Dynamic Observation of Vascular Regeneration in Femoral Head Necrosis: a 5-Year Follow-Up Case Report

Case Report

Phys Med Rehabil Int. 2021; 8(4): 1191.

Dynamic Observation of Vascular Regeneration in Femoral Head Necrosis: a 5-Year Follow-Up Case Report

Zhang WX¹, Zheng C¹ and Tong PJ²*

1Department of Traditional Chinese Medicine, Zhejiang Chinese Medicine University, China

2Department of Orthopedic Surgery, Zhejiang Provincial Hospital of TCM, China

*Corresponding author: Tong PJ, Department of Orthopedic Surgery, Zhejiang Provincial Hospital of TCM, 54 Youdian Road, Hangzhou 310005, China

Received: August 24, 2021; Accepted: October 07, 2021; Published: October 14, 2021


Femoral Head Necrosis (FHN) is an invasive hip disease of skeletal system, which associated with vascular dysfunction. Therefore, vessels regeneration and follow the posterolateral direction are regarded as a potential therapy target for FHN. We report a case of FHN that was treated by successful regeneration of the internal circumflex femoral artery via targeted Lipoaspirate (LPS) infusion and biomechanical support. A 35-year-old man with FHN involved. LPS isolated from the abdominal subcutaneous fat and infuse into the internal circumflex artery approximately seven times at every 1.5 months in both femoral heads. Besides, the porous tantalum rod was grafted after the first LPS infusion on each side. After the 5-year follow-up study, the primary outcomes showed obvious improvement in the number, distribution, and diameter of blood vessels in the ischemic area. In addition, the patient was now able to perform the daily activities; the congestive area increased from 73.4% to 94.2% on the left side and from 0% to 71.8% on the right side. The Harris Hip Score improved from 22 to 91. Multiple LPS infusions via the internal circumflex femoral artery combined with porous tantalum rod grafting offers an alternative treatment option for FHN.

Keywords: Femoral head necrosis; Angiogenesis; Lipoaspirate


FHN: Femoral Head Necrosis; LPS: Lipoaspirate; HHS: Harris Hip Score; DSA: Digital Subtraction Angiography; BMSCs: Bone Marrow Mesenchymal Stem Cells


Femoral Head Necrosis (FHN) is an invasive hip disease with multiple etiologic factors, such as corticosteroid use, alcohol overdoses, suffered trauma, and hemoglobinopathy [1,2]. During the progression of femoral head necrosis, there is a critical decrease in the blood vessel density and an increase in the intraosseous pressure. Although the pathogenic process has not been identified for FHN, femoral head ischemia can lead to the necrosis of bone tissues, and the resulting collapse of the necrotic segment has been reported [3]. Much research has been devoted to improving angiogenesis and avoiding this collapse [4]. More recently, an increasing number of pre-clinical and clinical studies have reported the limited efficacy of core decompression and mechanical support therapy. Consequently, the use of core decompression and mechanical support therapy has been increasingly debated [5]. Simultaneously, stem cell therapy has been proposed as an appropriate treatment for FHN. A systematic review of pre-clinical studies reveals that the use of stem cells containing uniformly improved osteogenesis and angiogenesis. In clinical studies, the effect of stem cells treatment showed significant improvements in patient-reported outcomes. Unfortunately, hip survivorship was not affected [6].Our team has reported on a combination treatment of biomechanical support and targeted intra-arterial infusion of stem cells [7]. Patients in that previous study received only one stem cell infusion, which was too limited to investigate the progression of tissue regeneration and angiogenesis. In this study, we report a case of FHN treated by multiple infusions of Lipoaspirates (LPSs) in combination with mechanical support therapy provided by implantation of a porous tantalum rod graft.

Case Presentation


The patient was a 35-year-old male who worked as a manager and experienced idiopathic deafness in May 2000. Hip joint dysmotility onset gradually more than one year after he began glucocorticoid treatment for the deafness. Conservative therapies, such as physical treatment and medical treatment, did not provide a satisfying curative effect. The patient characterized the bilateral pain of the hips as having intensified to the extent that he could not put on socks by himself, walk for several blocks, or sit for one hour.

Clinical manifestation

The physical examination showed a Harris Hip Score (HHS) of 22. X-ray examination of the femoral head reported heterogeneity of necrotic tissue density, sclerosis, and cyst formation (Figure 1). In addition, examination of the internal circumflex femoral artery found a weakly positive artery in the right-side femoral head and no severe defects of either the superior retinacular artery or the inferior retinacular artery in the left side (Figure 2).