scholarly journals Efficacy of tantalum rod insertion for preventing femoral head collapse in osteonecrosis in a paediatric population: a pilot study

2021 ◽  
Author(s):  
Muqtasid Hussaini ◽  
Jitendra Balakumar ◽  
David Slattery
Keyword(s):  
Femoral Head ◽  
Group Analysis ◽  
Paediatric Population ◽  
Porous Tantalum ◽  
Femoral Head Collapse ◽  
Femoral Head Osteonecrosis ◽  
Plain Films ◽  
Stage 1 ◽  
Tönnis Grade

ABSTRACT Femoral head osteonecrosis in the paediatric population is difficult to treat, with the primary goals of management being prevention of subchondral collapse and the avoidance of early total hip replacement. This study aims to describe the use of a porous tantalum rod implant to provide mechanical support in preventing femoral head collapse in a paediatric population. A retrospective chart-based analysis of patients with osteonecrosis of the hip was performed at our institution to identify those who had undergone tantalum rod insertion. A total of 10 patients (fives males and five females, median age 12.5 years, 9–18) had tantalum rods implanted between December 2013 and February 2018. One patient was excluded due to follow-up at a different institution. The radiographic degree of osteonecrosis was characterized according to the Ficat classification and the Kerboul angle. Radiographic assessment of pre- and post-operative plain films was performed. The outcome measures were Tonnis grade and percentage collapse of the femoral head. Nine patients with a mean follow-up time of 18.4 months were included in the analysis. There was no significant increase in the femoral head collapse percentage post tantalum rod insertion compared to pre-operatively (P = 0.63). There was a significant increase in the Tonnis grade post-operatively (P < 0.05), with sub-group analysis showing minimal increase in Ficat Stage 1 patients. This study is the first to examine the role of tantalum rod insertion in preventing femoral head collapse in a paediatric population, with results suggesting potential benefit in a subset of patients.

scholarly journals One-stage simultaneous hip-preserving surgeries for the management of bilateral femoral head osteonecrosis: a mean 7.0-year follow-up

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Wenjun Feng ◽  
Pengcheng Ye ◽  
Shihao Ni ◽  
Peng Deng ◽  
Lu Lu ◽  
...  
Keyword(s):  
Femoral Head ◽  
Group Analysis ◽  
Harris Hip Score ◽  
Greater Trochanter ◽  
One Stage ◽  
Femoral Head Osteonecrosis ◽  
Group A ◽  
Impaction Allografting ◽  
Group B

Abstract Background A retrospective study was conducted to evaluate and compare the clinical and radiological outcomes of one-stage fibular impaction allografting and vascularized greater trochanter flap autografting for the treatment of bilateral osteonecrosis of the femoral head (ONFH). Methods Patients who underwent one-stage aforementioned hip-preserving surgeries due to bilateral ONFH were retrospectively reviewed from January 2008 to December 2013. Sixty-nine patients (138 hips) with a mean age of 31.5 years and mean follow-up of 7.0 years were included. Hips that underwent fibular impaction allografting and vascularized greater trochanter flap autografting were assigned as group A and group B, respectively. Harris Hip Score (HHS) and Visual Analogue Scale (VAS) were used for clinical evaluation, and a series of X-ray images were used for radiological assessment. For inter-group analysis, the paired t test was used for continuous data, and the Wilcoxon rank sum test was used for non-parametric data, while the Mann-Whitney U test was used for intra-group analysis. Results The HHS and VAS in both groups A and B had a substantial advancement when compared with the preoperative level (p < 0.01). Fibular impaction allografting can achieve more pain relief (p < 0.01), though no clinical difference was found in terms of minimal clinically important difference (MCID < 10 points). Group A showed better radiological results than group B (p = 0.04). It was discovered that the appropriate indication for each procedure was patients with Association for Research on Osseous Circulation (ARCO) stages II and III, respectively. Conclusion One-stage hip-preserving surgeries for the management of bilateral ONFH could obtain good medium and long-term outcomes. It was recommended that fibular impaction allografting is more suitable for patients in ARCO stage II, while for patients in ARCO stage III, vascularized greater trochanter flap autografting is a better preference. Trial registration Retrospectively registered.

scholarly journals Outcome after a new porous tantalum rod implantation for treatment of early-stage femoral head osteonecrosis

2019 ◽  
Vol 7 (18) ◽  
pp. 441-441 ◽  
Author(s):  
Wei Huang ◽  
Xuan Gong ◽  
Steve Sandiford ◽  
Xiaoqiang He ◽  
Feilong Li ◽  
...  
Keyword(s):  
Femoral Head ◽  
Early Stage ◽  
Porous Tantalum ◽  
Femoral Head Osteonecrosis

Prediction of collapse in femoral head osteonecrosis: role of volumetric assessment

2020 ◽  
pp. 112070002097858
Author(s):  
Sajid Ansari ◽  
Tarun Goyal ◽  
Roop B Kalia ◽  
Souvik Paul ◽  
Sanny Singh
Keyword(s):  
Survival Analysis ◽  
Femoral Head ◽  
Lesion Size ◽  
Necrotic Lesion ◽  
Rank Test ◽  
Lesion Volume ◽  
Femoral Head Osteonecrosis ◽  
Volumetric Assessment ◽  
Angular Measurements ◽  
Stage 1

Purpose: The purpose of this study was to evaluate and compare the accuracy of three different techniques of measuring the extent of osteonecrosis involvement of the femoral head on MRI to determine the best predictor of collapse and to identify the size of the lesion volume which best predicts collapse. Methods: We prospectively enrolled 48 hips of osteonecrosis femoral head (ONFH) with stage 1 or 2 osteonecrosis and the enrolled patients were followed up for 1 year. Angular measurements (modified Kerboul Angle and modified index of necrotic extent) were compared with the 3D volumetric measurement of necrotic lesion based on MRI in predicting the collapse of the head. ROC analysis was done to evaluate the diagnostic performance of the 3 indices in predicting collapse. Survival analysis of all the hips in the collapsed and non-collapsed group were interpreted using Kaplan Meir survival analysis. Results: In lesion sizes larger than 25% of femoral head volume - 90.6% (29/32) of hips collapsed within 1 year as compared to 31.3% (5/16) hips collapsed in lesion volume <25% of femoral head (Log-rank test p = 0.001). There was good inter-observer (ICC, 0.94; 95% CI, 0.89–0.97) and intra-observer reliability (ICC, 0.93; 95% CI, 0.88–0.96). Conclusions: The Volumetric method assessed the severity of lesion size with the future collapse better and more predictably than angular measurements. Necrotic lesion volume of 25% is a potential cut off beyond which future collapse of early ONFH can be predicted and aid in the further management. This study can help in solving the mystery behind prediction of collapse in ONFH.

scholarly journals Porous tantalum implant for treatment of early-stage osteonecrosis of the femoral head: a minimum 5-year follow-up study

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yu Zhang ◽  
Wang Chen ◽  
Zhi Yang ◽  
Jian-Ning Sun ◽  
Zheng-Hao Hu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Marrow ◽  
Femoral Head ◽  
Bone Marrow Edema ◽  
Operation Time ◽  
Harris Hip Score ◽  
Porous Tantalum ◽  
Imaging Results ◽  
Marrow Edema

Abstract Background To evaluate the survival rate of porous tantalum rod implantation in the treatment of osteonecrosis of the femoral head (ONFH), evaluate its clinical effect and imaging results. Methods From January 2008 to December 2013, porous tantalum rod implantation for ONFH was performed in two institutions. Statistical analysis of operation data, including operation time, blood loss and blood transfusion were recorded. Results 52 hips received complete follow-up, the average follow-up time was 85.7 months (60–132 months). 24 hips turned to THA at the end of follow-up (46.2%), the average time was 44.3 ± 32.8 months, and the average Harris hip score before THA was 57.1 ± 7.6. Cox proportional-hazards model revealed that Association Research Circulation Osseous (ARCO) stage (P = 0.017), bone marrow edema (P = 0.006) and age > 40 years (P = 0.043) were independent risk factors for conversion to THA. Conclusion ARCO stage, age and bone marrow edema were risk factors for the failure of porous tantalum rod implantation to convert to THA.

Course of Femoral Head Avascular Necrosis Without Femoral Head Collapse at Initial Examination: Minimum 8-Year Follow-Up

Orthopedics ◽  
2008 ◽  
Vol 31 (8) ◽  
pp. 1-4
Author(s):  
Rui Niimi ◽  
Akihiro Sudo ◽  
Masahiro Hasegawa ◽  
Atsumasa Uchida
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Initial Examination ◽  
Femoral Head Collapse

Outcomes and indications of the single approach to double-channel core decompression and bone grafting with structural bone support for osteonecrosis of the femoral head

2021 ◽  
Author(s):  
Ju’an Yue ◽  
Xiaozhong Guo ◽  
Randong Wang ◽  
Bing Li ◽  
Qiang Sun ◽  
...  
Keyword(s):  
Femoral Head ◽  
Bone Grafting ◽  
Early Stage ◽  
Core Decompression ◽  
Harris Hip Score ◽  
Radiographic Evaluation ◽  
Femoral Head Collapse ◽  
Double Channel ◽  
Single Approach

Abstract BackgroundTo report the outcomes of the single approach to double-channel core decompression and bone grafting with structural bone support (SDBS) for osteonecrosis of the femoral head (ONFH) and define the indications.MethodsOne-hundred-and-thirty-nine hips in 96 patients (79 males, 17 females; mean age 37.53±10.31 years, range 14–58 years; mean body mass index 25.15±3.63 kg/m2) were retrospectively analysed. The Harris hip score (HHS) was used to assess hip function, and radiographs were used to assess the depth of femoral head collapse. Treatment failure was defined as the performance of total hip arthroplasty (THA). The variables assessed as potential risk factors for surgical failure were: aetiology, Japanese Osteonecrosis Investigation Committee (JIC) type, age, and Association Research Circulation Osseous (ARCO) stage. Complications were recorded.ResultsThe HHS increased from 79.00±13.61 preoperatively to 82.01±17.29 at final follow-up (P=0.041). The average HHS improvement was 3.00±21.86. The combined excellent and good rate at final follow-up (65.6%) was significantly higher than that before surgery (34.5%) (P=0.000). On radiographic evaluation, 103 (74.1%) hips remained stable, while 36 (25.9%) had femoral head collapse or aggravation of ONFH. THA was performed in 18 hips. Thus, the overall femoral head survival rate was 87.05% (121/139). The success rate was adversely affected by JIC type, but not by aetiology, age, or ARCO stage. The only complication was a subtrochanteric fracture in one patient.ConclusionThe SDBS effectively delays or even terminates the progression of ONFH, especially type B and C1. The SDBS is a good option for early-stage ONFH.

scholarly journals OUTCOMES OF CORE DECOMPRESSION WITH INJECTION OF BONE MARROW ASPIRATE FOR PEDIATRIC FEMORAL HEAD OSTEONECROSIS

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0028
Author(s):  
Myles Atkins ◽  
Josny Thimothee ◽  
Tyler McDonald ◽  
Patrick Wright ◽  
Jaysson T. Brooks
Keyword(s):  
Bone Marrow ◽  
Femoral Head ◽  
Pediatric Patients ◽  
Bone Marrow Aspirate ◽  
Slipped Capital Femoral Epiphysis ◽  
Core Decompression ◽  
Femoral Head Collapse ◽  
Femoral Head Osteonecrosis ◽  
Text Figure ◽  
Stulberg Classification

Background: Pediatric patients with femoral head osteonecrosis (FHON) often suffer from significant pain with decreased mobility. Once femoral head collapse occurs, few options are available short of a total hip arthroplasty (THA).[1,2] Core decompression by drilling of the femoral head is used to improve pain and prevent further femoral head collapse, however most of the literature on this technique involves adult patients.[3-5] Purpose: To date, there is no description of this technique or its outcomes in pediatric patients with FHON secondary to other etiologies other than sickle cell disease (SCD).[6] The purpose of our study is to determine outcomes in patients with FHON after undergoing core decompression with injection of bone marrow aspirate (BMA). Methods: A retrospective chart review was performed of all pediatric patients at our institution between 2007-2019 with FHON that underwent core decompression with injection of BMA. The following etiologies were identified: SCD, steroid-induced, Perthes disease (PD), slipped capital femoral epiphysis (SCFE), trauma, idiopathic, or other. To determine if core decompression with injection results in cessation of further femoral head collapse, two outcomes were assessed: Stulberg classification and number of cases that required THA. Furthermore, we evaluated whether core decompression with injection occurred in combination with any additional surgical procedure. Results: Twenty-six hips with FHON were identified with the following etiologies: 12 SCD (46.3%), 8 steroid-induced (30.8%), 2 PD (7.7%), 1 SCFE (3.8%), 1 trauma (3.8%), 1 idiopathic (3.8%), 1 other (3.8%). Mean age at the time of surgery was 12.7 years (range: 8-18). Twenty hips (76.9%) were seen in males and 6 (23.1%) were seen in females. Twenty-two hips (84.6%) were seen in black patients and 4 (15.4%) in white patients. Mean follow-up was 37.9 months (range: 0.6-77.8). Mean Stulberg classification was 3.15 (SD: 1.26). Twelve hips (46.2%) required concomitant femoral and/or pelvic osteotomies while 14 hips (53.8%) underwent core decompression with injection alone. Six hips required conversion to THA after initial core decompression and injection. All hips requiring THA were seen in patients with core decompressions and injections but no additional femoral and/or pelvic osteotomies. Conclusion: Most hips undergoing core decompression with injection did not require THA. Of the hips that required THA, all were seen in patients who only had core decompression and injection of BMA but no concomitant femoral and/or pelvic osteotomies. [Figure: see text][Figure: see text][Figure: see text]

scholarly journals Hip decompression combined with bone marrow concentrate and platelet-rich plasma for corticosteroid-induced osteonecrosis of the femoral head

2021 ◽  
Vol 2 (11) ◽  
pp. 926-931
Author(s):  
Matthew T. Houdek ◽  
Cody C. Wyles ◽  
John-Rudolph H. Smith ◽  
Andre Terzic ◽  
Atta Behfar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Marrow ◽  
Femoral Head ◽  
Platelet Rich Plasma ◽  
Corticosteroid Treatment ◽  
Term Outcome ◽  
Femoral Head Collapse ◽  
Early Results ◽  
Grade 3

Aims Bone marrow-derived mesenchymal stem cells obtained from bone marrow aspirate concentrate (BMAC) with platelet-rich plasma (PRP), has been used as an adjuvant to hip decompression. Early results have shown promise for hip preservation in patients with osteonecrosis (ON) of the femoral head. The purpose of the current study is to examine the mid-term outcome of this treatment in patients with precollapse corticosteroid-induced ON of the femoral head. Methods In all, 22 patients (35 hips; 11 males and 11 females) with precollapse corticosteroid-induced ON of the femoral head underwent hip decompression combined with BMAC and PRP. Mean age and BMI were 43 years (SD 12) and 31 kg/m² (SD 6), respectively, at the time of surgery. Survivorship free from femoral head collapse and total hip arthroplasty (THA) and risk factors for progression were evaluated at minimum five-years of clinical follow-up with a mean follow-up of seven years (5 to 8). Results Survivorship free from femoral head collapse and THA for any reason was 84% and 67% at seven years postoperatively, respectively. Risk factors for conversion to THA included a high preoperative modified Kerboul angle (grade 3 or 4) based on preoperative MRI (hazard ratio (HR) 3.96; p = 0.047) and corticosteroid use at the time of decompression (HR 4.15; p = 0.039). The seven-year survivorship for patients with grade 1 or 2 Kerboul angles for conversion to THA for articular collapse, and THA for any reason, were 96% and 72%, respectively, versus THA for articular collapse and THA for any reason in patients with grade 3 or 4 Kerboul angles of 40% (p = 0.003) and 40% (p = 0.032). Conclusion At seven years, hip decompression augmented with BMAC and PRP provided a 67% survivorship free from THA in patients with corticosteroid-induced ON. Ideal candidates for this procedure are patients with low preoperative Kerboul angles and can stop corticosteroid treatment prior to decompression. Cite this article: Bone Jt Open 2021;2(11):926–931.

scholarly journals Porous Tantalum Implant for Treatment of Early-stage Osteonecrosis of the Femoral Head: A Minimum 5-year Follow-up Study

2020 ◽  
Author(s):  
Yu Zhang ◽  
Jian-Ning Sun ◽  
Zhi Yang ◽  
Wang Chen ◽  
Zheng-Hao Hu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Marrow ◽  
Femoral Head ◽  
Bone Marrow Edema ◽  
Clinical Effect ◽  
Operation Time ◽  
Porous Tantalum ◽  
Imaging Results ◽  
Marrow Edema

Abstract Background To evaluate the survival rate of porous tantalum rod implantation in the treatment of osteonecrosis of the femoral head, to evaluate its clinical effect and imaging results, and to analyze the reasons for its failure to conversion to total hip arthroplasty (THA).Methods From January 2008 to December 2013, tantalum rod implantation for osteonecrosis of the femoral head was performed in two institutions. Statistical analysis of operation data, including operation time, blood loss and blood transfusion. Histopathological observations were performed on femoral head specimens with the tantalum rods that failed THA after tantalum rod implantation.Results 52 hips were followed up completely, the average follow-up time was 85.7 months (60-132 months). 24 hips turned to THA at the end of follow-up (46.2%), the average time was 44.3±32.8 months, and the average Harris score before THA was 57.1±7.6. Cox proportional-hazards model revealed that ARCO stage (P=0.017), bone marrow edema (P=0.006) and age＞40 years(P=0.043)were independent risk factors for conversion to THA. Histopathological examination revealed the implant surface is in contact with sparse Island bone. There is limited bone tissue extending inward from the implant.Conclusion The medium and long-term clinical effect of tantalum rod implantation in the treatment of osteonecrosis of the femoral head is not as satisfactory as we expected, and the osteogenic activity of tantalum rod in the femoral head is limited. ARCO stage, age and bone marrow edema were risk factors for the failure of tantalum rod implantation to THA.

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