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      Predicting the collapse of the femoral head due to osteonecrosis: From basic methods to application prospects

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          Summary

          Collapse of the femoral head is the most significant pathogenic complication arising from osteonecrosis of the femoral head. It is related to the disruption of the maintenance of cartilage and bone, and results in an impaired function of the vascular component. A method for predicting the collapse of the femoral head can be treated as a type of clinical index. Efforts in recent years to predict the collapse of the femoral head due to osteonecrosis include multiple methods of radiographic analysis, stress distribution analysis, finite element analysis, and other innovative methods. Prediction methods for osteonecrosis of the femoral head complications originated in Western countries and have been further developed in Asia. Presently, an increasing number of surgeons have chosen to focus on surgical treatments instead of prediction methods to guide more conservative interventions, resulting in a growing reliance on the more prevalent and highly effective total hip arthroplasty, rather than on more conservative treatments. In this review, we performed a literature search of PubMed and Embase using search terms including “osteonecrosis of femoral head,” “prediction,” “collapse,” “finite element,” “radiographic images,” and “stress analysis,” exploring the basic prediction method and prospects for new applications.

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          Most cited references70

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          Non-traumatic avascular necrosis of the femoral head.

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            The Pathogenesis of Nontraumatic Osteonecrosis

            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.
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              Fat-cell changes as a mechanism of avascular necrosis of the femoral head in cortisone-treated rabbits.

              Large doses of cortisone were given to growing and adult rabbits over a five-month period to produce avascular necrosis of the femoral head. The cortisone caused an increase in the serum cholesterol, fatty metamorphosis of the liver, and fat emboli visible in sections of the femur and humerus. These emboli partially obliterated the microcirculation of the subchondral vessels of both femoral and humeral heads. The average diameter of the marrow fat cells also increased more than ten micrometers. This increase in cell volume might be significant because in the closed chamber of the femoral head it could increase tissue pressure, diminish perfusion, and be the mechanism for avascular necrosis induced by cortisone.
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                Author and article information

                Contributors
                Journal
                J Orthop Translat
                J Orthop Translat
                Journal of Orthopaedic Translation
                Chinese Speaking Orthopaedic Society
                2214-031X
                2214-0328
                10 January 2017
                October 2017
                10 January 2017
                : 11
                : 62-72
                Affiliations
                [a ]Guangzhou University of Chinese Medicine, The National Key Discipline and The Orthopedic Laboratory, Guangzhou, Guangdong, PR China
                [b ]Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, PR China
                [c ]School of Pathology and Laboratory Medicine, The University of Western Australia, Perth, WA, Australia
                Author notes
                []Corresponding author. Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, 16 th Airport Road, Guangzhou 515000, Guangdong, China.Department of OrthopedicsThe First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine16 th Airport RoadGuangzhouGuangdong515000China yutian_1010@ 123456sina.com
                [1]

                Both authors contributed equally to the article.

                Article
                S2214-031X(16)30309-6
                10.1016/j.jot.2016.11.002
                5866406
                29662770
                87b77d5b-e8ee-477e-869c-1805197a8ba8
                © 2017 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 11 July 2016
                : 28 September 2016
                : 10 November 2016
                Categories
                Review Article

                clinic application,collapse,femoral head,finite element,osteonecrosis,radiographic analysis

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