Steroid-induced ischemic bone necrosis of femoral head: treatment strategies

Fat hypertrophy, intravascular coagulation, and fat emboli are important risk factors of steroid-induced ischemic bone necrosis [SI-IBN] which may develop during the initial one year after commencing the use of steroids. This pathology is best studied by MRI, particularly for its staging. The cautious strategies such as low dose, oral route, short duration of steroid usage, use of steroid sparing agent, and alcohol avoidance should be followed as a traditional therapy. The objective of this review article was to recognize and evaluate various treatment strategies for steroid-induced ischemic bone necrosis of femoral head. Various electronic databases including PubMed, Google and Cochrane library were comprehensively searched for articles on steroid-induced ischemic bone necrosis of femoral head and its treatment strategies. Ninety four articles were reviewed, examined and importantly appraised and the most appropriate 32 papers were used to write this review article. Bisphosphonates, alendronate, and hyperbaric oxygen [HBO] treatments have been reported to be effective against IBN. To recommend the regular use of bisphosphonate in IBN patients, more evidences with a larger number of patients are required to verify its therapeutic effectiveness. Core decompression, osteotomy, bone graft and tantalum rod are the surgical approaches for the management of IBN. Advance form of IBN [bone tissue collapse] is advised to be treated with arthroplasty which should be durable, particularly in young patients

Histomorphometric assessment of bone necrosis produced by two cryosurgery protocols using liquid nitrogen: an experimental study on rat femurs

OBJECTIVE: The aim of this study was to evaluate the effects of liquid nitrogen cryosurgery on the femoral diaphysis of rats. MATERIAL AND METHODS: The femoral diaphyses of 42 Wistar rats were exposed to three local and sequential applications of liquid nitrogen for 1 or 2 min, intercalated with periods of 5 min of passive thawing. The animals were sacrificed after 1, 2, 4 and 12 weeks and the specimens obtained were processed and analyzed histomorphometrically. RESULTS: The depth and extent of peak bone necrosis were 124.509 µm and 2087.094 µm for the 1-min protocol, respectively, and 436.424 µm and 12046.426 µm for the 2-min protocol. Peak necrosis was observed in the second experimental week with both cryotherapy protocols. CONCLUSIONS: The present results indicate that the 2-min protocol produced more marked bone necrosis than the 1-min protocol. Although our results cannot be entirely extrapolated to clinical practice, they contribute to the understanding of the behavior of bone tissue submitted to different cycles of liquid nitrogen freezing and may serve as a basis for new studies.

Necrosis avascular de cabeza y cuello de fémur en un paciente con sida / Avascular osteonecrosis of femoral head and neck in an AIDS patient

Avascular osteonecrosis (AON) has increased in the last few years in patients infected with the human immunodeficiency virus type-1 (HIV-1). The most commonly affected bone is the femoral head and neck. Frequently these bilateral and clinical findings include moderate to severe pain and functional impotence of the affected joints. The etiology is multifactorial and highly active antiretroviral therapy (HAART) with protease inhibitors (PI) is probably related to its development. In the evolution, a total hip replacement may be needed. We present an hemophilic patient with AIDS, who developed a bilateral AON of the femoral head and neck during HAART.

La osteonecrosis avascular (ONA) es una complicación que se describe con frecuencia creciente en pacientes infectados por el virus de la inmunodeficiencia humana tipo-1 (HIV-1). En su localización más común compromete la cabeza y cuello del fémur con dolor e impotencia funcional, en una o ambas caderas. Su etiología es multifactorial y la terapia antirretroviral de alta eficacia (HAART) con inhibidoresde proteasa (IP) puede estar relacionada con la patogenia. En su evolución puede requerir el reemplazo total de la cadera con la colocación de una prótesis. Se presenta un paciente hemofílico, HIV-1 seropositivo, quedesarrolló una ONA bilateral de cabeza y cuello de fémur mientras se encontraba bajo HAART.

Necrose asséptica da articulaçäo coxofemoral em pacientes com lúpus eritematoso sistêmico / Aseptic necrosis of coxofemoral joint in patients with systemic lupus erythematosus

Foram solicitadas radiografias das articulaçöes coxofemorais em 51 pacientes consecutivos com lúpus eritematoso sistêmico, visando estabelecer a prevalência de necrose asséptica da cabeça femoral nestes pacientes. As radiografias eram obtidas independentemente da presença ou näo de sintomas. A necrose asséptica foi diagnosticada em cinco pacientes (9,8 por cento), geralmente em estágio avançado (III e IV) e com acometimento multifocal. Observou-se tendência a um maior tempo de doença e uso mais prolongado de corticosteróides nestes pacientes, em comparaçäo com os pacientes sem a complicaçäo. Näo houve diferença estatística entre os dois grupos nos demais critérios avaliados