Intraosseous conduit-induced enhancement of ingrowth of blood vessels into the necrotic femoral head of rats (original) (raw)
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Theoretical biology & medical modelling, 2005
EXPERIMENTAL OSTEONECROSIS: The authors' experience with experimentally produced femoral capital osteonecrosis in rats is reviewed: incising the periosteum at the base of the neck of the femur and cutting the ligamentum teres leads to coagulation necrosis of the epiphysis. The necrotic debris is substituted by fibrous tissue concomitantly with resorption of the dead soft and hard tissues by macrophages and osteoclasts, respectively. Progressively, the formerly necrotic epiphysis is repopulated by hematopoietic-fatty tissue, and replaced by architecturally abnormal and biomechanically weak bone. The femoral heads lose their smooth-surfaced hemispherical shape in the wake of the load transfer through the hip joint such that, together with regressive changes of the joint cartilage and inflammatory-hyperplastic changes of the articular membrane, an osteoarthritis-like disorder ensues. THERAPEUTIC CHOICES: Diverse therapeutic options are studied to satisfy the different opinions conc...
International Journal of Experimental Pathology, 2002
The blood supply of rats 0 femoral heads was severed by cutting the ligamentum teres and stripping the periostium. Histologically, necrosis of the marrow was apparent on the 2nd postoperative day, necrosis of the bone on the 5th postoperative day and fibrous ingrowth on the 7th postoperative day. During the following 5 weeks, progressive resorption of the intertrabecular necrotic debris and necrotic bony trabeculae and subchondral bone plate and, concurrently, appositional and intramembranous new bone formation resulted in remodeling of the femoral heads. In 2 of 7 femoral heads, replacement of the necrotic bone by viable bone was complete at the 42-day postoperative interval. Also, the articular cartilage of the deformed and flattened femoral heads was undergoing degenerative changes. Reduplicating the pathogenically inferred clinical settings of blood supply deprivation, it is proposed that this model, in a small laboratory animal, satisfies the requirements sought for preclinical studies of treatment modalities of avascular osteonecrosis in man.
International Orthopaedics, 2009
In this paper, 152 patients with 187 osteonecrotic femoral heads (83 idiopathic, 56 corticosteroid induced, 40 post-traumatic, seven alcohol abuse and one associated with gout) were classified according to the staging by Ficat and Arlet (Ischemia and necroses of bone, Williams and Wilkins, Baltimore, Maryland, pp 171-182, 1980); four were in Stage I, 82 in Stage II and 101 in Stage III. The majority of the patients were young (average age 35.5 years). Multiple drilling, curettage of the necrotic bone and muscle-pedicle bone grafting using tensor fascia lata was carried out in all patients except in six adolescents, where sartorius grafting was performed. Cheilectomy of the femoral head and subcutaneous adductor tenotomy were also performed in the advanced stages. During the follow up of 10 to 21.5 years (average 16.5 years), radiological improvement was noted in 81.3% of patients in Stage II and 70.1% of patients in Stage III cases. Excellent and good results according to the Hospital for Special Surgery (HSS) score were obtained in 100% of cases in Stage I, 92% in Stage II and 80.4% in stage III, with a survivorship of 91% in Stage II and 82% in Stage III cases. The patients having an HSS score below 20 (non-survival) were recommended for total hip replacement (THR) therapy. Résumé 152 patients présentant 187 nécroses de la tête fémorale (83 idopathiques, 56 après corticoïdes, 40 posttraumatiques, 7 d'origine éthyliques et une associée à une goutte) ont été traités. Selon les classifications de Ficat et Arlet, 4 étaient au stade I, 82 au stade II et 101 au stade III. La majorité des patients étaient jeunes (35,5 ans). Forage et curetage de la nécrose et greffe pédiculaire ont été réalisés chez 6 adolescents. Cheilectomie et ténotomie percutanées des adducteurs ont été également réalisées. Le suivi moyen a été de 16.5 ans (10 à 21.5 ans). Il n'y a pas d'altération radiographique chez les patients de stade I. Une amélioration a été notée dans 81.3% des patients de stade II et 70.1% des patients de stade III. De bons résultats cliniques ont été mis en évidence (score de Salvati et Wilson) dans 100% des patients de stade I, 92% au stade II et 80.4% au stade III avec un taux de survie de 91% au stade II, et 82% de stade III. Les patients présentant une aggravation de la nécrose avec un score en dessous de 20 ont été considérés comme devant bénéficier d'une prothèse totale.
Fuel and Energy Abstracts, 1999
The reparative processes following vascular deprivationinduced necrosis of the femoral head were studied histologically in rats sacrificed 2, 7, 14,21,42 and 92 days postoperatively. The blood supply was severed by incision of the periosteum at the neck of the femoral head and transection of the ligamentum teres. Granulation tissue and a well-vascularized fibrous tissue originating from the joint capsule invaded the necrotic marrow spaces. With progressive resorption of the necrotic tissues and osteoneogenesis, both appositional and intramembranous, within the fibrotic intertrabecular spaces, the r emodeling process led to a shift of the normal spongy architecture of the femoral head to a compacta-like onc. In a few cases, osseous bridges bisected a necrotic physeal cartilage at the latest time intervals. The remodeling was associated with flattening of the femoral heads as well as with degenerative, regenerative and reparative alterations of the articular cartilage. In onc of the two femoral heads obtained three months postoperatively, cystic spaces developed in the fibrous subchondral zone. Our findings are consistent with the view that ineffective attempts at restoring the prenecrotic state of the femoral head by replacing the necrotic with viable tissue triggers the collapse of the femoral head. Thickening and condensation of the subchondral bone, leading to increased stiffness of the subchondral zone, result in the osteoarthritis-like disorder. Mimicking the well-known phases of human osteonecrosis, the model readily allows for preclinical studies of therapeutic regimens.
Computer-Assisted Image Analysis of the Rat Postosteonecrotic Remodeled Femoral Head
Experimental and Molecular Pathology, 2001
Osteonecrosis of rat femoral heads was induced by stripping the head that could rightfully be applied to experimental exploraperiosteum of the neck and cutting the ligamentum teres. The epiphyseal tion of treatment modalities premised to hinder or halt the marrow and bone were necrotic on the 5th postoperative day. Specimens progression of the disease in man. A review of the literature obtained 18 and 36 days postoperatively showed fibrous and hematopoion avascular osteonecrosis in animals was published recently etic-fatty tissue in the intertrabecular spaces, osteoclastic bone resorption, osteogenesis, and degeneration of the joint cartilage. Morphomet-(Boss and Misselevich, 2001). We examined rat necrotic rically, the means of the height-to-length ratios of the control, 6-day, femoral heads after vascular deprivation induced by strip-18-day, and 36-day femoral heads were 0.26, 0.28, 0.48, and 0.29, ping the periosteum of the neck and cutting the ligamentum respectively. The shape factor of the femoral heads of the control rats teres: Histologically, necrosis of the hematopoietic-fatty was higher than 0.81 in 80% of the cases, while those of rats killed marrow set in on the second postoperative day. Necrosis of on the 6th, 18th, and 36th postoperative day were higher than 0.81 in 65, 60, and 50% of cases, respectively. Statistically, the means of the the subchondral and trabecular bone was apparent on the height-to-length ratios and the values of the shape factors of the femoral fifth postoperative day. First evident during the second postheads of the rats killed 18 days postoperatively differed significantly operative week, sequentially evolving repair processes led from those of the other three groups of rats. The quantitatively gauged to remodeling of the epiphysis and, often, also of the metaphdata of the remodeled epiphyses negate the authors' subjective impression concerning early flattening of the femoral heads after surgically ysis: Granulation tissue invaded the intertrabecular spaces produced osteonecrosis. ᭧ 2001 Elsevier Science from the inflamed joint capsule, macrophages and osteoclasts Key Words: osteonecrosis of the femoral head; Perthes disease; removed the necrotic debris, fibroblasts produced fibrous architectural remodeling of the femoral head; animal model of human tissue, which was repopulated by hematopoietic and fat cells, disease; computer-assisted image analysis. and, eventually, the osteoblasts deposited appositional and intramembranous bone. This remodeling resulted in architectural distortion of the epiphysis and physis, a shift from spongy to near compacta-type bone, and degeneration of the
Postosteonecrotic Osteoarthritis-like Disorder of the Femoral Head of Rats
Journal of Comparative Pathology, 2003
The femoral heads of 15 rats were studied histologically 3 months after the induction of ischaemic necrosis by incising the cervical periosteum and cutting the ligamentum teres. The epiphyses consisted of immature disorganized subchondral and trabecular bone. The inter-trabecular spaces contained fibrous or haematopoietic tissue. Residual necrotic bone was rare. There was marked osteoblastic and osteoclastic activity. The articular aspect of the heads showed a spectrum of changes, ranging from cartilaginous degeneration with fibrillation and loss of glycosaminoglycans to an eburnated and polished bony surface. In seven rats, transphyseal bridges connected the epiphyseal and metaphyseal bony trabeculae to each other. It is suggested that the postnecrotic reparative processes, including the resorption of the necrotic debris and its replacement by newly formed, weak bone, led to an osteoarthritis-like disorder. This healing pattern of the necrotic femoral head was reminiscent of the progressive remodelling that occurs in rings in femoral capital osteonecrosis of adult human patients and in Perthes's disease of children.
Management of osteonecrosis of the femoral head: A novel technique
Indian Journal of Orthopaedics, 2016
Background: Osteonecrosis of the femoral head (ONFH) is a debilitating disease in orthopedics, frequently progressing to femoral head collapse and osteoarthritis. It is thought to be a multifactorial disease. ONFH ultimately results in femoral head collapse in 75-85% of untreated patients. Total hip arthroplasty (THA) yields satisfactory results in the treatment of the end stage of the disease. However, disease typically affects males between the ages of 20 and 40 years and joint replacement is not the ideal option for younger patients. Recently, mesenchymal stem cells and platelet rich plasma (PRP) have been used as an adjunct to core decompression to improve clinical success in the treatment of precollapse hips. Materials and Methods: A prospective study of 40 hips in 30 patients was done. There were 19 males and 11 females with a mean age 36.7 ± 6.93 years. The indication for the operation was restricted primarily to modified Ficat stages IIb and III. 16 hips (40%) had stage IIb and 24 hips (60%) had stage III ONFH. The period of follow up ranged between 36-50 months with a mean 41.4 ± 3.53 months. All patients were assessed clinically during pre-and post-operative period according to the Harris Hip Score (HHS), Visual Analog Score (VAS) and radiologically by X-rays. Magnetic resonance imaging (MRI) was done preoperatively to confirm the diagnosis and every 6 months postoperatively for assessment of healing. The operative procedure include removal of necrotic area with drilling then the cavity was filled with a composite of bone graft mixed with PRP. Results: The mean HHS improved from 46.0 ± 7.8 preoperatively to 90.28 ± 19 at the end of followup (P < 0.0001). The mean values of VAS were 78 ± 21 and 35 ± 19 at preoperatively period and final followup, respectively, with an average reduction of 43 points. Conclusion: We found that the use of PRP with collagen sheet can increase the reparable capacity after drilling of necrotic segment in stage IIb and III ONFH.
A new preclinical femoral head osteonecrosis model in sheep
2011
Introduction Animal models have been used as insight into the pathogenesis of osteonecrosis, even though most have failed to reproduce all stages of human disease, limiting progression in experimental treatment modalities. A new surgically induced animal model of femoral head osteonecrosis in sheep is presented. Method Osteonecrosis was achieved using an improved method of intracephalic cryogenic lesion by means of a cryoprobe and vascular ligation. Results Histologic Wndings at 6 and 12 weeks showed progression to advanced stage osteonecrosis. MRI, the gold standard in diagnosis and follow-up in human osteonecrosis showed concordant results with histology. Conclusion Our model can therefore be used as a preclinical femoral head osteonecrosis model in an easily accessible animal to assess biological treatments with MRI.