OBJECTIVETo establish a new animal model of osteonecrosis of the femoral head(ONFH) with improved consistency and incidence of femoral head collapse for studies on the mechanism of osteonecrosis. and on the assessment of treatment effectiveness.

METHODSTwenty adult male emus were used. Guide instrumentation was constructed to position the customized probe just articularly and at the proximal part of the femoral head. An alternating focal liquid nitrogen freezing and radiofrequency heating was applied. At 2, 4, 8, 12 and 16 weeks after surgery, hip magnetic resonance imaging (MRI) was performed. Before the emus were sacrificed, barium sulfate was infused to lower extremities for microangiography. The femoral samples were scanned by micro-computed tomography (Micro-CT) and evaluated histologically.

RESULTSNo bird demonstrated signs of infection or died unexpectedly. Hip MRI showed changes massive edema at the 4th week, increasingly localized abnormal signals at the 8th'" week, and femoral head collapse at the 12'h week. Micro-CT scans and histological images at the 16th week showed human-like osteonecrotic changes with impaired local blood supply. Bone mineral density of the collapsed head was (380. 31 + 28. 12) mg/cm3 and trabecular spaces were (0. 86 ±0.32) mm; both were significantly lower than those in the control side, which were (415.75 41.28) mg/cm3 and (1. 17 ± 0. 17) mm, respectively (P < 0. 05). Bone volume fraction of the collapsed head was(47.28 ± 17. 14)% and trabecular thickness was (506. 17 ± 220. 58) p.m; both were significantly higher than those at control side, which were (30. 92 ± 4. 01)% and (325. 50 ±44. 53) pm, respectively (P <0. 05). The microangiography at the 16th week showed that vessel volume fraction was (0. 315 ± 0. 055)% , which was significantly higher than the collapsed side [ (0. 142 ± 0. 059)% ] (P <0. 05).

CONCLUSIONSThe emu model of fem-oral head osteonecrosis was successfully established using focal alternating cooling and heating insults. The models, with improved consistency and incidence of femoral head collapse, can be used in studies on the mechanism of osteonecrosis and on the assessment of treatment effectiveness.

Animals ; Disease Models, Animal ; Dromaiidae ; Femur Head Necrosis ; etiology ; Freezing ; adverse effects ; Heating ; adverse effects ; Male

BACKGROUND: Osteonecrosis of the femoral head is classified into idiopathic and secondary forms. A number of etiological factors in the development of osteonecrosis have been suggested but the biological mechanisms are still unclear. Recently, some reports suggested that the apoptosis is closely related to osteonecrosis of the femoral head. Therefore, this study examined the expression of apoptosis in osteonecrosis of the femoral head. METHODS: Of the patients diagnosed preoperatively with osteonecrosis and underwent total hip replacement arthroplasty between August 2004 and July 2005, 58 patients (58 hips) were available for this study. Their diagnoses were confirmed by the postoperative pathology findings. Tissue samples of the femoral head sections were terminal deoxynucleotydyl transferase mediated dUTP nick-end labeling (TUNEL) stained using an in situ cell death detection POD kit. The number of total and TUNEL-positive osteocytes, and the average ratio of TUNEL-positive cells were calculated and analyzed according to the cause. RESULTS: Osteonecrosis was steroid-induced in 8 cases (13.8%), alcohol-induced in 29 cases (50%), post-traumatic in 6 cases (10.3%) and idiopathic in 15 cases (25.9%). The percentage of TUNEL-positive osteocytes was high in patients with steroid- and alcohol-induced osteonecrosis of the femoral head but low in patients with post-traumatic and idiopathic osteonecrosis. The difference in the percentage of TUNEL-positive osteocytes between these groups was significant (p < 0.05). CONCLUSIONS: Apoptosis might play an important role in the pathogenesis of osteonecrosis of the femoral head induced by steroid and alcohol. These findings highlight a need for further research into the role of apoptosis in the development of osteonecrosis of the femoral head.
Adult ; Aged ; Aged, 80 and over ; *Apoptosis ; Female ; Femur Head/*pathology ; Femur Head Necrosis/etiology/*pathology/surgery ; Humans ; In Situ Nick-End Labeling ; Male ; Middle Aged

INTRODUCTIONSlipped capital femoral epiphysis is the most common hip problem in the adolescent age group. It can involve both hips, presenting itself bilaterally at first presentation or sequentially. The overall incidence of bilateral disease is variable, but the risk of occurrence is higher when there is underlying endocrinopathy, renal disease and obesity.

MATERIALS AND METHODSAmongst the 36 cases (44 hips) of slipped capital femoral epiphysis that we had, there were 8 cases of bilateral disease, of which 3 were bilateral sequential slips. A retrospective review of all case records and X-rays was done.

RESULTSAccording to Aadalen's criteria, the results were excellent or good in 37 hips, fair in 3 hips, and poor in 2 hips. Two patients were considered as treatment failure because of avascular necrosis. The incidence of bilateral slipped capital femoral epiphysis was 22.2%. The overall average age was 11.4 years. All cases of sequential involvement presented within 15 months of the initial slip. One patient had hypothyroidism (who also had a positive family history for slipped capital femoral epiphysis), while 91.6% were above the 75th percentile for weight. There was no statistically significant difference in age, sex, race, body mass index (BMI) and weight percentile distribution between patients with unilateral and bilateral disease.

CONCLUSIONSatisfactory outcomes can be expected in most patients treated for slipped capital femoral epiphysis. The risk of avascular necrosis is higher in unstable slips. The role of prophylactic contra-lateral pinning should be restricted to patients with hypothalamic-pituitary-ovarian axis disease, especially hypothyroidism.

Adolescent ; Bone Nails ; Child ; Epiphyses, Slipped ; complications ; prevention & control ; surgery ; Female ; Femur Head ; surgery ; Femur Head Necrosis ; etiology ; Humans ; Male ; Recurrence ; Treatment Outcome

OBJECTIVE: To study the relationship between osteonecrosis of femoral head after internal fixation of femoral neck fracture and serum bone metabolism, vascular active factors, and analyze the risk factors. METHODS: Total 150 patients with femoral neck fracture who underwent reduction and internal fixation from April 2016 to April 2019 were selected, including 83 males and 67 females. According to whether there was necrosis of femoral head after operation, they were divided into necrosis group(32 cases) and non necrosis group (118 cases). Before operation and 1, 3, 5 days after operation, the serum levels of beta-C terminal cross-linked telopeptides of typeⅠ collagen(β-CTX), N-telopeptide of typeⅠ procollagen(PINP), nitric oxide (NO), Endothelin-1 (ET-1) were measured. The clinical characteristics of the two groups were compared. The risk factors of postoperative femoral head necrosis were analyzed by logistic regression model. The value of serum indexes in predicting postoperative femoral head necrosis was analyzed by ROC curve. RESULTS: There was no significant difference in the levels of serum PINP and β-CTX between necrotic group and non necrotic group before operation and 1, 3 and 5 days after operation( CONCLUSION The content of serum NO and ET-1 on the first day after operation can predict the necrosis of femoral head.
Female ; Femoral Neck Fractures/surgery* ; Femur Head ; Femur Head Necrosis/etiology* ; Fracture Fixation, Internal/adverse effects* ; Humans ; Male ; Osteonecrosis ; Retrospective Studies ; Risk Factors

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

Adult ; Decompression, Surgical ; Drugs, Chinese Herbal ; therapeutic use ; Femur Head Necrosis ; etiology ; therapy ; Humans ; Integrative Medicine ; Male ; Phytotherapy ; Young Adult

Adult ; Female ; Femur Head Necrosis ; diagnostic imaging ; Fibromyalgia ; etiology ; Humans ; Severe Acute Respiratory Syndrome ; complications ; Tomography, Emission-Computed, Single-Photon

BACKGROUNDMany potential causative factors are related to the initiation and progression of osteonecrosis of the femoral head. The aim of this research was to investigate the etiology and clinical features of osteonecrosis of the femoral head in Chinese patients.

METHODSFrom January 1990 to July 2011, 643 cases of osteonecrosis of the femoral head were investigated retrospectively to analyze the potential causative factors, age, gender, latency period, time from the onset of pain to diagnosis, and Association Research Circulation Osseous stage.

RESULTSOf 643 cases, 315 cases were bilateral and 328 cases were unilateral, with an average age of (47.55 ± 15.27) years. In the steroid-induced group, the average age at symptom onset was (41.80 ± 15.47) years, and the median duration from taking steroid to the onset of pain was 36 months. The underlying diseases in the steroid-induced osteonecrosis of the femoral head group consisted of autoimmune and other diseases, of which systemic lupus erythematosus was the most common. In the alcohol-induced group, the average age at onset of symptoms was (48.06 ± 11.90) years and the median time of habitual alcohol use was 240 months. In the traumatic group, the average age was (51.43 ± 14.23) years and the median time from trauma to the onset of pain was 20 months. In the idiopathic group, the average age was (50.33 ± 15.88) years. Of the total of 958 hips, 647 were at stage III or IV. The stage at diagnosis was earlier in the steroid-induced group than in the alcohol-induced, traumatic, or idiopathic groups.

CONCLUSIONSSteroid use is the most common cause for osteonecrosis of the femoral head in this study. The age at diagnosis, time from the onset of pain to diagnosis, and stage were significantly earlier in the steroid-induced group.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Femur Head Necrosis ; etiology ; Humans ; Male ; Middle Aged ; Risk Factors

Fifteen cases of Caisson's Disease or Decompression Sickness with spinal cord involvement treated at the Department of Rehabilitation Tan Tock Seng Hospital, from 1973 to 1978 are described. All the cases had bladder and bowel function involvement. Five cases developed bone complications, one of whom was referred to us primarily for rehabilitation after he had an operation for collapsed right femoral head which occurred two years after the incident.
Adult ; Decompression ; Decompression Sickness ; complications ; rehabilitation ; Diving ; Femur Head Necrosis ; etiology ; Humans ; Male ; Middle Aged ; Spinal Cord Diseases ; rehabilitation

Septic arthritis of the hip caused by Campylobacter fetus subsp. fetusis very rare. The authoris isolated C. fetus subsp. fetus from a specimen of the left hip. The patient was a 53-year old man with a history of heavy drinking, diabetes, and chronic hepatitis, and had been suffering from avascular necrosis of both femoral heads. It was considered that the organism invaded already damaged tissue of the joint. The patient was treated with intravenous antibiotics and later received successful total hip replacement.
Arthritis, Infectious/*etiology ; *Campylobacter Infections ; Campylobacter fetus/*isolation & purification ; Case Report ; Femur Head Necrosis/etiology ; Hip/*microbiology ; Human ; Male ; Middle Age