1/100. Intertrochanteric osteotomy for osteonecrosis.Intertrochanteric osteotomy is an effective surgical option in certain well-selected cases of osteonecrosis of the femoral head. The size of the lesion on plain radiographs in the anteroposterior and lateral projections is a critical determinant of success. The best candidates are patients with less than 50% of head involved in the necrotic sector. Collapse of the femoral head is not a contraindication to osteotomy. Location of the necrotic sector determines whether varus, valgus, flexion, or extension are most appropriate alone or in combination.- - - - - - - - - - ranking = 1keywords = osteonecrosis (Clic here for more details about this article) |
2/100. The prevalence and clinicopathological appearance of extension of osteonecrosis in the femoral head.In about 50% of cases, osteonecrosis of the femoral head is known to occupy more than one site. There is controversy as to whether a single focus may increase in size. We have reviewed 606 consecutive femoral heads which had been surgically removed for osteonecrosis. Extension of osteonecrosis was observed in only two (0.3%) and was confirmed histopathologically by the enlargement of the necrotic segment beyond the repair zone formed for the primary necrosis into the adjacent, previously uninvolved bone. In both cases, the necrotic regions were wedge-shaped and occupied over 80% of the femoral head. It appears that an increase in size is extremely rare and that osteonecrosis is due to a single event. Our findings may be of value in assessing the use of joint-salvage procedures for osteonecrosis of the femoral head.- - - - - - - - - - ranking = 1.8keywords = osteonecrosis (Clic here for more details about this article) |
3/100. A clinicopathologic study of transient osteoporosis of the hip.OBJECTIVE: It has been proposed that transient osteoporosis of the hip (TOH) may represent the early reversible phase of osteonecrosis of the femoral head (ON). The purpose of this study was to investigate the clinicopathologic characteristics of three cases of TOH. DESIGN AND patients: A bone biopsy was performed on three patients who had been diagnosed as having TOH based on the clinical course, radiograph, bone scintigram, and MR images. The biopsy specimens were studied histopathologically by light and electron microscopy. RESULTS: The most characteristic feature of TOH was focal areas of thin and disconnected bone trabeculae covered by osteoid seams and active osteoblasts. The surrounding bone marrow tissue showed edematous changes and mild fibrosis, frequently associated with vascular congestion and/or interstitial hemorrhage. No osteonecrotic region was observed in either the bone trabeculae or the bone marrow tissue. All patients have improved clinically and in the 3.5-9 years of follow-up have shown no evidence of ON. CONCLUSIONS: This study supports the concept that transient osteoporosis of the hip is a distinct entity.- - - - - - - - - - ranking = 0.2keywords = osteonecrosis (Clic here for more details about this article) |
4/100. Pathological fracture of the femoral neck as the first manifestation of osteonecrosis of the femoral head.We describe two cases of pathological fracture of the femoral neck occurring as the first manifestation of osteonecrosis of the femoral head (ONFH). No abnormal findings suggestive of ONFH were identified on the radiographs for either of the patients, and the fractures occurred like spontaneous fractures without any trauma or unusually increased activity. The patients' medical history, age, and good bone quality suggested ONFH as a possible underlying cause of the fractures. If we had not suspected ONFH as a predisposing condition, these minimally displaced fractures might have been fixed internally with multiple pins, and this would have led to nonunion or collapse of the femoral head. To avoid inappropriate treatment, ONFH should be considered as a predisposing factor in pathological fractures of the femoral neck.- - - - - - - - - - ranking = 1keywords = osteonecrosis (Clic here for more details about this article) |
5/100. Non-traumatic osteonecrosis of the femoral head treated with transtrochanteric anterior rotational osteotomy combined with vascularized iliac bone grafting.A 49-year-old Japanese man who had non-traumatic osteonecrosis of the femoral head with a wide necrotic lesion received transtrochanteric anterior rotational osteotomy combined with vascularized iliac bone grafting. After the bone graft (6 x 1.5 cm) was collected, the femoral head was anteriorly rotated by 90 degrees. A bone tunnel of 1.2 cm in diameter was prepared on the necrotic lesion adjacent to the intact area from the anterior part of the femoral neck to inside the femoral head. The bone graft was trimmed to the size of this bone tunnel, and inserted up to immediately below the articular surface. In the monitoring using T1-weighted magnetic resonance imaging (MRI), the low signal-intensity area between the bone graft and intact area had disappeared, and a high signal-intensity area on the weight-bearing portion of the femoral head had extended. With modifications on the insertion point of the bone graft, transtrochanteric anterior rotational osteotomy combined with vascularized iliac bone graft would be a useful means to preserve the femoral head in large non-traumatic osteonecrosis of the femoral head.- - - - - - - - - - ranking = 1.2keywords = osteonecrosis (Clic here for more details about this article) |
6/100. osteonecrosis of the femoral head that developed after long-term topical steroid application.This is a report of a 52-year-old man who developed osteonecrosis of the femoral head (ONF) following long-term application of steroid for facial eczema. Before hip pain appeared, the patient had applied 2-3g/day of 0.05% clobetasol propionate for 2 years and 10 months. This steroid is classified as being in the strongest category. ONF was diagnosed based on radiographic and magnetic resonance imaging findings, and the patient received surgical treatment for both hips. ONF was also confirmed by pathological examination of a specimen obtained from the right femoral head during surgery. Because there were no risk factors for ONF besides topical steroid application, this case was considered as ONF associated with topical steroid. Even when steroids are for external use, their dosage and administration should be monitored, and the risk of ONF should also be considered.- - - - - - - - - - ranking = 0.2keywords = osteonecrosis (Clic here for more details about this article) |
7/100. Idiopathic osteonecrosis of the hip during pregnancy: outcome in a subsequent gestation.BACKGROUND: Idiopathic osteonecrosis of the hip is a serious complication of pregnancy, but there is little information available regarding its recurrence in a subsequent gestation. CASE: A woman with a history of pregnancy-related osteonecrosis, successfully treated with conservative therapy, presented for preconceptual counseling. Because a literature search uncovered only one applicable case, the patient was managed empirically. Her subsequent pregnancy was uneventful with no recurrence. CONCLUSION: Although idiopathic osteonecrosis of the hip during pregnancy is uncommon, it is important to establish the outcome in subsequent pregnancies. Avoidance of vigorous physical activity, measures to limit edema, and low-dose aspirin therapy were successful in this patient.- - - - - - - - - - ranking = 1.4keywords = osteonecrosis (Clic here for more details about this article) |
8/100. osteonecrosis and bone infarction in association with Behcet's disease: report of two cases.We describe two cases with Behcet's disease (BD) developing osteonecrosis or bone infarction. One patient developed the extensive bone infarction of the left knee without the use of corticosteroids. The other patient had osteonecrosis at the right femoral head. He had had a past history of significant corticosteroid administration to treat several complications of BD such as central nervous system involvement, uveitis, gastrointestinal involvement, and pulmonary involvement. Anticardiolipin (aCL) antibodies were positive in these two patients. One was IgG type, and the other was IgM type. However, it remains unclear that there is relationship between the presence of aCL antibodies and occurrence of osteonecrosis.- - - - - - - - - - ranking = 0.6keywords = osteonecrosis (Clic here for more details about this article) |
9/100. Nontraumatic osteonecrosis after chemotherapy for testicular cancer: a systematic review.Nontraumatic osteonecrosis is a well-documented late complication of chemotherapy for hematologic malignancies, with prolonged corticosteroid exposure implicated. Reports of this treatment complication in patients treated with chemotherapy for solid tumors are sparse. We reviewed our institutional experience and the published medical literature to explore an association between chemotherapy for testicular cancer and the occurrence of nontraumatic osteonecrosis. Two databases of men with testicular cancer were reviewed. Search of the medical literature included medline, CANCERLIT, and EMBASE. Two of 107 men with testicular cancer treated with chemotherapy at our center were identified with nontraumatic osteonecrosis. literature review identified 14 reports describing patients with 39 solid tumors with osteonecrosis after chemotherapy. Of 38 adults, 28 had testicular cancer and 6 had breast cancer. All patients with testicular cancer had received cisplatin, vinblastine, and bleomycin, or bleomycin, etoposide, and cisplatin. Twenty-seven of 28 had received corticosteroids. diagnosis was subacute in three and delayed a mean of 26 months (range, 12-47 months) in 26. The femoral head was involved in 26 patients, with bilateral involvement in 18. Crude incidence was 1.5% (95% CI, 0.9-2.1). Nontraumatic osteonecrosis is an infrequent but disabling late complication of cancer chemotherapy reported most commonly in adult patients with testicular cancer. Corticosteroid exposure makes this association plausible.- - - - - - - - - - ranking = 1.8keywords = osteonecrosis (Clic here for more details about this article) |
10/100. fatigue subcapital fracture of the femur after the removal of the hip plate in transtrochanteric rotational osteotomy.We report two cases of fatigue subcapital fracture of the femur after the removal of the hip plate used for fixation in transtrochanteric rotational osteotomy for osteonecrosis. Two patients, a 42-year-old man and a 43-year-old man, underwent transtrochanteric rotational osteotomy, and bony union was achieved in both patients. However, fatigue subcapital fracture of the femur occurred in both patients 15 months after the removal of the hip plate. Transtrochanteric rotational osteotomy greatly changes the trabecular bone structure in the proximal femur, thus affecting the strength of the femoral neck. Therefore, for the trabecular bone to be remodeled and for the proximal femur to achieve sufficient strength, a sufficient period is necessary after complete bony union has occurred in the transtrochanteric lesion, before removal of the plate.- - - - - - - - - - ranking = 0.2keywords = osteonecrosis (Clic here for more details about this article) |
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