Cases reported "Femur Head Necrosis"

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1/37. Concomitant sickle cell disease and skeletal fluorosis.

    Skeletal fluorosis typically manifests as a diffuse increase in bone density, whereas avascular necrosis of the epiphyses and diaphyseal marrow are the main skeletal manifestations of sickle cell disease. The diagnostic and therapeutic challenges raised when both disorders are present are illustrated by two cases in Senegalese patients from an area characterized by high fluoride contents in the water and soil. Both had SS sickle cell disease. Skeletal fluorosis was diagnosed during evaluation for avascular necrosis in one patient and in the wake of septic arthritis in the other. Femoral head necrosis is difficult to identify in a patient with skeletal fluorosis. The bone lesions due to sickle cell disease and those due to fluorosis can mimic other bone diseases, most notably metastases. The combination of sickle cell disease and fluorosis results in significant medullary canal narrowing due to cortical thickening and to accumulation of necrotic bone. When performing hip replacement surgery, careful reaming of the medullary canal may reduce the risk of iatrogenic femoral fracture and inappropriate stem placement.
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2/37. pregnancy after avascular necrosis of the femur complicating Gaucher's disease.

    A patient with type I Gaucher's disease had avascular necrosis of the right femoral head that resulted in an altered bony pelvis and marked restriction of right hip abduction. enzyme replacement therapy with alglucerase prevented further deterioration and improved thrombocytopenia. Vaginal delivery was achieved with the patient in the left lateral position with exaggerated flexion at the contralateral hip.
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3/37. Biostructural augmentation for the treatment of osteonecrosis: rationale, technique, and case example.

    Avascular necrosis of the hip is a common disease that usually affects a young and active patient population. As the disease progresses, the undermined structural integrity of the subchondral bone leads to articular collapse and subsequent osteoarthrosis. The ideal treatment is one that hinders or arrests the progression of the disease, averting articular collapse and joint replacement surgery. A surgical strategy is described that attempts to address the multiple factors involved in the progression of the disease. This is accomplished through a modified core decompression procedure combined with the insertion of two interference screws into the subchondral plate to provide structural support and the use of osteoinductive material (i.e., demineralized bone matrix) in an effort to accelerate the bone healing process.
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4/37. Articular cartilage changes in avascular necrosis: an arthroscopic evaluation.

    Treatment methods for osteonecrosis (avascular necrosis) are wide and varied. When untreated, progression of the disease is common and may dictate femoral head replacement. However, before femoral head collapse, some patients have mechanical joint symptoms (locking, buckling, clicking) that are unaddressed by femoral head drilling alone. Radiographic examinations in these patients usually are nondiagnostic. patients with these clinical criteria were evaluated arthroscopically. Between 1993 and 2000, seven patients were identified with known documented or radiographic diagnosis of avascular necrosis who had hip arthroscopy. Each patient's preoperative history, physical examination, plain radiographs, magnetic resonance imaging scans, and operative notes were reviewed from a prospectively-derived database. The duration and onset of symptoms were identified carefully. Case histories are presented on five of these patients. Articular cartilage changes were recorded and correlated to the preoperative radiologic studies. Hip arthroscopy is a minimally invasive, highly effective, joint-preserving surgery in the young patient with mechanical symptoms (locking, catching, buckling) and early avascular necrosis. Treatable lesions include loose bodies, synovitis, chondral flaps, and labral tears. In addition, accurate staging can be accomplished through direct observation.
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5/37. Avascular necrosis of the femoral head after surgery for lumbar spinal stenosis.

    STUDY DESIGN: Case report. OBJECTIVE: To report a previously undescribed complication of lumbar spinal surgery under prolonged hypotensive anesthesia. BACKGROUND DATA: Avascular necrosis of bone most commonly affects the femoral head. The etiology of the condition is understood in only 75% of cases. There have been no prior reports of this condition following lumbar spine surgery carried out under hypotensive anesthetic. methods: Notes review, clinical examination, plain radiographs, and magnetic resonance imaging diagnosed three patients who developed avascular necrosis of the femoral heads (five joints in total) after surgery for lumbar spinal stenosis. All three were treated with total hip replacement (five joints), and the diagnosis of avascular necrosis was confirmed in two by histopathological examination. RESULTS: All three patients have recovered full mobility following hip replacement surgery. None had any residual symptoms of lumbar spinal stenosis or hip disease, and none of them had shown any clinical evidence of avascular necrosis in any other bone. CONCLUSIONS: The development of avascular necrosis of the femoral heads following surgery for spinal stenosis may be due to hypotensive anesthesia, prone positioning on a Montreal mattress, or a combination of the two. Careful intraoperative positioning may reduce the risk of this occurring after spinal surgery. However, close postoperative surveillance and a high index of suspicion of worsening hip pathology in patients who appear to mobilize poorly after lumbar spinal surgery may be the only method of early detection and treatment for this condition.
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6/37. Pyogenic arthritis of the hip due to campylobacter fetus--a case report.

    Septic arthritis of the hip caused by campylobacter fetus subsp. fetusis very rare. The authoris isolated C. fetus subsp. fetus from a specimen of the left hip. The patient was a 53-year old man with a history of heavy drinking, diabetes, and chronic hepatitis, and had been suffering from avascular necrosis of both femoral heads. It was considered that the organism invaded already damaged tissue of the joint. The patient was treated with intravenous antibiotics and later received successful total hip replacement.
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7/37. Bilateral femoral head osteonecrosis after septic shock and multiorgan failure.

    A case of bilateral femoral head osteonecrosis after septic shock is presented. We suggest that the osteonecrosis was caused by ischemic insults to the proximal femora. The association between septic shock and osteonecrosis has not been previously reported. INTRODUCTION: osteonecrosis is an uncommon disorder characterized by the in situ death of bone. A diverse range of conditions has been associated with osteonecrosis. We present a case of bilateral femoral head osteonecrosis that occurred after an episode of septic shock. MATERIALS AND methods: A 66-year-old woman presented with a left-sided renal stone and a urinary tract infection. Her condition rapidly progressed to a life-threatening illness with septic shock complicated by multiorgan failure, which necessitated prolonged intensive care and inotropic support. She made a full recovery but 3 months later developed bilateral osteonecrosis of the femoral heads requiring bilateral total hip joint replacement. RESULTS AND CONCLUSIONS: We propose that the osteonecrosis was caused by ischemic insults to the femoral heads as a result of the widespread systemic ischemia that occurred during her initial illness. To our knowledge, septic shock has not been previously described as a cause of osteonecrosis. Clinicians should be aware of this association, particularly in patients presenting with bone pain after episodes of sepsis.
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8/37. Femoral head preservation in non-united femoral neck fracture and head osteonecrosis in Cushing's disease.

    There have been few reports associating avascular necrosis of bone with Cushing's disease. patients with Cushing's disease and avascular necrosis of the femoral head usually receive total hip arthroplasty. However, hip prosthetic replacement in younger patients has been criticized due to a high incidence of component loosening. We report a case of successful femoral head preservation in non-united femoral neck fracture and head osteonecrosis in a 14-year-old girl with Cushing's disease (adrenocorticotropic hormone-secreting pituitary adenoma) who developed avascular necrosis of the right femoral head and pathologic fracture of the right femoral neck 2 years after the onset of hypercortisolism. Subtrochanteric valgus osteotomy was performed to preserve the femoral head after successful transsphenoidal surgery to remove pituitary microadenoma. At follow-up 10 years after the osteotomy, the femoral head had revascularized and the femoral neck fracture were united with much improvement of hip function. Dual energy X-ray absorptiometry scan of the right hip showed 0.86 SD from the normal bone densitometry. Aggressive femoral head preservation may be an effective alternative to treat this rare situation in a teenager.
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9/37. Aseptic osteonecrosis of acetabulum following prosthetic replacement of the femoral head. A case report.

    Acetabular osteonecrosis is a rare condition. Only five cases with histological analysis have been reported in the literature, and these patients had previously received radiotherapy. The 67-year-old woman reported on here, who had had no major systemic disorder or local radiotherapy, and who had never consumed alcohol, developed aseptic osteonecrosis of the acetabulum after femoral head replacement with a cemented Austin-Moore prosthesis for aseptic osteonecrosis of the femoral head following femoral neck fracture. The necrosis was found during surgery to go so deeply into each bone composing the acetabulum that the hip joint could not be revised, and we had to perform a Girdlestone resection arthroplasty. The radiographic and histological findings resembled those reported in cases of aseptic osteonecrosis of the acetabulum after radiotherapy.
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10/37. Bilateral femoral head and distal tibial osteonecrosis in a patient with fabry disease.

    fabry disease is a lysosomal storage disease caused by alpha-galactosidase A deficiency. The classic presentation of fabry disease involves multiple organs, including kidneys, heart, skin, eyes, and nervous system. osteonecrosis is rarely reported in patients with fabry disease. In this article, we describe the case of a 37-year-old white man who had fabry disease and no risk factors for osteonecrosis but who developed osteonecrosis in both femoral heads and in an unusual site, bilateral distal tibiae. Results of mutation analysis showed a nonsense mutation (R227X) in the alpha-galactosidase A gene. This case suggests that fabry disease may be a risk factor for development of osteonecrosis. The enzyme replacement therapy currently available may be an effective method of preventing this complication.
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ranking = 940.4550591863
keywords = enzyme replacement therapy, enzyme replacement, replacement therapy, replacement, enzyme
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