Analysis of incidence and clinical characteristics of osteonecrosis of femoral head in patients with systemic lupus erythematosus treated with glucocorticoid: A descriptive study based on a prospective cohort / 中国修复重建外科杂志

OBJECTIVE@#To describe the disease characteristics of osteonecrosis of the femoral head (ONFH) in patients with systemic lupus erythematosus (SLE) who experiencing prolonged glucocorticoid (GC) exposure.@*METHODS@#Between January 2016 and June 2019, 449 SLE patients meeting the criteria were recruited from multiple centers. Hip MRI examinations were performed during screening and regular follow-up to determine the occurrence of ONFH. The cohort was divided into ONFH and non-ONFH groups, and the differences in demographic baseline characteristics, general clinical characteristics, GC medication information, combined medication, and hip clinical features were compared and comprehensively described.@*RESULTS@#The age at SLE diagnosis was 29.8 (23.2, 40.9) years, with 93.1% (418 cases) being female. The duration of GC exposure was 5.3 (2.0, 10.5) years, and the cumulative incidence of SLE-ONFH was 9.1%. Significant differences ( P<0.05) between ONFH and non-ONFH groups were observed in the following clinical characteristics: ① Demographic baseline characteristics: ONFH group had a higher proportion of patients with body mass index (BMI)<20 kg/m 2 compared to non-ONFH group. ② General clinical characteristics: ONFH group showed a higher proportion of patients with cutaneous and renal manifestations, positive antiphospholipid antibodies (aPLs) and anticardiolipin antibodies, severe SLE patients [baseline SLE Disease Activity Index 2000 (SLEDAI-2K) score ≥15], and secondary hypertension. Fasting blood glucose in ONFH group was also higher. ③ GC medication information: ONFH group had higher initial intravenous GC exposure rates, duration, cumulative doses, higher cumulative GC doses in the first month and the first 3 months, higher average daily doses in the first 3 months, and higher proportions of average daily doses ≥15.0 mg/d and ≥30.0 mg/d, as well as higher full-course average daily doses and proportion of full-course daily doses ≥30.0 mg/d compared to non-ONFH group. ④ Combined medications: ONFH group had a significantly higher rate of antiplatelet drug use than non-ONFH group. ⑤ Hip clinical features: ONFH group had a higher proportion of hip discomfort or pain and a higher incidence of hip joint effusion before MRI screening than non-ONFH group.@*CONCLUSION@#The incidence of ONFH after GC exposure in China's SLE population remains high (9.1%), with short-term (first 3 months), medium-to-high dose (average daily dose ≥15 mg/d) GC being closely associated with ONFH. Severe SLE, low BMI, certain clinical phenotypes, positive aPLs, and secondary hypertension may also be related to ONFH.

Clinical study on new risk assessment and prediction system for early osteonecrosis of the femoral head / 中国骨伤

OBJECTIVE@#To establish a risk assessment and prediction system for early osteonecrosis of the femoral head (ONFH) in order to predict the collapse risk.@*METHODS@#The risk assessment system for early necrosis and collapse of femoral head was established based on the combination of Steinberg stage, ABC typing and the proportion of the proximal sclerotic rim. Firstly, Steinberg stage system was applied. ABC typing was applied to predict risk in stage I, type C was risk free, type B was low risk, type A and type BC were medium risk, type A-C and type AB were high risk. The classification of proximal sclerotic rim was first applied when the Steinberg stage was Ⅱ-Ⅲ, and type 2 was expected to be low risk. If the classification of proximal sclerotic rimwas type 1, then the ABC typing was applied, type C was risk-free, type B was low risk, type A and type BC were medium risk, type A-C and type AB were high risk. According to this prediction system, the collapse risk of femoral head in 188 cases(301 hips) were predicted by retrospective analysis. All the hips were enrolled at the out-patient department of orthopedic in Guang'anmen Hospital attached to China Academy of Chinese Medical Science. The consistency of the prediction results of three doctors and one doctor at different times were evaluated.@*RESULTS@#Among them, 136 cases were male, 52 were female. 75 cases were single hip, 113 were double hip. The age of the patients wa 19 to 64(42.61±12.07) years. The natural course of disease was 0.33 to 5.00(3.62±1.93) years. 206 hips in 301 hips had collapsed, with a collapse rate of 68.44%. In the risk-free group, none hip had collapsed, with a collapse rate of 0%. In the low-risk group, 9 hip in 91 hips had collapsed, with a collapse rate of 9.89%. In the medium-risk group, 12 hip in 19 hips had collapsed, with a collapse rate of 63.16%. And in the high risk group, 185 hips in 190 hips had collapsed, with a collapse rate of 97.37%. They were significantly differences in their collapse rate (@*CONCLUSION@#The risk assessment and prediction system for early ONFH selects different methods to predict the risk of collapse according to the imaging characteristics of different stages, which is combines with the comprehensive assessment of multiple risk factors. The system is applicable to a wide range, simple operation and convenient for clinical application.

Epidemiología, resultados clínicos y tasa de éxito en cirugía preservadora de cadera en la necrosis avascular de cabeza femoral / Epidemiology, clinical results and success rate in hip preservation surgery in avascular osteonecrosis of the femoral head

Resumen: Introducción: La necrosis avascular de cabeza femoral (NACF) es una patología frecuente que en sus inicios es asintomática y se manifiesta de forma insidiosa, por lo que a menudo el diagnóstico se realiza en estadios avanzados, donde la única solución eficaz es la artroplastía total de cadera (ATC). El diagnóstico en fases precoces permitirá utilizar opciones terapéuticas que eviten o retrasen la ATC. Nuestro objetivo es valorar los resultados demográficos, clínicos y la tasa de éxito en nuestro centro de pacientes con diagnóstico de NACF y que han sido subsidiarios de cirugía de preservación de cadera. Material y métodos: Estudio clínico unicéntrico, prospectivo, no controlado de pacientes con diagnóstico de NACF entre Enero de 2012 y Septiembre de 2017 con un estadio Steinberg ≤ IIIA. La técnica quirúrgica utilizada es el forage descompresivo, asociado a relleno con aloinjerto y aspirado de médula ósea. Resultados: Se intervinieron 26 caderas con nuestra técnica quirúrgica. La tasa de éxito obtenida es de 61.54%, ya que 10 casos han precisado ATC durante el estudio (38.46%). Conclusión: El éxito terapéutico en la NACF está directamente relacionado con el grado de la enfermedad, por lo que es importante el diagnóstico precoz. El forage descompresivo con relleno de aloinjerto que asocia aspirado de médula ósea es una opción a tener en cuenta, ya que en estadios iniciales muestra una elevada tasa de éxito.

Abstract: Introduction: Avascular osteonecrosis of the femoral head (ONFH) is a frequent pathology with an insidious and asymptomatic presentation in early stages, so the diagnosis is often made in advanced stages, where the only effective solution is total hip arthroplasty (THA). Diagnosis in early stages will allow the use of therapeutic options that avoid or delay ATC. Our objective is to evaluate the demographic, clinical results and the success rate in our center of patients diagnosed with ONFH and who have been subsidiary of hip preservation surgery. Material and methods: Unicentric, prospective, uncontrolled clinical study of patients diagnosed with ONFH between January 2012 and September 2017 with a Steinberg ≤ IIIA stage. The surgical technique used is decompressive forage, associated with bone allograft and bone marrow aspiration. Results: 26 hips were operated on with our surgical technique. The success rate obtained is 61.54%, since 10 cases have required THA during the study (38.46%). Conclusions: The therapeutic success in ONFH is directly related to the degree of the disease, which is why early diagnosis is important. The decompressive forage with bone allograft that associates bone marrow aspiration is an option to be taken into account, since in early stages it shows a high success rate.

Fracture neck of femur; avascular necrosis with cannulated screws

Fracture neck of femur is a devastating injury. One of its main complications is avascular necrosis [AVN] of the femoral head. For the fixation of femoral neck fractures, cannulated screws are now universally used. The aim of the study was to determine the frequency of avascular necrosis in fracture neck of femur fixed with cannulated screws. Descriptive cross sectional study. Orthopedic unit of Ayub Teaching Hospital Abbottabad. 7[th] March, 2011 to 6[th] September, 2011. Recruiting 113 patients of either gender between 15 to 60 years of age with fracture neck of femur who were fixed with cannulated screws. The data was entered and analyzed with the help of SPSS 10. There were 113 patients with an overall mean age of 43.51 years +/- 11.94SD. Maximum number of patients was 56 [49.50%] from the age group of 46 to 60 years. Avascular necrosis was noted in 23 [20.35%] cases. The maximum number of patients with avascular necrosis was 13 [56.52%] belonging to the age group of 15 to 25. Avascular necrosis was high in younger ages in displaced fractures of neck of femur treated with cannulated screws

Asymptomatic avascular osteonecrosis of the hip in new patients diagnosed as systemic lupus erythematosus in Ramathibodi Hospital.

OBJECTIVE: To determine asymptomatic avascular osteonecrosis (AVN) of the hip in new patients diagnosed as Systemic Lupus Erythematosus (SLE) in Ramathibodi Hospital. MATERIAL AND METHOD: A prospective descriptive study of new SLE patients with asymptomatic hip at the Rheumatology clinic of Ramathobodi Hospital was conducted from February 2005 to November 2005. The information of steroid and immunosuppressive drug treatment was recorded Plain film (AP and frog leg views) and MR study of both hips were analyzed. RESULTS: Twenty-two hips (II patients) were enrolled in the present study (women 100%; mean age 27.8 years; range 16-50). Four hips (2 patients, 18%) had A VN, without other abnormal imaging findigs of the hips and pelvis. Seventeen hips of nine patients hadjoint effusion; none of them had AVN. No marrow edema, secondary osteoarthritis, collapsed femoral head or pelvic insufficiency fracture in allpatients is detected. In the present study, the 2 AVN patients had longest duration of steroid treatment before MR study (105 & 99 days) and rather high cumulative dose of prednisolone or its equivalent dose (4920 & 4540 mg), compared to non-AVN patients. CONCLUSION: SLE patients without hip pain may have AVN of the hips. Joint effusion and marrow edema do not necessarily associate with early AVN, and the authors found early AVN without joint effusion. Cumulative dose and duration of steroid treatment seem to relate to AVN in the present study. However a larger number of cases, prospective clinical data, and long-term follow up will help better evaluate the prevalence of asymptomatic AVN of the hips, as well as to evaluate the benefit of MRI as a screening tool for patients at risk of AVN.

Estudo comparativo da freqüência da necrose avascular da cabeça femoral no tratamento cirúrgico da luxaçäo congênita do quadril com e sem osteotomia de encurtamento do fêmur / Comparative study of the frequency of avascular necrosis of the femoral head in surgical treatment of congenital dislocation of the hip with and without shortening of the femur

O presente estudo mostra uma avaliaçao da freqüência de necrose avascular na epífise femoral capital em pacientes de mesma faixa etária com luxuaçao congênitado quadril tratados por dois métodos cirúrgicos diferentes, durante o período de 1979 a 1993. No grupo A, com 12 pacientes (12 quadris), realizou-se reduçao cruenta e tetoplastia (Salter). Houve diferença significante da freqüência de necrose avascular no grupo A, quando comparado no grupo B.

Avascular necrosis of the femoral head in Saudi Arabians with homozygous sickle cell disease- Risk factors

Avascular necrosis of the femoral head [ANFH] in Saudi patients with homozygous sickle cell [SS] disease attending King Faisal Specialist Hospital and Research Centre [KFSH and RC] occurred in 29/118 [24.6%] patients or 32% of patients aged 10 years and above. This high prevalence was heavily influenced by symptomatic selection. Contrary to observations in patients of African origin, ANFH in Saudi subjects was not associated with high hemoglobin, low fetal hemoglobin levels or with alpha thalassemia. Bone densitometry failed to detect differences in bone mineral density or content between patients with and without ANFH. Levels of 25-OH vitamin D did not differ between patients with and without ANFH. Several patients showed very rapid and complete destruction of the femoral head suggestive of osteomyelitis of the femoral head or a pyogenic arthritis. ANFH appears common in Saudi patients with SS disease although an accurate prevalence is unknown. The lack of relationship with risk factors for ANFH identified in African SS disease highlights the need for further study in the Saudi SS population

La necrosis avascular de la epifisis femoral en el tratamiento quirurgico de la luzacion congenita de cadera / Avascular necrosis of the femoral epiphysis in the surgical treatment of the congenital hip dislocation

Se estudia retrospectivamente la evolucion clinica y rasiologica de 220 caderas en 170 pacientes, con luzacion congenita de cadera (LCC), durante los anos de 1978 a 1982, tratados mediante reduccion abierta, por via anterior o pos via interna, complementada o no con acetabuloplastia, osteotomia femoral o ambos. Se utilizaron los criterios de Salter y Kostuik para el diagnostico de la necrosis avascular (N.A.); y las valoraciones funcionales de McKay y radiologicas de Severin para los resultados finales. Se relaciono el estado previo del nucleo cefalico con la altura de la luxacion, el tipo de necrosis desarrollado y el procedimiento empleado. Encontramos una incidencia global del 17.7%de necrosis avasculares, siendo el 78.1%de estas, necrosis isquemicas mediales transitorias o necrosis avasculares del tipo I de Kalamchi cuyos resultados finales tanto clinicos como radiologicos fueron satisfactorios.