Distribution of TRAP‐positive cells and expression of HIF‐1α, VEGF,and FGF‐2 in the reparative reaction in patients with osteonecrosis of the femoral head

Osteogenesis and angiogenesis are closely associated with the reparative process in bone. In osteonecrosis of the femoral head (ONFH), although the progression of bone resorption by osteoclasts is considered to be followed by femoral head collapse, the reparative reaction remains unknown. In order to investigate the reparative reaction in patients with ONFH, the distribution of TRAP‐ positive cells and expression of HIF‐1α, VEGF, and FGF‐2 were observed in 51 hips in 42 patients. TRAP‐positive cells were detected around the teres insertion and retinaculum in the early radiologic stage, and increased around the new trabecular bone throughout the reparative interface zone in the late collapsed stage. HIF‐1α expression was detected at the fibrosis area and the transitional area, which included the proximal area of the reparative interface zone adjacent to the necrotic zone. VEGF was expressed at the edematous area of the reparative interface zone, while FGF‐2 was detected widely in the reparative interface zone and the normal zone. In the late radiologic stages, HIF‐1α, VEGF, and FGF‐2 were not detected in the necrotic zone, and they acted in angiogenesis in the reparative interface zone, while TRAP‐positive cells increased around the new bone formation in response to remodeling after the collapse. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27: 694–700, 2009