Three-dimensional distribution of cystic lesions in osteonecrosis of the femoral head.

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Abstract

The aim of this study was to investigate the location characteristics of cystic lesions in a three-dimensional context and discuss the mechanism of formation.

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Most cited references 27

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Hip joint loading during walking and running, measured in two patients.

Leigh Bergmann, F Graichen, A Rohlmann (1993)

The resultant hip joint force, its orientation and the moments were measured in two patients during walking and running using telemetering total hip prostheses. One patient underwent bilateral joint replacement and a second patient, additionally suffering from a neuropathic disease and atactic gait patterns, received one instrumented hip implant. The joint loading was observed over the first 30 and 18 months, respectively, following implantation. In the first patient the median peak forces increased with the walking speed from about 280% of the patient's body weight (BW) at 1 km h-1 to approximately 480% BW at 5 km h-1. Jogging and very fast walking both raised the forces to about 550% BW; stumbling on one occasion caused magnitudes of 720% BW. In the second patient median forces at 3 km h-1 were about 410% BW and a force of 870% BW was observed during stumbling. During all types of activities, the direction of the peak force in the frontal plane changed only slightly when the force magnitude was high. Perpendicular to the long femoral axis, the peak force acted predominantly from medial to lateral. The component from ventral to dorsal increased at higher force magnitudes. In one hip in the first patient and in the second patient the direction of large forces approximated the average anteversion of the natural femur. The torsional moments around the stem of the implant were 40.3 N m in the first patient and 24 N m in the second.

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Osteonecrosis of the hip: management in the 21st century.

Amar Rajadhyaksha, Anastasia Callaghan, Michael Mont … (2002)

Osteonecrosis of the femoral head is a progressive condition that often leads to collapse of the femoral head. The ultimate goal in the treatment for osteonecrosis of the hip is preservation of the femoral head. However, the condition is difficult to treat because it is associated with a number of different diseases, and the etiology and natural history of the condition have not been definitively determined. The delineation of new information regarding the etiology, pathogenesis, and natural history of osteonecrosis is ongoing. Core decompression, vascularized and nonvascularized bone grafting procedures, and arthroplasty procedures play an important role in treatment.

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Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head. Indications and long-term results.

Y Sugioka, T Hotokebuchi, H Tsutsui (1992)

From 1972 until 1988, transtrochanteric rotational osteotomy was used to treat 474 hips in 378 patients with idiopathic and steroid-induced osteonecrosis of the femoral head. Two hundred twenty-nine of 295 hips with anterior rotation and follow-up periods ranging from three to 16 years had excellent surgical results (success rate, 78%). Outcome was chiefly dependent on the ratio of transposed intact posterior articular surface to the acetabular weight-bearing area after osteotomy. This relationship suggested that the transposed intact area should occupy more than 36% of the acetabular weight-bearing area by adequate rotation and intentional varus position in addition to rotation, especially for extensive lesions. Salvage operations, such as total hip arthroplasty, were performed on 18 hips, of which ten hips were cases of either relative indication for extensive lesions in young patients or other misindications for rotational osteotomy. Four hips sustained neck fracture, including three hips after 180 degrees of posterior rotation; two hips were complicated with avascular necrosis, and another two hips developed osteoarthrosis. Histologically, femoral heads with osteoarthrosis removed at the time of salvage operation showed complete healing of the necrotic lesion. The overall findings indicate that healing of the necrotic lesion of the femoral head may be brought about by rotational osteotomy if it spares the vulnerable site from the brunt of mechanical stress.