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Chondrolysis of the Ankle Joint following Ankle Arthroscopy and Microfracture of the Osteochondral Lesion of the Talar Dome  [PDF]
Tsz Lung Choi,Tun Hing Lui
Case Reports in Orthopedics , 2013, DOI: 10.1155/2013/908082
Abstract: Chondrolysis of the ankle is a very rare condition. We report a case of chondrolysis of the ankle following ankle arthroscopy and microfracture of the osteochondral lesion of the talar dome. The patient’s symptoms were relieved after articulated distraction arthroplasty. 1. Introduction Chondrolysis is a clinical condition characterized by rapid destruction of articular cartilage on both sides of the joint leading to loss of joint space and joint stiffness. The cause has not truly been identified [1]. Chondrolysis has most commonly been described in the hip, shoulder, and knee joints. There were three cases of chondrolysis of the ankle joint reported in the English literature [1–3]. We report a case of chondrolysis of the ankle following ankle arthroscopy and microfracture of the osteochondral lesion of the talar dome. 2. Case Report A 32-year-old gentleman had inversion injury to his left ankle on 2007 resulting in persistent medial ankle pain. He was treated with physiotherapy without improvement. Radiographs and magnetic resonance imaging (MRI) of his left ankle showed the presence of osteochondral lesion (OCL) of the medial talar dome (Figure 1). Ankle arthroscopy and microfracture of the osteochondral lesion were performed on May 2008. His left ankle pain persisted after the operation and MRI of his left ankle was repeated and showed no interval change as compared to the previous MRI. Ankle arthroscopy was repeated on March 2009. Intraoperative findings showed that the medial talar OCL was covered with fibrocartilage and the other articular cartilage of the ankle joint was normal. However, his left ankle pain deteriorated afterwards as that he needed to walk with crutches. He complained of medial ankle pain and there was no rest pain or systemic upset. He was referred to our clinic for further management. Clinical examination showed that his left ankle was stiff with tenderness at the medial talar dome. Standing radiographs and MRI of his left ankle showed decreased ankle joint space without significant osteophytes formation, subchondral cyst, or subchondral sclerosis (Figure 2). Blood tests and gallium scan did not suggest any underlying infection. Ankle arthroscopy and distraction arthroplasty with Universal Compress Hinge were performed on May 2010. Arthroscopic findings showed marked fibrosis of the capsule with minimal synovitis. Most of the articular cartilage of the ankle joint was gone with exposure of the subchondral bone. There was an osseous defect at the medial talar dome. The patient was advised on active ankle mobilization exercise
Cell therapy for avascular osteonecrosis of femoral head  [cached]
Tomoki Aoyama,Junya Toguchida
Journal of Stem Cells and Regenerative Medicine , 2009,
Abstract: Avascular osteonecrosis of femoral head causes severe musculoskeletal disability. There is not standard treatment to cure avascular osteonecrosis.? Recently, cell therapy using bone marrow stromal cells has begun for this disease.
Spontaneous Knee Osteonecrosis: A Case Report  [cached]
Mahmut Yener,Ayhan A?k?n,Süreyya ?er?i,Serpil Sava?
Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi , 2010,
Abstract: Osteonecrosis is a pathological process which results in death of bone and bone marrow elements and can be associated with a variety of medical conditions. Involvement of the knee is believed to account for approximately 10% of all cases. The most frequent type of knee osteonecrosis is idiopathic osteonecrosis (spontaneous), and commonly involves the medial femoral condyl. Spontaneous osteonecrosis is more common in patients older than 60 years. In this case report, a 31-year-old female patient diagnosed as having spontaneous osteonecrosis of the knee after a sudden pain was presented. Turk J Phys Med Rehab 2010;56:40-2.
History of arthroscopy
Mari? Du?an M.,Garces Gerardo,Martinez Armando,Petkovi? Lazar D.
Medicinski Pregled , 2002, DOI: 10.2298/mpns0202051m
Abstract: Arthroscopy has developed as one of the branches of former cystoscopy. During the past 200 years a few people have made invaluable contributions to development of arthroscopy (Bozzini, Takagi, Watanabe) After the World War II scientific and technological progress was so fast that arthroscopy proved to be a valuable tool in orthopedics, not only as a diagnostic, but also as a therapeutic procedure.
Evaluation of a pig femoral head osteonecrosis model
Ping Zhang, Yun Liang, Harry Kim, Hiroki Yokota
Journal of Orthopaedic Surgery and Research , 2010, DOI: 10.1186/1749-799x-5-15
Abstract: Avascular osteonecrosis of the femoral head was induced in Yorkshire pigs by transecting the ligamentum teres and placing two ligatures around the femoral neck. After heparinized saline infusion and microfil perfusion via the abdominal aorta, blood circulation in the femoral head was evaluated by optical and CT imaging.An angiogram of the microfil casted sample allowed identification of the major blood vessels to the proximal femur including the iliac, common femoral, superficial femoral, deep femoral and circumflex arteries. Optical imaging in the femoral neck showed that a microfil stained vessel network was visible in control sections but less noticeable in necrotic sections. CT images showed a lack of microfil staining in the epiphysis. Furthermore, no transphyseal vessels were observed to link the epiphysis to the metaphysis.Optical and CT imaging analyses revealed that in this present pig model the ligatures around the femoral neck were the primary cause of induction of avascular osteonecrosis. Since the vessels surrounding the femoral neck are comprised of the branches of the medial and the lateral femoral circumflex vessels, together with the extracapsular arterial ring and the lateral epiphyseal arteries, augmentation of blood circulation in those arteries will improve pathogenetic alterations in the necrotic femoral head. Our pig model can be used for further femoral head osteonecrosis studies.Osteonecrosis of the femoral head and neck is one of the major orthopedic diseases of bone degradation in the hip joint [1-4]. It can lead to collapse of the femoral head, resulting in permanent deformity and premature degenerative arthritis. Osteonecrosis usually affects individuals with a mean age in the 30's [5], but it can also affect children. Many etiologies such as trauma, radiation, exposure to corticosteroid use, alcohol intake, and various chronic diseases are considered to be associated with femoral head degeneration [6]. One of the primary pathomechanisms
Tratamiento de la osteonecrosis de cabeza femoral
Alvarez López,Alejandro; García Lorenzo,Yenima;
Revista Cubana de Ortopedia y Traumatolog?-a , 2006,
Abstract: an updating bibliographic review of the treatment of femoral head osteonecrosis is made aimed at going deeper into the methods used in the treatment of the initial and late stages. in the initial stage, reference is made to the support suspension, to the pharmacological treatment, to the hyperbaric oxygenation, to electrical stimulation, and to the perforations or trepanations of the femoral head. the results obtained by diverse authors in the latter technique are shown. in the treatment of advanced or late stage osteonecrosis, it is recommended the use of osteotomies, merle d aubigne's technique; cup hemiarthroplasty, with partial prothesis, or total hip arhroplasty.
The Pathogenesis of Nontraumatic Osteonecrosis  [PDF]
Jesse Seamon,Thomas Keller,Jamal Saleh,Quanjun Cui
Arthritis , 2012, DOI: 10.1155/2012/601763
Abstract: Nontraumatic osteonecrosis continues to be a challenging problem causing debilitating major joint diseases. The etiology is multifactorial, but steroid- and alcohol-induced osteonecrosis contribute to more than two thirds of all cases with genetic risk factors playing an important role in many other cases, especially when they contribute to hypercoagulable states. While the exact mechanisms remain elusive, many new insights have emerged from research in the last decade that have given us a clearer picture of the pathogenesis of nontraumatic osteonecrosis of the femoral head. Progression to end stage osteonecrosis of the femoral head appears to be related to four main factors: interactions involving the differentiation pathway of osteoprogenitor cells that promote adipogenesis, decreased angiogenesis, direct suppression of osteogenic gene expression and proliferation of bone marrow stem cells, and genetic anomalies or other diseases that promote hypercoagulable states. 1. Introduction Nontraumatic osteonecrosis (ON) of the femoral head continues to represent a significant challenge to orthopaedic surgeons [1–3] and is a devastating disease for affected patients with complete collapse of the femoral head occurring in 80% of untreated patients [4, 5]. Nontraumatic conditions associated with ON are numerous [1, 2, 6, 7]. Some of the well accepted and common associations include corticosteroid use [8, 9], alcohol abuse [10], systemic lupus erythematous [11], hemoglobinopathies including sickle cell anemia [12–14], Legg-Calve Perthes disease [15], and exposure to radiation [16] or cytotoxic agents [17]. Other less common associations include Gaucher’s disease [11, 18, 19], dysbarisms [4], HIV [20], hyperlipidemia [21], pancreatitis, and gout [22]. A substantial number of cases have no identifiable etiologic factors and have been referred as idiopathic [23]. The pathogenic mechanisms leading to impaired circulation in these conditions are most likely multifactorial [3, 21, 24, 25]. Mechanical blood vessel interruption, thrombotic intravascular occlusion, and extravascular compression are the three most commonly accepted general mechanisms leading to ON [1, 3, 24, 26]. Recent attention has been given to the interplay between individual genetic predisposition and environmental factors related to ON [26–50]. Both heritable and acquired risk factors for femoral head ON related to hypercoagulability [28, 32–36, 47, 50–52], hemoglobinopathies [27, 28, 36], steroids [48], angiogenesis [43], and oxidative stress [45] have been identified in many patients.
OSTEONECROSIS OF THE FEMORAL HEAD – DIFFERENTIAL DIAGNOSIS  [PDF]
C. Zar?,P. Botez
Jurnalul de Chirurgie , 2009,
Abstract: Osteonecrosis of the femoral head (ONFH) is a disabling condition that affects mainly young subjects (average age 33-38 years old); to this day, it has remained a devastating disease. Osteonecrosis may be defined as the death of the cell components of bone - both osteocytes and bone marrow cells. ONFH is not a specific entity, but the final common pathway of various conditions that impair the blood supply to the femoral head - hence the frequently used term avascular necrosis. Surgical technological advancements have improved outcomes for these patients. However, due to the relatively young age of onset, these patients are often subjected to multiple operative procedures during their lifetime. Differential diagnosis should be made with: pigmented villonodular synovitis; idiopathic transient osteoporosis of the hip; stress fractures of femoral neck; metastastic bone carcinoma.
Rapid resolution of femoral head osteonecrosis after rotational acetabular osteotomy
Masahiko Nozawa,Keiji Matsuda,Katsuhiko Maezawa,Sungon Kim,Kouichi Maeda,Takashi Ikegami,Reiko Kubota,Kentaro Hayashi,Masataka Nagayama,Haruka Kaneko
Journal of Orthopaedics and Traumatology , 2008, DOI: 10.1007/s10195-008-0032-4
Abstract: The natural history of osteonecrosis of the femoral head is generally thought to be one of progressive deterioration if no intervention is undertaken. However, it is unknown whether surgical intervention is beneficial for patients with a small region of osteonecrosis. We observed rapid improvement of MRI findings after rotational acetabular osteotomy (RAO) was performed in a young patient with osteonecrosis of the femoral head. The band-like low signal area on T2-weighted images almost resolved by six months after surgery. He returned to work as an electrician by six months after surgery. Early surgical intervention such as RAO that alters the mechanical force acting on the necrotic region of the femoral head may accelerate the recovery of osteonecrosis and the improvement of symptoms.
Role of Electromagnetic Stimulation in the Treatment of Osteonecrosis of the Femoral Head in Early Stages  [PDF]
Juan L. Cebrián, Guillermo L. Milano, Alberto Francés, Yaiza Lopiz, Fernando Marco, Luis López-Durán
Journal of Biomedical Science and Engineering (JBiSE) , 2014, DOI: 10.4236/jbise.2014.75028
Abstract: Osteonecrosis of the femoral head is a disorder that leads to collapse and osteoarthritis in young patients. This study examines the effectiveness of pulsed electromagnetic fields [PEMF] in the treatment of osteonecrosis of the head in precollapse bone stages. A retrospective evaluation was done of 51 patients including 70 hips with symptomatic osteonecrosis of the hip treated with pulsed electromagnetic fields. Criteria for inclusion in the study group were evidence of osteonecrosis and absence of collapse of the femoral head. The average follow-up was 26 months (range, 18 - 90). Etiologies included idiopathic (40 cases), steroid use (26) and alcohol (4). To demonstrate the existence of osteonecrosis and its evolution, magnetic resonance imaging [MRI] and plain radiography techniques were used. Results: Procedures were radiological success in 80% of cases, and no progression to collapse in 88.57% of hips. Eight of the 70 hips had radiographic progression to collapse. This study suggests that selected PEMF reduce the incidence of progression of osteonecrosis of femoral head in early stage.
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