Avascular necrosis is a progressively devastating disease and primarily affects weight-bearing joints. The hip is the most commonly affected joint. In early stage, nonoperative (including pharmacologic intervention and biophysical treatments) and operative modalities for protecting hip joint have become the main therapeutic methods. However there is still no satisfied mothod with reasonable effect. According to the treatment of the avascular necrosis of the femoral head of the pre-collapse stage, core decompression with modification of technique is still one of the safest and most commonly employed procedures. Recently there have been attempts to enhance the effect of core decompression with use of various growth and differentiation factors. Which is the hot spot of current research. Early diagnosis is the key to the treatment of the avascular necrosis of the femoral head. Comprehensive treatment which is based on the core decompression is still the main treatment of today.
Biophysical Phenomena ; Femur Head Necrosis ; drug therapy ; physiopathology ; surgery ; therapy ; Humans ; Weight-Bearing

Adult ; Femur Head Necrosis ; chemically induced ; drug therapy ; Glucocorticoids ; therapeutic use ; Humans ; Male ; Paraquat ; poisoning

OBJECTIVETo evaluate the clinical effect of avascular necrosis of femoral head (ANFH) with interventional therapy in the near future.

METHODSTwenty-eight patients (19 males, 9 females, the age was from 14 to 70 years old with an average of 38 years) with ANFH were treated by catheterization. The thrombolytic drugs, vasodilator drugs and improving microirculative drugs were respectively injected directly into the arteries supplying the femoral head after ultraselection. Contrasted the changing of the arteries suppplying the femoral head between pretreatment and posttreatment, and observed the bone density of the femoral head at 12-36 months after treatment,and analyzed clinical symptoms (hip pain and joint range of motion) improving.

RESULTSThe angiography showed the arteries supplying the femoral head were manifold, the coloration or the femoral head were enhanced after interventional therapy. The X-ray showed the bone density of the femoral head gradually recovered of nearly common by 97.2% (35/36). And hip pain and joint range of motion significantly improved than that of before treatment.

CONCLUSIONInterventiomal therapy is a safe and effective method to ANFH, which seems to be promising for wide clinical application.

Adolescent ; Adult ; Aged ; Cardiovascular Agents ; therapeutic use ; Female ; Femur Head ; blood supply ; drug effects ; Femur Head Necrosis ; drug therapy ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate and compare the histopathology effects and mechanisms of the methods of "invigorating spleen to remove phlem & promoting blood circulation to remove meridian obstruction" and "invigorate the kidney & promoting blood circulation to remove meridian obstruction" preventing hormone induced femoral head necrosis in hens.

METHODSSixty-four healthy hens were randomly divided into 4 groups: blank control group, model group, Jianpi group (with therapeutics of invigorating spleen to remove phlem), Bushen group (with the effect of warming kidney for duresis). All hens were injected intramuscularly with Medrat once a week for 16 weeks but normal saline in blank control group. Bilateral femoral heads were dissected on 8 weeks or 16 weeks. Paraffin tissue sections were prepared to detect histopathologic change with hematoxylin and eosin, or mason staining.

RESULTSHistological analysis showed that Huogu recipe I and Huogu recipe II can promote osteogenesis and repair osteonecrosis, increase blood circulation of bone marrow, and inhibit pimelosis of bone marrow. Compared with blank control group, the areas of adipose cells increased significantly (t = -12.9, P < 0.01), the area of immature collagen increased significantly (t = -2.0, P < 0.05) and the ratio of empty lacuna in medullary cavity (t = -3.7, P < 0.05). Compared with model group, both the area of adipose cells and the ratio of empty lacuna decreased in Jianpi group and Bushen group (F = 26.8, 13.5, P < 0.01), so it was with the Bushen group immature collagen (F = 4.6, P < 0.01).

CONCLUSIONBoth the methods of "invigorating spleen to remove phlem & promoting blood circulation to remove meridian obstruction" and "invigorate the kidney & promoting blood circulation to remove meridian obstruction" can prevent hormone induced femoral head necrosis. The time taking effect in the method of "invigorating spleen to remove phlem" was shorter.

Animals ; Chickens ; Drugs, Chinese Herbal ; Female ; Femur Head ; pathology ; Femur Head Necrosis ; chemically induced ; drug therapy ; pathology ; Glucocorticoids ; adverse effects ; Medicine, Chinese Traditional

BACKGROUND: Accumulating evidence suggests that lithium influences mesenchymal stem cell (MSC) proliferation and osteogenic differentiation. As decreased bone formation in femoral heads is induced by glucocorticoids (GCs), we hypothesized that lithium has a protective effect on GC-induced osteonecrosis of femoral heads (ONFH). METHODS: A rat ONFH model was induced by methylprednisolone (MP) and the effect of lithium chloride on the models was evaluated. Micro-computed tomography (CT)-based angiography and bone scanning were performed to analyze the vessels and bone structure in the femoral heads. Hematoxylin and eosin and immunohistochemical staining were performed to evaluate the trabecular structure and osteocalcin (OCN) expression, respectively. Bone marrow-derived MSCs were isolated from the models, and their proliferative and osteogenic ability was evaluated. Western blotting and quantitative real-time polymerase chain reaction were performed to detect osteogenic-related proteins including Runx2, alkaline phosphatase, and Collagen I. RESULTS: Micro-CT analysis showed a high degree of osteonecrotic changes in the rats that received only MP injection. Treatment with lithium reduced this significantly in rats that received lithium (MP + Li group); while 18/20 of the femoral heads in the MP showed severe osteonecrosis, only 5/20 in the MP + Li showed mild osteonecrotic changes. The MP + Li group also displayed a higher vessel volume than the MP group (0.2193 mm3vs. 0.0811 mm3, P < 0.05), shown by micro-CT-based angiography. Furthermore, histological analysis showed better trabecular structures and more OCN expression in the femoral heads of the MP + Li group compared with the MP group. The ex vivo investigation indicated higher proliferative and osteogenic ability and upregulated osteogenic-related proteins in MSCs extracted from rats in the MP + Li group than that in the MP group. CONCLUSIONS We concluded that lithium chloride has a significant protective effect on GC-induced ONFH in rats and that lithium also enhances MSC proliferation and osteogenic differentiation in rats after GC administration.
Animals ; Cell Differentiation ; Femur Head ; Femur Head Necrosis/drug therapy* ; Glucocorticoids ; Lithium Chloride ; Mesenchymal Stem Cells ; Osteogenesis ; Rats ; Rats, Sprague-Dawley ; X-Ray Microtomography

OBJECTIVE: To describe the disease characteristics of osteonecrosis of the femoral head (ONFH) in patients with systemic lupus erythematosus (SLE) who experiencing prolonged glucocorticoid (GC) exposure. METHODS: Between January 2016 and June 2019, 449 SLE patients meeting the criteria were recruited from multiple centers. Hip MRI examinations were performed during screening and regular follow-up to determine the occurrence of ONFH. The cohort was divided into ONFH and non-ONFH groups, and the differences in demographic baseline characteristics, general clinical characteristics, GC medication information, combined medication, and hip clinical features were compared and comprehensively described. RESULTS: The age at SLE diagnosis was 29.8 (23.2, 40.9) years, with 93.1% (418 cases) being female. The duration of GC exposure was 5.3 (2.0, 10.5) years, and the cumulative incidence of SLE-ONFH was 9.1%. Significant differences ( P<0.05) between ONFH and non-ONFH groups were observed in the following clinical characteristics: ① Demographic baseline characteristics: ONFH group had a higher proportion of patients with body mass index (BMI)<20 kg/m ² compared to non-ONFH group. ② General clinical characteristics: ONFH group showed a higher proportion of patients with cutaneous and renal manifestations, positive antiphospholipid antibodies (aPLs) and anticardiolipin antibodies, severe SLE patients [baseline SLE Disease Activity Index 2000 (SLEDAI-2K) score ≥15], and secondary hypertension. Fasting blood glucose in ONFH group was also higher. ③ GC medication information: ONFH group had higher initial intravenous GC exposure rates, duration, cumulative doses, higher cumulative GC doses in the first month and the first 3 months, higher average daily doses in the first 3 months, and higher proportions of average daily doses ≥15.0 mg/d and ≥30.0 mg/d, as well as higher full-course average daily doses and proportion of full-course daily doses ≥30.0 mg/d compared to non-ONFH group. ④ Combined medications: ONFH group had a significantly higher rate of antiplatelet drug use than non-ONFH group. ⑤ Hip clinical features: ONFH group had a higher proportion of hip discomfort or pain and a higher incidence of hip joint effusion before MRI screening than non-ONFH group. CONCLUSION The incidence of ONFH after GC exposure in China's SLE population remains high (9.1%), with short-term (first 3 months), medium-to-high dose (average daily dose ≥15 mg/d) GC being closely associated with ONFH. Severe SLE, low BMI, certain clinical phenotypes, positive aPLs, and secondary hypertension may also be related to ONFH.
Female ; Male ; Humans ; Glucocorticoids/adverse effects* ; Incidence ; Femur Head ; Prospective Studies ; Femur Head Necrosis/epidemiology* ; Lupus Erythematosus, Systemic/chemically induced* ; Hypertension/drug therapy*

Adult ; Antibodies, Anticardiolipin ; blood ; Antiretroviral Therapy, Highly Active ; Female ; Femur Head Necrosis ; etiology ; HIV Infections ; complications ; drug therapy ; immunology ; Humans

OBJECTIVETo observe the effect and mechanism of zoledronate on prevention of collapse in an animal model of osteonecrosis.

METHODSIschemic osteonecrosis was surgically induced in 16 SD rats (which were further divided into zoledronate group and placebo group); another 8 rats were used as sham surgery group (n=8). The animals were killed 5 weeks after surgery. Radiographic, Micro-CT, histological, and immunohistochemical assessments were performed.

RESULTSRadiographic assessment showed better preservation of the femoral head shape in the zoledronate group than in the placebo group but not significantly different from the sham surgery group. Micro-CT assessment showed higher total volume, bone volume, and total mineralized content in the zoledronate group(all P0.05). Compared with the placebo group, the zoledronate group had reduced osteoclast and osteoblast activity, as confirmed by histological examinations.

CONCLUSIONZoledronate can decrease the femoral head deformity by reducing the osteoclast activity while suppressing new bone and vessels formation in a rat model of traumatic osteonecrosis, and therefore may delay the collapse of femoral head.

Animals ; Diphosphonates ; therapeutic use ; Disease Models, Animal ; Femur Head ; drug effects ; pathology ; Femur Head Necrosis ; drug therapy ; pathology ; Imidazoles ; therapeutic use ; Male ; Osteoblasts ; drug effects ; pathology ; Osteoclasts ; drug effects ; pathology ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo observe effects of blood circulation promoting compounds combined with medicinal guides on content of bone glaprotein (BGP), bone morphogenetic protein-2 (BPM-2) and expression of BMP-2 mRNA in rabbits with femoral head necrosis, and explore its mechanism.

METHODSNinety-eight healthy Spragur-Dawley male rabbits were collected and weighted 2.2 to 2.8 kg. Eighty-four rabbits were built femoral head necrosis model by freezing left femoral head in liquid nitrogen, then randomly divided into 6 groups, 14 in each group. The 6 groups included model group,promoting blood circulation to remove meridian obstruction group,promoting blood circulation to remove meridian obstruction combined with achyranthes bidentata group,radix angelicae pubescentis, asarum group, and platycodon grandiflorum group,other 14 rabbits were sham operation group. While drug groups were administrated corresponding Chinese herb after molding,model group and shamp operation group were given saline. Recombinant human granulocyte-colony stimulating factor ( 30 microg x kg(-1) x d(-1))were injected into all rabbits for 7 days. Samples were taken on the second and fourth week,the content of BGP and BMP-2 were detected by enzyme-linked immunosorbent assay (ELSA) and radioimmunoassay (RIA), histopathological changes of left femoral head were observed by Hematoxylin and Eeosin staining (HE), and expression of BMP-2 mRNA were tested by fluorescence in situ hybridization.

RESULTSCompared with sham operation group, the rate of empty lacunae femoral head were obviously increased in model group, and the content of BGP were increased on the second week, and BMP-2 and BMP-2 mRNA were decreased on the fourth week. Compared with model group, the content of BGP, BMP-2 and BMP-2 mRNA were higher both of the second and fourth week in promoting blood circulation to remove meridian obstruction group. The rate of empty la- cunae femoral head were lower in achyranthes bidentata group, BGP, BMP-2 and BMP-2 mRNA were higher on the fourth week. The rate of empty lacunae femoral head were lower in platycodon grandiflorum group, and BGP were decreased on the second and fourth week, BMP-2 were lower on the second week ,while BMP-2 mRNA were decreased on the fourth week; the content of BMP-2 and BMP-2 mRNA were increased in radix angelicae pubescentis group on the second week; while there was no change in asarum group.

CONCLUSIONRadix angelicae pubescentis can increase the content of BGP, BMP-2 and expression of BMP-2 mRNA ,which is an effective mechanism of preventing femoral head necrosis.

Animals ; Blood Circulation ; drug effects ; Bone Morphogenetic Protein 2 ; analysis ; genetics ; Femur Head Necrosis ; drug therapy ; pathology ; physiopathology ; Male ; Meridians ; Osteocalcin ; blood ; Osteogenesis ; drug effects ; Rabbits

OBJECTIVETo evaluate the histological changes on the femoral heads of the SANFH rabbit animal models and after it were intervened by Osteoking (herbs of the Yi minority in Yunnan province) using general and light microscope observation.

METHODA total of 150 New Zealand white rabbits were randomly divided into a non-treatment control group (A group, n = 24), normal rabbits with Osteoking treatment group (B group, n = 24), and the experimental group (n = 102). The experimental group was injected with escherichia coli endotoxin (10 microg x kg(-1)) into auricular vein twice by 24-hour intervals, and prednisolone (20 mg x kg(-1)) was injected into buttock three times by 24-hour intervals to make steroid-induced femoral head necrosis model. At the fifth week, 48 out of 53 rabbits were equally divided into model group (C group, n = 24, models with non-treatment Osteoking) and abnormal rabbits with Osteoking treatment group (D group, n = 24). B group and D group were intragastrically administrated with Osteoking, once every two days. A group and C group were intragastrically administrated with the equal volume of saline. At 8th, 12th and 16th week after model preparation, the femoral head specimens were observed under the general and a light microscope.

RESULTMacroscopic and light microscopic analysis showed that, clear bone necrosis of femoral head was observed in the C group, and a large number of fat cell proliferation was found in the bone marrow cavity. As compared with C group, the damage level of cells in D group was milder, however, the density of bone trabecula from Osteoking treatment was high, and the ratio of bone lacuna was very low. It is also demonstrated that the surface area of bone necrosis was decreased, and the number of cells from adiposities was reduced significantly. The phenomenon of bone necrosis repaired apparently. The morphology of femoral head from A group and B group is normal.

CONCLUSIONIt suggested that Osteoking could effectively help repair steroid-induced femoral head necrosis in the early stage.

Animals ; Bone Density ; Disease Models, Animal ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Femur Head ; anatomy & histology ; drug effects ; pathology ; physiopathology ; Femur Head Necrosis ; drug therapy ; pathology ; physiopathology ; Humans ; Male ; Microscopy ; Rabbits ; Random Allocation