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Analysis of peripheral bone reconstruction after the failure of hip osteonecrosis treatment with porous tantalum rod implantation

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Abstract

Purpose

Failure of porous tantalum rod (PTR) implantation in treating early osteonecrosis of femoral head (ONFH) has been frequently reported, but the underlying mechanism remains uncertain, which raised the concern of its efficacy. The study aimed to discuss the underlying mechanism from the perspectives of bone reconstruction and pathological changes.

Methods

Five patients with PTR implantation experienced total hip arthroplasty (THA) due to recurrent pain, whose femoral heads were collected as “tantalum group.” Normal (fracture) and necrotic femoral heads were respectively collected (both n = 5) after THA. The bone quality and structure, biomechanical properties, and histopathological features were analyzed by micro-CT scanning, mechanical measurement, and histological examination.

Results

Both the tantalum group and necrotic group had significantly poorer bone quantity and quality than the normal group. Three-dimensional imaging reconstruction showed that the trabeculae of the tantalum group were poorest in quality. Significant differences in terms of bone quality, structure, and biomechanical properties were present between the inside and outside regions around PTR, which revealed abnormal bone reconstruction. Biomechanical analysis revealed inferior properties in the tantalum group and necrosis group. H&E staining demonstrated neutrophil infiltration among the peripheral trabeculae around PTR, and the inflammation cells were significantly more abundant than that in the normal and necrosis groups.

Conclusion

Abnormal bone reconstruction around PTR was an important cause for failure of PTR implantation in the treatment of ONFH, which was related to biomechanical stress distribution and chronic inflammation infiltration. Insufficient biomechanical support and inflammatory trabeculae edema might account for the recurrent pain.

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Acknowledgements

We sincerely thank Ms. Jing Xu for her language assistance.

Funding

This research was supported by the Scientific Research Foundation from Southern Medical University (PY2018N027).

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Authors and Affiliations

  1. Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong Province, China

    Weilu Liu, Yong Hu, Zhifa Huang, Zhanjun Shi & Jun Xiao

  2. Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Southern Medical University, Southern Medical University, Guangzhou, 510000, Guangdong Province, China

    Yong Hu

  3. Department of Joint Surgery, Liuzhou Worker’s Hospital, Liuzhou, 545000, Guangxi Province, China

    Zhifa Huang

Authors
  1. Weilu Liu
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  2. Yong Hu
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  3. Zhifa Huang
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  4. Zhanjun Shi
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  5. Jun Xiao
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Contributions

Jun Xiao contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Weilu Liu, Yong Hu, and Zhifa Huang. The first draft of the manuscript was written by Weilu Liu and Yong Hu. Zhanjun Shi made important revisions. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jun Xiao.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Southern Medical University Nanfang Hospital.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

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The authors affirm that informed consents of human research participants were not applicable for publication as individual person’s data in any form (including any individual details, images or videos) were not included in the manuscript.

Competing interests

Wei-Lu Liu receives a grant (PY2018N027) from Southern Medical University to support the current research, but there is no financial conflict to disclose. The rest authors also certify that he or she has no commercial associations that might pose a conflict of interest in connection with the submitted article.

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Weilu Liu and Yong Hu contributed equally as co-first authors.

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Liu, W., Hu, Y., Huang, Z. et al. Analysis of peripheral bone reconstruction after the failure of hip osteonecrosis treatment with porous tantalum rod implantation. International Orthopaedics (SICOT) 46, 1323–1330 (2022). https://doi.org/10.1007/s00264-022-05334-z

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  • DOI: https://doi.org/10.1007/s00264-022-05334-z

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