• Title/Summary/Keyword: Femoral head

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Pediatric Hip Disorders (소아 고관절 질환)

  • Seunghyun Lee;Young Hun Choi;Jung-Eun Cheon;Seul Bi Lee;Yeon Jin Cho
    • Journal of the Korean Society of Radiology
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    • v.85 no.3
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    • pp.531-548
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    • 2024
  • Developmental dysplasia of the hip is a condition characterized by hip joint instability due to acetabular dysplasia in infancy, necessitating precise ultrasound examination. Legg-Calvé-Perthes disease is caused by a temporary disruption in blood flow to the femoral head during childhood, progressing through avascular, fragmentation, re-ossification, and residual stages. Slipped capital femoral epiphysis is a condition where the femoral head shifts medially along the epiphyseal line during adolescence due to stress, such as weight-bearing. Differentiating between transient hip synovitis and septic arthritis may require joint fluid aspiration. Osteomyelitis can be associated with soft tissue edema and osteolysis. When multiple lesions are present, it is essential to distinguish between Langerhans cell histiocytosis and metastatic neuroblastoma. This review will introduce imaging techniques and typical findings for these conditions.

Peroxisome Proliferator-activated Receptor-γ Gene Polymorphisms are not associated with Osteonecrosis of the Femoral Head in the Korean Population

  • Kim, Tae-Ho;Hong, Jung Min;Park, Eui Kyun;Kim, Shin-Yoon
    • Molecules and Cells
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    • v.24 no.3
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    • pp.388-393
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    • 2007
  • Osteonecrosis of the femoral head (ONFH) is a multifactorial disease to which certain individuals are more at risk. Altered lipid metabolism is one of the major risk factors for osteonecrosis, especially corticosteroid therapy and alcoholism. Peroxisome Proliferator-Activated Receptor-${\gamma}$ ($PPAR{\gamma}$) plays a crucial role in differentiation of mesenchymal cells to adipocytes, lipid homeostasis, and bone metabolism. To investigate the possible association between $PPAR{\gamma}$ gene variants and susceptibility to ONFH, we genotyped three common polymorphisms (-796A > G, +34C > G[Pro12Ala], and +82466C > T[His477His]) in 448 ONFH patients and 336 control subjects. Genotypes, allele frequencies, and haplotypes of the polymorphisms in the complete set of patients as well as in subgroups by sex or etiology were not significantly different from those in the control group. This suggests that the examined polymorphisms and haplotypes of the $PPAR{\gamma}$ gene are unlikely to be associated with susceptibility to ONFH.

Three cases of affections of the hip treated with Korean Bee-Venom therapy (봉약침요법(蜂藥鍼療法)을 이용한 고관절병변(股關節病變) 치험(治驗) 증례보고(症例報告))

  • Kim, Tae-Hee;Kang, Kye-Sung;Kwon, Gi-Rok
    • Journal of Pharmacopuncture
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    • v.4 no.3
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    • pp.127-134
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    • 2001
  • Objective : In this study, we have discovered that Korean Bee-Venom therapy is effective in treating various hip joint diseases. For example, A vacular Necrosis, Degenerative Arthritis and Rheumatoid Arthritis. Methods & Results: We have treated three cases of affections of the hip(eg. Degenerative arthritis, Rheumatoid arthritis and Avascular Necrosis of Femoral Head) with Korean Bee-Venom therapy and herbal acupuncture treatments. For acupuncture, Korean Bee-Venom therapy was observed for its pain relieving effects. Korean Bee-Venom therapy was treated on the following acupuncture points: GB29(Koryo), GB30(Hwando:環跳), ST36(Chok-samni:足三理). As the results of these treatments, a little change of inflammation around the hip joint on X-ray scan study was observed. but the degree of pain and range of motion were improved. in addition to general conditions of the patients. Conclusions: Based on the clinical results, Korean Bee-Venom therapy is believed to be effective for treating Avascular Necrosis of Femoral Head, Degenerative arthritis and Rheumatoid arthritis of hip joint. However, it is expected that further studies should be conducted to provide more objective information.

Analgesic Effect of Electroacupuncture after Femoral Head Osteotomy in Dogs (개에서 대퇴골두 제거술 후 전침 자극이 통증완화에 미치는 영향)

  • Choi In-young;Cheong Jongtae;Shin Taekyun;Lee Joo-myoung
    • Journal of Veterinary Clinics
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    • v.21 no.4
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    • pp.374-397
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    • 2004
  • This experiment was designed to investigate the analgesic effect of non-invasive electroacupuncture treatment on femoral head osteotomy in dogs. Twelve dogs were divided into 3 groups in this experiment. Electroacupuncture group was non-invasively electrostimulated in Huan Tiao (GB-30) acupoint for 10 minutes by 4.5V, 5Hz for 10 days. Medication group was treated with carprofen (4mg/kg, P.O.) for 10 days. Control group was not treated. Each group was pre-operatively and post-operatively scored by using VAS (Visual Analogue Scale), SDS (Simple Descriptive Scale), NRS (Numerical Rating Scale), and measured serum cortisol levels. The results of VAS, SDS and NRS in electroacupuncture and medication groups were better than those of control group. And, the results of electroacupuncture group were better than those of medication group since 6th day after osteotomy in pain management(p<0.05). But, there were no significances in serum cortisol level among 3 groups. In conclusion, non-invasive electroacupuncture treatment showed sufficient analgesic effect on postoperative pain management after femoral head osteotomy, and VAS, SDS, and NRS scoring system would be adapted in evaluation of pain management.

A Finite Element Analysis of the Effects of Necrotic Area on Stresses in Early Osteonecrosis of Femoral Head (대퇴 골두내 무혈성괴사 영역에 따른 응력변화 분석 -3차원 유한요소법을 이용한 분석-)

  • Kang, S.B.;Joo, W.;Kim, Y.M.;Kim, H.J.;Choi, J.B.;Choi, K.
    • Proceedings of the KOSOMBE Conference
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    • v.1996 no.11
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    • pp.349-350
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    • 1996
  • Using FEM, we analyzed the stress changes on early osteonecrosis of femoral head as the necrotic area increases. A 3D FEM model of proximal femur was made from the CT scam data of fresh frozen adult proximal femur with the material properties from literature. The model consisted of 5994 elements and 5275 nodes. FE analyses were peformed using MSC/NASTRAN. At normal states, stress transmission is mainly along the primary compression trabeculae(PCT). Until 60% involvement of PCT with necrotic lesion, stress transmission is still along the remained PCT. When the PCT involvement is from 60% to 85%, stress transmission is along the PCT and margin of the necrotic lesion. When involvement is more than 85%, stress is mostly transferred to posterior part of femoral head.

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Avascular Necrosis of Femoral Head on Bone Scan (대퇴골두 무혈성 괴사의 뼈스캔상의 병기)

  • Yang, Hyung-In;Kim, Eui-Jong;Kim, Deog-Yoon;Ryu, Kyung-Nam;Cho, Kyung-Sam
    • The Korean Journal of Nuclear Medicine
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    • v.28 no.2
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    • pp.206-213
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    • 1994
  • We studied 90 patients(179 femoral heads) with avascular necrosis of femoral head, who had been performed X-ray, bone scan and MRI to compare of the findings of AVN on bone scan between each other, retrospectively. The patients were 82 males and 9 females, their mean age was 45 years. Radiographic stages were classified by Steinberg modification, radionuclide stages were classified as followed; stage o(or type 0) : normal, stage 1 : faint ring like uptake around the femoral head, stage 2: intense ring like uptake, stage 3: irregular increased uptake with central photon defect, stage 4 : Intense diffuse increased uptake at femoral head and stage 5 : hip joint deformity with relatively mild increased uptake. The findings of MRI were classified according to extent, location, early or advanced lesion, signal intensity of the lesion and joint effusion. 156(87%) of 179 femoral heads had avascular necrosis, 68(75.5%) of 90 patients had bilateral AVN, 35 femoral heads had early stage and 120 had advanced stage. The detection rate of AVN by X-ray and bone scan were 85% (134), 91.6% (143), respectively. Early AVN with atypical types of bone scan showed larger extent, moderate to large amount of joint effusion, soft tissue hypertrophy within joint, and secondary degenerative changes. Bone scan had relatively high detection rate in the diagnosis of AVN of femoral head, and demonstrated various types depending on the disease stage.

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A Biomechanical Analysis of Various Surgical Procedures for Osteonecrosis of the Femoral Head using a Finite Element Method (유한요소법을 이용한 대퇴 골두내 무혈성 괴사증의 다양한 수술적 기법에 대한 생체역학적 분석)

  • Kim, J.S.;Lee, S.J.;Shin, J.W.;Kim, Y.S.;Choi, J.B.;Kim, Y.S.
    • Proceedings of the KOSOMBE Conference
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    • v.1997 no.05
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    • pp.374-378
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    • 1997
  • Operative procedures such as core drilling with and without fibular bone grafting have been recognized as the treatment methods for osteonecrosis of femoral head(ONFH) by delaying or preventing the collapse of the femoral head. In addition, core drilling with cementation using polymethylmethacrylate (PMMA) has been proposed recently as another surgical method. However, no definite treatment modality has been found yet while operative procedures remain controversial to many clinicians In this study, a finite element method(FEM) was employed to analyze and compare various surgical procedures of ONFH to provide a biomechanical insight. This study was based upon biomechanical findings which suggest stress concentration within the femoral head may facilitate the progression of the necrosis and eventual collapse. For this purpose, five anatomically relevant hip models were constructed in three dimensions : they were (1) intact(Type I), (2) necrotic(Type II), (3) core drilled only(Type III), (4) core drilled with fibular bone graft(Type IV), and (5) core drilled with cementation(Type V). Physiologically relevant loading were simulated. Resulting stresses were calculated. Our results showed that the volumetric percentage subjected to high stress in the necrotic cancellous region was greatest in the core drilled only model(Type III), followed by the necrotic(Type II), the bone graft (Type IV), and the cemented(Type V) models. Von Mises stresses at the tip of the graft(Type IV) was found to be twice more than those of cemented core(Type V) indicating the likelihood of the implant failure. In addition, stresses within the cemented core(Type V) were more evenly distributed and relatively lower than within the fibular bone graft(Type IV). In conclusion, our biomechanical analyses have demonstrated that the bone graft method(Type IV) and the cementation method(Type V) are both superior to the core decompression method(Type III) by reducing the high stress regions within the necrotic cancellous bone. Also it was found that the core region filled with PMMA(Type V) provides far smoother transfer of physiological load without causing the concentration of malignant stresses which may lead to the failure than with the fibular bone graft(Type IV). Therefore, considering the above results along with the degree of difficulties and risk of infection involved with preparation of the fibular bone graft, the cementation method appears to be a promising surgical treatment for the early stage of osteonecrosis of the femoral head.

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Bilateral Avascular Necrosis of the Femoral Head After Epidural Steroid Injection for the Management of Low Back Pain (요통 치료를 위한 경막외 스테로이드 주입후 발생한 양측 무혈성 대퇴골두괴사)

  • Kim, Dong-Gin;Roh, Seon-Ju;Ban, Jong-Seock;Min, Byung-Woo
    • The Korean Journal of Pain
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    • v.5 no.1
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    • pp.117-120
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    • 1992
  • Non traumatic aseptic necrosis of the head of the femur is well documented with respect to its clinical roentgenographic and pathological aspect, but not with respect to etiology. A number of reports have associated various diseases and conditions with necrosis of the femoral head. Prominent among these are alcoholism, steroid therapy and hemostatic disorder. The increased incidence of avascular necrosis of bone associated with long-term corticosteroid therapy has aroused much interest. The pathogenesis of cortisone-induced avascular necrosis is as yet unproved. But cortisone-induced fatty liver with hyperlipidemia, leading to systemic embolization of fat and avascular necrosis of bone has much experimental support. We present a case of bilateral avascular necrosis of the femur head following several epidural steroid injections in a 30 year old male patient who had low back pain with radiation to both legs for 1 year and who had Cushinoid appearance for several months. One week later, he had a total replacement of both hip operation.

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A NEW MEASUREMENT METHOD OF FEMORAL ANTEVERSION BASED ON THREE DIMENSIONAL MODELING (3차원 모델링을 이용한 대퇴 전염각의 측정)

  • Kim, June-S.;Park, Hee-J.;Choi, Kwang-S.;Choi, Kui-W.;Kim, Sun-I.
    • Proceedings of the KOSOMBE Conference
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    • v.1997 no.05
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    • pp.141-144
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    • 1997
  • Femoral neck anteversion is the angle between the neck and the knee axis projected on a plane perpendicular to the longitudinal axis. Conventional methods that use cross-sectional Computed Tomography(CT) images to estimate femoral anteversion have several problems because of the complex 3D structure of the femur. These are the ambiguity of defining the longitudinal axis, the femoral neck axis and condylar line, and the dependence on patient positioning. Especially the femoral neck axis that is known as a major source of error is hard to determine from a single or multiple 2D transverse images. So we developed a new method for measuring femoral anteversion by 3D modeling method. In this method, femoral head is modeled as a sphere. The center of femoral neck is the mid-point of the 2D reconstructed oblique image in the femoral neck part. Then neck axis is a line connecting foregoing two centers. We model the longitude of femur as a cylinder, and the long axis is defined from the fitted cylinder. The knee axis which is tangent to the back of the femoral condyles is easily determined by table-top method. By the definition of femoral anteversion, the femoral anteversion is easily calculated from this model.

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Ankle Salvage Procedure without Internal Fixation for Large Bone Defect after Failed Total Ankle Arthroplasty: A Case Report (실패한 족관절 인공관절 치환술 후 큰 골결손에서 내고정 없이 시행한 족관절 구제술: 증례 보고)

  • Park, Man-Jun;Eun, Il-Soo;Jung, Chul-Young;Ko, Young-Chul;Yoo, Chong-Il;Kim, Min-Woo;Hwang, Keum-Min
    • Journal of Korean Foot and Ankle Society
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    • v.18 no.2
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    • pp.76-79
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    • 2014
  • In treatment of failure in ankle joint replacement therapy, talar avascular necrosis with massive bone defect, talus fracture with severe comminution and bone defect and ankle dislocation, treatment of large bone defects is considerably important for ankle joint stability and union, therefore, the choice of treatment for large bone defects is use of femoral head or iliac crest bone graft and rigid internal fixation. Because first generation total ankle arthroplasty performed for the first time using a cemented fixation technique requires a large amount of bone resection during re-surgery and there is some possibility of a larger bone defect after removal of implants, in cases where prosthesis for the defect is needed, performance of palliative femoral head or iliac crest bone graft and rigid internal fixation can be difficult. We report on a case of a 48-year-old woman who had experienced ankle pain for 25 years since undergoing total ankle arthroplasty. Because the patient had little ankle motion and rigid soft tissue despite a large bone defect caused by aseptic loosening, a good outcome was obtained only for the femoral cancellous bone graft using allo femoral head without internal fixation.