Letter to the editor concerning “Guidelines for clinical diagnosis and treatment of osteonecrosis of the femoral head in adults (2019 version)” by Zhao et al., Journal of Orthopaedic Translation, 2019, https://doi.org/10.1016/j.jot.2019.12.004
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A method for quantifying the uptake of Tc-99m-labeled phosphate complexes in the femoral head has been clinically evaluated, being used specifically for studying the uptake of these bone-seeking agents in Perthes' disease. The analysis depends on the selection, by computer program, of a reliable reference area in the femoral shaft, which is then compared with the mean uptake from each femoral head. The femoral-head activity is then represented as an uptake ratio. These ratios, together with a fixed contour representing the uptake in the femoral-head regions, provide more clinical information than the radiograph or scintiphoto, particularly in the early stages of unilateral or bilateral femoral-head disease and during followup. No correlation has been found between these ratios and qualitative techniques for assessing Perthes' disease by radiograph. From the quantitative data so far obtained it is clear that osteotomy reduces the vascularity of the femoral head, and in certain cases this reduction persists for some years. Tc-99m-labeled diphosphonate compounds were used in more recent studies, and a significant increase in sensitivity was obtained, compared with earlier polyphosphate data.
Vascularity
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Objective: To establish the animal model for the study of anemic necrosis of the femoral head.Methods: The animal model of bone defect of bilateral femoral heads was established in 40 healthy Rabbits.The femoral heads from bone defect were frozen by liquid nitrogen.Four rabbits was brought to the death every 2,4,6,8,weeks.X-ray and gross-model observation were studied after the model had made for 2,4,6,8 weeks.Results:(1)Gross-model observation: Most of the femoral heads was normal,at second week.Some cartage was stripped from the femoral heads at 4 and 6 weeks after treatment.Some heads was deformed at 8 weeks.(2)X-ray: the femoral head was normal at 2 weeks after operation.Bone density was increased at 4 and 6 weeks after operation found 6 weeks after operation.Cystis degeneration and collapse can be seen in some specimens at 8 weeks after operation.Conclusion: The animal model of bone defect and necrosis of the femoral head in Rabbits could be suited to mimic the clinical situation to study the treatment of anemic necrosis of the femoral head.
Avascular Necrosis
Animal model
Femoral bone
Liquid nitrogen
Experimental animal
Animal study
Hindlimb
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Avascular Necrosis
Proton magnetic resonance
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Abstract Background Osteonecrosis of the femoral head (ONFH) is a common orthopedic disease that is characterized by the interruption of blood supply to the femoral head. This leads to ischemia of the internal tissues, subchondral bone fractures, necrosis, and ultimately, the collapse of the weight-bearing portion of the femoral head, resulting in severe functional impairment, pain, and even disability of the hip joint. Currently, available animal models of ONFH are limited in their ability to accurately replicate the natural progression of the disease. Therefore, there is a need for the development of a new animal model that can better simulate the localized pressure on the human femoral head to facilitate research related to ONFH. Method In this study, we have developed a novel method for modeling ONFH that incorporates stress factors into the modeling process using 3D printing technology and principles of biomechanics. 36 animals were randomly assigned to six groups and received either a novel modeling technique or traditional hormone induction. Following an 8-week treatment period, Micro CT scans and histological evaluations were conducted to assess tissue outcomes. Results The new model effectively replicates the pathological features of ONFH, including femoral head collapse, with a large number of empty bone lacunae observed, cartilage defects, and subchondral bone fractures in the subchondral bone region. Furthermore, the new model shows the ability to simulate the progression of the disease, making it a valuable tool for research in this field. Conclusion In conclusion, our study provides evidence that the new ONFH model is a useful tool for simulating the disease and can contribute to the development of better treatment strategies for this debilitating condition. It holds great promise for advancing our understanding of the pathogenesis of ONFH and the potential therapeutic interventions for this challenging clinical problem.
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Subchondral bone
Biomechanics
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The lack of an experimental animal model that can reliably mimic all stages of osteonecrosis of the femoral head has hindered progress toward the successful prevention and treatment of the disease.A goat model of osteonecrosis of the femoral head (ONFH) was established and observed from the early to the intermediate-to-late stage of mechanical failure. Absolute alcohol was injected slowly into the center of bilateral femoral heads in 12 adult Small Tail Han goats. Postoperatively, the femoral heads were harvested and examined using macrostructural and histological analyses and radiographic and MRI examinations at weeks 4, 8, 12, and 25.Macrostructural and radiographic examinations revealed that the contour of both femoral heads was deformed slightly at 12 weeks, but a contour deformation with joint space narrowing was observed at 25 weeks. Histologically, a strong concordance with the natural history of ONFH in humans was found. The present model demonstrated bone trabeculae, marrow necrosis, a reconstruction deficiency and destruction of the microcirculation.Among quadrupedal models, the goat model of ONFH, which is induced by a single injection of absolute alcohol, may be suitable and valuable for the evaluation of various therapeutics and side effects in the treatment of ONFH.
Quadrupedalism
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Animal model
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Objective To study the value of radionuclide bone imaging for patients with avascular necrosis of the femoral head.Method 30 patients with avascular necrosis of the femoral head were studied by the radionuclide bone imaging after injection of 99m Tc MDP.Result 47 femoral head of avascular necrosis showed the types of “defect”,“concentrate” and “doughunt”in plane imaging and the“defect” and “doughunt” in tomography.Of 13 normal femoral head,3 femoral head showed the “defect”.Conclusion Radionuclide bone imaging was the diagnostic method for early assessment of the avascular necrosis of the femoral head. [
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Bone imaging
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Legg-Calve-Perthes disease
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Objective To observe the viability of blood flow after ligating different blood vessels supplying femoral head and to provide basis for choosing different treatment of avascular necrosis of femoral head(ANFH).Methods The rabbits were divided into A,B and C group,and their medial or lateral femoral circumflex arteries were ligated.The radioactive count of experimental femoral head(E_(head)),experimental femoral shaft(E_(shaft)),control femoral head(C_(head))and control femoral shaft(C_(shaft))of rabbits were measured by single photon emission computed tomugraphy in the second hour,the third day,the fourth week and the eighth week after operation.Results C_(head)/C_(head) is 2.72.E_(head)/C_(head) and E_(head)/E_(shaft) of A and B groups decreased distinctively,no significant difference was found between these two groups(P0.05).E_(head)/C_(head) and E_(head)/E_(shaft) of C group decreased indistinctivly,significant difference were found between C group and A or B groups(P0.05).Conclusion The viability of blood flow could be observed,bone imaging of()~(99m)Tc-MDP and quantitative analysis could provide conductive significance for diagnosis,treatment and prognosis of ANFH.
Avascular Necrosis
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Objective The onset and development of necrosis of femoral head is related with slow and progressive process.Over the last few years,a lot of results were reported to set up a scientific quantitative system for evaluation of the stage,area,location,and pathological changes of the acetabulum in osteonecrosis of femoral head as well as estimation of prognosis and direction of treatment.In this paper,the developments in quantitative analysis methods of clinical observation of osteonecrosis of femoral head were summarized,including integration and optimization regrouping of clinical imaging techniques,to provide the scientific basis for improvement of diagnosis and treatment of osteonecrosis of the femoral head.
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Quantitative assessment
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Purpose : In this study, we investigated the magnetic resonance (MR) imaging characteristics of rapidly destructive coxarthrosis (RDC) caused by osteonecrosis of the femoral head. Material and Method : We reviewed 11 hip MR images (10 patients) of osteonecrosis of the femoral head with RDC. MR findings of 11 RDC were compared with those of Ficat stage IV osteonecrosis of the femoral head as a control. Results : The MR findings of osteonecrosis, involving the entire femoral head, bone marrow edema in the acetabulum, intraarticular loose bodies on the inferomedial portion of the hip joint, and synovial proliferation were significant in RDC as compared with those of osteonecrosis of the femoral head only. Conclusion : Distinct findings of MR imaging in conjunction with plain radiographs could be used to facilitate diagnosis, treatment, and prognosis in RDC.
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