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Musculoskeletal complications following COVID-19 infection or because of its medications had been reported in the literature. Here, we report on seven hips in four patients who presented with osteonecrosis of the femoral head (ONFH) after having COVID-19 infection, and their treatment regimen included glucocorticoid. Four patients presented to us complaining of hip pain (bilateral in three patients and unilateral in one), all reported being diagnosed as having COVID-19 infection, and their line of management included corticosteroid intake for various durations. The diagnosis was confirmed by plain hip radiographs and magnetic resonance imaging. The disease was in the early stages in all patients without femoral head collapse. Thus, all hips were treated by core decompression. ONFH is a real concern in patients who have COVID-19 infection, especially when corticosteroids are administered as part of their management. A follow-up and screening strategy should be established for patients who had COVID-19 infection to detect the early development of hip osteonecrosis.

We report two cases of Kienböck's disease associated with systemic lupus erythematosus SLE. The characteristics of these cases associated with SLE differed from those previously reported for Kienböck's disease. Corticosteroid may be a cause of Kienböck's disease in SLE.

The purpose of the study was to compare angiogenic response of isolated saphenous and epigastric arteriovenous bundles in avascular environment, in an in-vivo model. Saphenous and epigastric bundles of 20 rats were dissected and ligated distally. The bundles were implanted into silicone tubing to create a biologically neutral environment. Gross and histologic examination was performed at different intervals. No thrombus was detected in any of bundles prior to 24 hours. An adherent thrombus was seen at 24 hours in all ligated saphenous bundles; it persisted at three weeks with no evidence of neovascular sprouting. The ligated epigastric bundles remained patent with evidence of neovascular sprouting. The saphenous vessels are more likely to thrombose and do not show vascular proliferation when placed in an isolated environment, whereas the epigastric vessels are likely to remain patent and show vascular proliferation.

This case report details the osteonecrosis of the interphalangeal (IP) joint of the thumb two months after a rattlesnake bite. It describes the clinical presentation, imaging studies, histological review, pathology review, and review of literature. Our patient was a fifty-one year-old male who obtained a poisonous snakebite to the thumb. While in the hospital for acute treatment, a blood blister was debrided. He was seen two weeks after discharge for further debridement of epidermolysis. Patient presented one month later with a hand x-ray demonstrating bony erosions, and a bone scan showing active changes in the IP joint of his right thumb. He was taken to the OR for further debridement and definitive diagnosis. Pathology results confirmed osteonecrosis with negative bone cultures. The clinical presentation, diagnosis, and operative management of osteonecrosis offer a unique challenge, especially in a patient presenting with osteonecrosis from a poisonous snakebite.

Kümmell's disease is defined as delayed post-traumatic vertebral collapse, common in osteoporotic people with/without a trauma history. Its clinical course is progressive, and treatment modalities have to be tailored to the patient. In the literature, no staging system has been reported. Based on clinical symptomatology, radiographic and MRI imaging, a staging system for Kümmell's disease was developed. This study involved 129 Kümmell's disease patients with 348 compression fractures involving 136 vertebrae. The mean age was 72.5 ± 6.6 years, with a female to male ratio of 103 to 26. Osteoporosis is a common risk factor. Minor trauma can be traced in some of the patients. A three-stage system was proposed. Stage I: Intact or minor compression on plain X-ray films with signs of osteonecrosis on the MRI. Stage II: Body collapse with dynamic mobility, but with intact posterior body wall. Stage III: Collapse of posterior body wall with resultant cord compression. There were 19, 90 and 33 vertebrae respectively classified in Stages I, II and III. Kümmell's disease is most common threat to the thoracolumbar junction. Treatments based on clinical symptomatology and radiographic findings were well correlated with the staging system. The present staging system therefore seems appropriate to describe the natural course of Kümmell's disease and to guide management policy.

Tetracyclines are reported to be able to protect many organs from ischemic injury. The objective of current study was to investigate the preventive effect of tetracycline on bone ischemic injury induced by Lipopolysaccharide (LPS) in rabbit. Through a LPS induced Shwartzman reaction, the osteonecrosis (ON) animal model without use of tetracycline was produced. Tetracycline was given daily for 10 days by gavage 24 hours before the ON animal model was produced in tetracycline-preventive animals. Vital fluorescent bone stains were given to the animals 5 weeks (calcein green) post-operatively. Before both humeral and femoral specimens were retrieved at 8 weeks post-operatively, the decalcified specimens were prepared and stained with hematoxylin and eosin or Hoechst dye; the presence of microcirculatory disturbance were also examined by macrography, vital fluorescent bone stains; thrombosis was examined by histopathology and scanning electron microscope. The incidence of ON (5/20), bone necrosis index (17.21 ± 20.15%), ischemic area (0), vasculitis or thrombosis (4/20~6/20), and vascular endothelium damage (6/20) of tetracycline-preventive group were significantly lower than that of ON animal model group (12/16, 51.71±11.62%, 9/16~12/16, 13/16~14/16, 14/16 respectively). Therefore, preventive use of tetracycline could protect bone tissue from LPS induced ischemic injury and might be a new option in the management of LPS induced ON.

Osteoarthritis (OA) results from aging joints, injury, and obesity, emerging as an epidemic joint disease in addition to being a significant cause of pain disability. Despite decades of efforts from scientists and physicians, the trend of the global increase in the incidence of OA does not slow down. As there are no effective pharmacotherapies able to reverse the degenerative process, cell-based and biological therapies for OA were invented and developed into a thriving field of regenerative medicine for orthopedics. First, autologous chondrocyte implantation (ACI) has been used to treat osteoarticular defects for over two decades. While ACI has demonstrated its capability to decelerate OA progression, there are still many issues that hamper its therapeutic efficacy. Therefore, researchers and physicians invented innovative biomaterials-assisted cell therapies, advanced surgical techniques for preserving primary chondrocytes’ biological function and avoiding the donor-site mortality. Later, the discovery of mesenchymal stem cells (MSCs) revoluted cell therapies for cartilage repair. MSCs not only provide an alternative cell source with much higher proliferation rates but also have these advantages: no donor-site mortality, non-tumorigenic, and, most importantly, the capability of chondrogenic differentiation. This review paper explores the challenges associated with OA treatments using cell-based therapies and shares our vision for the future development of regenerative medicine for cartilage.

Purpose: The appropriate surgical procedure for Stage 3 osteonecrosis of the femoral head (ONFH) remains controversial. This study aimed to evaluate and compare postoperative quality of life (QOL) in patients who underwent total hip arthroplasty (THA) and bipolar hemiarthroplasty (BHA) for ONFH based on comprehensive and disease-specific scales using patient-directed questionnaires.

Methods: We included 54 of 66 patients who underwent artificial joint replacement for ONFH more than 1 year ago at our hospital between April 2013 and September 2020. THA was performed for ONFH Stage 4 and BHA for Stage 3 or below. The mean postoperative observation period in the THA and BHA groups was 3.9 and 3.7 years, respectively. The Short-Form 6-Dimension measure was used to calculate utility values.

Results: No significant differences in questionnaire results regarding disease-specific or comprehensive measures were observed after arthroplasty for ONFH between the THA and BHA groups. The utility values were 0.60 and 0.58 in the THA and BHA groups, respectively.

Conclusion: The postoperative QOL was similar between patients who underwent THA for Stage 4 ONFH and BHA for Stage 3 ONFH. Therefore, THA or BHA can be performed on patients with ONFH after considering age, stage classification, and previous medical conditions.

The purpose of this study was to demonstrate the accuracy of a novel, surgically useful guide that could place a drill or pin within the femoral head. The radiolucent guide for attachment to the lateral femoral cortex was tested for reproducibility on cadaveric specimens simulating a surgical procedure. The guide allows selection of the three-degree freedom angle of insertion of a drill or pin via two circular channels allowing anterior–posterior or superior–inferior adjustment. The guide can accurately place a pin tip within 2.5–3.8 mm of a desired location. We conclude this guide could be used to accurately place a fibular graft in an osteonecrotic lesion, or place pins or nails during many different surgical procedures such as fractures or slipped capital femoral epiphysis.

Thermal osteonecrosis of bone in drilling procedure is caused by improper parameters which can lead to poor bone-implant integration and loss of fixation. In this study, Taguchi technique for parameter optimization and multiple regression models for temperature prediction were employed. The main aim of the study was to determine the optimal parameters of bone drilling to control the temperature rise below the thermal osteonecrosis threshold (47${}^{\circ }$C) in respect of the bone density variations at different drilling directions. A 3² full factorial design with nine sets of parameters was used in the study. Drilling operations were performed along the longitudinal, radial and circumferential directions at the proximal-diaphysis, mid-diaphysis and distal-diaphysis regions of the 10 adult cadaveric femurs with different feed rates (40, 60 and 80mm/min) and spindle speeds (500, 1000 and 1500rpm) using 3.2mm diameter surgical drill bit. The in-situ drilling temperatures were measured with T-type thermocouple. The optimum drilling parameters for each drilling direction were determined from signal to noise ratios and the effect of each parameter was determined using analysis of variance. By using computed tomography scan data of patients, the proposed method is able to predict the temperature rise at the bone-drilling sites, optimal parameters and possibility for the occurrence of thermal osteonecrosis. This important tool could assist in reducing localized temperature induced from surgical drilling by up to 32% and 18${}^{\circ }$C and as such significantly reduce associated osteonecrosis and improve patient outcome and quality of life.

For the treatment of humeral fractures, numerous strategies exist to improve the clinical outcome of the reconstruction and to reduce the incidence of fixation failure. Injection of acrylic-based cements to reinforce the bone and/or augment the screws is one option. The heat generated during cement polymerization raises some concerns, as it could cause tissue damage. The first aim of this study was to measure the temperature over time during polymerization when acrylic cements are delivered inside the bone to treat fracture. The second aim was to assess if the ISO-5833:2002 standard can predict what happens in a real bone. Different tests were performed using two acrylic-based cements (Mendec and Cal-Cemex): (i) the ISO-5833:2002 standard (Annex C); (ii) tests on human bones (humeral diaphysis and humeral head) injected with cement to simulate fracture treatment. In the humeri, the highest temperature was measured in the diaphysis (68.6^∘C for Mendec, 62.7^∘C for Cal-Cemex). These values are comparable with the temperature reached in other consolidated applications (vertebroplasty). Exposure to high temperature was shorter for the diaphysis than for the head. For both cements, in both the diaphysis and the head, temperatures exceeded 48^∘C for less than 10min. This is within the threshold for tissue necrosis. The ISO-5833:2002 yielded significantly different results in terms of maximum temperature (difference exceeding 15^∘C) and exposure to temperature above 48^∘C and 45^∘C. This discrepancy is probably due to a combination of factors affecting the amount of heat produced and dissipated (e.g., amount and shape of the cement, thermal conductivity).

Scaphoid lunate advanced collapse (SLAC) is the most frequently encountered cause of wrist osteoarthritis. Proximal row carpectomy (PRC) and four-orner arthrodesis (4CA) are the two main surgical options to address it. Three three-corner arthrodesis (3CA) was introduced in 1997 as an alternative to PRC and 4CA. It is a motion preserving midcarpal arthrodesis easier to perform than 4CA, for which the literature has documented satisfactory outcomes and low complication rates. We report a case of a SLAC wrist treated with 3CA complicated by postoperative osteonecrosis of the lunate. To our knowledge, this complication has not been previously reported. Our patient developed osteonecrosis of the lunate 1 year after 3CA despite a good consolidation of the arthrodesis. In this case study, we discuss reasons this may have occurred, the aetiology of which is likely multifactorial. We are reporting this case to inform surgeons of this potential complication after 3CA.

Level of Evidence: Level V (Therapeutic)

Osteonecrosis affecting the carpal bones is rare and is mostly seen in the lunate (Kienböck’s disease). Osteonecrosis of the scaphoid (Preiser disease) is even rarer. There are only four individual case reports published on patients presenting with trapezium necrosis, none with previous history of corticosteroid injection. This case report is the first presentation of isolated trapezial necrosis in the setting of prior corticosteroid injection for thumb basilar arthritis.

Level of Evidence: Level V (Therapeutic)