scholarly journals Tissue Engineering Strategies for Treating Avascular Necrosis of the Femoral Head

2021 ◽  
Vol 8 (12) ◽  
pp. 200
Author(s):  
Sumit Murab ◽  
Teresa Hawk ◽  
Alexander Snyder ◽  
Sydney Herold ◽  
Meghana Totapally ◽  
...  
Keyword(s):  
Tissue Engineering ◽  
Stem Cells ◽  
Femoral Head ◽  
Avascular Necrosis ◽  
Hip Replacement ◽  
Surgical Techniques ◽  
Significant Activity ◽  
X Rays ◽  
Early Stages ◽  
Surgical Methods

Avascular necrosis (AVN) of the femoral head commonly leads to symptomatic osteoarthritis of the hip. In older patients, hip replacement is a viable option that restores the hip biomechanics and improves pain but in pediatric, adolescent, and young adult patients hip replacements impose significant activity limitations and the need for multiple revision surgeries with increasing risk of complication. Early detection of AVN requires a high level of suspicion as diagnostic techniques such as X-rays are not sensitive in the early stages of the disease. There are multiple etiologies that can lead to this disease. In the pediatric and adolescent population, trauma is a commonly recognized cause of AVN. The understanding of the pathophysiology of the disease is limited, adding to the challenge of devising a clinically effective treatment strategy. Surgical techniques to prevent progression of the disease and avoid total hip replacement include core decompression, vascular grafts, and use of bone-marrow derived stem cells with or without adjuncts, such as bisphosphonates and bone morphogenetic protein (BMP), all of which are partially effective only in the very early stages of the disease. Further, these strategies often only improve pain and range of motion in the short-term in some patients and do not predictably prevent progression of the disease. Tissue engineering strategies with the combined use of biomaterials, stem cells and growth factors offer a potential strategy to avoid metallic implants and surgery. Structural, bioactive biomaterial platforms could help in stabilizing the femoral head while inducing osteogenic differentiation to regenerate bone and provide angiogenic cues to concomitantly recover vasculature in the femoral head. Moreover, injectable systems that can be delivered using a minimal invasive procedure and provide mechanical support the collapsing femoral head could potentially alleviate the need for surgical interventions in the future. The present review describes the limitations of existing surgical methods and the recent advances in tissue engineering that are leading in the direction of a clinically effective, translational solution for AVN in future.

scholarly journals Role of FGF-2 Transfected Bone Marrow Mesenchymal Stem Cells in Engineered Bone Tissue for Repair of Avascular Necrosis of Femoral Head in Rabbits

2018 ◽  
Vol 48 (2) ◽  
pp. 773-784 ◽  
Author(s):  
Fei Zhang ◽  
Wu-xun  Peng ◽  
Lei Wang ◽  
Jian Zhang ◽  
Wen-tao Dong ◽  
...  
Keyword(s):  
Tissue Engineering ◽  
Stem Cells ◽  
Bone Marrow ◽  
Mesenchymal Stem Cells ◽  
Femoral Head ◽  
Avascular Necrosis ◽  
Therapeutic Effect ◽  
The Other ◽  
X Ray ◽  
Marrow Mesenchymal Stem Cells

Background/Aims: Avascular necrosis of the femoral head (ANFH) is the focus and difficulty of orthopedic diseases. Recently, tissue engineering bone for this disease has shown a good therapeutic effect. The aim of the present study was to investigate the therapeutic effect of basic fibroblast growth factor (FGF-2) as cytokines transfected bone marrow mesenchymal stem cells (BMSCs) in constructing tissue-engineered bone for avascular necrosis of the femoral head. Methods: The FGF-2 gene overexpressed lentivirus-transfected rBMSCs with xenogeneic antigen-extracted cancellous bone (XACB) to construct tissue engineered bone, and the model of early avascular necrosis of the femoral head was established by lipopolysaccharide (LPS) combined with hormone. The models were randomly divided into five groups: A (control), B (XACB), C (XACB+rBMSCs), D (XACB+rBMSCs+Lv-GFP), and E (XACB+rBMSCs+Lv-FGF-2/GFP) groups. The therapeutic effect of the tissue engineered bone for the avascular necrosis of the femoral head was evaluated by gross anatomy, X-ray examination, immunohistochemistry and H&E staining. Results: The FGF-2 gene was transfected into rBMSCs (Multiplicity of infection [MOI] = 100) by lentivirus, and its efficiency was above 95%. The rBMSCs were successfully transfected overexpressing FGF-2 by qPCR and western blot. After tissue engineering bone implantation, X-ray examination and gross specimen observation revealed that the repair area in the E group was > 80% at six weeks, the defect was completely repaired at 12 weeks, and osteogenesis was stronger, when compared with the other groups. For the X-ray score, vascular area density and new bone formation area were higher, when compared with the other groups, and the difference was statistically significant (P< 0.05). Conclusion: FGF-2 gene overexpression lentivirus transfection BMSCs combined with XACB to construct tissue engineered bone can effectively promote vascular regeneration, and improve the repair effect of avascular necrosis of the femoral head.

CaO2/Gelatin Oxygen Slow-Releasing Microspheres Facilitate Tissue Engineering Efficiency for Osteonecrosis of Femoral Head via Enhancing Angiogenesis and Survival of Grafted Bone Marrow Mesenchyml Stem Cells

2021 ◽  
Author(s):  
Chengqiang Wang ◽  
Haixia Xu ◽  
Chun Liu ◽  
Ziyue Peng ◽  
Ruoxing Min ◽  
...  
Keyword(s):  
Tissue Engineering ◽  
Stem Cells ◽  
Bone Marrow ◽  
Femoral Head ◽  
Refractory Disease ◽  
Pathogenic Factor ◽  
Osteonecrosis Of Femoral Head ◽  
Critical Challenge

Osteonecrosis of femoral head (ONFH), a common refractory disease, is not fully understood today. Hypoxia caused by ischemia is not only an important pathogenic factor, but also a critical challenge...

Results of the Surgical Treatment in Children with Hirschprung Disease: A 12-Year Experience

2021 ◽  
Author(s):  
Ceren Cesur ◽  
Ayşenur Celayir
Keyword(s):  
Surgical Treatment ◽  
Complication Rate ◽  
Operative Procedure ◽  
Surgical Techniques ◽  
Hirschsprung Disease ◽  
Rectal Biopsy ◽  
X Rays ◽  
Surgical Methods ◽  
Pull Through ◽  
Subacute Intestinal Obstruction

Objective: In the treatment of Hirschsprung’s disease, many surgical techniques have been developed and modified including laparotomy, resection of the affected colon segment, and pull-through of the functional bowel segment to the anus. Conventional surgical methods have many early and late postoperative complications, albeit at a reduced rate today. In this study, it was aimed to compare the treatment results of children with Hirschsprung Disease who were operated with single or two-stage techniques in our department. Method: Hospital records of the patients operated for Hirschsprung disease were retrospectively evaluated. Demografic characteristics, findings of physical and rectal examinations, X-rays findings, rectal biopsy results, surgical treatment methods and outcomes were analyzed. Results: Fifty-two children including 41-male (78.8%) and 11-female (21.2%) patients with age ranging from 1-day to 5-year and mean age of 6.8-day in neonates and 6.3-month in others were enrolled in the study. All patients presented with acute or subacute intestinal obstruction. Levels were observed on supine abdominal radiographs in all; transition zone and retention of opaque material were observed on opaque enema or retention radiographs.In patients whose rectal biopsies revealed aganglionic megacolon two staged procedures were performed including initial colostomy followed by definitive procedure of Duhamel with stapler in 30, and Soave in 12, and Swenson in 1 patient. Nine patients were operated with one-stage endorectal pull-through technique. The complication rate in 43 patients with Hirschsprung disease managed by two staged operative procedure was (78.8%), and it was 11.1% in 9 cases that underwent transanal endorectal pullthrough procedure. It was learned that effective anal dilatation was not performed in 22-patients who had postoperative enterocolitis attacks. Conclusion: In addition to the low complication rate, the morbidity rates in the transanal endorectal pull-through method, which achieved successful results with only one procedure, were very low compared to multiple-stage operations.

A Combined Intracapsular and Extracapsular Fracture of the Hip

2002 ◽  
Vol 12 (1) ◽  
pp. 43-46
Author(s):  
S. Shabat ◽  
G. Mann ◽  
V. Barchilon ◽  
B. Kish ◽  
B. Fredman ◽  
...  
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Blood Supply ◽  
Weight Bearing ◽  
Surgical Techniques ◽  
Optimal Solution ◽  
Anatomical Site ◽  
Rare Type ◽  
Non Union ◽  
Extracapsular Fracture

We report a case of an unusual hip fracture that involved the intracapsular area and continued vertically to the extracapsular region below the trochanteric line. The division between these two types of fractures is based on the anatomical site, the blood supply and the mechanical forces that act on the hip. This division is important and influences the different surgical techniques to treat these individual fractures. Femoral neck fractures (intracapsular), particularly those with displacement, can disrupt the blood supply to the femoral head and may be associated with an increased incidence of complications, especially non-union and avascular necrosis (AVN) of the femoral head. These fractures are usually treated either by reduction and fixation, or by hemiarthroplasty. Non-union and avascular necrosis following extracapsular fractures are rare. Treatment involves reduction of the fracture and insertion of a dynamic hip screw. The combination of these two types of fractures is extremely rare and creates a surgical problem without any optimal solution. The focus of this case report is placed on the mechanical axis and weight-bearing forces that play a role in the hip and on the optional surgical techniques in such a rare type of fracture in an elderly osteoporotic patient.

New Advances in Stem Cell Therapy for Osteonecrosis of the Femoral Head

2019 ◽  
Vol 14 (3) ◽  
pp. 226-229 ◽  
Author(s):  
Wei Zhou ◽  
Ming Qu ◽  
Yajie Lv ◽  
Jinyu Zhu
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Femoral Head ◽  
Cell Therapy ◽  
Stem Cell Therapy ◽  
Hip Replacement ◽  
Early Stage ◽  
Platelet Rich Plasma ◽  
Young Patients ◽  
Plasma Therapy

Osteonecrosis of the femoral head (ONFH) is a common refractory orthopedic disease with multiple etiologies that more frequently occurs in middle-aged and young people. ONFH is the main cause of hip replacement in young patients. Since Professor Hernigou first reported the use of stem cells in the treatment of early stage ONFH, a large number of studies have demonstrated the potential of stem cells in the treatment of adult patients with ONFH. With the rise of interdisciplinary stem cell therapy combined with platelet-rich plasma therapy, gene therapy or other methods have gradually attracted the attention of researchers. This article summarizes the current advances in stem cell therapy for ONFH, as well as the problems and challenges, which may provide reference for further research.

scholarly journals Autologous Stem Cells Combined Core Decompression for Treatment of Avascular Necrosis of the Femoral Head: A Systematic Meta-Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Shibing Xu ◽  
Lei Zhang ◽  
Hongting Jin ◽  
Letian Shan ◽  
Li Zhou ◽  
...  
Keyword(s):  
Stem Cells ◽  
Bone Marrow ◽  
Femoral Head ◽  
Avascular Necrosis ◽  
Meta Analysis ◽  
Core Decompression ◽  
Autologous Bone Marrow ◽  
Bone Marrow Stem Cells ◽  
Harris Hip Score ◽  
Autologous Bone

Objective. This study aims to systematically evaluate the efficacy and safety of core decompression combined transplantation of autologous bone marrow stem cells (CDBMSCs) for treatment of avascular necrosis of the femoral head (ANFH). Methods. Randomized controlled trials (RCTs) regarding effectiveness of core decompression combined transplantation of autologous bone marrow stem cells for treating ANFH were searched in 8 comprehensive databases prior to September 2016. The data analysis was performed by using the RevMan version 5.3. Results. A total of 11 studies with 507 participants were included. Results showed that CDBMSCs group was more effective than CD group in increasing Harris hip score, decreasing necrotic area of femoral head, collapse of femoral head, and conversion to total hip replacement incidence. In the subgroup analysis, the results did not change in different intervention measure substantially. In addition, the safety of CDBMSCs for ANFH is reliable. Conclusion. Based on the systematic review, our findings suggest that core decompression combined transplantation of autologous bone marrow stem cells appeared to be more efficacious in the treatment at early stages of ANFH.

scholarly journals Surgical management of avascular necrosis of femoral head in young adults treated with uncemented total hip replacement

2021 ◽  
Vol 7 (6) ◽  
pp. 1166
Author(s):  
Vijaya Bhaskar Reddy ◽  
N. Brahma Chary ◽  
Kacham Nikitha
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Avascular Necrosis ◽  
Total Hip Replacement ◽  
Hip Arthroplasty ◽  
Hip Replacement ◽  
Daily Activities ◽  
Harris Hip Score ◽  
Total Hip ◽  
Uncemented Total Hip Replacement

<p class="abstract"><strong>Background: </strong>Normal hip joint is subjected to many stresses during daily activities performed by an individual. Since it is one of the major weight bearing joints of the body, its normal function is necessary for daily activities. Avascular necrosis (AVN) of the femoral head is one of the common causes of painful hip in a young adult. Core decompression, fibular sturt graft can be considered in early stages, total hip arthroplasty in later stages of AVN of femoral head.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective study of 30 patients following uncemented total hip replacement, who were operated between August 2017 and March 2020 at MNR medical college and hospital, Sangareddy. They were followed up for a minimum period of 1 year and evaluated using Harris hip scoring system. Harris hip score is designed specifically for measuring functional outcomes in hip arthroplasty.</p><p class="abstract"><strong>Results: </strong>There was a significant improvement in function as measured with the Harris hip score. The overall preoperative Harris hip score was 43, which remarkably improved to 89 postoperatively. The results observed, showed that all patients had good to excellent results, (Harris hip score ≥0) thus showing a good degree of pain relief, improvement in function and range of motion.</p><p class="abstract"><strong>Conclusions: </strong>Although the use of total hip arthroplasty in young patients will more likely necessitate future revision surgery, the consistent relief of pain and good functional results have made this procedure an attractive treatment choice for the debilitating arthritis resulting from osteonecrosis of the femoral head.  </p>

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