PURPOSE: The purpose of this study was to evaluate the efficacy of gadolinium enhanced MR imaging for making the diagnosis of Legg-Calve-Perthes (LCP) disease. MATERIALS AND METHODS: We studied the gadolinium enhanced MR images of 14 hips in 12 children who had the diagnosis of LCP disease. We retrospectively analyzed the extent of necrosis, the epiphyseal revascularization pathways and the metaphyseal changes. RESULTS: The absence of enhancement on gadolinium enhanced MRI was noted in all cases of LCP disease. Diffuse absence of enhancement was observed in 9 femoral epiphyses. Two of them showed normal bone marrow signal intensity on the T1 and T2-weighted images. Focal absence of enhancement was observed in 5 femoral epiphyses. Enhanced MRI showed better epiphyseal revascularization in the lateral column (five cases), in the lateral and medial columns (four cases) and in the transphyseal pathway (three cases). Metaphyseal change was observed in two cases. CONCLUSION: Gadolinium enhanced MRI allows detection of LCP disease and an accurate analysis of the different revascularization patterns, and this helpful for predicting the prognosis.
Bone Marrow ; Child ; Epiphyses ; Femur Head Necrosis ; Gadolinium ; Hip ; Humans ; Legg-Calve-Perthes Disease ; Necrosis ; Prognosis ; Retrospective Studies

BACKGROUND: Within the lateral pillar classification of the Legg-Calve-Perthes (LCP) disease, hips seem quite variable in the pattern of fragmentation as seen in radiographs. The purpose of this study was to determine: if it is possible to reliably subdivide the lateral pillar groups into femoral head fragmentation patterns, and if such a subdivision of the lateral pillar groupings is clinically useful in managing LCP disease. METHODS: Two hundred and ninety-three anteroposterior radiographs taken at the maximal fragmentation stage (189 lateral pillar B, 57 B/C border, and 47 C hips; mean bone/chronologic age at the time of first visit, 6.2/7.9 years) and at skeletal maturity (mean age, 16.6 years) were analyzed. We distinguished 3 fragmentation patterns in each pillar group based on the region of major involvement. We tested the inter- and intraobserver reliability of our classification system and analyzed the relationships between the fragmentation patterns and the Stulberg outcomes as well as other factors such as surgical treatment and age. RESULTS: Inter- and intraobserver consistency in fragmentation pattern assignments was found to be substantial to excellent. A statistically significant trend (p = 0.001) in the proportion of Stulberg III or IV outcomes in comparison with Stulberg I and II was only found for the different fragmentation patterns in our lateral pillar B patients: fragmentation patterns having mainly lateral-central necrosis led to poor outcomes. No significant association was found between fragmentation patterns and Stulberg outcomes in pillar groups B/C border and C. CONCLUSIONS: Our results are consistent with the lateral pillar classification itself. Therefore, fragmentation patterns in each lateral pillar classification did not provide clinical usefulness in the management of LCP disease.
Adolescent ; Child ; Femur Head/*radiography ; Femur Head Necrosis/classification/radiography ; Humans ; Legg-Calve-Perthes Disease/*classification/radiography ; Observer Variation ; Prognosis ; Retrospective Studies ; Young Adult

BACKGROUND: Ganz surgical hip dislocation via a posterior (Kocher-Langenbeck) approach is a popular procedure in the management of femoroacetabular impingement (FAI). We report the results of surgery performed through an anterolateral (Watson-Jones) approach in the management of anterolateral FAI. METHODS: Twenty-one hips in 20 patients (mean age at the time of operation, 17.3 years) were treated surgically using an anterolateral approach: 12 hips with Legg-Calvé-Perthes disease, three septic hips, three hips with avascular necrosis (combined with slipped capital femoral epiphysis [SCFE], femoral neck fracture, and developmental dislocation of the hip), two hips with epiphyseal dysplasia, and one hip with SCFE. All patients had anterolateral FAI. Surgical hip dislocation was performed in four hips with trochanteric osteotomy. Combined osteotomies were for neck lengthening in 11 hips, varus or valgus osteotomy in the proximal femur in four hips, and pelvic osteotomy in four hips. Clinical results were evaluated using a modified Harris hip score (mHHS). RESULTS: Range of hip flexion and abduction showed statistically significant improvement after surgery; however, the improvement in mean mHHS was not statistically significant. CONCLUSIONS: An anterolateral approach can be used as an alternative to a posterior approach in the management of anterolateral FAI with or without hip dislocation while safely preserving the blood supply to the femoral head and allowing simultaneous procedures in the proximal femur.
Dislocations ; Femoracetabular Impingement ; Femoral Neck Fractures ; Femur ; Head ; Hip Dislocation ; Hip ; Humans ; Legg-Calve-Perthes Disease ; Neck ; Necrosis ; Osteotomy ; Slipped Capital Femoral Epiphyses

An experimental study on the effect of the induced avascular necrosis of the femoral head on the femoral anteversion was made in the hips of 74 three to four-week-old rabbits. The results were as follows; l. In 18 of the 74 operated rabbits, a relative increase of anteversion was observed on the operated side, as compared with the nonoperated femur, the differences ranging from 10 to 75°(average increase was 25.9°). 2. Anteversion increase was actually internal rotation of femoral shaft starting from the subtrochanteric level and progressively increasing downward with spiral fashion. 3. The cause of anteversion increase was not proved in this experiment, but anteversion increase was a result of avascular necrosis.
Femur ; Head ; Hip ; Necrosis ; Rabbits

OBJECTIVETo compare emu necrotic femoral head micro structure repaired in two different methods.

METHODSFifteen adult emus were divided into 3 groups (all n=5), and the right femoral head was selected to research. The first group was the control group; in the second group, femoral head necrosis was made by cryogen with liquid nitrogen; and in the third group, femoral head necrosis was made by local pure ethanol injection. Right femurs were taken for micro CT examination,then femoral head micro structures were compared among these three groups.

RESULTSNo infection or unexpected death was found in all groups. Compared with normal group, necrotic femoral heads in cryogen group showed that bone mineral density significantly reduced after repaire (P=0.015), trabecular space significantly reduced (P=0.001), bone volume fraction significantly enlarged (P=0.036), bone surface/volume fraction (P=0.032) and trabecular numbers (P=0.002) significantly enlarged; trabecular thickness showed no significant difference (P=0.060). Compared with control group, necrotic femoral heads in ethanol group showed that bone mineral density significantly enlarged after repaire (P=0.001), trabecular thickness (P=0.003) and bone surface/volume fraction (P=0.022) significantly enlarged, trabecular space (P=0.001) and bone volume fraction (P=0.001) significantly reduced; the trabecular numbers showed no significant difference (P=0.143). Compared with ethanol group, necrotic femoral heads in cryogen group showed significant lower bone mineral density after repair (P=0.001), significantly lower bone volume fraction (P=0.001), significantly lower trabecular thickness (P=0.001), significantly higher bone surface/volume fraction (P=0.022) and higher trabecular numbers (P=0.003); the trabecular space showed no significant difference (P=0.398).

CONCLUSIONDifferent repair methods make reconstructed femoral head weight bearing area have different bone structure and bone mineral density, along with different bone trabecular quality.

With the in-depth understanding of osteonecrosis of femoral head (ONFH), and more and more patients seeking medical treatment in the early stage of the disease, surgical treatment of femoral head necrosis alone is no longer sufficient for the current treatment of patients' demand, how to rationally and effectively apply drugs to strengthen the early prevention and treatment of femoral head necrosis and delay the progression of disease is becoming more and more important. This article combines the latest expert consensus and evidence-based medical evidence on the principles of ONFH diagnosis and treatment in Chinese and Western medicine at home and abroad, combined with domestic actual clinical application experience, and is organized by experts from Association Related to Circulation Osseous Chinese Microcirculation Society (CSM-ARCO) to write this consensus, focusing on the types of ONFH drugs, the characteristics, safety, rationality and basic principles of drug use provide reference opinions for the safe, reasonable, standardized and effective drug use of medical institutions at all levels. This consensus is only an expert guideline based on literature and clinical experience, not as a requirement for mandatory implementation, let alone as a legal basis. The clinical practice could be tailored to the actual local conditions to develop appropriate prevention and treatment measures for patients.
Humans ; Consensus ; Femur Head ; Femur Head Necrosis/prevention & control*

There are many methods of conservative treatment for early non-traumatic osteonecrosis of femoral head, but still lack of a mature and effective treatment. Gene therapy is a new treatment method for non-traumatic osteonecrosis of femoral head in recent years. This article showed that the non-traumatic osteonecrosis of femoral head related to progress and problems on pathogenesy, molecular biology foundation, exogenous theoretical gene,carrier selection and so on, discussed some problems and countermeasure and future applications.
Femur Head Necrosis ; therapy ; Genetic Therapy ; Humans

PURPOSE: We investigated coagulation disorders in Korean patients of idiopathic avascular necrosis of the femoral head. MATERIALS AND METHODS: Ten laboratory parameters related with coagulation pathway were measured and analyzed in fifty-three patients with idiopathic avascular necrosis of the femoral head and compared the results with those of thirty-one healthy persons. RESULTS: Differences in the values of plasminogen activator inhibitor and D-dimer in the two groups were statistically significant (p<0.05). The number of three or four abnormal parameters in the patient group was nearly twice that of the control. Hypofibrinolytic activity, determined by increased plasminogen activator inhibitor and lipoprotein(a), were observed in eleven cases (20.8%) of the patient group. CONCLUSION: The abnormal results that were observed in the patient group may contribute to the predisposition of thrombotic venous occlusion in the head of the femur, leading to avascular necrosis of the femoral head.
Femur ; Head* ; Humans ; Lipoprotein(a) ; Necrosis* ; Plasminogen Activators

PURPOSE: To observe the morphological changes of the femoral head following vascular infarct produced by surgical devascularization of the capital femoral epiphysis in a mongrel puppy model. MATERIALS AND METHODS: Forty-six mongrel, weaned puppies, 7 to 9 weeks old, and between 1.5 to 2.5 kg in weight, were experimentedupon. They were divided into three groups: 12 underwent only simple capsular incision (Group A), 18 underwent ligamentum teres disruptionwith temporary subluxation of the hip joint (Group B), and 16 underwent both ligamentum teres and posterior retinacular arterydisruption (Group C). Three to five puppies in each experimental group were periodically sacrificed at 2 weeks and at 1, 2, 5 months, postoperatively. Both femurs, extracted from the sacrificed puppies, were studied by eye, radiographically and histologically. RESULTS: Puppies from the single (Group B) and double devascularization groups (Group C) showed definite findings of vascular infarct macroscopically, radiologically, and histologically. These findings were more frequent and severe in the group with the double infarct thanthe single infarct. CONCLUSION: Morphological changes similar to those seen in human Legg-Calve-Perthes' disease (LCPD) were observed in puppy specimens. This puppy model of LCPD may be useful for experimental studies.
Epiphyses ; Femur ; Head* ; Hip Joint ; Humans ; Necrosis*

The twelve patients, whose ages ranged from 18 years to 87 years, 5 of males and 7 of females, were admitted to Department of Orthopaedic Surgery of Korea University Hospital from January, 1978 to November, 1979 for total hip replacement surgery: 5 cases of the post traumatic femur neck fracture, 2 case of idiopathic aseptic necrosis, 2 cases of post infectious bony ankylosis of the hip, 1 case of sequele of Legg-Perthes disease, 1 case of secondary osteoarthritis secondary due to congenital acetabular dysplasia and acetabular dysplasia secondary to old infection. For these cases, the authors carrid out the surgery of total hip replacement through the new method of anterolateral “S” approach,combined with innominate osteotomy and autogenous bone graft of resected femoral head. Regular type of eleven Muller prosthesis and one Charnley prosthesis were adequately inserted in the enlarged acetabular socket. The results obtained are as follows: 1. This approach had the following advantages; such as the sufficient exposure of the operative field without the greater trochanteric osteotomy, the shortened operative time, the decreased amount of blood loss and the easy widening of the acetabular socket during the surgery. 2. There was no difficulty to perform simultaneously innominate osteotomy with autogenous bone graft of resected femoral head to the ilium during the same operative period. 3. The release of the rectus femoris from the anteroinferior iliac spine does not cause any weakness of the knee extension. 4. In all 12 patients, the end results of the function after this new method revealed saticefactory.
Acetabulum ; Ankylosis ; Arthroplasty, Replacement, Hip ; Female ; Femoral Neck Fractures ; Femur ; Head ; Hip ; Humans ; Ilium ; Knee ; Korea ; Legg-Calve-Perthes Disease ; Male ; Methods ; Necrosis ; Operative Time ; Osteoarthritis ; Osteotomy ; Prostheses and Implants ; Quadriceps Muscle ; Spine ; Transplants