scholarly journals CORR Insights®: High Pelvic Incidence Is Associated with Disease Progression in Nontraumatic Osteonecrosis of the Femoral Head

2020 ◽  
Vol 478 (8) ◽  
pp. 1877-1879
Author(s):  
Michael A. Mont
Keyword(s):  
Femoral Head ◽  
Disease Progression ◽  
Pelvic Incidence

scholarly journals High Pelvic Incidence Is Associated with Disease Progression in Nontraumatic Osteonecrosis of the Femoral Head

2020 ◽  
Vol 478 (8) ◽  
pp. 1870-1876 ◽  
Author(s):  
Hyuck Min Kwon ◽  
Ick-Hwan Yang ◽  
Kwan Kyu Park ◽  
Byung-Woo Cho ◽  
Jin Hwa Kam ◽  
...  
Keyword(s):  
Femoral Head ◽  
Disease Progression ◽  
Pelvic Incidence

Lightbulb technique for the treatment of osteonecrosis of the femoral head

2017 ◽  
Vol 28 (3) ◽  
pp. 272-277 ◽  
Author(s):  
Cemil Yildiz ◽  
Yusuf Erdem ◽  
Kenan Koca
Keyword(s):  
Femoral Head ◽  
Disease Progression ◽  
Bone Grafting ◽  
Treatment Effectiveness ◽  
Treatment Success ◽  
Total Hip ◽  
Kaplan Meier ◽  
Grafting Technique ◽  
Stage 4 ◽  
Stage 1

Introduction: The aim of this study was to report the clinical and radiological outcomes for 21 patients (28 hips) treated for osteonecrosis of the femoral head using the lightbulb technique, a nonvascularised bone grafting technique. Methods: The study group included 14 men and 7 women, with a mean age of 33.2 (range 22-50) years, presenting with avascular necrosis of the femoral head of stage 4a or earlier, according to the Steinberg classification. Patients were treated using the nonvascularised lightbulb bone grafting technique. The primary clinical outcome was the Harris Hip Scores (HHS), while primary outcomes of treatment effectiveness and disease progression were based on radiographic evidence of disease progression and the need for total hip replacement. The rate of treatment success and failure was evaluated using the Kaplan-Meier survival analysis. Results: The mean HHS increased from 52.66 to 74.33 after treatment, with excellent-to-good outcomes obtained in 21 (75%) of the cases. Fair-to-poor results were obtained in 7 (25%) of the cases, with total hip arthroplasty subsequently required in 5 of these cases. The radiological failure rate was 50% among cases treated in Steinberg stage 1 (1/2), 42% in stage 3 (5/12), and 100% in stage 4 (2/2). Conclusions: The lightbulb technique can provide a clinically acceptable rate of successful treatment of osteonecrosis of the femoral head when used in the early stages of the disease, prior to collapse of the femoral head.

Prophylactic Decompression and Bone Grafting for Small Asymptomatic Osteonecrotic Lesions of the Femoral Head

2011 ◽  
Vol 21 (6) ◽  
pp. 672-677 ◽  
Author(s):  
Jason E. Hsu ◽  
Tristan Wihbey ◽  
Roshan P. Shah ◽  
Jonathan P. Garino ◽  
Gwo-Chin Lee
Keyword(s):  
Femoral Head ◽  
Disease Progression ◽  
Bone Grafting ◽  
Core Decompression ◽  
Surgical Decompression ◽  
Initial Surgery ◽  
Relieve Pain ◽  
Lost To Follow Up ◽  
Mean Time

Core decompression and grafting has been shown to relieve pain and possibly prevent disease progression in patients with symptomatic osteonecrosis (ON) of the hip. However, there is a lack of evidence regarding the management of the asymptomatic hip with femoral head ON. The purpose of this study was to evaluate the outcome of core decompression in the asymptomatic hip with ON. We prospectively followed 37 consecutive patients with MRI confirmed ON of the hips that underwent simultaneous bilateral core decompression and bone grafting. Prior to surgery, only one of the hips was symptomatic, and the main indication for surgical decompression of the asymptomatic side was to prevent disease progression. No hip on the asymptomatic side was staged greater than Steinberg IIB classification. Serial radiographs were followed for evidence of disease progression. Six patients were lost to follow-up prior to two years. The remaining 31 patients were followed for an average of 32.6 months. There were 20 men and 11 women with an average age of 40.6 years. Ten patients with asymptomatic hips at the time of surgical decompression had disease progression requiring THA. The mean time to arthroplasty in this group was 15.1 months. Meanwhile, 13 symptomatic hips at the initial surgery progressed to THA at an average of 12.9 months following core decompression. The proportion of hips requiring conversion to THA was similar between the two groups (p=0.30), and the rate of progression to THA was not significantly faster compared to patients with symptomatic hips who subsequently required THA (p=0.18). Core decompression for asymptomatic ON of the femoral head is unpredictable. Based on our results, asymptomatic ON lesions particularly in the setting of bilateral disease should be closely observed and surgery reserved for when symptoms arise.

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.

scholarly journals DESCRIPTION OF A NEW METHOD OF MEASURING THE PELVIC INCIDENCE ANGLE THROUGH COMPUTED TOMOGRAPHY

2020 ◽  
Vol 19 (1) ◽  
pp. 30-33
Author(s):  
MURILO TAVARES DAHER ◽  
RENATO FLEURY DI SOUZA LOPES ◽  
RENATO TAVARES DAHER ◽  
RICARDO TAVARES DAHER ◽  
NILO CARRIJO MELO ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Femoral Head ◽  
Pelvic Incidence ◽  
Incidence Angle ◽  
Accurate Method ◽  
Diagnostic Study ◽  
Lumbosacral Region ◽  
Level Of Evidence ◽  
X Ray ◽  
The Mean

ABSTRACT Objective To describe a more accurate method for measuring the pelvic incidence angle using computed tomography, without the influence of the positioning of the pelvis in relation to the X-ray tube. Methods Thirteen CT scans of the lumbosacral region, abdomen or pelvis were randomly assessed, as all these exams include the sacrum and femoral heads. All the exams were performed in multichannel devices with six channels. The technique of overlapping images, already common in other musculoskeletal exams, such as TT-TG, was used. The centered sagittal cut of the left femoral head, the center of S1, and the right femoral head were used. From these, a fourth image was created, analogous to an X-ray of the pelvis, from which measurements were taken using the dedicated software. Results Of the thirteen exams, three were of the lumbar spine and 10 were of the total abdomen, six of them being of males.. The mean age was 56 years. The mean PI was 45°, ranging from 31 to 81 degrees. Among the women, the mean was 52° (31 to 81°) and among the men, 38° (32 to 46°). Conclusion CT can be used to calculate the PI, using the technique of overlapping images common to other musculoskeletal exams, such as TT-TG. Level of Evidence IIIB. Diagnostic study; Retrospective study.

scholarly journals AB1137 CLASSIFICATION OF THE EARLY STAGE OF RAPIDLY DESTRUCTIVE COXOPATHY ACCORDING TO THE FEMORAL HEAD DESTRUCTION

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1858.1-1859
Author(s):  
T. Yasuda ◽  
K. Matsunaga ◽  
T. Hashimura ◽  
Y. Tsukamoto ◽  
T. Sueyoshi ◽  
...  
Keyword(s):  
Femoral Head ◽  
Disease Progression ◽  
Operating Characteristic ◽  
Pelvic Tilt ◽  
Early Stage ◽  
Characteristic Curve ◽  
Hip Pain ◽  
Partial Destruction

Background:Rapidly destructive coxopathy (RDC) is an unusual subset of osteoarthritis of the hip characterized by rapid chondrolysis with progressive loss of the joint space as the first manifestation of the disease. Because rapid progression of RDC makes it difficult to obtain sequential radiographs in its early stage, the process of disease progression in the early stage remains unclear. Although the pathogenesis of RDC is still unclarified, the potential causes of RDC include subchondral insufficiency fracture of the femoral head resulting from osteoporosis, pelvic posterior inclination in RDC as a mechanical factor, and increased serum levels of matrix metalloproteinase (MMP)-3 as a biological factor.Objectives:This study aimed to differentiate the process of disease progression in the early stage of RDC and provide its new classification system.Methods:This monocentric retrospective study included 42 female patients who met the criteria of RPOH, chondrolysis >2 mm during 12 months from the onset of hip pain based on a series of radiographs and computed tomography (CT). This study also included 9 female patients with osteoarthritis secondary to developmental dysplasia of the hip (DDH), who demonstrated chondrolysis >2 mm during 12 months from the onset of hip pain. Cortical thickness index (CTI) correlated with bone mineral density of the hip, pelvic tilt, and serum concentrations of matrix metalloproteinase (MMP)-3 were analyzed.Results:RDC were classified into two types based on the absence (type 1, n=17) and presence (type 2, n=25) of subsequent femoral head destruction shown by CT within 12 months after the onset of hip pain. MMP-3 significantly increased in RDC type 2 compared with type 1 and DDH. Increased posterior pelvic tilt was found in RDC type 2 compared with DDH. Logistic regression and receiver operating characteristic curve analyses indicated that MMP-3 may be associated with differentiation between RDC types 1 and 2. No difference was found in CTI between RDC types and DDH.RDC type 2 hips developed partial (type 2A) and massive (type 2B) femoral head destruction within the first 12 months. Whereas partial destruction showed <20% collapse ratio, massive destruction demonstrated >40% collapse ratio. Increased posterior pelvic tilt was found in massive destruction. Femoral head destruction started earlier within the first 6 months in massive destruction compared with that in partial destruction. From receiver operating characteristic curve analysis, pelvic tilt differentiated the femoral head destruction types using the initial radiograph at the onset before first demonstration of femoral head destruction. No difference was found in CTI or MMP-3 between the two subtypes.Conclusion:Disease progression of RDC during 12 months after the onset of hip pain could be classified into two distinct types based on the absence (type 1) and presence (type 2) of femoral head destruction in association with MMP-3 and pelvic tilt as biological and mechanical factors, respectively. MMP-3 may be helpful to differentiate those two types in the early stage of RPOH. The extent of femoral head destruction could further differentiate RDC type 2 into two subtypes based on pelvic tilt.Acknowledgments :This study was supported by the Japan Hip Joint Foundation.Disclosure of Interests:None declared

scholarly journals A Functional and Radiological Outcome Analysis of Hip Forage Procedure, done for Early Stages(Ficat and Arlet Grade 1 and 2A) of Avascular Necrosis of Head of Femur

2021 ◽  
pp. 97-105
Author(s):  
Shubham Padmawar ◽  
Dr. Suhas Landge ◽  
Prateek Upadhyay ◽  
Mitali Madhusmita
Keyword(s):  
Femoral Head ◽  
Disease Progression ◽  
Avascular Necrosis ◽  
Core Decompression ◽  
Foot Drop ◽  
Harris Hip Score ◽  
Moderate Pain ◽  
Radiological Outcome ◽  
Mild Pain

Background: Avascular necrosis of the femoral head is a severe disease and causes osteoarthritis of the hip joint in young adults. Early diagnosis leads to better prognosis and therapeutic success. Aim: To study pain, radiological outcome & functional outcome post hip forage procedure in patients of avascular necrosis of head of femur (Ficat and Arlet grade 1 and grade 2A). Study Design: This was a prospective observational study. Place and Duration of Study: Conducted in the Department of Orthopaedics, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Nerul, Navi Mumbai over a period of 2 years from 2015 to 2017 Methodology: We included 50 patients (39 males, 11 females) with Avascular necrosis of unilateral or bilateral head of femur (Grade 1 and Grade 2A), clinical, radiological and functional(with the help of Harris hip score) examination was done at 6 months and 12 months follow up post operatively.  Results: Out of the 50 patients, pre-peratively, 60% reported moderate pain, 20% mild pain and 20% severe pain. At follow-up, 36% patients reported slight pain, 26% mild pain, 26% moderate pain, 8% marked pain, and no pain was reported by 4% patients. Pre-operatively, no limp was seen in 34% patients, while 66% patient had a limp. At follow-up, 70% patient had a limp and no limp in 30% patients. Before surgery, support (cane use) was required by 6% patients, while at follow-up, support was noted by 12% patients. Preoperative mean Harris Hip Score was 63.6, while that at follow-up it was 74.74. Radiological worsening of the disease occurred only in 38% of the patients which suggests that disease progression was delayed in most patients(62%). 2% patients had a complication of foot drop. Conclusion: Avascular necrosis of femoral head is more common in young males. Core decompression by multiple drilling and/or core decompression with fibular strut grafting are equally effective in pre collapse stages (stage 1 and stage 2A) with better functional and radiological outcomes and hence these procedures can play a vital role in delaying the disease progression.

Femoral head retroposition as a potential compensatory mechanism in patients with a severe mismatch between pelvic incidence and lumbar lordosis

2017 ◽  
Vol 46 (12) ◽  
pp. 1679-1685
Author(s):  
Xiaofei Cheng ◽  
Kai Zhang ◽  
Xiaojiang Sun ◽  
Changqing Zhao ◽  
Hua Li ◽  
...  
Keyword(s):  
Femoral Head ◽  
Lumbar Lordosis ◽  
Pelvic Incidence ◽  
Compensatory Mechanism

Distribution of Nanomechanical Properties and Mineralization of the Osteochondral Interface in the Femoral Head

2011 ◽  
Author(s):  
Rebecca Pak ◽  
Sara E. Campbell ◽  
Rachel C. Paietta ◽  
Virginia L. Ferguson
Keyword(s):  
Articular Cartilage ◽  
Femoral Head ◽  
Disease Progression ◽  
Vertebral Bone ◽  
Nanomechanical Properties ◽  
Load Transmission ◽  
Calcified Cartilage ◽  
Hyaline Articular Cartilage

Stiff vertebral bone and compliant hyaline articular cartilage (HAC) anchor together through a thin (∼100’s of microns) region of articular calcified cartilage (ACC). This bone–cartilage, or osteochondral (OC), interface may play a role in osteoarthritis pathogenesis through increased mineralization, disrupting loading, and damaging neighboring tissues [1,2]. Load transmission through OC regions is poorly understood, thus limiting understanding of disease progression and ability to engineer OC interface-like tissues [3].

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