Short-Term Efficacy and Safety of Secukinumab for Ankylosing Spondylitis: A Systematic Review and Meta-Analysis of RCTs.

Secukinumab is a novel IL-17A inhibitor that has been confirmed to be effective for treating PsA and RA. Several studies have demonstrated that secukinumab also provides benefits for AS patients. Thus, we performed a meta-analysis of RCTs to evaluate the short-term efficacy and safety of secukinumab for the management of AS. The PubMed, Medline, Embase, Web of Science, and Cochrane Library databases were searched for RCTs published prior to March 2020 on the treatment of AS with secukinumab. The primary outcome was the ASAS20 response, and the secondary outcomes included the ASAS40 response, ASAS5/6 response, SF-36 PCS score, ASQoL score, and AEs. Dichotomous data were expressed as pooled RRs with 95% CIs, while continuous data were expressed as pooled MDs with 95% CIs. Subgroup analysis was conducted based on whether the AS patients previously underwent treatment with TNFi. A total of 4 RCTs with 1166 patients were included in our meta-analysis. At week 16, secukinumab 150 mg yielded significant improvements in the clinical response and patient-reported outcomes for AS patients. There was no increased risk of AEs. Consistent results were detected in the meta-analysis of secukinumab 75 mg versus a placebo. Furthermore, no significant difference was detected between the secukinumab 75 mg group and secukinumab 150 mg group. We concluded that secukinumab is effective for treating AS and generally well tolerated by AS patients in the short term, regardless of whether they previously underwent TNFi treatment. The superiority of secukinumab 150 mg over secukinumab 75 mg seems to be limited, since no significant difference in any endpoint was detected between the two groups.

Extracorporeal shock wave therapy in the treatment of primary bone marrow edema syndrome of the knee: a prospective randomised controlled study.

BACKGROUND: The aim of this prospective study was to evaluate the effectiveness of extracorporeal shock wave therapy (ESWT) in normalizing the symptoms and imaging features of primary bone marrow edema syndrome (BMES) of the knee. METHODS: This study compared the outcomes of ESWT (Group A) (n = 20) and intravenously applied prostacyclin and bisphosphonate (Group B) (n = 20) in the treatment of BMES of the knee in our department between 2011 and 2013. The Visual Analog Scale for pain (VAS, 100 mm), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), the SF-36 scores and MRI scans as well as plain radiographs were obtained before and after therapy between two groups. RESULTS: Compared with Group B, we found greater improvement in VAS, the WOMAC Osteoarthritis Index and SF-36 score at 1, 3 and 6 months post-treatment in Group A (P < 0.05). Furthermore, MRI scans showed a higher incidence of distinct reduction and complete regression of bone marrow edema at 6 months in Group A (95 vs. 65 %; P = 0.018). The MRI at 1 year follow-up showed complete regression in all patients in Group A. However, two cases in Group B continued to normalize over the subsequent follow-up period. CONCLUSIONS: ESWT can produce rapid pain relief and functional improvement. It may be an effective, reliable, and non-invasive technique for rapid treatment of BMES of the knee. TRIAL REGISTRATION: Research Registry UIN 528, September 03, 2015.

Minimally invasive unicompartmental knee arthroplasty in treatment of osteonecrosis versus osteoarthritis: a matched-pair comparison.

This study was conducted to compare the differences of the outcome and surgical technique for minimally invasive unicompartmental knee arthroplasty(UKA) in treatment of osteonecrosis versus osteoarthritis. Twenty-nine spontaneous osteonecrosis of the knee (SONK) cases were reviewed retrospectively. An equal number of patients with osteoarthritis (OA) performed in the same period were selected and matched with respect to age, preoperative range of motion and radiological grade of knee arthrosis. The mean follow up time were 44.14±14.05 and 44.45±14.45 months, respectively. The preoperative hospital for special surgery knee score and visual analogue score were significantly better in group OA than those of group SONK. However, the results were comparable in terms of postoperative pain, knee score, range of motion and axial alignment. From a technical point of view, the osteonecrosis stage and bone defect must be taken into account when using UKA for SONK.

[Risk factors for lateral compartmental cartilage wear in varus knee osteoarthritis].

OBJECTIVE: To analyze the gross features of articular cartilage wear in varus knee osteoarthritis, and discuss the risk factors for lateral compartmental cartilage erosion. METHODS: Data prospectively collected from the dissection of 286 total knee arthroplasties (223 patients) with varus knee osteoarthritis from January 2013 to December 2013 were analyzed. At the operation, the gross assessments of articular cartilage, ligament and meniscus were recorded, and then the slices were evaluated for histologic analysis. Parameters of the patients with lateral compartmental cartilage erosion were compared with those without lateral compartmental cartilage erosion using the univariate analysis. Logistic regression analysis was used to analyze the risk factors associated with lateral compartmental cartilage erosion. RESULTS: There were 223 patients with 286 knees were included,including 37 male patients (47 knees) and 189 female patients (239 knees), with an average age of (66±8) years (range 50-86 years), body mass index (BMI) was (27±5) kg/m2 (18.0-40.0 kg/m2). Varus degree was 8°±4° (1°-34°). Range of motion was 103°±21° (0°-143°), and Hospital for Special Surgery (HSS) score was 53±12 (29-76). Seventy-five knees (60 patients) showed lateral compartmental cartilage wear (26.2%). Environmental factors showed no differences in age, side, gender, BMI, range of motion,and HSS score (P>0.05). Factors significantly increasing the risk of lateral compartmental cartilage wear by univariate analysis included varus degree, activity level, duration of onset, meniscus, Weidow grade, Kellgren-Lawrence grade, collateral ligament and anterior cruciate ligament (P<0.05). Multiple Logistic regression analysis revealed the factors most highly associated with the increase risk for lateral compartmental wear were high activity level (OR=2.843, 95% CI: 1.010-8.002) and longer duration of onset (OR=1.216, 95% CI: 1.115-1.325). However, intact lateral meniscus (OR=0.012, 95% CI: 0.003-0.048) and anterior cruciate ligament (OR=0.406, 95% CI: 0.192-0.857) were associated with the protection of lateral compartmental. CONCLUSIONS: In varus knee osteoarthritis, the wear incidence of lateral compartmental is low. High activity and increased duration of onset are risk factors of lateral compartmental wear, and intact meniscus and anterior cruciate ligament are protective factors.

[Radiological assessments of proximal femoral geometry and its clinical significance in hip arthroplasty].

OBJECTIVE: To explore the reliability of the relationship between the tip of greater trochanter and the center of femoral head in restoring leg length discrepancy during hip arthroplasty. METHODS: From June 2013 to October 2013, 370 standard anterior-posterior pelvic radiographs were performed. There were 160 males and 210 females with a mean age of 47.6 years. Landmarks were selected by Picture Archiving and Communication Systems (PACS) as follows: the center of femoral head of concentric circles, anatomic axis of proximal femur, the lines perpendicular to anatomic axis of proximal femur through the tip of greater trochanter and the center of femoral head. The distance between two intersected points, i.e. vertical distance between the tip of greater trochanter and the center of femoral head, aka greater trochanter height (GTH), was measured by two orthopedic surgeons respectively. If the tip of greater trochanter was above the center of femoral head, the distance was defined as positive. And the distance was negative if the tip of greater trochanter fell below the center of femoral head. The distance of male and female and that of right and left femurs were compared. RESULTS: Only 6 tips of greater trochanter were below the center of femoral head, 9 at the same level and 725 above the center of femoral head. And 96.89% of tips of the greater trochanter were at 0-15 mm above the center of femoral head. The difference between male and female (P = 0.032) and the difference between right and left sides were statistically significant (P < 0.001). CONCLUSION: The center of femoral head is not at the same level as the tip of greater trochanter. And the distances of right and left tips of greater trochanter to the ipsilateral center of femoral head are not always at the same level. So it should be cautious to employ the relationship between the tip of greater trochanter and the center of femoral head in restoring leg length discrepancy during hip arthroplasty.

[Treatment of patellofemoral osteoarthritis with patello-femoral joint arthroplasty].

OBJECTIVE: To study the outcome and surgical technique of patello-femoral joint arthroplasty (PFJ) for osteoarthritis of the knee. METHODS: From January 2010 to June 2012, 17 patients (24 knees) with patello-femoral compartmental osteoarthritis treated by PFJ were reviewed retrospectively. There were 2 male patients (4 knees) and 15 female patients (15 knees), with an average age of (64 ± 9) years (52-77 years) . The mean body mass index was (24 ± 3) kg/m² (18.0-30.1 kg/m²) . Patients were asked to return for follow-up examinations at 3, 6 months and at every year after PFJ. The range of motion (ROM), visual analogue scale(VAS), Hospital for Special Surgery score (HSS score) , Feller patella score, quadriceps muscle strength were evaluated before and after PFJ. The paired sample t-test and one-way analysis of variance (ANOVA) with replicate measures were used to determine whether there were statistically significant differences between the mean data. RESULTS: All of the patients were followed up for 18-47 months, with a mean time of (29 ± 10) months, 75.0% patients were satisfied with the outcome of this surgical procedure 1 year postoperative, and 87.5% were satisfied 2 years postoperative. HSS score was increased from 61 ± 11 to 90 ± 6 at the final follow-up (t = 12.24, P = 0.000). VAS score was reduced from 6.7 ± 1.0 to 2.4 ± 1.0 (t = 15.84, P = 0.000). The mean post-operative ROM of the knees was 126° ± 7° (t = 3.25, P = 0.003). Feller patella scores were 18.0 ± 3.2 before operation, and 18.5 ± 4.5, 19.7 ± 3.4, 24.0 ± 3.8, 26.0 ± 3.3, 26.6 ± 2.5 at 3, 6, 12, 24 months after operation, final follow-up, respectively. Quadriceps muscle strength were 3.9 ± 0.5 before operation, and 3.7 ± 0.5, 3.9 ± 0.5, 4.2 ± 0.5, 4.3 ± 0.5, 4.3 ± 0.5 at 3, 6, 12, 24 months after operation, final follow-up, respectively. Repeated measures ANOVA found significant time effects for Feller patella scores (F = 38.97, P = 0.000) and quadriceps muscle (F = 6.89, P = 0.000). Feller patella scores and quadriceps muscle strength were low at 3, 6 months after operation, with no significant differences compared with pre-operation data (P > 0.05). The improvements of Feller patella scores and quadriceps muscle strength after 6 months were of significant difference compared with pre-operation and postoperative 6 months data (t = 5.65-10.65 and t = 2.18-2.73, P < 0.05) . Three knee reported continuing pains with quadriceps muscle strength less than 4 level. CONCLUSIONS: PFJ is an effective method for patello-femoral compartmental osteoarthritis with less trauma. The early term outcome of PFJ is encouraging. Quadriceps muscle strength should be enhanced.

Quality of sexual life after total hip arthroplasty in male patients with osteonecrosis of femoral head.

BACKGROUND: Patients with osteonecrosis of the femoral head (ONFH) have a severe impact on their health status, functionality and quality of life. Sexual life is an important component of the quality of life and is still a frequently neglected domain in patients with ONFH. The aims of the study were to evaluate the influence of the disease and the total hip arthroplasty (THA) surgery on quality of sexual life (QSL) in these patients. METHODS: A prospective, self-controlled study was done. 247 patients of ONFH who underwent unilateral or bilateral THA were asked to complete a standardized QSL questionnaire, and the score of QSL was evaluated preoperatively and at first year follow-up of post-THA operation. RESULTS: The mean age of the patient was 46.8 (range 25-60) years. 194 cases (78.5%, 276 hips) were alcohol-induced ONFH. There is significant decrease (p = 0.026) in sexual relationship impairment on the 0-8 scale from pre-THA (5.3 ± 0.7) to post-THA (2.3 ± 0.4). There is no significant difference for effect on sexual function (p = 0.14) between pre-THA (2.3 ± 0.4) and post-THA (1.8 ± 0.3). There is significant improvement (p = 0.018) in overall sexual satisfaction degree of patients on the 1-5 scale from pre-THA (2.7 ± 0.2) to post-THA (4.7 ± 0.6), but no significant increase for sexual partner. CONCLUSION: ONFH has impaired relationships with partner and overall sexual satisfaction degree of the male patients; THA has improved significantly relationships with partner and overall sexual satisfaction degree of the male patients, but no effect on sexual function of the patients and overall sexual satisfaction degree of sexual partner.

Correction: Ma et al. Extracellular Vesicles from BMSCs Prevent Glucocorticoid-Induced BMECs Injury by Regulating Autophagy via the PI3K/Akt/mTOR Pathway. Cells 2022, 11, 2104.

In the original publication [...].

[Effects of posterior tibial slope on non-contact anterior cruciate ligament rupture and stability of anterior cruciate ligament rupture knee].

OBJECTIVE: To retrospectively explore the correlation between anterior cruciate ligament (ACL)-ruptured knees, stability of ACL-rupture knee and posterior tibial slope (PTS). METHODS: From January 2008 to October 2012, 150 knees with ACL rupture underwent arthroscopic surgery for ACL reconstruction. A control group was established for subjects undergoing arthroscopic surgery without ACL rupture during the same period. PTS was measured on a digitalized lateral radiograph. Lachman and mechanized pivot shift tests were performed for assessing the stability of knee. RESULTS: There was significant difference (P = 0.007) in PTS angle between the patients with ACL rupture (9.5 ± 2.2 degrees) and the control group (6.6 ± 1.8 degrees). Only among females, increased slope of tibial plateau had effect on the Lachman test. There was a higher positive rate of pivot shift test in patients of increased posterior slope in the ACL rupture group. CONCLUSION: Increased posterior tibial slope (>6.6) appears to contribute to non-contact ACL injuries in females. And the changes of tibial slope have no effect upon the Lachman test. However, large changes in tibial slope affect pivot shift.

Subchondral Bone Plate Classification: A New and More Sensitive Approach for Predicting the Prognosis of Osteonecrosis of the Femoral Head.

BACKGROUND: This study explores the impact of subchondral bone plate necrosis on the development of the osteonecrosis of femoral head (ONFH) and its joint collapse. METHODS: This retrospective study included 76 ONFH patients (89 consecutive hips) with Association for Research on Osseous Circulation stage II who received conservative treatment without surgical intervention. The mean follow-up time was 15.60 ± 12.29 months. ONFH was divided into 2 types (I and II): Type I with a necrotic lesion involving subchondral bone plate and Type II with a necrotic lesion not involving subchondral bone plate. The radiological evaluations were based on plain x-rays. The data were analyzed using SPSS 26.0 statistical software. RESULTS: The collapse rate in Type I ONFH was significantly higher than that in Type II ONFH (P < 0.001). The survival time of hips with Type I ONFH was significantly shorter than those with Type II ONFH and with the endpoint of the femoral head collapse (P < 0.001). The collapse rate of Type I in the new classification (80.95%) was higher compared with that of the China-Japan Friendship Hospital (CJFH) classification (63.64%), and the difference was statistically significant (χ2 = 1.776, P = 0.024). CONCLUSION: Subchondral bone plate necrosis is an important factor that affects ONFH collapse and prognosis. Current classification using subchondral bone plate necrosis is more sensitive for predicting collapse compared with the CJFH classification. Effective treatments should be taken to prevent collapse if ONFH necrotic lesions involve the subchondral bone plate.

Clinical Outcomes of Unicompartmental Knee Arthroplasty in Patients with Full-versus Partial-Thickness Cartilage Loss: A Systematic Review and Meta-Analysis.

OBJECTIVE: The objective of the study was to compare postoperative patient-reported outcomes and reoperation rates following unicompartmental knee arthroplasty (UKA) between patients with full-thickness cartilage loss (FTCL) and partial-thickness cartilage loss (PTCL). DESIGN: Multiple databases, including PubMed, Embase, Cochrane Library, and CNKI, were searched until October 2019 for studies comparing the Oxford Knee Score (OKS), American Knee Society (AKS) score, and reoperation rates between patients with FTCL and PTCL following UKA. Data analysis was performed using Review Manager software. RESULTS: A total of 613 UKA cases from 5 retrospective cohort studies were included. The mean difference in postoperative OKSs was significantly higher by 2.92 in FTCL group than in PTCL group (95% confidence interval [CI] = -5.29 to -0.55; P = 0.02). Improvement in OKS was significantly higher by 2.69 in FTCL group than in PTCL group (95% CI = -4.79 to -0.60; P = 0.01). However, the differences in OKSs were not clinically significant. The mean difference in AKS knee scores was similar between the 2 groups (95% CI = -9.14 to -3.34; P = 0.36), whereas the pooled mean difference in AKS function scores was higher by 5.63 in FTCL group than in PTCL group (95% CI = -9.27 to -1.98; P = 0.002), which was clinically relevant. The reoperation rates were statistically higher in PTCL group than in FTCL group (odds ratio = 2.24; 95% CI = 1.15 to 4.38; P = 0.02). CONCLUSIONS: Patients with FTCL achieved superior postoperative patient-reported outcomes and lower reoperation rates following UKA compared with those with PTCL. Thus, we believe this procedure should only be applied to end-stage medial osteoarthritis of the knee joint.

Extracellular Vesicles from BMSCs Prevent Glucocorticoid-Induced BMECs Injury by Regulating Autophagy via the PI3K/Akt/mTOR Pathway.

Osteonecrosis of the femoral head (ONFH) is a common clinical disease with a high disability rate. Injury of bone microvascular endothelial cells (BMECs) caused by glucocorticoid administration is one of the important causes of ONFH, and there is currently a lack of effective clinical treatments. Extracellular vesicles derived from bone stem cells (BMSC-EVs) can prevent ONFH by promoting angiogenesis and can inhibit cell apoptosis by regulating autophagy via the PI3K/Akt/mTOR signaling pathway. The present study aimed to investigate the effect of extracellular vesicles derived from bone marrow stem cells (BMSC) on a glucocorticoid-induced injury of BMECs and possible mechanisms. We found that BMSC-EVs attenuated glucocorticoid-induced viability, angiogenesis capacity injury, and the apoptosis of BMECs. BMSC-EVs increased the LC3 level, but decreased p62 (an autophagy protein receptor) expression, suggesting that BMSC-Exos activated autophagy in glucocorticoid-treated BMECs. The protective effects of BMSC-EVs on the glucocorticoid-induced injury of BMECs was mimicked by a known stimulator of autophagy (rapamycin) and could be enhanced by co-treatment with an autophagy inhibitor (LY294002). BMSC-EVs also suppressed the PI3K/Akt/mTOR signaling pathway, which regulates cell autophagy, in glucocorticoid-treated BMECs. In conclusion, the results indicate that BMSC-EVs prevent the glucocorticoid-induced injury of BMECs by regulating autophagy via the PI3K/Akt/mTOR pathway.

Autologous Osteochondral Transplantation for Young Patients with Postcollapse Osteonecrosis of the Knee: A Retrospective Cohort Study with an Average 7-Year Follow-Up.

BACKGROUND: Only a few studies exist that have assessed the efficacy of autologous osteochondral transplantation (AOT) treatment of osteonecrosis (ON) of the knee. The purpose of this study was to clarify the clinical and radiographic results of AOT performed on young patients with postcollapse ON of the knee. METHODS: This retrospective study included 14 young patients (6 men, 8 women, mean age 34.71 ± 5.41 years) with stage III knee ON undergoing AOT surgery. Mean follow-up time was 87 ± 10.23 months. The postoperative clinical and radiological evaluations were based on Hospital for Special Surgery (HSS) scores and plain x-rays. Paired t tests were used for the statistical analysis by SPSS software. RESULTS: Preoperative HSS (mean 66.86 ± 7.49 points) was significantly improved at mean 7 years to a postoperative HSS (mean 87.36 ± 8.63 points) (P < 0.001). The postoperative rangeof motion (ROM; 125.71° ± 4.74°) was not significantly different from the preoperative ROM (126.86° ± 7.13°) (P = 0.626). There was no progression of collapse observed in any knees at the last follow-up. No knees required any reoperations during the follow-up period. CONCLUSION: Fourteen young patients with local ON of the knee were treated by AOT. No progression of bone collapse was seen and clinical improvement sustained at mean 7 years postsurgery. AOT seems to be a safe technique that can give long-term improvement and durability in young ON patients. However, large-sample and high-quality clinical trials are still needed in the future.

[Progress of developmental mechanism of subtype H vessels in osteonecrosis of the femoral head].

OBJECTIVE: To review the research progress of subtype H vessels in the occurrence and development of osteonecrosis of the femoral head (ONFH). METHODS: The relevant domestic and foreign literature was extensively reviewed. The histological features, biological mechanism of subtype H vessels involved in promoting of osteogenesis, and the role and application of the subtype H vessels in ONFH were summarized. RESULTS: The subtype H vessel is a newly discovered bone vessel, mainly distributed in metaphysis and subperiosteum, highly expressing endomucin and CD31. The subtype H vessel has a dense arrangement of Runx2 + early osteoprogenitors, collagen type Ⅰα + osteoblast cells, and Osterix + osteoprogenitors that have the ability to induce osteogenesis and angiogenesis. Factors such as platelet-derived growth factor BB, slit guidance ligand 3, hypoxia inducible factor 1α, Notch signaling pathway, and vascular endothelial growth factor are involved in the mechanism of subtype H vessels in promoting osteogenesis. CONCLUSION: Subtype H vessels play an important role in the regulation of angiogenesis and osteogenesis during bone tissue repair and reconstruction. The discovery of subtype H vessels provides new insights into the molecular and cellular mechanisms of osteogenesis and angiogenesis coupling. In the future, new techniques targeting the regulation of subtype H blood vessels may become a promising method for the treatment of ONFH.

Lower early revision rates after uncemented Oxford Unicompartmental Knee Arthroplasty (UKA) than cemented Oxford UKA: A meta-analysis.

BACKGROUND: UKA has been proved to offer good results in treating patients with unicompartmental knee osteoarthritis (OA). However, there is still a controversy about the better fixation mode in UKA procedure between cemented and uncemented prosthesis. Therefore, this meta-analysis was conducted to compare clinical and radiological outcomes of cemented versus uncemented Oxford UKA. HYPOTHESIS: The study surmised that uncemented Oxford UKA was associated with shorter operation time, higher function scores, lower revision rate and less radiolucency than cemented Oxford UKA. METHODS: A meta-analysis to compare postoperative outcomes between cemented and uncemented Oxford UKA wsa conducted. The primary outcomes included Oxford knee score (OKS), revision rate, and incidence of radiolucency. The secondary outcomes included operation time, knee society score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion (ROM). PubMed, Embase, Web of Science, the Cochrane Library and China national knowledge infrastructure were searched until April, 2020 to identify studies for including. Relevant data were analyzed using RevMan v5.3. RESULTS: We identified nine studies involving 901 patients meeting our inclusion criteria. No significant difference of OKS was found in both groups. Compared with cemented group, uncemented Oxford UKA group was associated with lower revision rate (95% CI: 0.90 to 3.73; OR=1.83) and less radiolucent lines (95% CI: 0.79 to 9.52; OR=2.75) after following up for at least 2years. The operation time was significantly shorter by 10.12minutes (95% CI: p<0.00001) in the uncemented group when compared against the cemented group. The KSS, WOMAC, ROM were not significantly different between two groups. CONCLUSIONS: Uncemented Oxford UKA had lower revision rate, shorter operation time and less radiolucent lines than cemented Oxford UKA did. There is still need for more long follow-up clinical trials with high evidence level to determine which method of fixation is of preferable for Oxford UKA in the future. LEVEL OF EVIDENCE: I.

Treatment of nontraumatic osteonecrosis of the femoral head using bone impaction grafting through a femoral neck window.

Nontraumatic osteonecrosis of the femoral head (non-ONFH) is a disorder that can lead to femoral head collapse and the need for total hip replacement. Various head-preserving procedures have been used for this disease to avert the need for total hip replacement. These include various vascularised and nonvascularised bone grafting procedures. We examined the effect of bone-grafting through a window at the femoral head-neck junction known as the "light bulb" approach for the treatment of osteonecrosis of the femoral head with a combination of demineralised bone matrix (DBM) and auto-iliac bone. The study included 110 patients (138 hips; 41 females, 69 males; mean age 32.36 years, range 17-54 years) with stage IIA-IIIA nontraumatic avascular necrosis of the femoral head according to the system of the ARCO (Association Research Circulation Osseous). The bone grafting procedure is called "light bulb" procedure in which the diseased bone was replaced by a bone graft substitute (combination of DBM and auto-iliac bone).The outcome was determined by the changes in the Harris hip score, by progression in radiographic stages, and by the need for hip replacement. The mean follow-up was 25.37 months (range 7-42 months). All data were processed by a statistics analysis including Cox risk model analysis and Kaplan-Meier survival analysis. Pre- and postoperative evaluations showed that the mean Harris hip score increased from 62 to 79. Clinically, 94 of 138 hips (68%) were successful at the latest follow-up, and radiological improvement was noted in 100% of patients in stage IIA, 76.67% of patients in stage IIB and 50.96% of patients in stage IIC and IIIA cases. Excellent and good results according to the Harris score were obtained in 100% of cases in stage IIA, 93.33% in stage IIB and 59.62% in stages IIIA and IIC stage, with a survivorship of 85% in stages IIA and IIB and 60% in stage IIIA and IIC cases. Cox risk model analysis showed that the clinical success rate correlated with both pre-operation stage and the necrotic area of the femoral head. The complications included ectopic ossification, lateral femoral cutaneous nerve lesion and joint infection. This procedure may be effective at avoiding or forestalling the need for total hip replacement in young patients with early to intermediate stages of osteonecrosis of the femoral head. Therefore, it may be the treatment of choice particularly in nontraumatic osteonecrosis of the femoral head of pre-collapse stage with small and middle area (<30%, or the depth of collapse <2 mm).

Treatment of nontraumatic osteonecrosis of the femoral head with the implantation of core decompression and concentrated autologous bone marrow containing mononuclear cells.

BACKGROUND: Since self-limited repair ability of the necrotic lesion may be a cause for failure of the technique, the possibility has been raised that bone marrow mononuclear cells (BMMCs) containing BMSCs implanted into a necrotic lesion of the femoral head with core decompression (CD) may be of benefit in the treatment of this condition. For this reason, we studied the implantation of the concentrated autologous bone marrow containing mononuclear cells in necrotic lesion of the femoral head to determine the effect of the method. METHODS: The study included 45 patients (59 hips, 9 females, 36 males; mean age 37.5 years, range 16-56 years) with stages I-IIIA nontraumatic avascular necrosis of the femoral head according to the system of the Association Research Circulation Osseous. Concentrated bone marrow (30-50 ml) containing mononuclear cells has been gained from autologous bone marrow (100-180 ml) obtained from the iliac crest of patient with the cell processor system. Concentrated bone marrow was injected through a CD channel into the femoral head. The outcome was determined by the changes in the Harris hip score, by progression in radiographic stages, and by the need for hip replacement. The mean follow-up was 27.6 months (range 12-40 months). RESULTS: Pre- and post-operative evaluations showed that the mean Harris hip score increased from 71 to 83. Clinically, the overall success is 79.7%, and hip replacement was done in 7 of the 59 hips (11.9%). Radiologically, 14 of the 59 hips exhibited femoral head collapse or narrowing of the coxofemoral joint space, and the overall failure rate is 23.7%. The number of BMMCs increased from 12.2 +/- 3.2 x 10(6)/ml to 35.2 +/- 12 x 10(6)/ml between pre-concentration and post-concentration. CONCLUSION: The concentrated autologous bone marrow containing mononuclear cells implantation relieves hip pain, prevents the progression of osteonecrosis. Therefore, it may be the treatment of choice particularly in stages I-II nontraumatic osteonecrosis of the femoral head.

Outcomes of conversion THA after failed porous tantalum implant for osteonecrosis of the femoral head: a comparative matched study.

BACKGROUND: As a joint-preserving surgery, porous tantalum implantation (PTI) provides an additional treatment option for osteonecrosis of the femoral head (ONFH). However, conversion to a total hip arthroplasty (THA) after failed PTI is considered a challenging procedure. The purpose of this study was to compare the clinical and radiologic outcomes and complications of THA after failed PTI with those of primary THA without any previous surgery for ONFH. METHODS: This retrospective study included 32 patients undergoing THA after failed PTI and 25 age, sex, and body mass index matched patients who underwent primary THA without any previous surgery for ONFH between December 2009 and March 2014. All patients were followed for at least 36 months. The postoperative clinical and radiological evaluations were based on Harris Hip Score (HHS) and plain radiographs. The independent sample test and the chi-square test were used for the statistical analysis. RESULTS: The HHS in the PTI group was similar to that in the primary group at the latest follow-up (p = 0.274), but longer operation time and greater intraoperative blood loss were observed in the PTI group (p < 0.001, respectively). No significant differences in radiological parameters and postoperative complications were found between the 2 groups (p > 0.05). CONCLUSIONS: THA after PTI showed similar clinical and radiological outcomes to primary THA except for longer operation time and greater intraoperative blood loss.

A novel extramedullary technique to guide femoral bone preparation in mobile unicompartmental knee arthroplasty based on tibial cut and overall alignment.

BACKGROUND: The mobile Oxford unicompartmental knee arthroplasty (UKA) implant has been widely used with an intramedullary guide for femoral preparation. We modified the femoral guide technique based on the tibial cut first and spacer block technique. This study was performed to determine the radiographic accuracy and early clinical outcomes of the extramedullary method. METHODS: We retrospectively evaluated 50 consecutive patients who underwent UKA using the extramedullary technique. An equal number of patients who underwent UKA with the conventional technique were matched as the control group. Clinical outcomes were evaluated in terms of the operating time, blood loss, range of motion, and Hospital for Special Surgery score. Radiographic accuracy was evaluated by the implant position and alignment in the coronal and sagittal planes. RESULTS: The mean follow-up period was 39.76 ± 5.77 months. There were no differences in the postoperative Hospital for Special Surgery score, range of motion, or hip-knee-ankle angle between the two groups. The operating time in the extramedullary group was shorter than that in the conventional group (54.78 ± 7.95 vs. 59.14 ± 10.91 min, respectively; p = 0.025). The drop in hemoglobin after 3 days was only 12.34 ± 4.98 g/L in the extramedullary group which was less than that in the conventional group (p = 0.001). No significant differences were found in the postoperative coronal and sagittal angles between the two groups. Acceptable radiographic accuracy of the implant alignment and position was achieved in 92% of patients in the extramedullary group and 96% of patients in the conventional group. CONCLUSIONS: The radiographic and clinical results of the extramedullary technique were comparable with those of the conventional technique with the advantage of no intramedullary interruption, less blood loss, a shorter operating time, and more rapid recovery. As the technique depends on the accurate tibial cut and overall alignment, we do not recommend it to surgeons without high volume experiences. TRIAL REGISTRATION: Retrospectively registered LEVEL OF EVIDENCE: IV, retrospective study.

The Role of Immune Regulatory Cells in Nontraumatic Osteonecrosis of the Femoral Head: A Retrospective Clinical Study.

The immunologic factors have been implicated in the pathogenesis of osteonecrosis. We aimed to investigate the potential role of immune regulatory cells in the development of osteonecrosis of femoral head (ONFH). Sixty-seven patients diagnosed with ONFH and fifty-eight age-, height-, and weight-matched healthy subjects were included in this retrospective study between September 2015 and September 2018. The flow cytometry was used to test the count, percentage, and ratio of T and B lymphocyte subsets in peripheral blood. The T and B lymphocyte levels were compared among different ARCO stages, CJFH types, and etiology groups. The total lymphocyte count, CD3+T cells, Ts cells (CD3+CD8+), B-1 cell count, and B-1 cells (CD5+CD19+) were significantly higher in the patients with ONFH than those in the control subjects. The percentage of T lymphocytes in the patients with ARCO IV stage was significantly smaller than that in the ONFH patients with ARCO II and III stages. The percentage of inhibitory T lymphocytes in patients with CJFH type L3 was significantly smaller than that in the patients with types L1 and L2. In terms of the different ONFH etiologies, the total lymphocyte count and Ts cells (CD3+CD8+) were significantly lower in the ONFH patients induced by excessive alcohol intake than those in the idiopathic ONFH patients. Our results seem to indicate that immune regulatory cells, such as T and B lymphocytes, play an important role in the pathogenesis of ONFH. The development and progression of ONFH may be associated with immune system imbalance.