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Avascular necrosis of the femoral head in HIV infected patients
Matos, Marcos Almeida;Alencar, Rafael Watt de;Matos, Simone Souza da Rocha;
Brazilian Journal of Infectious Diseases , 2007, DOI: 10.1590/S1413-86702007000100009
Abstract: avascular necrosis (avn) of the femoral head is an emerging complication in hiv infected patients. it has been suggested that the increased incidence of avn in this population may be caused by an increased prevalence of predisposing factors for osteonecrosis, including protease inhibitors, hyperlipidemia, corticosteroid use, alcohol and intravenous drug abuse. the aim of this study was to assess the risk factors for avascular necrosis developing in the femoral head of hiv infected individuals. this study consisted of meta-analysis of the secondary data extracted from current literature. the selected articles allowed two study groups to be drawn up for comparison. group 1 comprised 324 individuals infected by the hiv virus, who did not present femoral head avn. group 2 comprised 32 hiv positive patients, who presented femoral head avn. the parameters used for analysis were as follows: age, gender, sexual preference, use of intravenous drugs, time of diagnosis, cd4+ cell count, use of antiretroviral agents and duration, serum cholesterol and serum triglycerides. the present study found a statistically significant association between hypertriglyceridemia, hypercholesterolemia, sexual preference and intravenous drug abuse. the authors concluded that femoral head osteonecrosis is associated with hyperlipidemia (hypercholesterolemia and hypertriglyceridemia) and intravenous drug abuse. this study supports the hypothesis that protease inhibitors play a role in the development of osteonecrosis through a tendency to cause hyperlipidemia.
Coxalgia crónica: necrosis avascular de la cabeza femoral
Castellano del Castillo,M. A.; González álvarez,A.; Blanco Ramos,M. A.;
Medifam , 2002, DOI: 10.4321/S1131-57682002000100007
Abstract: avascular bone necrosis is a very rare pathological entity that can appears in an primary way or a secondary one due to diverse factors. it can be found in a few levels, especially in the femoral head and the carpal navicular bone in the adult patient. if the lession is located in the femoral head leads to a hip pain, a very frequent clinical manifestation studied in primary health care centers, so it is very important its early and differential diagnosis, above all, in the case that exist risk factors. we present a clinical case of avascular necrosis of the femoral head and perform a current bibliographic revision on the matter.
Surgical management of avascular necrosis of the femoral head: an update
Karatoprak O,Karaca S
Orthopedic Research and Reviews , 2012,
Abstract: Omer Karatoprak, Sinan KaracaOrthopaedics and Traumatology Department, Kadikoy Florence Hospital, Kadikoy, Istanbul, TurkeyAbstract: Osteonecrosis or avascular necrosis of the femoral head (ANFH) is a progressive, multifactorial, and disabling disease that can result in significant clinical morbidity and affect patients of any age, including young and active patients. The pathogenesis and etiology of nontraumatic ANFH has not been elucidated completely, but could be mainly due to an inadequate blood supply, causing death of osteocytes and bone marrow cells. Surgical procedures like core decompression, nonvascularized autologous bone grafts, porous tantalum implant procedures, and various osteotomies have been used to delay progression of the disease and conversion to total hip arthroplasty. Noninvasive treatment modalities like pharmacologic measures, electrical stimulation, shock wave therapy, and electromagnetic field therapy are also used to treat ANFH. Various efforts have been made in an attempt to enhance the healing of osseous defects at the femoral head before collapse occurs. Current treatment techniques for ANFH have varying results, according to the patient population and disease stage involved. With modifications of older techniques and developing technologies, treatment strategies have the ability to alter the course of ANFH. Further management options are required for the treatment of ANFH, and will be widely studied in the coming decades.Keywords: avascular necrosis, osteonecrosis, femoral head, total hip arthroplasty, core decompression, hip
生物型人工全髋关节置换术治疗 HIV 感染者股骨头缺血性坏死
Treatment of avascular necrosis of femoral head in patients with human immunodeficiency virus infection by cementless total hip arthroplasty
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段于平,溪应龙,寸新华,杨毅,李彪,周俊洁,唐兴,李正刚
- , 2018, DOI: 10.7507/1002-1892.201806126
Abstract: 目的 探讨采用生物型人工全髋关节置换术治疗 HIV 感染者股骨头缺血性坏死的疗效。 方法 回顾分析 2014 年 2 月—2017 年 1 月,采用生物型人工全髋关节置换术治疗的 22 例(35 髋)股骨头缺血性坏死的 HIV 感染者(阳性组)临床资料,以同期治疗的 33 例(43 髋)未感染 HIV 患者(阴性组)作为对照。阳性组患者年龄、性别、双侧股骨头缺血性坏死发生率以及股骨头缺血性坏死病程比较,差异均有统计学意义( P<0.05);股骨头缺血性坏死分期比较,差异无统计学意义( P>0.05)。记录两组患者手术时间、术中出血量、输血率、术后并发症及住院时间。随访期间髋关节功能采用 Harris 评分评价,复查髋关节正侧位 X 线片观察假体位置。 结果 阳性组随访时间 13~24 个月,平均 20.2 个月;阴性组为 14~25 个月,平均 21.6 个月。阴性组手术时间较阳性组明显缩短( t=3.677, P=0.001);但两组术中出血量、输血率及住院时间比较,差异无统计学意义( P>0.05)。两组患者术前及术后 1、3、6、12 个月 Harris 评分比较,差异均无统计学意义( P>0.05)。阳性组术中及术后均未发生职业暴露,住院期间出现切口浅表感染 2 例、肺部感染 1 例;阴性组出现切口浅表感染 1 例、下肢静脉血栓形成 1 例,均经对症处理后痊愈。两组随访期间无患者死亡,未出现假体松动、下沉。 结论 生物型人工全髋关节置换术是一种治疗 HIV 感染者股骨头缺血性坏死的安全、有效方法。
Objective To investigate the effectiveness of cementless total hip arthroplasty (THA) in treatment of avascular necrosis of the femoral head (ANFH) in patients with human immunodeficiency virus (HIV) infection. Methods The clinical data of 22 patients (35 hips) with HIV infection and ANFH (positive group), who were treated with cementless THA between February 2014 and January 2017, was retrospectively analyzed. Tirty-three cases (43 hips) without HIV infection, who were treated with cementless THA during the same period, were collected as control (negative group). There were significant differences in the age, gender, incidence of bilateral ANFH, and disease duration between 2 groups ( P<0.05). There was no significant difference in the Ficat stage of ANFH between 2 groups ( P>0.05). The operation time, intraoperative blood loss, rate of blood transfusion, postoperative complications, and hospitalization time were recorded. The hip joint function was evaluated by Harris score and X-ray film was performed to observe the position of the prosthesis. Results The follow-up time was 13-24 months (mean, 20.2 months) in positive group and 14-25 months (mean, 21.6 months) in negative group. The operation time of negative group was significantly shorter than that of positive group ( t=3.677, P=0.001). However, there was no significant difference in intraoperative blood loss, rate of blood transfusion, and hospitalization time between 2 groups ( P>0.05). There was no significant difference in Harris score between 2 groups before operation and at 1, 3, 6, and 12 months after operation ( P>0.05). There were 2 cases of superficial infection of incision and 1 case of pulmonary infection during hospitalization in positive group, and 1 case of superficial infection of incision and 1 case of venous thrombosis of lower extremity in negative group. No death or loosening and sinking of the
Avascular Necrosis of the Femoral Head: A Case Report with Emphasis on Imaging Findings  [PDF]
S Ansari,K Dhungel,K Ahmad,MK Gupta,MF Amanullah,RK Rauniyar
Nepalese Journal of Radiology , 2012, DOI: 10.3126/njr.v2i2.7694
Abstract: Avascular necrosis (AVN) of the femoral head is a disease caused by reduced blood supply to the subchondral bone leading to destruction of the hip joint. Most common sites are femoral and humeral head. Initially, patients are asymptomatic, but, in time, AVN leads to joint destruction, requiring surgical treatment and, in later stages, total hip replacement. Magnetic resonance imaging (MRI) has been proved to be a highly accurate method both for early diagnosis and for staging of the disease. We present a case of avascular necrosis of right femoral head in 28 year old male following trauma to hip. Nepalese Journal of Radiology; Vol. 2; Issue 2; July-Dec. 2012; 92-95 DOI: http://dx.doi.org/10.3126/njr.v2i2.7694
Factors influencing the development of avascular necrosis in non-operative treatment of the acute slipped capital femoral epiphysis  [PDF]
Slavkovi? Nemanja,Vuka?inovi? Zoran,Slavkovi? Slobodan
Srpski Arhiv za Celokupno Lekarstvo , 2007, DOI: 10.2298/sarh0702054s
Abstract: Introduction: The acute slipped capital femoral epiphysis can result in development of avascular necrosis of the femoral head which is very difficult condition to treat. Orthopedic surgeon can influence the development of avascular necrosis. Objective The main objective in our study was to identify factors influencing the development of avascular necrosis in nonoperative treated patients for the acute slipped capital femoral epiphysis. Method A total of 53 patients and 59 hips treated for the acute slipped capital femoral epiphysis at the Institute for Orthopedic Surgery "Banjica" between 1968-2004 were studied. Necessary data were obtained from the accurate medical records. Results Avascular necrosis of the femoral head was diagnosed in 8 patients (13.56%). Six of them (75%) were treated by manipulative reduction in general anesthesia and spica cast immobilization. Fischer test, used for statistical data processing, found significant difference between two non-operative methods of treatment (p=0.0008). Conclusion Higher-degree epihyseal displacement as well as complete separation of the physis and metaphysis were found to be the risk factors of avascular necrosis. Every manipulation with the affected hip was also associated with higher percentage of avascular necrosis of the femoral head.
Surgical management of avascular necrosis of the femoral head: an update
Karatoprak O, Karaca S
Orthopedic Research and Reviews , 2012, DOI: http://dx.doi.org/10.2147/ORR.S25333
Abstract: rgical management of avascular necrosis of the femoral head: an update Review (1051) Total Article Views Authors: Karatoprak O, Karaca S Published Date November 2012 Volume 2012:4 Pages 97 - 102 DOI: http://dx.doi.org/10.2147/ORR.S25333 Received: 23 May 2012 Accepted: 18 September 2012 Published: 07 November 2012 Omer Karatoprak, Sinan Karaca Orthopaedics and Traumatology Department, Kadikoy Florence Hospital, Kadikoy, Istanbul, Turkey Abstract: Osteonecrosis or avascular necrosis of the femoral head (ANFH) is a progressive, multifactorial, and disabling disease that can result in significant clinical morbidity and affect patients of any age, including young and active patients. The pathogenesis and etiology of nontraumatic ANFH has not been elucidated completely, but could be mainly due to an inadequate blood supply, causing death of osteocytes and bone marrow cells. Surgical procedures like core decompression, nonvascularized autologous bone grafts, porous tantalum implant procedures, and various osteotomies have been used to delay progression of the disease and conversion to total hip arthroplasty. Noninvasive treatment modalities like pharmacologic measures, electrical stimulation, shock wave therapy, and electromagnetic field therapy are also used to treat ANFH. Various efforts have been made in an attempt to enhance the healing of osseous defects at the femoral head before collapse occurs. Current treatment techniques for ANFH have varying results, according to the patient population and disease stage involved. With modifications of older techniques and developing technologies, treatment strategies have the ability to alter the course of ANFH. Further management options are required for the treatment of ANFH, and will be widely studied in the coming decades.
Idiopathic avascular necrosis of the femoral head in adolescents: Diagnostics and management  [PDF]
Slavkovi? Slobodan,Bumba?irevi? Marko,Tomi? Slavko,Le?i? Aleksandar
Acta Chirurgica Iugoslavica , 2005, DOI: 10.2298/aci0502043s
Abstract: Idiopathic avascular necrosis of the femoral head still represents incompletely explained clinical entity. In the period 1978-2003. we have treated sixteen hips in ten patients with this condition in the IOHB "Banjica". Diagnosis have been founded on clinical and radiographic features, in addition to MRI findings. One patient have been operated, curretaging necrotic part of the femoral head and placing homografts instead. The other fifteen patients have been treated by the same procedure: skin traction for several months following immediate rehabilitation of the hip. The goal of treatment was reducing the pain, increasing the range of movements and preservation of the normal joint space. Evaluation of the treatment was based on unique criteria founded on Howorth-Ferguson index, clinical and radiographic features. The follow-up period was 2-7 years. The authors have stressed the following advantages of the non-operative treatment in adolescents with idiopathic avascular necrosis if the femoral head: increased range of joint movements, decreased pain and low risk rate of any complications following surgical procedures. Formed changes in the femoral head are irreversible, and they are real basic for premature arthrosis of the hip.
A Novel p. Gly630Ser Mutation of COL2A1 in a Chinese Family with Presentations of Legg–Calvé–Perthes Disease or Avascular Necrosis of the Femoral Head  [PDF]
Na Li, Jian Yu, Xiang Cao, Qiu-Yue Wu, Wei-Wei Li, Tian-Fu Li, Cui Zhang, Ying-Xia Cui, Xiao-Jun Li, Zhi-Min Yin, Xin-Yi Xia
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0100505
Abstract: Objective Mutations in the type II collagen gene are associated with certain human disorders, collectively termed type II collagenopathies. They include Legg–Calvé–Perthes disease (LCPD) and avascular necrosis of the femoral head (ANFH). These two diseases are skeletal dysplasias, inherited in an autosomal dominant fashion, characterized by groin pain, dislocation of the hip and diminished joint mobility. Coxa vara and elevation of the greater trochanter of the femur comprise the typical phenotype of LCPD, but do not occur in ANFH. Lack of synthesis of type II collagen and structural defects are responsible for the major clinical outcomes, because collagen is the essential matrix protein of all connective tissues. Type II collagen, encoded by the COL2A1 gene, contains N- and C- terminal regions that are cleaved after secretion into the extracellular matrix, and the core area is composed of a triple helical (Gly–X–Y) domain. If the Gly in this specific region is replaced by other amino acids, the structure of type II collagen will be destroyed. Method Forty-five members of a four-generation family were recruited and investigated. Diagnosis was made by independent orthopedic surgeons and radiologists. A mutation of the COL2A1 gene was detected. Result In our research, we identify a heterozygous mutation (c.1888 G>A, p. Gly630Ser) in exon 29 of COL2A1 in the Gly–X–Y domain, in a Chinese family affected by LCPD and ANFH. Our findings provide significant clues to the phenotype–genotype relationships in these syndromes and may be helpful in clinical diagnosis. Furthermore, these results should assist further studies of the mechanisms underlying collagen diseases. Conclusion Our data add new variants to the repertoire of COL2A1 mutation resulting in related collagenopathies.
Management of Avascular Necrosis of Femoral Head (ANFH) in Sickle Cell Disease
JAO Mulimba
East and Central African Journal of Surgery , 2011,
Abstract: Sickle cell disease manifests itself in various forms the worst of which is sickle cell crisis. Among tissues most affected is bone with avascular necrosis of the femoral head (ANFH) being the most chronic and debilitating. After various treatments failed, recourse was made to total hip replacement or arthroplasty (THA). Over a period of 10 years 1999 to 2009, 27 THAs in 25 patients were done, 13 male and 12 female. There was one resurfacing done elsewhere. There were 11 cemented and 16 uncemented. Age ranged between 16 and 38 years. All patients came late with Ficat grade 4. Peak age for operations was 16 – 20 years. Six patients died, no death surgery related. End result was improvement of Harris hip score to between 70 and 88 from 40 to 55. Very few complications were noted and the overall outcome rated as good. Further research is recommended to identify viable biological treatment modalities.
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