SAS Weekly Rounds: Avascular Necrosis

Abstract

Osteonecrosis of the femoral head is a condition that affects upwards of 10,000 individuals in the USA each year. The peak incidence is in the fourth decade of life, and overall, there is a male preponderance. The condition accounts for up to 12% of total hip arthroplasties performed in developed countries. The etiology can be traumatic or non-traumatic, with 90% of atraumatic cases attributed to corticosteroid therapy or excess alcohol consumption. Osteonecrosis of the femoral head reflects the final common pathway of a range of insults to the blood supply and ultimately results in femoral head collapse, acetabular involvement, and secondary osteoarthritis. Currently, conservative treatment options, which aim to correct pathophysiologic features allowing revascularization and new bone formation, appear to be able to delay but not halt the progression of this condition. As a consequence of femoral head osteonecrosis, many individuals undergo surgical treatments including: core decompression, osteotomy, non-vascularized bone matrix grafting, free vascularized fibular grafts, limited femoral resurfacing, total hip resurfacing, and total hip arthroplasty.

Factors Associated with Aseptic Osteonecrosis in Hospital Settings in Yaounde, Cameroon

“…Despite the fact that there were insufficiencies in our technical scale (lake of magnetic resonance imaging and bone scintigraphy), aseptic osteonecrosis main location was the femoral head, and most of patients were rather young. Our results were close to those from Burkina Faso [7] and to data from western countries [14]. Men were more affected than women, as previously observed [15].…”

A study of uncemented total hip replacement in various hip disorders

“…Recent studies have demonstrated excellent outcomes with the use of improved cementing techniques and contemporary uncemented components. Seyler TM et al have compared around 23 studies between 1989 and 2004 and have found success rates varying from 52% to 98 % [50,51] . Ours is a prospective study comprising of 32 patients with 32 uncemented total hip arthroplasties.…”

A steroid-induced bilateral avascular necrosis of the femoral head in an underage patient affected by multiple sclerosis

“…Results are generally positive with early recovery from disabilities (2)(3)(4). The intravenous administration is not free from complications (5,6). Frequently, an avascular necrosis of bones may occur due to several mechanisms not yet cleared (5)(6)(7).…”

“…The intravenous administration is not free from complications (5,6). Frequently, an avascular necrosis of bones may occur due to several mechanisms not yet cleared (5)(6)(7). Femoral heads represent a specific target as reported recently in adult patients even with a bilateral involvement (2,8).…”