Microarchitecture features and pathology of necrotic region in patients with steroid-induced and alcohol-induced osteonecrosis of femoral head_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WEI Qiushi ^1,2,3 , YANG Fan ^2,4 , CHEN Xiaojun ^2,4 , HE Mincong ^2,4 , CHEN Zhenqiu ^1,3 , ZHANG Qingwen ^1,3 ,  HE Wei ^1,2,3

1. Hip Preserving Ward, No.3 Orthopaedic Region, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;
2. Lab of Orthopaedics and Traumatology, Chinese Medicine of Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;
3. Institute of Hip Diseases, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;
4. First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510407, P.R.China;

Corresponding author：

HE Wei, Email: hw13802516062@126.com

Keywords：

Osteonecrosis of the femoral head; steroid; alcohol; pathology; Micro-CT

DOI：

10.7507/1002-1892.201711130

Video：

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ObjectiveTo investigate the pathological and microstructural features of the osteonecrosis samples from subjects with steroid-induced or alcohol-induced osteonecrosis of the femoral head (ONFH).MethodsThirty femoral head bone samples were collected from ONFH patients who underwent total hip arthroplasty between August 2015 and April 2016. There were 22 males and 8 females. The etiology of ONFH was alcohol-induced in 15 patients and steroid-induced in 15 patients. No significant difference of Association Research Circulation Osseous (ARCO) stage was found between alcohol-induced and steroid-induced ONFH (Z=2.143, P=0.143). The femoral head bone samples in different areas (necrosis, sclerosis, and normal) from involved subjects was taken, and gross observation, HE staining were carried out (the rate of empty lacunaes was calculated). The intact femoral head was scanned by Micro-CT and the parameters of bone microstructure were analyzed quantitatively. The parameters included bone volume to total volume (BV/TV), bone surface area to bone volume ratio (BS/BV), bone mineral density (BMD), bone mineral content (BMC), structural model index (SMI), trabecular plate number (Tb. N), trabecular plate thickness (Tb. Th), and trabecular spacing (Tb. Sp).ResultsAs observed in hard tissue slicing of both groups, the integrity of trabecular bone was destructed and cystic lesions left by the bone resorption was replaced by granulation tissues. Significant revascularization was found in granulation tissues of steroid-induced ONFH, but not in the alcohol-induced one. HE staining showed that the bone marrow structure was disordered in both group, as well as bone marrow necrosis and empty bone lacunaes noticed. The structure and integrity of trabecular bone of steroid-induced ONFH was far more severe whereas that of alcohol-induced one were thicker and better. The rate of empty bone lacunae in necrosis area of steroid-induced group was significantly higher than that of alcohol-induced one (P<0.05), but no significant difference was found in sclerotic and normal areas between 2 groups (P>0.05). Micro-CT showed that necrotic and sclerotic areas of both groups were low bone density. Bone structure in the former area was mostly heterogeneous. Further blood-rich granulation tissues formation was observed in the same places of hard tissue slicing, while the sclerotic one wasn’t. The results of quantitative bone structure analysis showed that BV/TV, BMD, BMC, Tb.N, and Tb.Th of the necrotic and sclerotic areas of steroid-induced ONFH were significantly lower than those of alcohol-induced one (P<0.01), BS/BV, SMI, and Tb.Sp of steroid-induced ONFH were significantly higher than those of alcohol-induced one (P<0.01). No significant difference among the indexes above was found in the normal areas of both groups (P>0.05).ConclusionThe integrity of trabecular bone was destroyed in necrotic area of steroid-induced or alcohol-induced ONFH. However, they performed different features of osteonecrosis and contrasted with each other. The steroid-induced ONFH was characterized by multiple " osteolytic bone destruction”, while the alcohol-induced one was manifested by some kinds of " coagulative destruction”.

Citation： WEI Qiushi, YANG Fan, CHEN Xiaojun, HE Mincong, CHEN Zhenqiu, ZHANG Qingwen, HE Wei. Microarchitecture features and pathology of necrotic region in patients with steroid-induced and alcohol-induced osteonecrosis of femoral head. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(7): 866-872. doi: 10.7507/1002-1892.201711130 Copy

1.	Chen SB, Hu H, Gao YS, et al. Prevalence of clinical anxiety, clinical depression and associated risk factors in chinese young and middle-aged patients with osteonecrosis of the femoral head. PLoS One, 2015, 10(3): e0120234.
2.	Samara S, Dailiana Z, Chassanidis C, et al. Expression profile of osteoprotegerin, RANK and RANKL genes in the femoral head of patients with avascular necrosis. Exp Mol Pathol, 2014, 96(1): 9-14.
3.	Miao Q, Hao S, Li H, et al. Expression of osteoprotegerin, RNAK and RANKL genes in femoral head avascular necrosis and related signaling pathway. Int J Clin Exp Pathol, 2015, 8(9): 10460-10467.
4.	Song HM, Wei YC, Li N, et al. Effects of Wenyangbushen formula on the expression of VEGF, OPG, RANK and RANKL in rabbits with steroid-induced femoral head avascular necrosis. Mol Med Rep, 2015, 12(6): 8155-8161.
5.	Chen YX, Zhu DY, Xu ZL, et al. The protective effect of cordycepin on alcohol-induced osteonecrosis of the femoral head. Cell Physiol Biochem, 2017, 42(6): 2391-2403.
6.	Zhu HY, Gao YC, Wang Y, et al. Circulating exosome levels in the diagnosis of steroid-induced osteonecrosis of the femoral head. Bone Joint Res, 2016, 5(6): 276-279.
7.	Chughtai M, Piuzzi NS, Khlopas A, et al. An evidence-based guide to the treatment of osteonecrosis of the femoral head. Bone Joint J, 2017, 99-B(10): 1267-1279.
8.	Li J, Wang J, Zhao J, et al. BOLD-MRI early detect femoral head osteonecrosis following steroid-treated patients. Medicine (Baltimore), 2017, 96(44): e8401.
9.	Zhao D, Xie H, Xu Y, et al. Management of osteonecrosis of the femoral head with pedicled iliac bone flap transfer: A multicenter study of 2190 patients. Microsurgery, 2017, 37(8): 896-901.
10.	Song Y, Du ZW, Yang QW, et al. Association of genes variants in RANKL/RANK/OPG signaling pathway with the development of osteonecrosis of the femoral head in Chinese Population. Int J Med Sci, 2017, 14(7): 690-697.
11.	Wang J, Shi X, Yang H, et al. Association between alcohol-induced osteonecrosis of femoral head and risk variants of MMPS in Han population based on a case-control study. Oncotarget, 2017, 8(38): 64490-64498.
12.	Lin Z, Lin Y. Identification of potential crucial genes associated with steroid-induced necrosis of femoral head based on gene expression profile. Gene, 2017, 627: 322-326.
13.	Yu T, Xie L, Zhang Z, et al. Prediction of osteonecrosis collapse of the femoral head based on the proportion of the proximal sclerotic rim. Int Orthop, 2015, 39(6): 1045-1050.
14.	Sonoda K, Motomura G, Kawanami S, et al. Degeneration of articular cartilage in osteonecrosis of the femoral head begins at the necrotic region after collapse: a preliminary study using T1 rho MRI. Skeletal Radiol, 2017, 46(4): 463-467.
15.	Ma JX, He WW, Zhao J, et al. Bone microarchitecture and biomechanics of the necrotic femoral head. Sci Rep, 2017, 7(1): 13345.
16.	Wang C, Wang X, Xu XL, et al. Bone microstructure and regional distribution of osteoblast and osteoclast activity in the osteonecrotic femoral head. PLoS One, 2014, 9(5): e96361.
17.	Wang C, Wang Y, Meng H, et al. Microstructure and nanomechanical properties of single trabecular bone in different regions of osteonecrosis of the femoral head. J Nanosci Nanotechnol, 2016, 16(3): 2264-2269.

1. Chen SB, Hu H, Gao YS, et al. Prevalence of clinical anxiety, clinical depression and associated risk factors in chinese young and middle-aged patients with osteonecrosis of the femoral head. PLoS One, 2015, 10(3): e0120234.
2. Samara S, Dailiana Z, Chassanidis C, et al. Expression profile of osteoprotegerin, RANK and RANKL genes in the femoral head of patients with avascular necrosis. Exp Mol Pathol, 2014, 96(1): 9-14.
3. Miao Q, Hao S, Li H, et al. Expression of osteoprotegerin, RNAK and RANKL genes in femoral head avascular necrosis and related signaling pathway. Int J Clin Exp Pathol, 2015, 8(9): 10460-10467.
4. Song HM, Wei YC, Li N, et al. Effects of Wenyangbushen formula on the expression of VEGF, OPG, RANK and RANKL in rabbits with steroid-induced femoral head avascular necrosis. Mol Med Rep, 2015, 12(6): 8155-8161.
5. Chen YX, Zhu DY, Xu ZL, et al. The protective effect of cordycepin on alcohol-induced osteonecrosis of the femoral head. Cell Physiol Biochem, 2017, 42(6): 2391-2403.
6. Zhu HY, Gao YC, Wang Y, et al. Circulating exosome levels in the diagnosis of steroid-induced osteonecrosis of the femoral head. Bone Joint Res, 2016, 5(6): 276-279.
7. Chughtai M, Piuzzi NS, Khlopas A, et al. An evidence-based guide to the treatment of osteonecrosis of the femoral head. Bone Joint J, 2017, 99-B(10): 1267-1279.
8. Li J, Wang J, Zhao J, et al. BOLD-MRI early detect femoral head osteonecrosis following steroid-treated patients. Medicine (Baltimore), 2017, 96(44): e8401.
9. Zhao D, Xie H, Xu Y, et al. Management of osteonecrosis of the femoral head with pedicled iliac bone flap transfer: A multicenter study of 2190 patients. Microsurgery, 2017, 37(8): 896-901.
10. Song Y, Du ZW, Yang QW, et al. Association of genes variants in RANKL/RANK/OPG signaling pathway with the development of osteonecrosis of the femoral head in Chinese Population. Int J Med Sci, 2017, 14(7): 690-697.
11. Wang J, Shi X, Yang H, et al. Association between alcohol-induced osteonecrosis of femoral head and risk variants of MMPS in Han population based on a case-control study. Oncotarget, 2017, 8(38): 64490-64498.
12. Lin Z, Lin Y. Identification of potential crucial genes associated with steroid-induced necrosis of femoral head based on gene expression profile. Gene, 2017, 627: 322-326.
13. Yu T, Xie L, Zhang Z, et al. Prediction of osteonecrosis collapse of the femoral head based on the proportion of the proximal sclerotic rim. Int Orthop, 2015, 39(6): 1045-1050.
14. Sonoda K, Motomura G, Kawanami S, et al. Degeneration of articular cartilage in osteonecrosis of the femoral head begins at the necrotic region after collapse: a preliminary study using T1 rho MRI. Skeletal Radiol, 2017, 46(4): 463-467.
15. Ma JX, He WW, Zhao J, et al. Bone microarchitecture and biomechanics of the necrotic femoral head. Sci Rep, 2017, 7(1): 13345.
16. Wang C, Wang X, Xu XL, et al. Bone microstructure and regional distribution of osteoblast and osteoclast activity in the osteonecrotic femoral head. PLoS One, 2014, 9(5): e96361.
17. Wang C, Wang Y, Meng H, et al. Microstructure and nanomechanical properties of single trabecular bone in different regions of osteonecrosis of the femoral head. J Nanosci Nanotechnol, 2016, 16(3): 2264-2269.

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Microarchitecture features and pathology of necrotic region in patients with steroid-induced and alcohol-induced osteonecrosis of femoral head

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