Avascular Necrosis

Kienbock's disease, a condition involving ischemic necrosis of the lunate bone, has several surgical treatments depending on the disease stage and anatomical risk factors. This research focuses on stages II and III of the disease. Various surgeries aim to unload the lunate bone, restore its blood supply, or replace damaged parts, with most options working to maintain wrist structure, prevent disease progression, and reduce pain. This study evaluates the use of 3D printing models and personalized guides to plan different types of radial osteotomies tailored to patients' anatomical features. These osteotomies include radial shortening, closed wedge, and dorsolateral biplane closing osteotomies, chosen based on factors like cubitus minus and radial inclination angle. The procedures involve osteosynthesis with a plate on the distal radius to decompress and protect the lunate bone. Participants will undergo clinical and radiological evaluations before and after surgery, including assessments of wrist function, pain, grip strength, and range of motion. Radiographic measurements such as Lichtman classification, carpal height ratio, and various wrist angles will be monitored over 22 months. These evaluations aim to track changes related to the surgical planning aided by 3D models, with ongoing follow-up to assess outcomes and recovery.

Heart disease is the leading cause of death worldwide, contributing to 16% of global fatalities and imposing a significant economic burden, especially as the population ages. Some patients with heart disease experience symptoms not relieved by medications and require coronary artery bypass graft (CABG) surgery. Although CABG can improve chest pain and has life-prolonging potential, it may increase inflammation and is often accompanied by high levels of anxiety and depression around the time of surgery, which can affect health outcomes and quality of life. This trial is a randomized controlled feasibility study comparing a brief, two-session telehealth Acceptance and Commitment Therapy (ACT) intervention to treatment as usual for patients undergoing CABG surgery. The ACT intervention focuses on psychological flexibility through core processes such as being present, opening up, and doing what matters, and includes workbooks and mindfulness audio exercises. The control group receives usual preoperative care, including appointments with surgeons and nurse practitioners and educational workbooks about hospital orientation and lifestyle factors. Participants will be assessed on measures of anxiety, depression, psychological flexibility, well-being, cardiovascular health-related quality of life, and inflammation markers before surgery and at 8 weeks after. Researchers will monitor feasibility factors like participant satisfaction, adherence, enrollment, intervention delivery, and retention. The study aims to evaluate both the feasibility and preliminary effects of ACT during the perioperative period for CABG patients, helping guide future larger trials.

Researchers are evaluating the use of oral alendronate in adults who have sickle cell disease (SCD) along with osteonecrosis of the hip and/or shoulder. This phase 2, single-arm, open-label study aims to assess the safety, tolerability, and preliminary effectiveness of alendronate over a 6-month period. The study also investigates changes in bone health markers and quality of life related to pain in this population. Participants will receive oral alendronate 70 mg once a week for 24 weeks (6 months). This study involves one treatment group where all enrolled adults with SCD and osteonecrosis receive the study drug. Bone biomarkers will be collected from blood and urine samples at baseline, 3 months, and 6 months to monitor biological changes. During the study, participants will be monitored for recruitment and retention rates, treatment-emergent adverse events, and changes in pain impact using the Adult Sickle Cell Quality of Life Measurement System (ASCQ-Me) questionnaire, assessed up to 28 weeks. The trial includes safety checks and collection of laboratory data at specific time points, with a goal to complete data analysis by May 2026. The total study duration for participants is approximately 6 months.

Osteonecrosis of the femoral head (ONFH) is a painful condition where bone cells in the hip die, leading to the collapse of the femoral head and potentially arthritis. This condition often affects younger adults in their 20s and 30s, and joint-preserving treatments are important to delay or avoid joint replacement surgery. This study aims to compare core decompression surgery alone with core decompression combined with autologous bone marrow aspirate concentrate (BMAC) to see which method leads to better clinical and imaging results in early-stage ONFH. Participants will be randomly assigned to one of two groups: one receiving core decompression alone with a sham bone marrow aspiration, and the other receiving core decompression plus concentrated bone marrow aspirate injected into the hip bone. The bone marrow sample will be analyzed to understand the cells and biological pathways involved. Both procedures follow a standardized protocol to ensure consistency across participants. Throughout the study, participants will be monitored with routine surgical follow-ups and assessments including radiographs, MRIs, and questionnaires at multiple time points up to 24 months. Key outcomes measured include radiological progression of ONFH, pain levels using the Pain Visual Analog Scale, and time until treatment failure. Additional assessments of symptoms, function, quality of life, and mental and physical health will be collected at baseline, 6, 12, and 24 months. This study will help understand which treatment better preserves the hip joint in early ONFH cases.

Researchers are studying the pain-relief effects of liposomal bupivacaine plus bupivacaine compared to ropivacaine for Pericapsular Nerve Group (PENG) block in patients undergoing hip replacement surgery. The trial aims to determine if liposomal bupivacaine plus bupivacaine provides better pain control, longer duration of relief, reduced opioid use, and higher patient satisfaction while monitoring safety. This is a randomized, double-blind, active-controlled Phase 4 study sponsored by Huazhong University of Science and Technology. Participants receive either liposomal bupivacaine plus bupivacaine or ropivacaine as a local anesthetic for the PENG block under ultrasound guidance. All undergo hip replacement surgery under spinal anesthesia. The study compares analgesic efficacy, pain relief duration, opioid consumption, and safety profiles between the two interventions within 72 hours after surgery. During the trial, pain intensity, opioid use, and complications are assessed multiple times within 72 hours following surgery. Researchers also track time to first rescue analgesic, incidence of complications or adverse events up to 90 days post-surgery, and the duration of hospital stay for about one year. The main outcome measured is overall opioid consumption within 72 hours after surgery, with safety and patient satisfaction also evaluated throughout the study period.

Camptodactyly-Arthropathy-Coxa Vara-Pericarditis (CACP) syndrome is a rare inherited disorder caused by mutations in the PRG4 gene. It is characterized by the combination of camptodactyly (bent fingers or toes), joint problems without inflammation, and deformity of the hip bone, sometimes also involving heart and lung issues. The syndrome shows variable symptoms and may be underdiagnosed due to its rarity and resemblance to juvenile arthritis. This European multicenter study aims to collect detailed clinical, genetic, and therapeutic data to better understand the disease's characteristics and progression in children diagnosed with CACP syndrome. Participants are children diagnosed with CACP syndrome confirmed by genetic testing who were diagnosed between 2005 and early 2026. The study involves regular clinical visits approximately every six months to monitor symptoms, joint function, and possible complications like pericarditis. Imaging and lab tests are done every 1 to 2 years or as needed. No specific drug treatment is available, and the study focuses on observing the disease course, treatment approaches, and genotype-phenotype relationships over a 10-year period. Throughout the study, researchers will collect epidemiological and clinical information, including disease incidence, geographic and ethnic distribution, symptom progression, and treatment outcomes. Patient disability, pain levels, and well-being will be tracked using questionnaires. The study will also document any misdiagnoses before confirmation of CACP. Monitoring adverse events related to treatments used will be included. This long-term observation will help improve understanding and management of CACP syndrome in affected children.

Researchers are investigating the effects of a categorized physical therapy program on people with non-arthritic hip and groin pain. This study addresses a gap in current research, which has mostly focused on osteoarthritis of the hip, by exploring how a standardized physical therapy approach can help those without arthritis-related hip problems. The trial is randomized and aims to better understand treatment options for hip and groin pain. Participants will be assigned to one of two groups: one receiving standard-of-care physical therapy, and the other receiving matrix-based physical therapy in addition to the standard care. Matrix-based therapy involves tailoring stretches and strengthening exercises based on the patient's hip mobility and strength. Both approaches will be monitored over the course of the study. Throughout the study, participants will be evaluated using the International Hip Outcome Tool-12 (iHOT-12) for up to 6 months to measure hip function and health. Pain levels will be assessed with a numerical rating scale, and adherence to home exercise programs will be tracked. The study includes double-masked procedures to reduce bias and will provide detailed monitoring of participants' progress and response to therapy.

Researchers are observing clinical and radiological outcomes of the Medacta Shoulder System in patients with various shoulder conditions including primary and secondary osteoarthritis, rotator cuff tear arthropathy, rheumatoid arthritis, avascular necrosis, fractures, and revision of shoulder arthroplasty. This post-marketing surveillance study evaluates how well the system performs over time in real-world settings. The study involves monitoring patients who have received the Medacta Shoulder System implant. Outcomes assessed include implant survival rate up to 10 years, clinical and functional shoulder scores at 1, 2, 5, and 10 years, radiographic evaluations for implant positioning and signs of loosening, patient quality of life, and any adverse events related to the implant. Participants will be followed for up to 10 years with scheduled assessments including clinical exams, shoulder function scoring, imaging studies, and patient questionnaires. Researchers will track the implant's durability and patient health over time to understand long-term outcomes and safety. The total participation period can last a decade to capture comprehensive data.

Researchers are evaluating the use of tissue-engineered bone made from commercial decalcified bone scaffolds combined with a patient's own bone marrow mesenchymal stem cells to treat early non-traumatic avascular necrosis of the femoral head. This condition progresses quickly, often leading to femoral head collapse within 1 to 4 years. Early intervention aims to preserve the femoral head and improve outcomes compared to current treatments like core decompression and bone grafting, which have limitations including donor site damage and limited biological activity. The study uses tissue engineering to create a composite of seed cells, growth factors, and scaffold materials that are transplanted to the bone defect site. This method provides structural support and promotes bone and blood vessel regeneration. The intervention involves using tissue-engineered bone with autologous bone marrow mesenchymal stem cells for femoral head repair. The treatment is applied during surgery, and the study will monitor its effects over time to assess clinical benefits and safety. Participants will be assessed before surgery and followed up at multiple time points including 1 month, 2 months, 3 months, 6 months, and one year after the operation. Evaluations will include effectiveness measures of the tissue-engineered bone in treating femoral head necrosis and safety monitoring. The study involves clinical examinations, imaging, and other tests to track bone repair and function. The total participation duration for each patient spans at least one year after surgery to observe long-term outcomes.

Researchers are evaluating the effects of two manual therapy techniques, post-isometric relaxation (PIR) and active isolated stretch (AIS), on pain, range of motion, and functional disability in people with piriformis syndrome. This randomized controlled trial will enroll 40 participants aged 20 to 55 years with confirmed piriformis syndrome, aiming to guide clinicians toward the most effective approach for symptom relief and improved mobility. Participants will be randomly divided into two groups: Group A will receive post-isometric relaxation therapy, which involves isometric muscle contractions followed by relaxation phases, and Group B will receive active isolated stretching, involving active limb movement with therapist-applied stretches. Both groups will also receive conventional physiotherapy including thermotherapy and electrotherapy. The intervention lasts two weeks with six sessions total, scheduled three times per week. Participants will undergo assessments before treatment and after every second session, measuring pain using the Visual Analog Scale, functional disability via the Oswestry Disability Index, and range of motion with a goniometer. Data will be compared within and between groups to evaluate immediate and short-term effects of each therapy. The study includes baseline and post-intervention evaluations to track changes over the two-week period.