeons and orthopedic surgery residents. Read More

J Pediatr Orthop B 2022 Jul 24;31(4):359-364. Epub 2022 May 24.

Department of Orthoapedics and Spine Surgery, Ganga Hospital, Coimbatore, India.

The ideal management of an unstable slipped capital femoral epiphysis (SCFE) is still controversial. The currently available options are in-situ screw fixation with delayed corrective osteotomy, closed reduction and screw fixation and anatomic reduction by modified Dunn's procedure (MDP). We present the results of our technique of controlled re-positioning (CRP) with primary osteoplasty in which the epiphysis is repositioned to the preacute slip stage and a mini-open osteoplasty is done in the same sitting to avoid later femoro-acetabular impingement. Read More

BMC Musculoskelet Disord 2022 May 26;23(1):499. Epub 2022 May 26.

Department of Joint Diseases, Traumatology & Orthopedics Institute of Guangzhou University of Chinese Medicine, The Third Afliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.

Background: Osteonecrosis of the femoral head (ONFH) may occur in the adolescent and younger adults (AYAs). Total hip arthroplasty (THA) is not the best treatment option for younger patients. Surgical hip dislocation (SHD) combined with bone graft can be used in patients at different stages to reconstruct the bone structure in the head and delay the replacement time. Read More

Orthop Surg 2022 Jun 19;14(6):1186-1192. Epub 2022 May 19.

Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, China.

Objective: To analyze necrotic femoral head after long-term internal fixation for femoral neck fractures using micro-computed tomography (CT) for bone histomorphometry.

Methods: The experimental group included six patients (two men and four women; mean age 62.00 ± 9. Read More

J Orthop Surg Res 2022 May 16;17(1):278. Epub 2022 May 16.

Department of Orthopedic Surgery, Ajou University School of Medicine, Yeongtong-gu, Suwon-si, Gyeonggi-do, Republic of Korea.

Background: The study aim was to report the treatment outcomes of trochanteric flip osteotomy (TFO) with surgical hip dislocation (SHD) for femoral head fracture and dislocation (FHFD) and to investigate the risk factors for avascular necrosis (AVN) of the femoral head.

Methods: The data of 34 patients (29 men, 5 women; mean age 37.9 years) diagnosed with FHFD and treated with TFO with SHD between May 2009 and February 2018 with an average follow-up period of 5. Read More

Osteoarthritis Cartilage 2022 May 12. Epub 2022 May 12.

Univ. Lille, CHU Lille, Univ. Littoral Côte D'Opale, ULR 4490 - MABLab- Adiposité Médullaire et Os, F-59000 Lille, France; Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France.

Objective: To determine changes of subchondral bone composition, micro-structure, bone marrow adiposity and micro-vascular perfusion in end-stage osteonecrosis of the femoral head (ONFH) compared to osteoarthritis (OA) using a combined in vivo and ex vivo approach.

Design: Male patients up to 70 years old referred for total hip replacement surgery for end-stage ONFH were included (n = 14). Fifteen patients with OA were controls. Read More

Cell Prolif 2022 Jun 14;55(6):e13252. Epub 2022 May 14.

Department of Orthopedic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China.

Objectives: Osteonecrosis of the femoral head (ONFH) is a devastating disease characterized by destructive bone structures, enlarged adipocyte accumulation and impaired vascularization. The aldehyde dehydrogenase 2 (ALDH 2) is the limiting enzyme for ethanol metabolism with many physiological functions. The aim was investigated the potential protective role of activated ALDH 2 by Alda-1 for ethanol-induced ONFH. Read More

BMC Surg 2022 May 10;22(1):165. Epub 2022 May 10.

Department of Traumatic Orthopedics, Shandong Provincial Hospital, Shandong University, No. 324 Jingwu Weiqi Road, Jinan, 250012, Shandong, China.

Background: In clinical practice, acetabular posterior wall fracture combined with femoral head fracture is rare. However, with the increasing number of engineering and traffic accidents, such fractures, have increased significantly in recent years. This paper aims to explore the clinical efficiency of the Kocher-Langenbeck (K-L) and Smith-Petersen (S-P) combined approaches for open reduction and internal fixation (ORIF) of acetabular posterior wall fractures accompanied by femoral head fractures (Pipkin type IV fractures). Read More

Orthop Surg 2022 Jun 7;14(6):1251-1259. Epub 2022 May 7.

Department of Orthopedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.

Background: Osteonecrosis of the femoral head (ONFH) is a multifactorial disease, and agnogenic ONFH, otherwise known as idiopathic ONFH, is rare in clinic. Idiopathic ONFH that exhibits severe necrosis and progresses extremely rapidly is called rapidly destructive hip disease (RDHD). RDHD greatly affects patients but is rarely reported in clinical practice and literature. Read More

J Am Acad Orthop Surg Glob Res Rev 2022 May 1;6(5). Epub 2022 May 1.

From Weill Cornell Medicine, New York, New York (Mr. George), and the Hospital for Special Surgery, New York, New York (Dr. Lane).

Osteonecrosis of the femoral head is a progressive and debilitating condition with a wide variety of etiologies including trauma, steroid use, and alcohol intake. Diagnosis and staging are based on imaging including MRI at any stage and plain radiography in more advanced lesions. The only definitive treatment is total hip arthroplasty, although numerous treatments including disphosphonates and core decompression are used to delay the progression. Read More

J Vis Exp 2022 04 12(182). Epub 2022 Apr 12.

Department of Orthopedic Surgery, Beijing Key Lab of Immunes-Mediated Inflammatory Disease, China-Japan Friendship Hospital;

Osteonecrosis of the femoral head (ONFH) is a common joint disease in young and middle-aged patients, which seriously burdens their lives and work. For early-stage ONFH, core decompression surgery is a classical and effective hip preservation therapy. In traditional procedures of core decompression with Kirschner wire, there are still many problems such as X-ray exposure, repeated puncture verification, and damage to normal bone tissue. Read More

Front Surg 2022 8;9:662722. Epub 2022 Apr 8.

Sports Medicine Institute, Hospital for Special Surgery, New York, NY, United States.

Osteonecrosis of the femoral head (ONFH) is caused when circulation within the femoral head is disrupted. Etiology of this disease is characterized by either traumatic events or atraumatic risk factors, such as chronic alcohol consumption or glucocorticoid use. ONFH commonly presents as pain in the groin, gluteus muscles, and/or knee with reductions in internal rotation range of motion of the hip. Read More

BMC Musculoskelet Disord 2022 Apr 21;23(1):374. Epub 2022 Apr 21.

Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, 221000, Xuzhou, Jiangsu, China.

Background: Clinical angiography and vascular microperfusion confirmed that the femoral head retains blood supply after a collum femur fracture. However, no animal model accurately mimics this clinical situation. This study was performed to establish a rat model with retained viability of the femoral head and partial vasculature deprivation-induced traumatic caput femoris necrosis by surgery. Read More

Orthop Surg 2022 May 21;14(5):831-839. Epub 2022 Apr 21.

Department of Bone and Joint Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.

Osteonecrosis of the femoral head (ONFH) is a crippling disease which is due to a lack of effective therapeutic measures. Its natural progression is rapid, the internal bone structure of the femoral head changes dramatically, and the subsequent fractures and collapse cause severe hip pain and loss of hip function. Femoral head collapse is a critical turning point in the development of ONFH and is related to the prognosis of patients. Read More

J Pediatr Orthop 2022 Jul 21;42(6):e570-e576. Epub 2022 Apr 21.

Former Head of Paediatric Orthopaedic Service, Kasturba Medical College, Manipal, Karnataka, India.

Background: Among a cohort of 402 children with Legg-Calvé-Perthes disease (LCPD), 32 children presented with sclerosis and severe collapse of the entire femoral epiphysis that closely resembled a discus.This study was undertaken to identify the characteristics of children with this form of a "discoid epiphysis," compare them with typical LCPD and ascertain the radiologic outcome of their hips when the disease healed.

Methods: Sequential radiographs of the children were studied to monitor disease evolution. Read More

Orthop Surg 2022 May 18;14(5):851-859. Epub 2022 Apr 18.

Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, China.

Objective: To evaluate whether core decompression could prevent progression of asymptomatic type C osteonecrosis of the femoral head (ONFH) according to the Japanese Investigation Committee (JIC) classification.

Methods: This retrospective cohort study included 124 hips (117 patients) with asymptomatic type C ONFH. Seventy-one hips (67 patients) received core decompression (core decompression group) and 53 hips (50 patients) received no surgical treatment (control group). Read More

Acta Orthop Traumatol Turc 2022 Mar;56(2):120-124

Department of Orthopaedics and Traumatology, Çukurova University, School of Medicine, Adana, Turkey.

Objective: The aim of this study was to investigate whether there is a relationship between Salter and Pemberton pelvic osteotomies and avascular necrosis of femoral head in the management of developmental dysplasia of the hip (DDH).

Methods: This retrospective study included 69 hips of 52 patients aged between 12-36 months, diagnosed as DDH who had undergone either Salter or Pemberton pelvic osteotomy with Smith Petersen approach. There were 35 patients in Salter Pelvic Osteotomy and 34 patients in Pemberton Pelvic Osteotomy groups. Read More

J Orthop Case Rep 2021 Nov;11(11):47-49

Department of Orthopaedic, Franz Tappeiner Hospital, Via Rossini, Meran, Italy.

Introduction: Evaluation of pain in children after trauma can sometimes be difficult; in particular, a knee pain in a child could originate from the hip, until evidence of the contrary. Often is the low-energy trauma that leads to a joint dislocation in children. Furthermore, the present guidelines state that a hip dislocation in a child should be replaced within 6 (maximum 12) hours, to reduce the risk of avascular necrosis (AVN) of the femoral head. Read More

J Bone Joint Surg Am 2022 04;104(Suppl 2):54-60

Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota.

Background: Core decompression (CD) with bone marrow aspiration concentrate (BMAC) is a technique that may improve outcomes in osteonecrosis of the femoral head (ONFH). The primary aim of this study was to evaluate the radiographic progression free survival (PFS) of CD augmented with BMAC. Secondary aims were to determine the survivorship with conversion (CFS) to total hip arthroplasty (THA) as an endpoint, determine prognostic factors, and characterize the cellular quality of the BMAC. Read More

J Bone Joint Surg Am 2022 04;104(Suppl 2):47-53

Department of Orthopaedics, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, P.R. China.

Background: Femoral head collapse (FHC) is associated with a poor prognosis in osteonecrosis of the femoral head (ONFH). Preserved angles (PAs), including the lateral preserved angle (LPA), the anterior preserved angle (APA) and the combined preserved angle (CPA), can be used to quantify the extent of femoral head necrosis and predict the risk of femoral head collapse. The purpose of this retrospective cohort study was to assess the efficacy of these preserved angles in the prediction of femoral head collapse using plain radiographs. Read More

J Bone Joint Surg Am 2022 04;104(Suppl 2):40-46

Centre for Osteonecrosis and Joint-preserving & Reconstruction, Orthopaedic Department, China-Japan Friendship Hospital, Beijing, China.

Background: The purpose of this study was to analyze the interobserver reliability and intraobserver repeatability of the China-Japan Friendship Hospital (CJFH) typing classification system for nontraumatic osteonecrosis of the femoral head (ONFH).

Methods: Image data of 50 hips were randomly selected in 289 patients (433 hips) with ONFH who underwent treatment in the China-Japan Friendship Hospital from 2012 to 2016. Bilateral hip plain radiography, magnetic resonance imaging (MRI), or computerized tomography (CT) were performed in all hips. Read More

J Bone Joint Surg Am 2022 04;104(Suppl 2):13-18

Laboratory of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China.

Background: To investigate the collapse mechanism in osteonecrosis of the femoral head (ONFH), we studied the relationship between the femoral head (FH) blood circulation changes and the collapse area histomorphometry characteristics.

Methods: A technique involving microvascular perfusion of the FH in vitro to reconstruct the vessels in the FH at different stages of nontraumatic ONFH (40 cases). In addition, we also examined the histomorphometry characteristics in the collapse area during ONFH at different stages using the hard tissue section technique. Read More

Cureus 2022 Mar 1;14(3):e22735. Epub 2022 Mar 1.

Rheumatology, Einstein Medical Center Philadelphia, Philadelphia, USA.

Corticosteroid therapy is a known risk factor for osteonecrosis, more commonly with chronic use and high cumulative dose. Osteonecrosis (avascular necrosis) has been described in pregnancy involving primarily the femoral head. To our knowledge, only rare cases of femoral meta diaphysis or knee osteonecrosis in pregnancy have been documented in the literature. Read More

Exp Clin Transplant 2022 03;20(Suppl 1):140-144

From the Nephrology Department, Hamed Al-Essa Organ Transplant Center, Sabah Area, Kuwait.

Nocardiosis is a life-threatening infection in immunocompromised patients. The prevalence of the disease ranges from 2.3% to 5% in renal allograft recipients. Read More