Dataset Information

Application of protective weight-bearing in osteonecrosis of the femoral head: A systematic review and meta-analysis of randomized controlled trials and observational studies.

ABSTRACT:

Background

The aim of this systematic review and meta-analysis was to estimate the efficacy and prognostic value of protective weight-bearing for ONFH.

Methods

The authors searched the PubMed, EMBASE and Cochrane Library databases, up to February 25, 2022. RCTs and observational studies on conservative treatment, including the use of crutches, for skeletally mature patients with ONFH and written in English were included. Outcomes were the total hip arthroplasty (THA) rate, collapse rate, Hip Harris score (HHS) and visual analog scale (VAS) score. Cochrane Review Manager Software 5.4 and Stata 15.1 were used to perform the statistical analyses.

Results

A total of 14 studies involving 813 patients (1,025 hips) were included in this meta-analysis. The results showed that the THA rate, collapse rate, HHS and VAS scores in the protective weight-bearing group were not significantly different from those in the surgical group. In the protective weight-bearing group, the results showed that the THA rate was 40%, 8% in ARCO stage II, 37% in ARCO stage III, and the collapse rate was 46%. The mean HHS and VAS score was 80.86 and 1.00, respectively. The HHS score at the 3-, 6-, 12-, and 24-month follow-up was 79.93, 83.94, 85.94, and 96.09 points, respectively, whereas the VAS score at the 6- and 12-month follow-up was 2.20 and 1.29, respectively.

Conclusion

Protective weight bearing could achieve satisfactory results in terms of THA rate, collapse rate, HHS and VAS scores. Protective weight-bearing allows most precollapse patients to preserve the hip but also allows postcollapse patients to delay THA or hip-preserving surgery. The effects and prognosis of protective weight-bearing in the short or mid-term are noninferior to surgical hip preservation and are a viable alternative option for osteonecrosis of the femoral head.

SUBMITTER: Chen WH

PROVIDER: S-EPMC9667948 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Publications

Application of protective weight-bearing in osteonecrosis of the femoral head: A systematic review and meta-analysis of randomized controlled trials and observational studies.

Chen Wen-Huan WH Guo Wen-Xuan WX Li Jian-Xiong JX Wei Qiu-Shi QS Li Zi-Qi ZQ He Wei W

Frontiers in surgery 20221102

<h4>Background</h4>The aim of this systematic review and meta-analysis was to estimate the efficacy and prognostic value of protective weight-bearing for ONFH.<h4>Methods</h4>The authors searched the PubMed, EMBASE and Cochrane Library databases, up to February 25, 2022. RCTs and observational studies on conservative treatment, including the use of crutches, for skeletally mature patients with ONFH and written in English were included. Outcomes were the total hip arthroplasty (THA) rate, collaps ...[more]

PMID: 36406362

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Project description:BackgroundGlucocorticoid usage and alcohol abuse are the most widely accepted risk factors for nontraumatic osteonecrosis of femoral head (ONFH). Despite distinct etiologies between glucocorticoid-associated ONFH (GONFH) and alcohol-associated ONFH (AONFH), little is known about the differences of the microarchitectural and histomorphologic characteristics between these subtypes of ONFH.PurposesTo investigate bone microarchitecture, bone remodeling activity and histomorphology characteristics of different regions in femoral heads between GONFH and AONFH.MethodsFrom September 2015 to October 2020, 85 patients diagnosed with GONFH and AONFH were recruited. Femoral heads were obtained after total hip replacement. Femoral head specimens were obtained from 42 patients (50 hips) with GONFH and 43 patients (50 hips) with AONFH. Micro-CT was utilized to assess the microstructure of 9 regions of interest (ROIs) in the femoral head. Along the supero-inferior orientation, the femoral head was divided into necrotic region, reactive interface, and normal region; along the medio-lateral orientation, the femoral head was divided into medial region, central region and lateral region. Decalcified and undecalcified bone histology was subsequently performed to evaluate histopathological alterations and bone remodeling levels.ResultsIn the necrotic region, most of the microarchitectural parameters did not differ significantly between GONFH and AONFH, whereas both the reactive interface and normal region revealed a less sclerotic microarchitecture but a higher bone remodeling level in GONFH than AONFH. Despite similar necrotic pathological manifestations, subchondral trabecular microfracture in the necrotic region was more severe and vasculature of the reactive interface was more abundant in GONFH.ConclusionsGONFH and AONFH shared similar microarchitecture and histopathological features in the necrotic region, while GONFH exhibited a less sclerotic microarchitecture and a more active bone metabolic status in both the reactive interface and normal region. These differences between GONFH and AONFH in bone microarchitectural and histopathological characteristics might contribute to the development of disease-modifying prevention strategies and treatments for ONFH, taking into etiologies.

Project description:PurposeThis study aims to investigate the suitable surgical strategies for applying TaBw01 porous tantalum rod across different stages of osteonecrosis of the femoral head (ONFH).MethodsTaBw01 tantalum rods were fabricated using type FTaY-1 tantalum powder via the foam impregnation-sintering method. Mechanical testing with the Instron 8801 universal testing machine and finite element analysis (FEA) assessed single tantalum rod implantation and impaction bone grafting combined with rod implantation. A total of 86 osteonecrosis of the femoral head (ONFH) patients (94 hips) were treated: the experimental group (45 patients, 50 hips) underwent surgical hip dislocation (SHD) with impaction bone grafting and tantalum rod implantation, while the control group (41 patients, 44 hips) received single rod implantation. Primary failure criteria included femoral head collapse (≥ 2 mm) or total hip arthroplasty. Patient-reported outcomes (PROs), including Harris Hip Score (HHS), Visual Analog Score (VAS), Hip Outcome Score Activities of Daily Living Subscale (HOS-ADL), and Hip Outcome Score Sport-Specific Subscale (HOS-SSS), were analyzed based on Minimum Clinically Important Difference (MCID).ResultsFEA confirmed stresses below the material's yield and compressive strength. At 3 years, survival rates for ARCO (Association Research Circulation Osseous) stage IIb and IIc were higher in the experimental group (100%, 80.38%) than the control group, while stage IIa survival was 100% in the control group. The experimental group also had higher MCID attainment for HHS, HOS-ADL, and HOS-SSS.ConclusionsCompared with single TaBw01 implantation, impaction bone grafting combined with TaBw01 implantation via SHD demonstrated superior outcomes for ARCO stage IIb and IIc, with a minimum 2-year follow-up. while single TaBw01 implantation may be more suitable for stage IIa. This study emphasizes the importance of combining biological and biomechanical reconstruction in ONFH treatment.

Dataset Information

Application of protective weight-bearing in osteonecrosis of the femoral head: A systematic review and meta-analysis of randomized controlled trials and observational studies.

Background

Methods

Results

Conclusion

Publications

Application of protective weight-bearing in osteonecrosis of the femoral head: A systematic review and meta-analysis of randomized controlled trials and observational studies.

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