scholarly journals Atraumatic femoral head necrosis: a biomechanical, histological and radiological examination compared to primary hip osteoarthritis

2021 ◽  
Author(s):  
Hofmann Alexander ◽  
Fischer Benjamin ◽  
Schleifenbaum Stefan ◽  
Kurz Sascha ◽  
Edel Melanie ◽  
...  
Keyword(s):  
Bone Density ◽  
Femoral Head ◽  
Hip Osteoarthritis ◽  
Head Group ◽  
Common Disease ◽  
Stress Tests ◽  
Value Analysis ◽  
Femoral Neck Axis ◽  
Significant Difference ◽  
Femoral Heads

Abstract 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.

scholarly journals Insufficient blood supply of fovea capitis femoris, a risk factor of femoral head osteonecrosis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Keyang Zhao ◽  
Fangfang Zhang ◽  
Kun Quan ◽  
Bin Zhu ◽  
Guangyi Li ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Femoral Head ◽  
Blood Supply ◽  
Maximum Diameter ◽  
Head Group ◽  
Minimum Diameter ◽  
Nutrient Foramen ◽  
Nutrient Foramina ◽  
Significant Difference ◽  
Femoral Heads

Abstract Background A defective nutrient foramen in the fovea capitis femoris was hypothesized to reflect the blood circulation pattern of the femoral head, leading to insufficient blood supply and causing osteonecrosis of the femoral head. Methods Normal and necrotic femoral head specimens were collected. The necrotic femoral head group was divided into a non-traumatic and traumatic subgroup. 3D scanning was applied to read the number, the diameter, and the total cross-sectional area of the nutrient foramina in the fovea capitis femoris. Chi-squared tests and independent t-tests were used to detect any differences in the categorical and continuous demographic variables. Logistic regression models were used to estimate the odds ratio (OR) for non-traumatic and traumatic osteonecrosis in different characteristic comparisons. Results A total of 249 femoral head specimens were collected, including 100 normal femoral heads and 149 necrotic femoral heads. The necrotic femoral head group revealed a significantly higher percentage of no nutrient foramen (p < 0.001), a smaller total area of nutrient foramina (p < 0.001), a smaller mean area of nutrient foramina (p = 0.014), a lower maximum diameter of the nutrient foramen (p < 0.001), and a lower minimum diameter of the nutrient foramen (p < 0.001) than the normal femoral head group. The logistic regression model demonstrated an increasing number of nutrient foramina (crude OR, 0.51; p < 0.001), a larger total area of nutrient foramina (crude OR, 0.58; p < 0.001), a larger mean area of nutrient foramina (crude OR, 0.52; p = 0.023), a greater maximum diameter of the nutrient foramen (crude OR, 0.26; p < 0.001), and greater minimum diameter of the nutrient foramen (crude OR, 0.20; p < 0.001) significantly associated with reduced odds of osteonecrosis of the femoral head (ONFH). The necrotic femoral head group was further divided into 118 non-traumatic and 31 traumatic necrotic subgroups, and no significant difference was observed in any characteristics between them. Conclusions Characteristics of the nutrient foramen in the fovea capitis femoris showed a significant defect of necrotic than normal femoral heads, and significantly reduced odds were associated with the higher abundance of the nutrient foramen in ONFH. Therefore, the condition of the nutrient foramen might be the indicator of ONFH.

Heat Generation and Dissipation Behavior of Various Orthopaedic Bearing Materials

2006 ◽  
Vol 309-311 ◽  
pp. 1281-1284 ◽  
Author(s):  
Stanley Tsai ◽  
Abraham Salehi ◽  
Patrick Aldinger ◽  
Gordon Hunter
Keyword(s):  
Femoral Head ◽  
Peak Load ◽  
Tetragonal Zirconia ◽  
Ultrahigh Molecular Weight Polyethylene ◽  
Interface Surface ◽  
Hip Simulator ◽  
Significant Difference ◽  
Femoral Heads ◽  
Oxidized Zirconium ◽  
Bearing Materials

It has been shown that with high interfacial temperatures in hip bearings, it is possible to precipitate proteins, greatly reduce the compressive creep properties of ultrahigh molecular weight polyethylene (UHMWPE), and change the phase content of monolithic tetragonal zirconia. These induced features may alter the wear rate of UHMWPE. It was the objective of this study to examine the interfacial temperatures of oxidized zirconium (OxZr) heads as compared with metallic and ceramic heads coupled with polyethylene in a hip simulator. The interface temperatures were measured by placing thermocouples within 0.5 mm of the interface surface of both femoral heads and acetabular liners, and then articulating the surfaces using a 12-station AMTI anatomic hip simulator. The alumina femoral heads had the lowest average interfacial temperature, followed in increasing order by OxZr, CoCr, and zirconia. The ranking corresponds to the thermal conductivity of each material. A statistically significant difference (p<0.05) was found between all four materials for the femoral head temperature. No difference was seen in liner temperature between the alumina and OxZr groups, but statistical differences were found between all other combinations. Additionally, increasing head diameter, peak load, cyclic frequency, and serum concentration all resulted in statistically significant increases in both femoral head and liner temperatures.

Pelvic incidence is not associated with the development of hip osteoarthritis

2021 ◽  
Vol 103-B (11) ◽  
pp. 1656-1661
Author(s):  
Makoto Iwasa ◽  
Wataru Ando ◽  
Keisuke Uemura ◽  
Hidetoshi Hamada ◽  
Masaki Takao ◽  
...  
Keyword(s):  
Femoral Head ◽  
Pelvic Incidence ◽  
Hip Osteoarthritis ◽  
Developmental Dysplasia ◽  
Acetabular Anteversion ◽  
Femoral Head Coverage ◽  
Significant Difference ◽  
Hip Disease ◽  
The Difference ◽  
Α Angle

Aims Pelvic incidence (PI) is considered an important anatomical parameter for determining the sagittal balance of the spine. The contribution of an abnormal PI to hip osteoarthritis (OA) remains controversial. In this study, we aimed to investigate the relationship between PI and hip OA, and the difference in PI between hip OA without anatomical abnormalities (primary OA) and hip OA with developmental dysplasia of the hip (DDH-OA). Methods In this study, 100 patients each of primary OA, DDH-OA, and control subjects with no history of hip disease were included. CT images were used to measure PI, sagittal femoral head coverage, α angle, and acetabular anteversion. PI was also subdivided into three categories: high PI (larger than 64.0°), medium PI (42.0° to 64.0°), and low PI (less than 42.0°). The anterior centre edge angles, posterior centre edge angles, and total sagittal femoral head coverage were measured. The correlations between PI and sagittal femoral head coverage, α angle, and acetabular anteversion were examined. Results No significant difference in PI was observed between the three groups. There was no significant difference between the groups in terms of the category distribution of PI. The DDH-OA group had lower mean sagittal femoral head coverage than the other groups. There were no significant correlations between PI and other anatomical factors, including sagittal femoral head coverage, α angle, and acetabular anteversion. Conclusion No associations were found between mean PI values or PI categories and hip OA. Furthermore, there was no difference in PI between patients with primary OA and DDH-OA. From our evaluation, we found no evidence of PI being an independent factor associated with the development of hip OA. Cite this article: Bone Joint J 2021;103-B(11):1656–1661.

Holding Power of Orthopaedic Screws in Bovine Femoral Heads

1993 ◽  
Vol 06 (03) ◽  
pp. 160-162 ◽  
Author(s):  
M. J. Ulm ◽  
D. G. Wilson
Keyword(s):  
Femoral Head ◽  
Cannulated Screws ◽  
Cancellous Screw ◽  
Holding Power ◽  
Cortical Screw ◽  
Femoral Heads ◽  
Cancellous Screws ◽  
Physeal Fractures

SummaryFemoral capital physeal fractures have been successfully repaired using 7.0 mm cannulated screws. The holding power of 7.0 mm cannulated screws was compared to the holding power of 5.5 mm cortical screws and 6.5 mm cancellous screws using paired bovine femoral heads. The 7.0 mm cannulated screw’s holding power was superior to the 6.5 mm cancellous screw and similar to that of the 5.5 mm cortical screw.When placed in the bovine femoral head, 7.0 mm cannulated screws have holding power greater than 6.5 mm cancellous screws and similar to 5.5 mm cortical screws.

Epidemiological Study of Femoral Head Osteonecrosis

2017 ◽  
Vol 68 (5) ◽  
pp. 974-976
Author(s):  
Alexandru Patrascu ◽  
Liliana Savin ◽  
Dan Mihailescu ◽  
Victor Grigorescu ◽  
carmen Grierosu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Young Patients ◽  
Head Group ◽  
Bipolar Hemiarthroplasty ◽  
Aseptic Necrosis ◽  
Total Hip ◽  
Femoral Head Osteonecrosis

In recent years, there has been an increase in the number of studies on the etiology of femoral head necrosis. We retrospectively reviewed all patients diagnosed with aseptic necrosis of the femoral in the period of 2010-2015. We recorded a total of 230 cases diagnosed with aseptic necrosis of the femoral head, group was composed of 65.7% men and 34.3% women, risk factors identified was 19.13% (post-traumatic), 13.91% (glucocorticoids), 26.52% (alcohol), 3.47% (another cause) and in 36 95% of the cases no risk factors were found. The results of the study based on the type of surgery performed on the basis of stages of disease progression, 8 patients (3.48%) benefited from osteotomy, 28 patients (12.17%) benefited of bipolar hemiarthroplasty prosthesis and 188 patients (81.74%) benefited of total hip arthroplasty. Osteonecrosis of the femoral head is characteristic to young patients between the age of 30-50 years old. Predisposing factors, alcohol and corticosteroid therapy remains an important cause of the disease. Total hip arthroplasty remains the best option for the patients with osteonecrosis of the femoral head.

A comparison of 2 cementing techniques in hip resurfacing using human femoral heads

2021 ◽  
pp. 112070002199706
Author(s):  
Sarah J Shiels ◽  
Martin Williams ◽  
Gordon C Bannister ◽  
Richard P Baker
Keyword(s):  
Femoral Head ◽  
Femoral Component ◽  
Bubble Formation ◽  
Young Male ◽  
Cement Mantle ◽  
Hip Resurfacing ◽  
Air Bubble ◽  
Low Viscosity ◽  
Femoral Heads ◽  
Group 2

Introduction: Hip resurfacing remains a valid option in young male patients. The creation of the optimum cement mantle aids fixation of the femoral component. If the cement mantle is too thick the prosthesis can remain proud leading to early failure or if it penetrates too far into the femoral head, it may cause osteonecrosis. Method: 18 of 96 femoral heads collected from patients undergoing total hip arthroplasty were matched for their surface porosity. They were randomly allocated into 2 different cementing groups. Group 1 had the traditional bolus of cement technique, while group 2 had a modified cementing technique (swirl) where the inside of the femoral component was lined with an even layer of low viscosity cement. Results: The traditional bolus technique had significantly greater cement mantle thickness in 3 of 4 zones of penetration ( p = 0.002), greater and larger air bubble formation (6 of 9 in bolus technique vs. 1 in 9 in swirl technique, p = 0.05) and more incomplete cement mantles compared with the swirl technique. There was no relationship to femoral head porosity. Conclusion: The swirl technique should be used to cement the femoral component in hip resurfacing. Long-term clinical studies would conform if this translates into increased survivorship of the femoral component.

The association between femoral neck shaft angle and degenerative disease of the hip in a cadaveric model

2021 ◽  
pp. 112070002110130
Author(s):  
Leigh-Anne Tu ◽  
Douglas S Weinberg ◽  
Raymond W Liu
Keyword(s):  
Femoral Head ◽  
Femoral Neck ◽  
Hip Osteoarthritis ◽  
Volume Ratio ◽  
Femoral Head Coverage ◽  
Neck Shaft Angle ◽  
Hip Arthritis ◽  
Femoral Version ◽  
Shaft Angle ◽  
The Impact

Background: While the influences of acetabular dysplasia and overcoverage on hip arthritis have been studied, the impact of femoral neck-shaft angle on hip arthritis is much more poorly understood. The purpose of this study is to determine if a relationship exists between neck shaft angle and the development of osteoarthritis, a better understanding of which would be useful to surgeons planning osteotomies about the hip. Methods: 533 cadaveric femora and acetabulae (1066 total) from the Hamann-Todd Osteological Collection (Cleveland, OH) were acquired. We measured true neck shaft angle using an AP photograph with the femoral neck parallel to the table. Femoral head volume to acetabular volume ratio, representing femoral head coverage, as well as femoral version were utilised. Correlation between neck shaft angle, femoral version, femoral head coverage and osteoarthritis were evaluated with multiple regression analysis. Results: The mean age and standard deviation was 56 ± 10 years. There were 64 females (12%) and 469 males. There were 380 Caucasians (71%) and 153 African-Americans. Mean femoral version was 11° ± 12° and mean true neck shaft angle was 127.7° ± 5.9° There was a strong correlation between age and arthritis (standardised beta 0.488, p < 0.001). There was a significant correlation between increasing true neck shaft angle and decreasing hip arthritis (standardised beta -0.024, p = 0.038). In the femoral head overcoverage subset, increasing true neck shaft angle was still significantly associated with decreasing hip arthritis (standardised beta −0.088, p = 0.018), although this relationship was not significant with femoral head undercoverage subset. Conclusions: With sufficient acetabular coverage, a relative increase in femoral neck shaft angle within the physiologic range is associated with decreased hip osteoarthritis. Clinical relevance: An understanding of the relationship between femoral neck shaft angle and hip osteoarthritis could be useful for surgeons planning pelvic or proximal femur osteotomies in children.

scholarly journals Microvascular Density of Rapidly Destructive Arthropathy of the Hip Joint

2005 ◽  
Vol 13 (1) ◽  
pp. 40-45 ◽  
Author(s):  
T Yamakawa ◽  
A Sudo ◽  
M Tanaka ◽  
A Uchida
Keyword(s):  
Femoral Head ◽  
Hip Joint ◽  
Joint Destruction ◽  
Bone Destruction ◽  
Microvascular Density ◽  
Blood Capillaries ◽  
Secondary Osteoarthritis ◽  
Femoral Heads ◽  
Formalin Fixed Paraffin Embedded ◽  
Destructive Arthropathy

Purpose. To assess the vascularity of the femoral head and determine how it is related to the destruction of the arthritic hip joint. The process of destructive arthropathy in arthritic hip joints is variable. Some patients with osteoarthritis of the hip have rapidly progressive destructive changes resulting in the disappearance of the femoral head. Method. Six femoral heads from patients diagnosed with rapidly destructive arthropathy and 6 femoral heads from patients with secondary osteoarthritis caused by acetabular dysplasia were analysed to reveal the association between blood capillaries and osteoclasts. The von Willebrand Factor immunostaining and counterstaining with Mayer's haematoxylin were used to label the microvessels and osteoclasts in formalin-fixed, paraffin-embedded specimens of femoral heads. The numbers of immunostained microvessels and osteoclasts in selected regions were counted. Result. The microvascular density of the bone surfaces of rapidly progressive arthritic hips was hypervascular. Osteoclasts were also found in increased numbers on the bone surfaces of rapidly progressive arthritic hips. The higher microvascular density coincided with extensive bone destruction and with the increased osteoclast count. Conclusion. These findings suggested that hypervascularity of the granulation in the femoral head may be associated with bone and joint destruction.

Two Types of Anesthesia and Hemodynamic Changes in Patients Over 60 Years of Age Who Need Artificial Femoral Head Replacement: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Weiqi Ke ◽  
Yuting WANG ◽  
Xukeng GUO ◽  
Ronghua HUANG ◽  
Xiangdong ZHANG ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Femoral Head ◽  
Elderly Patients ◽  
The Elderly ◽  
Hemodynamic Changes ◽  
Medical College ◽  
Replacement Surgery ◽  
Elder Patients ◽  
Significant Difference ◽  
And Gender

Abstract Background:Artificial femoral head replacement is one of the most effective methods for treatment of severe diseases of femoral joint in the elderly. The ideal anesthetic effect is one of the key elements for the success of the operation because it brings fast recovery. However, the multiple comorbidities of the elder patients make them too weak to tolerate the hemodynamic changes after anesthesia. In this case, the most suitable anesthesia method for patients undergoing femoral head replacement surgery is of great significance.Objective:To compare the post-anesthetic hemodynamic changes between combined lumbar plexus and sciatic nerve block(CLPSB) and combined spinal and epidural anesthesia(CSEA) in elderly patients undergoing unilateral artificial femoral head replacement.Methods:We reviewed records of the patients who aged over 60 years old (age 62-103 years) and received unilateral artificial femoral head replacement between January 2015 and December 2020 in the first affiliated hospital of Shantou University Medical College. After adjustment according to the inclusion criteria, 477 patients were included and divided into CLPSB group (n=90) and CSEA group (n=387). The primary outcome was comparison of the hemodynamic changes after anesthesia, including the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR). The second outcome was the comparison of the vasopressor used during the surgery.Results:We established three models to compare the two anesthesia methods on hemodynamic changes. Crude model included all variates for analysis, while model I adjusted age and gender. Model II adjusted other comorbidities in addition to model I. All three models exhibit that changes of MAP (∆MAP) after CSEA were higher than that after CLPSB(β= 6.88, 95% CI: 4.33 - 9.42, P < 0.0001), with significant difference, which indicated that CSEA causes higher fluctuation of MAP. Concurrently, the use of vasopressors increased by 137% (OR=2.37, 95%CI: 1.24-4.53, P=0.0091) in the CSEA group, which is statistically significant. However, the changes of HR (∆HR) between the CLPSB and CSEA was not significant(β= 0.50, 95% CI: 1.62 - 2.62, P = 0.6427). Conclusions:Both CLPSB and CSEA are ideal anesthesia methods for patients receiving femoral head eplacement, though CLPSB is more suitable for elderly patients with advanced hemodynamic stability.

Sign in / Sign up

Export Citation Format

Share Document