scholarly journals Arthroscopic assessment of concomitant intraarticular pathologies in patients with osteonecrosis of the femoral head

2020 ◽  
Author(s):  
Sebastian Serong ◽  
Johannes Haubold ◽  
Jens Theysohn ◽  
Stefan Landgraeber
Keyword(s):  
Femoral Head ◽  
Cohort Analysis ◽  
Core Decompression ◽  
Radiologic Evaluation ◽  
Radiologic Findings ◽  
Chondral Defects ◽  
Cam Deformity ◽  
Retrospective Cohort Analysis ◽  
Arthroscopic Findings

ABSTRACT This study's purpose is to arthroscopically assess the occurrence of intraarticular pathologies in patients with osteonecrosis of the femoral head (OFNH) and to compare arthroscopic with radiologic findings. In a retrospective cohort analysis of ONFH patients undergoing combined core decompression (CD) and hip arthroscopy, concomitant intraarticular pathologies were qualitatively and quantitatively assessed by means of arthroscopy. Intraoperative findings were compared with preoperative radiodiagnostics. Descriptive statistics were performed with results displaying type, degree and prevalence of co-pathologies. Based on a cohort of 27 hips with ONFH at ARCO stages II and III, 26 (96.3%) presented with concomitant intraarticular findings. Cam-deformity (n = 22; 81.5%), labral defects (n = 23; 85.2%) and chondral defects (n = 20; 74.1%) were the most frequent. Four hips (14.8%) had foveal ligament anomalies. Intraoperative detection of cam-deformity positively correlated with radiologically assessed pathologic α angles (p = 0.09). Radiologic evaluation of the acetabular labrum distinctly differed from arthroscopic findings. Reliable statements concerning the cartilage status were not possible due to the great difference in quality of the magnetic resonance imaging (MRIs). The results of this study revealed an arthroscopically proven prevalence of co-pathologies in >95% of patients with ONFH. Cam-type deformity, labral anomalies and chondral defects were the most frequent. Comparison of arthroscopic and radiologic findings showed coherent results regarding cam-deformity but revealed distinct difficulties in the assessment of the labral and chondral status emphasizing the need for standardization of preoperative radiodiagnostics. Moreover, it still has to be evaluated whether combined CD and arthroscopy can improve on the overall outcomes achieved by performance of CD only.

scholarly journals Correlation between the efficacy of stem cell therapy to osteonecrosis of the femoral head and cell viability

2019 ◽  
Author(s):  
ZhanYu Wu ◽  
Qi Sun ◽  
Ming Liu ◽  
Brian Grottkau ◽  
ZhiXu He ◽  
...  
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Femoral Head ◽  
Cell Therapy ◽  
Core Decompression ◽  
Mean Value ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract Background: Osteonecrosis of the femoral head (ONFH) is a common disease that greatly affects the quality of life of patients. Repair of necrotic area is the key to treatment.At present, the combination of stem cell transplantation and decompression is used clinically to promote the repair of necrotic areas through the characteristics of stem cells. However, a considerable number of patients cannot achieve a satisfactory outcome in repairing the femoral head necrotic area. It is very important to find out the reasons for the poor curative effect. The aim of this study was to investigate the correlation between stem cell viability and the repair efficacy of stem cell therapy combined with core decompression to early-stage of ONFH. Methods: A total of 30 patients with idiopathic ONFH were performed core decompression combined with autologous stem cell transplantation. The Harris score (HHS) and necrosis area change of patients before and after operation were observed. The mean value of repair ratio was set as a threshold dividing the patients into group A (ratios greater than the mean value) and group B (ratios less than the mean value). The ultrastructure, proliferative capacity and multidirectional differentiation ability were compared between the groups. Results: At 9 months after surgery, HHS and magnetic resonance imaging (MRI) findings had improved by varying degrees. Based on the repair ratio, i.e., (62.2 ± 27.0) %, 62.2% was set as a threshold dividing the patients into group A and group B. Better repair(Group A) showed faster proliferation efficiency and healthier ultrastructure. The cells of Group A also showed stronger specific staining after osteogenesis and chondrogenesis induced differentiation. The activity of alkaline phosphatase (ALP) was also higher in group A (OD 2.39 ± 0.44 vs 1.85 ± 0.52; P <0.05) after osteogenic differentiation. Conclusions: The quality of implanted stem cells is closely related to the efficacy of this procedure and determines whether the defects of self-repair in the necrotic areas can be corrected to enhance the repair capacity of necrotic tissue and to promote the repair of necrotic areas to achieve the desired therapeutic outcome.

scholarly journals Correlation between the efficacy of stem cell therapy for osteonecrosis of the femoral head and cell viability

2020 ◽  
Author(s):  
ZhanYu Wu ◽  
Qi Sun ◽  
Ming Liu ◽  
Brian Grottkau ◽  
ZhiXu He ◽  
...  
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Femoral Head ◽  
Cell Therapy ◽  
Core Decompression ◽  
Necrotic Area ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract Background: Osteonecrosis of the femoral head (ONFH) is a common disease that greatly affects the quality of life of patients. Repair of the necrotic area is key to successful treatment. Currently, the combination of stem cell transplantation and decompression is used clinically to promote the repair of necrotic areas based on the characteristics of stem cells. However, a considerable number of patients do not achieve a satisfactory outcome in terms of repair of the femoral head necrotic area, and it is very important to determine the reasons for the poor curative effect. The aim of this study was to investigate the correlation between stem cell viability and the repair efficacy of stem cell therapy combined with core decompression for early-stage ONFH. Methods: A total of 30 patients with idiopathic ONFH underwent core decompression combined with autologous stem cell transplantation. The Harris hip score (HHS) and difference in necrosis area before and after surgery were measured. The mean repair ratio was set as the threshold to divide the patients into group A (ratio above the mean) and group B (ratio below the mean). The ultrastructure, proliferative capacity, and multidirectional differentiation ability were compared between the groups. Results : At 9 months after surgery, the HHS and magnetic resonance imaging (MRI) findings improved by varying degrees. Based on the mean repair ratio of (62.2 ± 27.0)%, the threshold for dividing the patients into groups A and B was set to 62.2%. Better repair (group A) was associated with more rapid proliferation and a healthier ultrastructure. The cells in group A showed stronger specific staining signifying osteogenic and chondrogenic differentiation; alkaline phosphatase (ALP) activity, an indicator of osteogenic differentiation, was higher in group A than in group B (OD, 2.39 ± 0.44 and 1.85 ± 0.52; p < 0.05). Conclusions: The quality of implanted stem cells is closely related to treatment efficacy and determines whether the defective self-repair in the necrotic area can be corrected to enhance repair and thus achieve the desired therapeutic outcome.

scholarly journals Correlation between the efficacy of stem cell therapy for osteonecrosis of the femoral head and cell viability

2019 ◽  
Author(s):  
ZhanYu Wu ◽  
Qi Sun ◽  
Ming Liu ◽  
Brian Grottkau ◽  
ZhiXu He ◽  
...  
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Femoral Head ◽  
Cell Therapy ◽  
Core Decompression ◽  
Necrotic Area ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract Background: Osteonecrosis of the femoral head (ONFH) is a common disease that greatly affects the quality of life of patients. Repair of the necrotic area is key to successful treatment. Currently, the combination of stem cell transplantation and decompression is used clinically to promote the repair of necrotic areas based on the characteristics of stem cells. However, a considerable number of patients do not achieve a satisfactory outcome in terms of repair of the femoral head necrotic area, and it is very important to determine the reasons for the poor curative effect. The aim of this study was to investigate the correlation between stem cell viability and the repair efficacy of stem cell therapy combined with core decompression for early-stage ONFH. Methods: A total of 30 patients with idiopathic ONFH underwent core decompression combined with autologous stem cell transplantation. The Harris hip score (HHS) and difference in necrosis area before and after surgery were measured. The mean repair ratio was set as the threshold to divide the patients into group A (ratio above the mean) and group B (ratio below the mean). The ultrastructure, proliferative capacity, and multidirectional differentiation ability were compared between the groups. Results : At 9 months after surgery, the HHS and magnetic resonance imaging (MRI) findings improved by varying degrees. Based on the mean repair ratio of (62.2 ± 27.0)%, the threshold for dividing the patients into groups A and B was set to 62.2%. Better repair (group A) was associated with more rapid proliferation and a healthier ultrastructure. The cells in group A showed stronger specific staining signifying osteogenic and chondrogenic differentiation; alkaline phosphatase (ALP) activity, an indicator of osteogenic differentiation, was higher in group A than in group B (OD, 2.39 ± 0.44 and 1.85 ± 0.52; p < 0.05). Conclusions: The quality of implanted stem cells is closely related to treatment efficacy and determines whether the defective self-repair in the necrotic area can be corrected to enhance repair and thus achieve the desired therapeutic outcome.

scholarly journals Hip arthrodiastasis combined with core decompression and diamond concept for postcollapse femoral head avascular necrosis

2019 ◽  
Vol 12 (8) ◽  
pp. e231081 ◽  
Author(s):  
Ioannis V Papachristos ◽  
James Rankine ◽  
Peter V Giannoudis
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Hip Replacement ◽  
Articular Surface ◽  
Core Decompression ◽  
Bone Graft Substitute ◽  
Patient Reports ◽  
Diamond Concept ◽  
Surface Collapse

In postcollapse hip avascular necrosis (AVN), the femoral head cannot be salvaged, necessitating total hip replacement. We report a case of a 39-year-old woman who developed idiopathic femoral head AVN with marked symptoms and radiological evidence of articular surface collapse. We treated her with core decompression combined with the ‘diamond concept’ (implantation of bone marrow concentrate, a growth factor and bone graft substitute) and distracted the hip joint with external fixator. Four years postoperatively the articular surface has been restored and the patient reports excellent quality of life. Hip arthrodiastasis with core decompression and ‘diamond concept’ regeneration could be considered a treatment option in advanced AVN of the femoral head.

scholarly journals Issues of the diagnosis of hepatorenal syndrome in the practice of clinical medicine and pathoanatomy

2020 ◽  
pp. 49-55
Author(s):  
V. A. Savarina ◽  
V. M. Mitsura ◽  
A. G. Skuratov ◽  
L. A. Martemyanova
Keyword(s):  
Liver Cirrhosis ◽  
Diagnostic Criteria ◽  
Digestive System ◽  
Hepatorenal Syndrome ◽  
Clinical Medicine ◽  
Cohort Analysis ◽  
Clinical Protocol ◽  
Retrospective Cohort Analysis ◽  
Quality Of Medical Care

Objective: to study the results of autopsies of patients with liver cirrhosis, to analyze the frequency of diagnosing «hepatorenal syndrome» (HRS) and its conformity with diagnostic criteria. Material and methods. A retrospective cohort analysis of 130 autopsies of patients with liver cirrhosis was performed. HRS was detected clinically and/or pathologically in 43.8 % of the patients. Clinical data and autopsy protocols of 27 patients with liver cirrhosis were analyzed in detail for compliance of the diagnosis of HRS with diagnostic criteria. The data were recorded and analyzed in MS Excel 2010. Results. The frequency of the diagnosis «hepatorenal syndrome» significantly exceeds the real prevalence of this pathology; its diagnostic criteria are often not followed; HRS is not considered to be the diagnosis of exclusion; the type of HRS is not indicated; for healthcare specialists there is often equality in the terms «hepatorenal syndrome» and «hepato-renal failure». Conclusion. To improve the quality of medical care for patients with liver cirrhosis, it is necessary to adhere more strictly to the clinical protocol «Diagnosis and treatment of patients with diseases of the digestive system», to introduce more accurate additions to it, and to increase knowledge of healthcare specialists in the field of HRS diagnosis.

Drilling and plombage (core decompression) of a femoral head avascular necrosis

2010 ◽  
Vol 19 (01) ◽  
pp. 36-39 ◽  
Author(s):  
P. Chládek ◽  
V. Havlas ◽  
T. Trc
Keyword(s):  
Surgical Treatment ◽  
Femoral Head ◽  
Core Decompression ◽  
Effective Treatment Option ◽  
Simple Method ◽  
X Ray ◽  
Large Femoral Head ◽  
Press Fit ◽  
Round Shape ◽  
Late Stages

SummaryThe treatment of femoral head necrosis of adults is still rather problematic. Conservative treatment has been reported relatively unsuccessful and surgical treatment does not show convincing results either. The most effective seems to be a surgical treatment in early stages of the disease, however, the diagnosis still remains relatively complicated. For the late stages (2B and above) the most effective treatment option is represented by core decompression and vascular grafting. However, drilling and plombage (especially when using press-fit technique) seems to be successful, although not excellent. The authors describe their own method of drilling and plombage of the necrotic zone of the femoral head in 41 patients with X-ray detected necrotic changes of the femoral head. The pain measured by VAS was seen to decrease after surgery in all patients significantly. The Jacobs score was also observed to have increased (from fair to good outcome). We have not observed any large femoral head collapse after surgery, moreover, in some cases an improvement of the round shape of the femoral head was seen. It is important to mention that in all cases femoral heads with existing necrotic changes (flattening or collapse) were treated. Although the clinical improvement after surgery was not significantly high, the method we describe is a safe and simple method of diminishing pain in attempt to prepare the femoral head for further treatment in a future, without significant restriction of the indication due to necrosis (osteochondroplasty, resurfacing, THR).

Urban and rural millennials: Heterogeneity of the young adult generation

2019 ◽  
pp. 5-28
Author(s):  
Vadim V. Radaev
Keyword(s):  
Coming Out ◽  
Generational Differences ◽  
Cohort Analysis ◽  
Social Indicators ◽  
Well Being ◽  
Generational Cohort ◽  
Rural Infrastructure ◽  
Sociological Approach ◽  
Monitoring Survey

A sociological approach towards the generational cohort analysis is developed. A special emphasis is made upon the youngest adult generation of millennials coming out of their adolescence in the 2000s. A broad range of social indicators is used for empirical exploration of intra-generational differences between urban and rural millennials. Data were collected from the annual Russian Longitudinal Monitoring Survey (RLMS-HSE) in 2003—2016. Numerous significant differences have been revealed with regard to the educational level, family planning, use of modern gadgets and digital technologies, commitment to healthy lifestyles, and some values. Some practices are more widely spread among rural millennials, whereas other practices are more characteristic of urban millennials. Most of revealed differences are explained by the lower level of material well-being of rural millennials and lower quality of rural infrastructure.

Are perceptual disorder signs in diplegic cerebral palsied children stable over time? A retrospective cohort analysis

2020 ◽  
Vol 72 (2) ◽  
Author(s):  
Silvia Alboresi ◽  
Alice Sghedoni ◽  
Giulia Borelli ◽  
Stefania Costi ◽  
Laura Beccani ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Retrospective Cohort Analysis ◽  
Over Time
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