Clin Orthop Surg.  2010 Dec;2(4):250-255. 10.4055/cios.2010.2.4.250.

Apoptosis in the Osteonecrosis of the Femoral Head

• Youm YS
• Lee SY
• Lee SH

• KMID: 1719327
• DOI: http://doi.org/10.4055/cios.2010.2.4.250

Abstract

BACKGROUND
Osteonecrosis of the femoral head is classified into idiopathic and secondary forms. A number of etiological factors in the development of osteonecrosis have been suggested but the biological mechanisms are still unclear. Recently, some reports suggested that the apoptosis is closely related to osteonecrosis of the femoral head. Therefore, this study examined the expression of apoptosis in osteonecrosis of the femoral head.
METHODS
Of the patients diagnosed preoperatively with osteonecrosis and underwent total hip replacement arthroplasty between August 2004 and July 2005, 58 patients (58 hips) were available for this study. Their diagnoses were confirmed by the postoperative pathology findings. Tissue samples of the femoral head sections were terminal deoxynucleotydyl transferase mediated dUTP nick-end labeling (TUNEL) stained using an in situ cell death detection POD kit. The number of total and TUNEL-positive osteocytes, and the average ratio of TUNEL-positive cells were calculated and analyzed according to the cause.
RESULTS
Osteonecrosis was steroid-induced in 8 cases (13.8%), alcohol-induced in 29 cases (50%), post-traumatic in 6 cases (10.3%) and idiopathic in 15 cases (25.9%). The percentage of TUNEL-positive osteocytes was high in patients with steroid- and alcohol-induced osteonecrosis of the femoral head but low in patients with post-traumatic and idiopathic osteonecrosis. The difference in the percentage of TUNEL-positive osteocytes between these groups was significant (p < 0.05).
CONCLUSIONS
Apoptosis might play an important role in the pathogenesis of osteonecrosis of the femoral head induced by steroid and alcohol. These findings highlight a need for further research into the role of apoptosis in the development of osteonecrosis of the femoral head.

Keyword

Osteonecrosis of the femoral head; Apoptosis

MeSH Terms

Adult
Aged
Aged, 80 and over
*Apoptosis
Female
Femur Head/*pathology
Femur Head Necrosis/etiology/*pathology/surgery
Humans
In Situ Nick-End Labeling
Male
Middle Aged

Figure

• 

  Fig. 1 After the terminal deoxynucleotydyl transferase mediated dUTP nick-end labeling (TUNEL) reaction, (A) condensed apoptotic osteocytes in cancellous bone from a femoral head removed from a patient with steroid-induced osteonecrosis show intense green fluorescence (× 400). (B) In a patient with alcohol-induced osteonecrosis, intermediate fluorescence is shown (× 100). Non-apoptotic cells are not visible using immunofluorescence microscopy. (C) In a patient with idiopathic osteonecrosis, no fluorescence is shown (× 100).

• 

  Fig. 2 Optical microscopy shows (A) extensive apoptosis in femoral head osteocytes from a patient with steroid-induced osteonecrosis, (B) absence of apoptotic osteocytes in a patient with idiopathic osteonecrosis and (C) moderate apoptotic osteocytes in a patient with alcohol-induced osteonecrosis. The apoptotic osteocytes were stained brown with diaminobenzidine substrates, whereas non-apoptotic osteocytes are stained blue with hematoxylin (× 400).

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