scholarly journals Degradation of subchondral bone collagen in the weight-bearing area of femoral head is associated with osteoarthritis and osteonecrosis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Zongyi Wu ◽  
Bingzhang Wang ◽  
Jiahao Tang ◽  
Bingli Bai ◽  
Sheji Weng ◽  
...  
Keyword(s):  
Femoral Head ◽  
Trabecular Bone ◽  
Subchondral Bone ◽  
Weight Bearing ◽  
Collagen Fibers ◽  
Bone Collagen ◽  
Control Group ◽  
Neck Fracture ◽  
Hematoxylin And Eosin ◽  
Weight Bearing Area

Abstract Background The aim of the study was to evaluate the change of subchondral bone collagen and trabecular bone in the weight-bearing area of femoral head from patients with osteoarthritis (OA) or osteonecrosis of femoral head (ONFH), and discuss the effect of collagen degradation on OA and ONFH. Methods Femoral heads from patients with femoral neck fracture (FNF) were collected as control group. All collected samples were divided into OA group (N = 10), ONFH group (N = 10), and FNF group (N = 10). Differences of subchondral bone collagen were compared through scanning electron microscope (SEM) observation, immunohistochemistry staining, and Masson’s trichrome staining. Alteration of subchondral bone was displayed through hematoxylin and eosin (H&E) staining and gross morphology. Results SEM results showed that collagen fibers in OA and ONFH group appeared to be thinner, rougher, sparser, and more wizened. Immunohistochemistry and Masson’s trichrome staining results demonstrated that the content of collagen fibers in the OA and ONFH group was obviously less than the FNF group. H&E staining results showed that trabecular bone in OA and ONFH group appeared to be thinner and ruptured. Gross morphology results showed that the degeneration and destruction of cartilage and subchondral bone in OA and ONFH group were severer than FNF group. The characteristics mentioned above in ONFH group were more apparent than OA group. Conclusions This study revealed that degradation of collagen fibers from subchondral bone in the weight-bearing area of femoral head was associated with OA and ONFH, which may help to find new therapeutic strategies of the diseases.

scholarly journals Finite element modeling of proximal femur with quantifiable weight-bearing area in standing position

2020 ◽  
Author(s):  
Yang Peng ◽  
Tian-Ye Lin ◽  
Jing-Li Xu ◽  
Hui-Yu Zeng ◽  
Da Chen ◽  
...  
Keyword(s):  
Finite Element ◽  
Femoral Head ◽  
Proximal Femur ◽  
Physical Phenomenon ◽  
Weight Bearing ◽  
Positional Distribution ◽  
Standing Position ◽  
Fe Model ◽  
X Ray ◽  
Weight Bearing Area

Abstract BackgroundThe positional distribution and size of the weight-bearing area of femoral head in the standing position as well as the direct active surface of joint force can directly affect the result of finite element (FE) stress analysis, however in most studies related separate FE models of femur, the division of this area is vague, imprecise and un-individualized. The purpose of this study was to quantify the positional distribution and size of the weight-bearing area of femoral head in standing position by a set of simple methods, to realize individualized reconstruction of proximal femur FE model.MethodsFive adult volunteers were recruited for X-ray and CT examination in the same simulated bipedal standing position with a specialized patented device. We extracted these image data, calculated the 2D weight-bearing area on X-ray image, reconstructed the 3D model of proximal femur based on CT data, and registered them to realize the 2D weight-bearing area to 3D transformation as the quantified weight-bearing surface. One of the 3D models of proximal femur was randomly selected for finite element analysis (FEA), and we defined three different loading surfaces, and compared their FEA results.ResultsA total of 10 weight-bearing surfaces in 5 volunteers were constructed, they were mainly distributed on the dome and anterolateral of femoral head with crescent shape, in the range of 1,218.63mm2 - 1,871.06mm2. The results of FEA showed stress magnitude and distribution in proximal femur FE models among three different loading conditions were significant differences, the loading case with quantized weight-bearing area was more in accordance with the physical phenomenon of the hip.ConclusionThis study confirmed an effective FE modeling method of proximal femur, which can quantify weight-bearing area to define more reasonable load surface setting without increasing the actual modeling difficulty.

A Quantitative Assessment of the Subchondral Changes in Osteoarthritis and its Association to the Cartilage Degeneration

1993 ◽  
Vol 06 (04) ◽  
pp. 198-201 ◽  
Author(s):  
E. Svalastoga ◽  
H. Strøm
Keyword(s):  
Trabecular Bone ◽  
Weight Bearing ◽  
Cartilage Degeneration ◽  
Control Group ◽  
Grading System ◽  
Cartilage Lesions ◽  
Femoral Heads ◽  
Percentage Volume ◽  
Trabecular Bone Area ◽  
And Cartilage

SummaryIn order to quantify the alterations in subchrondral bone and to compare the changes with the severity of the cartilage lesions, a quantitative histological analysis of articular cartilage and subchrondral bone from osteoarthritic and normal femoral heads was performed.The analyses were based on 12 femoral heads, seven which were osteoarthritic and five controls. Coronal sections were made and divided into four separate sites to include two weight-bearing and two non-weight-bearing. For each area the percentage volume of trabecular bone was determined by histomorphometry and the degree of cartilage degeneration was evaluated according to a histologicalhistochemical grading system.The data obtained showed wide variations from site to site, in osteoarthritic femoral heads, with consistently more pronounced alterations in cartilage and subchrondral bone in the weight-bearing areas. Bone thickening and cartilage degeneration were distinctly increased in osteoarthritic joints, in contrast to the control group. By comparing the bony changes with the severity of the cartilage lesions, a correlation of moderate significance was found between the degeneration of the cartilage and sclerosis of the subchrondral bone.Sections from osteoarthritic and normal canine femoral heads were obtained and divided into weight-bearing and non-weight-bearing areas. The trabecular bone area (%) and the severity of cartilage degeneration were determined by bone histo-morphology and a cartilage histological-histochemical grading system.Bone thickening and cartilage degeneration were increased in osteoarthritic joints, when compared to normal controls with consistently more pronounced alterations in weight-bearing areas. The severity of the cartilage lesions were found to corre-late with subchrondral bone sclerosis.

scholarly journals Increased COUP-TFII Expression Mediates the Differentiation Imbalance of Bone Marrow-Derived Mesenchymal Stem Cells in Femoral Head Osteonecrosis

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Sheng-Hao Wang ◽  
Guo-Hau Gou ◽  
Chia-Chun Wu ◽  
Hsain-Chung Shen ◽  
Leou-Chyr Lin ◽  
...  
Keyword(s):  
Stem Cells ◽  
Bone Marrow ◽  
Mesenchymal Stem Cells ◽  
Femoral Head ◽  
Bone Tissue ◽  
Mesenchymal Cells ◽  
Control Group ◽  
Differentiation Potential ◽  
Femoral Head Osteonecrosis ◽  
Neck Fracture

Objective. Bone marrow-derived mesenchymal stem cells (BMSCs) have multilineage differentiation potential, which allows them to progress to osteogenesis, adipogenesis, and chondrogenesis. An imbalance of differentiation between osteogenesis and adipogenesis will result in pathologic conditions inside the bone. This type of imbalance is also one of the pathological findings in osteonecrosis of the femoral head (ONFH). Chicken ovalbumin upstream promoter-transcription factor II (COUP-TFII) was previously reported to mediate the differentiation of mesenchymal stem cells. This study investigated the expression of the osteogenesis regulator Runx2, osteocalcin, the adipogenesis regulator PPARγ, and COUP-TFII in the femoral head tissue harvested from ONFH patients, and characterized the effect of COUP-TFII on the differentiation of primary BMSCs. Methods. Thirty patients with ONFH were recruited and separated into 3 groups: the trauma-, steroid- and alcohol-induced ONFH groups (10 patients each). Bone specimens were harvested from patients who underwent hip arthroplasty, and another 10 specimens were harvested from femoral neck fracture patients as the control group. Expression of the osteogenesis regulator Runx2, osteocalcin, the adipogenesis regulator PPARγ, C/EBP-α, and COUP-TFII was analyzed by Western blotting. Primary bone marrow mesenchymal cells were harvested from ONFH cells treated with COUP-TFII RNA interference to evaluate the effect of COUP-TFII on MSCs. Results. ONFH patients had significantly increased expression of the adipogenesis regulator PPARγ and C/EBP-α and decreased expression of the osteogenesis regulator osteocalcin. ONFH bone tissue also revealed higher COUP-TFII expression. Immunohistochemical staining displayed strong COUP-TFII immunoreactivity adjacent to osteonecrotic trabecular bone. Increased COUP-TFII expression in the bone tissue correlated with increased PPARγ and decreased osteocalcin expression. Knockdown of COUP-TFII with siRNA in BMSCs reduced adipogenesis and increased osteogenesis in mesenchymal cells. Conclusion. Increased COUP-TFII expression mediates the imbalance of BMSC differentiation and progression to ONFH in patients. This study might reveal a new target in the treatment of ONFH.

scholarly journals Research in the precaution of recombinant human erythropoietin to steroid-induced osteonecrosis of the rat femoral head

2017 ◽  
Vol 45 (4) ◽  
pp. 1324-1331 ◽  
Author(s):  
Lu-yong Jiang ◽  
Xiao Yu ◽  
Qing-jiang Pang
Keyword(s):  
Femoral Head ◽  
Recombinant Human Erythropoietin ◽  
Positive Control ◽  
The Other ◽  
Positive Control Group ◽  
Control Group ◽  
Human Erythropoietin ◽  
Hematoxylin And Eosin ◽  
Hematoxylin And Eosin Staining ◽  
Experimental Group

Objective To elucidate the effects of recombinant human erythropoietin (rHuEPO) on steroid-induced osteonecrosis of the femoral head in rats. Methods Twenty-four adult Wistar rats were randomly divided into three groups of eight rats each. The rats in the positive control group were injected with dexamethasone at 1 mg/kg twice a week for 5 weeks. The rats in the negative control group were injected with sodium chloride alone. The rats in the experimental group were injected with dexamethasone at 1 mg/kg twice a week for 5 weeks and rHuEPO (500 u/d/kg) daily for 5 weeks. The femoral head on one side was examined by hematoxylin and eosin staining, and that on the other side was examined by CD31 staining of the capillaries. Results Hematoxylin and eosin staining in the positive control group showed that the bony trabeculae had become obviously narrow and sparse with discontinuity of the integrity. The integrity of the trabeculae was better in the experimental group than positive control group. The CD31 expression was lower in the positive control group than in the other two groups. Conclusion rHuEPO can effectively prevent osteocyte apoptosis, delaying or decreasing osteonecrosis of the femoral head.

scholarly journals Implantation of autologous Expanded Mesenchymal Stromal Cells in Hip Osteonecrosis through Percutaneous Forage: Evaluation of the Operative Technique

2021 ◽  
Vol 10 (4) ◽  
pp. 743
Author(s):  
Enrique Gómez-Barrena ◽  
Norma Padilla-Eguiluz ◽  
REBORNE Consortium
Keyword(s):  
Femoral Head ◽  
Mesenchymal Stromal Cells ◽  
Stromal Cells ◽  
Treatment Efficacy ◽  
Weight Bearing ◽  
Central Area ◽  
Transverse Plane ◽  
Coronal Plane ◽  
Multinational Clinical Trial ◽  
Weight Bearing Area

Bone forage to treat early osteonecrosis of the femoral head (ONFH) has evolved as the channel to percutaneously deliver cell therapy into the femoral head. However, its efficacy is variable and the drivers towards higher efficacy are currently unknown. The aim of this study was to evaluate the forage technique and correlate it with the efficacy to heal ONFH in a multicentric, multinational clinical trial to implant autologous mesenchymal stromal cells expanded from bone marrow (BM-hMSCs). Methods: In the context of EudraCT 2012-002010-39, patients with small and medium-sized (mean volume = 13.3%, range: 5.4 to 32.2) ONFH stage II (Ficat, ARCO, Steinberg) C1 and C2 (Japanese Investigation Committee (JIC)) were treated with percutaneous forage and implantation of 140 million BM-hMSCs in a standardized manner. Postoperative hip radiographs (AP—anteroposterior and lateral), and MRI sections (coronal and transverse) were retrospectively evaluated in 22 patients to assess the femoral head drilling orientation in both planes, and its relation to the necrotic area. Results: Treatment efficacy was similar in C1 and C2 (coronal plane) and in anterior to posterior (transverse plane) osteonecrotic lesions. The drill crossed the sclerotic rim in all cases. The forage was placed slightly valgus, at 139.3 ± 8.4 grades (range, 125.5–159.3) with higher dispersion (f = 2.6; p = 0.034) than the anatomical cervicodiaphyseal angle. Bonferroni’s correlation between both angles was 0.50 (p = 0.028). More failures were seen with a varus drill positioning, aiming at the central area of the femoral head, outside the weight-bearing area (WBA) (p = 0.049). In the transverse plane, the anterior positioning of the drill did not result in better outcomes (p = 0.477). Conclusion: The forage drilling to deliver cells should be positioned within the WBA in the coronal plane, avoiding varus positioning, and central to anterior in the transverse plane. The efficacy of delivered MSCs to regenerate bone in ONFH could be influenced by the drilling direction. Standardization of this surgical technique is desirable.

scholarly journals Allograft Fibula Combined with Cannulated Screw for Femoral Head Necrosis: A Finite Element Analysis

2021 ◽  
Author(s):  
Gan Zhao ◽  
Ming Liu ◽  
Bin Li ◽  
Tianye Lin ◽  
JingLi Xu ◽  
...  
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Femoral Head ◽  
Cortical Bone ◽  
Maximum Stress ◽  
Weight Bearing ◽  
Cannulated Screw ◽  
Element Analysis ◽  
Osteonecrosis Of Femoral Head ◽  
Weight Bearing Area

Abstract Background: Osteonecrosis of femoral head (ONFH) is characterized by high incidence and disability. Allograft fibula combined with cannulated screw has been extensively applied for treating Osteonecrosis of femoral head. However, its biomechanical outcomes remain unclear. The present study aimed to investigate the optimal placement of the allograft fibula and cannulated screw for treating ONFH.Methods: Two types (C1 and C2) of NONFH finite element models were built based on a healthy subject and the Japanese Investigation Committee (JIC) classification system. The allograft fibula combined with cannulated screw was simulated in the respective type of the model. Different models were built by complying with the different positions of allograft fibula and cannulated screw (below model, posteriorly below model, anteriorly below model and anteriorly above model). Furthermore, a comparison was drawn on the maximum stress value and the mean stress value of the subchondral cortical bone of femoral head weight-bearing area.Results: As indicated from the finite element analysis, normal femoral head, necrotic femoral head and postoperative femoral head achieved the different maximum stress values, and the maximum stress value achieved by necrotic femoral head significantly reached over that of normal femoral head. After the operation, the maximum stress value of subchondral cortical bone in the weight-bearing area of the femoral head was noticeably down-regulated compared with that before the operation (necrotic femoral head). When the cannulated screw was directly below the fibula, subchondral cortical bone in the weight bearing area of femoral head achieved the smallest maximum stress value and average stress value, which showed a statistical difference from those of other models (P<0.05).Conclusion: Allograft fibula combined with cannulated screw is capable of significantly reducing the stress of subchondral cortical bone in the weight-bearing area of the ONFH femoral head, as well as down-regulating the stress concentration in the ONFH weight-bearing area. For JIC C1 and C2 osteonecrosis of the femoral head, when administrated with allograft fibula combined with cannulated screw, the optimal biomechanics was the cannulated screw located just directly below the fibula.

scholarly journals Biomechanical Analysis of Fibular Graft Techniques for Nontraumatic Osteonecrosis of Femoral Head: A Finite Element Analysis

2020 ◽  
Author(s):  
Jian Xu ◽  
Shi Zhan ◽  
Ming Ling ◽  
Dajun Jiang ◽  
Hai Hu ◽  
...  
Keyword(s):  
Finite Element ◽  
Femoral Head ◽  
Healthy Subject ◽  
Proximal Femur ◽  
Weight Bearing ◽  
Biomechanical Properties ◽  
Patient Specific ◽  
Structural Stiffness ◽  
Osteonecrosis Of Femoral Head ◽  
Weight Bearing Area

Abstract Background: Free vascularized fibula graft (FVFG) technique has achieved the most consistent successful therapeutic effect on young patients diagnosed as nontraumatic osteonecrosis of femoral head (NONFH), of which the Core Track Technique (CTT) has been the most commonly used. As an alternative to CTT, the modified Light Bulb Technique (LBT) was reported to have a higher success rate. However, its biomechanical characters have been poorly understood. This study aimed to investigate the biomechanical properties of modified LBT in treating NONFH by comparing with CTT.Methods: Two types (C1 and C2) of NONFH finite element models were established from a healthy subject according to the Japanese Investigation Committee (JIC) classification, and CTT and LBT procedures were simulated in each type of the models. The average Von Mises stresses and stiffness of the proximal femur were calculated by applying 250% body weight loading on femoral head to simulate walking condition. In addition, two patient-specific models were built and simulated under the same boundary condition for the further validation of LBT.Results: In the healthy subject-derived models, both LBT and CTT resulted in reduced stresses in the weight-bearing area, central femoral head, femoral neck, and trochanteric and subtrochanteric regions, and increased structural stiffness after surgery. In the weight-bearing area, CTT reduced more stresses than LBT (36.19% vs 31.45%) for Type C1, while less reduction (23.63% vs 26.76%) for Type C2. In patient-specific models, stiffness and stresses of before and after surgery were also increased and reduced respectively, which is consistent with healthy subject-derived models.Conclusion: LBT and CTT have different biomechanical performance on different JIC type of NONFH. In terms of preventing the collapse of femoral head, LBT may be more effective for JIC Type C2, which could alternatively be chosen, while for JIC Type C1, CTT is still a better choice. Both techniques can improve biomechanical properties of NONFH with patients’ proximal femur stress reduced and structural stiffness enhanced.

scholarly journals Treatment of Pauwels type III femoral neck fracture with medial femoral neck support screw: a biomechanical and clinical study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Zhichao Gao ◽  
Mei Wang ◽  
Baojie Shen ◽  
Xiaodong Chu ◽  
Di Ruan
Keyword(s):  
Femoral Head ◽  
Femoral Neck ◽  
Fracture Healing ◽  
Femoral Neck Fracture ◽  
Biomechanical Study ◽  
Femoral Head Necrosis ◽  
Vertical Shear ◽  
Control Group ◽  
Fixation Failure ◽  
Neck Fracture

AbstractA femoral neck fracture is currently one of the most common types of fracture in clinical practice. The incidence continues to increase due to traffic accidents, trauma, and osteoporosis. This research includes a biomechanical study and a clinical retrospective study. In the biomechanical studies, three groups’ effects (Control Group: 3CCS, DHS group, and study Group: 3CCS + mFNSS group) were compared by vertical compression tests, torsion tests, and fatigue tests. All the data were collected and analyzed. We subsequently performed a retrospective analysis of 131 patients with femoral neck fractures. The operative time, intraoperative blood loss, quality of postoperative fracture reduction, and follow-up observation of fracture healing, screw retreatment rates and fixation failure rates, as well as femoral head necrosis rates and hip function in two groups with 3CCS and 3CCS + mFNSS were compared. By the biomechanical study, we found that 3CCS + Mfnss group were biomechanically superior to 3CCS group and superior to the DHS group in terms of resistance to torsion. However, it was less effective than the DHS group in compressive strength and fatigue resistance. In terms of clinical application, 3CCS + mFNSS group was found to have lower screw retreatment rates and femoral head necrosis rates, and to have better fracture healing rates than group with 3CCS, indicating that medial support screws can effectively resist the vertical shear forces of fracture ends and promote the stability and healing of fracture ends, as well as to reduce the incidence of postoperative complications.

Application of a Personalized Finite Element Analysis and 3D-Printed Navigation Template in The Treatment of Femoral Neck Fracture With Cannulated Screw

2021 ◽  
Author(s):  
Sizhe Wang ◽  
Bin Wang ◽  
Xiaoquan Lan ◽  
Zhenzhen Xu ◽  
Haoran Huang ◽  
...  
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Femoral Head ◽  
Cannulated Screw ◽  
Control Group ◽  
Study Group ◽  
Element Analysis ◽  
Neck Fracture ◽  
3D Printed ◽  
Navigation Template

Abstract Purpose: To investigate the feasibility and accuracy of combining a personalized finite element analysis with 3D-printed navigation template on the treatment of femoral neck fracture (FNF) with cannulated screw. Methods: A total of 60 patients as unstable FNT with cannulated screw were evolved in this study from October 2016 to December 2019, who were randomly divided into two groups (n=30/group): The subjects in the study group were examined using the a finite element analysis according to the three-dimensional CT of hip joint before operation and then underwent 3D-printed navigation template of the femur to complete the implantation of the cannulated screw whereas the other 30 patients in the control group were underwent the implantation of the cannulated screw using the conventional FNF treatment in the inverted isosceles triangle. The success rate of one-time implantation of the cannulated screw, the postoperative shortest distance of talus cortex, and the healing of fracture, necrosis of femoral head and Harris function scores of hip joint in 12 months after operation were recorded and compared between the study and control groups.Results: According to the finite element analysis, the biomechanics of three screws were the most stable when they were close to the bone cortex (<3mm). Further more, it was demonstrated that the patients in the study group have more effectively success rate of one-time nail placement (93.33%) and significant reduction in the distance of talus cortex of cannulated screws (3.04 ± 0.39mm) than those in the control group (66.67% and 5.38±0.71mm). At 12 months post-surgery, higher healing rate of fracture (93.33%) and Harris functional score of hip (93.67 ± 4.01), as well as lower necrosis rate of femoral head (6.67%) were underwent in the study group when compared with the control group (83.33%, 91.57±4.18 and 16.67%). Conclusion: The results of this study suggest that combined application of a personalized finite element analysis and 3D-printed navigation template in the treatment of femoral neck fracture with cannulated screw can not only improve the effective nail placement, but also make the screw more in line with the requirements of biomechanical stability to promote the fracture healing and reduce the risk of femoral head necrosis. So it is a digital orthopedic technology for clinical popularization.

Sign in / Sign up

Export Citation Format

Share Document