Core decompression in osteonecrosis of the femoral head: risk-factor-dependent outcome evaluation using survivorship analysis. (9/547)

The results of core decompression of the femoral head in the treatment of osteonecrosis are analyzed. This study includes 94 hips in 74 patients with a follow-up time ranging between 18 months and 15 years (average 6 years). There had been no need for further surgery 2 years postoperatively in 85% of the hips with preoperative Steinberg stages 0, I and II when compared with 66% with preoperative stages III, IV and V. At 4 years postoperatively the corresponding figures are 73 compared to 55%; and 6 years postoperatively 69 compared to 49%. This difference was significant (P=0.0402). Further significant risk factors are corticosteroid administration, smoking and alcohol intake. The results of core decompression are good when the preoperative lesion is at Steinberg stage 0, I and II and the patient does not present with other risk factors. In cases with risk factors the outcome is significantly less good. The procedure is not indicated in the presence of advanced disease.  (+info)

Osteonecrosis of the femoral head. Simple varus intertrochanteric osteotomy. (10/547)

We present the long-term results of simple varus intertrochanteric osteotomy for osteonecrosis of the femoral head. We followed 26 hips in 20 patients, with a mean age at the time of surgery of 36 years, for a mean of 12.5 years. The mean varus angulation was 23 degrees. The outcome in 19 of the hips (73%) was good or excellent; seven (27%) had a fair or poor result, with four needing some form of prosthetic arthroplasty. Simple varus intertrochanteric osteotomy is indicated, even if the extent of the capital infarct comprises more than 50% of the diameter of maximum radial distance from the circumference, provided that after operation the medial necrotic lesion measures less than two-thirds of the weight-bearing area, and the superolateral bone is normal.  (+info)

Avascular necrosis and the Aberdeen splint in developmental dysplasia of the hip. (11/547)

Between January 1987 and December 1988 there were 7575 births in the Swansea maternity unit. Of these 823 (10.9%) were considered to be at 'high risk' for developmental dysplasia of the hip (DDH). Static ultrasound examination was performed in each case and the results classified on the basis of the method of Graf. A total of 117 type III-IV hips in 83 infants was splinted using the Aberdeen splint. Radiographs of these hips were taken at six and 12 months. Hilgenreiner's measurements of the acetabular angle were made in all cases and the development of the femoral capital epiphysis was assessed by measuring the epiphyseal area. The effect of splintage on the acetabular angle and the epiphyseal area between the normal and abnormal splinted hips was compared. Radiographs of 16 normal infants (32 normal unsplinted hips) were used as a control group. This cohort has now been followed up for a minimum of nine years. There have been no complications as a result of splintage. The failure rate was 1.7% or 0.25 per 1000 live births. No statistical difference was found when comparing the effect of splintage on the acetabular angle and epiphyseal area between normal and abnormal splinted hips and normal unsplinted hips. Our study has shown that while the Aberdeen splint had a definite but small failure rate, it was safe in that it did not produce avascular necrosis. The current conventional view that a low rate of splintage is always best is therefore brought into question if the Aberdeen splint is chosen for the management of neonatal DDH.  (+info)

Subchondral insufficiency fracture of the femoral head: a differential diagnosis in acute onset of coxarthrosis in the elderly. (12/547)

OBJECTIVE: To document subchondral insufficiency fracture (SIF) of the femoral head and investigate its frequency. METHODS: The study was based on a retrospective review of 464 removed femoral heads (from 419 patients) with both radiologic and histologic evidence of subchondral collapse. Gross photographs, specimen radiographs, and histologic sections were reevaluated in all cases. Available clinical notes and imaging studies were also reviewed. RESULTS: Ten cases previously diagnosed as osteonecrosis were reinterpreted as SIF on a histopathologic basis. All of these patients were women over 65 years old (average age 75) with osteopenia. The initial symptom was acute onset of hip pain. Radiologically, a subchondral collapse, mainly in the superolateral segment of the femoral head, was noted. Magnetic resonance imaging, available in 3 cases, showed diffuse low intensity on T1-weighted images and high intensity on T2-weighted or fat-suppressed images. Bone scintigraphy, available in 4 cases, showed increased uptake in the femoral head. Histopathologically, a 1.0-2.5-cm long linear whitish gray zone, comprising fracture callus and granulation tissue, was found beneath the subchondral bone end plate. There was no evidence of antecedent osteonecrosis. CONCLUSION: The results of this study indicate that SIF should be included in the differential diagnosis of acute onset of coxarthrosis in the elderly.  (+info)

Increased osteocyte apoptosis during the development of femoral head osteonecrosis in spontaneously hypertensive rats. (13/547)

We investigated the presence of osteocyte apoptosis in the necrotic trabeculae of the femoral head of spontaneously hypertensive rat (SHR) using the in situ nick end labeling (TUNEL) method and transmission electron microscopy. The occurrence of osteonecrosis and ossification disturbance was significantly higher in SHR compared with Wistar Kyoto (WKY) rats, and Wistar (WT) rats used as control animals (P < 0.01). A high population of TUNEL positive osteocytes was detected mainly in 10- and 15-week-old SHRs. Sectioned examination of the femoral head of SHRs and WKY rats by electron microscopy revealed apoptotic cell appearances such as aggregation of chromatin particles and lipid formation. In contrast, a positive reaction was significantly lower in osteocytes in the femoral heads of WT rats (P < 0.01). Our results indicate that apoptosis forms an important component of the global pathologic process affecting the femoral head of SHR, which leads to osteonecrosis in this region.  (+info)

Idiopathic osteonecrosis of the femoral head in the elderly. (14/547)

Idiopathic osteonecrosis of the femoral head (ION) is a disease prevalent in adulthood, and its development in elderly persons is known to show a low incidence. To clarify its characteristics in elderly patients, radiological and histological examinations were performed on 18 patients aged 60 years or older histologically diagnosed as having ION. On roentgenography, three characteristic points were observed, 1) progress of collapse in the femoral head within a short period (12 cases, 66.7%), 2) narrowing in the joint space within a short period (6 cases, 33.3%), and 3) rapid destruction and resorption of the femoral head (4 cases, 22.2%). The lesion expanded to the acetabular region, and a course similar to that of so-called rapidly destructive coxarthrosis (RDC) was developing in 3 cases (16.7%). However, in these 3 cases, changes in the acetabular region were mild, compared with ordinary RDC, and they were considered different from common RDC. These radiological characteristics were found more clearly in women than in men. In the histopathological examination, severe degeneration in the cartilage of the femoral head was found, while wide infiltration of repairing tissue into the necrotic area was seen from the early stage. When necrotic trabecula were collapsed markedly and degraded severely, then destruction and resorption of bone expanded to non-necrotic regions in some cases. Osteogenic sclerotic line (the demarcation line), which has been often seen in ordinary ION, was not developed in most cases. These characteristics were more prominent in women.  (+info)

Prediction of the outcome of transtrochanteric rotational osteotomy for osteonecrosis of the femoral head. (15/547)

We have studied the correlation between the prevention of progressive collapse and the ratio of the intact articular surface of the femoral head, after transtrochanteric rotational osteotomy for osteonecrosis. We used probit analysis on 125 hips in order to assess the ratio necessary to prevent progressive radiological collapse over a ten-year period. The results show that a minimum postoperative intact ratio of 34% was required. This critical ratio may be useful for surgical planning and in assessing the natural history of the condition.  (+info)

Soft-tissue interposition after closed reduction in developmental dysplasia of the hip. The long-term effect on acetabular development and avascular necrosis. (16/547)

We reviewed 98 children (133 hips) with developmental dysplasia of the hip who underwent arthrography immediately after closed reduction by overhead traction. We followed the patients to skeletal maturity to investigate whether soft-tissue interposition influences acetabular development and avascular necrosis over the long term. The shape of the limbus and the thickness of the soft-tissue interposition at the acetabular floor, as shown on arthrograms at the time of reduction, were not directly related to the final radiological results or to the incidence of avascular necrosis. Even if marked soft-tissue interposition was found on the initial arthrogram, spontaneous disappearance was noted in 71% up to the age of five years. The final radiological results showed no difference between those in which the interposition disappeared and those with none at the time of closed reduction. However, the requirement for secondary surgery at the age of five years was significantly higher in those with more than 3.5 mm of soft-tissue interposition. In the no-disappearance group (group C) further operation was necessary in 100% and the results were significantly worse at maturity according to Severin's classification. We suggest that the indications for open reduction should not be based solely on the arthrographic findings at the time of closed reduction.  (+info)