Outcomes for core decompression with multiple drilling of the osteonecrosis of the femoral head in patients with solid organ transplantation

Abstract

Amaç: Bu çalışmada femur başı osteonekrozu (FBO) olan solid organ transplantasyonu hastalarında çoklu drilleme ile yapılan kor dekompresyon cerrahisinin klinik ve radyolojik sonuçları araştırıldı ve bu işlemin kortikosteroid kullanım süresi ve osteonekroz evresi açısından etkililiği değerlendirildi. Hastalar ve yöntemler: Femur başı osteonekrozu için çoklu drilleme ile kor dekompresyon cerrahisi planlanan toplam 22 solid organ transplantasyonu (kalp, karaciğer veya böbrek) hastası (14 erkek, 8 kadın; ort. yaş 43.3 yıl; dağılım, 23-67 yıl) değerlendirildi. Hastaların Harris kalça skorları (HKS'leri) ve Kemik Dolaşımını Araştırma Birliği (ARCO) evrelemesi ve Kerboul evrelemesi dahil radyolojik verileri ameliyat öncesi ve sonrası kontrollerde retrospektif olarak incelendi. Bulgular: Hastalar ortalama 34.3 ay (dağılım, 12-76 ay) takip edildi. İki hastaya (%9.09) total kalça artroplastisi uygulandı. Bu iki hastada Kerboul evresi 3 idi. ARCO evrelemesi açısından ameliyat öncesinde ve sonrasındaki son kontrol arasında istatistiksel olarak anlamlı ilişki yoktu. Ameliyat öncesi ve sonrası HKS'leri arasında istatistiksel olarak anlamlı farklılık yoktu. Sonuç: Çoklu drilleme güvenli ve minimal invaziv bir cerrahi olsa da özellikle uzun süreli kortikosteroid kullanımı nedeniyle FBO'su olan solid organ transplantasyonu hastalarında etkisi sınırlıdır. Bu nedenle, solid organ transplantasyonu hastaları FBO gelişimi açısından yakından takip edilmelidir.

Chinese herbal Huo-Gu formula for the treatment of steroid-associated osteonecrosis of femoral head: A 14-year follow-up of convalescent SARS patients

“…We observed a mean HHS of 63.89 AE 10.30 in 28 patients without THA at the end of the present study. Although the data suggest that HGF therapy only yields poor results (HHS < 70), but our data are still comparable to previous relevant studies [30][31][32][33]. Alendronate is one of the most commonly used pharmacological treatments for ONFH [34].…”

Effects of osteoblast autophagy on glucocorticoid-induced femoral head necrosis

“…The pathogenesis of FHN is the interruption or damage of blood supply to the femoral head, leading to apoptosis of bone cells. [ 18 ] At present, there are many theories on the pathogenesis of hormonal FHN, such as osteoporosis, intraosseous hypertension, intravascular coagulation, osteotoxin effect, osteocyte apoptosis, and fat metabolism disorder,[ 1 - 3 ] but its exact pathogenesis remains unclear.…”

“…Femoral head necrosis (FHN) is a pathological process typified by the death of bone active components. [ 1 - 3 ] With the aggravation of hormonal drug abuse, steroid-induced avascular necrosis of the femoral head (SANFH) has become a common bone and joint disease clinically, which usually endangers bilateral femoral heads with a wide range of osteonecrosis at the end stage. Because of the high disability rate after onset, most patients eventually choose hip replacement surgery.…”

Avascular necrosis of the femoral head due to low-dose corticosteroid used in a patient with panhypopituitarism: A case report and literature review

“…[2] The risk of glucocorticoid-induced osteonecrosis is associated with the dose and the duration of glucocorticoid use. [3,4] In most cases, AVN is a result of high doses of steroids given for a long period of time, and Osteonecrosis, commonly known as avascular necrosis (AVN) of bone, is one of the universally recognized side effects of high-dose steroids and commonly involves femur head leading to significant morbidity. However, the development of AVN in the femoral head due to low-dose oral corticosteroid therapy in a short time is a rare occurrence.…”

“…[ 2 ] The risk of glucocorticoid-induced osteonecrosis is associated with the dose and the duration of glucocorticoid use. [ 3 , 4 ] In most cases, AVN is a result of high doses of steroids given for a long period of time, and usually, such doses are used for immunosuppressive, chemotherapeutic, or anti-inflammatory effects. Since the usual doses used in endocrinology are physiological doses given as replacement for steroid deficiency, this complication is rarely seen in endocrinology practice.…”