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Avascular necrosis hip bisphosphonates

Alia M Daoud, Mack Hudson, Kenneth G Magnus, Fleur Huang, Brita L Danielson, Peter Venner, Ronak Saluja, Bronwen LeGuerrier, Helene Daly, Urban Emmenegger, Alysa Fairchild
Avascular necrosis (AVN) is the final common pathway resulting from insufficient blood supply to bone, commonly the femoral head. There are many postulated etiologies of non-traumatic AVN, including corticosteroids, bisphosphonates, and radiotherapy (RT). However, it is unclear whether there is a dose threshold for the development of RT-induced AVN. In this case report, we describe a patient with prostate cancer metastatic to bone diagnosed with AVN after receiving single-fraction palliative RT to the left femoral head...
2016: Curēus
Joaquin Moya-Angeler, Arianna L Gianakos, Jordan C Villa, Amelia Ni, Joseph M Lane
It is estimated that 20000 to 30000 new patients are diagnosed with osteonecrosis annually accounting for approximately 10% of the 250000 total hip arthroplasties done annually in the United States. The lack of level 1 evidence in the literature makes it difficult to identify optimal treatment protocols to manage patients with pre-collapse avascular necrosis of the femoral head, and early intervention prior to collapse is critical to successful outcomes in joint preserving procedures. There have been a variety of traumatic and atraumatic factors that have been identified as risk factors for osteonecrosis, but the etiology and pathogenesis still remains unclear...
September 18, 2015: World Journal of Orthopedics
Jan Juréus, Mats Geijer, Carl J Tiderius, Magnus Tägil
Femoral neck fractures in children and young adults are rare, but have a high risk of avascular necrosis (AVN) and subsequent gradual collapse of the femoral head. In 2006, we initiated the use of scintigraphy for the diagnosis of vascular impairment after a cervical fracture in children. In the present retrospective case study, we evaluated the effect of the remaining postoperative circulation in the femoral head after fracture in terms of the development of AVN and secondary degenerative changes of the hip joint...
January 2016: Journal of Pediatric Orthopedics. Part B
Scott E Sheehan, Jeffrey Y Shyu, Michael J Weaver, Aaron D Sodickson, Bharti Khurana
Each year, more than 250,000 hip fractures occur in the United States, resulting in considerable patient mortality and morbidity. The various types of adult proximal femoral fractures require different treatment strategies that depend on a variety of considerations, including the location, morphologic features, injury mechanism, and stability of the fracture, as well as the patient's age and baseline functional status. The authors discuss femoral head, femoral neck, intertrochanteric, and subtrochanteric fractures in terms of injury mechanisms, specific anatomic and biomechanical features, and important diagnostic and management considerations, including the diagnostic utility of imaging modalities...
September 2015: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Anhar Yassin, Issrah Jawad, Ross Coomber, Aurora Gonzalez-Castro
A 28-year-old Romanian woman, presented 2 weeks postnatally with pain in her left hip. Plain radiography suggested a left intracapsular, subcapital hip fracture. A CT scan of the pelvis showed diffuse osteopaenia with bilateral subcapital fractures of both femurs. From this imaging and subsequent investigation, a diagnosis of transient osteoporosis of pregnancy was made. The patient was treated with a closed reduction and cannulated screw fixation. Rehabilitative treatment, vitamin D, calcium and bisphosphonate therapy were initiated...
2014: BMJ Case Reports
K L Chan, C C Mok
Glucocorticoid use is one of the most important causes of avascular bone necrosis (AVN). The pathogenesis of glucocorticoid-induced AVN is not fully understood but postulated mechanisms include fat hypertrophy, fat emboli and intravascular coagulation that cause impedance of blood supply to the bones. Data regarding the relationship between AVN and dosage, route of administration and treatment duration of glucocorticoids are conflicting, with some studies demonstrating the cumulative dose of glucocorticoid being the most important determining factor...
2012: Open Orthopaedics Journal
W Drescher, T Pufe, R Smeets, R V Eisenhart-Rothe, M Jäger, M Tingart
Femoral head necrosis is an ischaemic bone necrosis of traumatic or nontraumatic pathogenesis which can lead to hip joint destruction in young age. It is today the indication for 10 % of all the total hip joint replacements. Known aetiologies of nontraumatic femoral head necrosis are alcoholism, steroids, sickle cell anaemia, caisson, and Gaucher's disease. Further risk factors are chemotherapy, chronic inflammatory bowel disease, systemic lupus erythematosus, and multiple sclerosis, in which also steroids are involved...
April 2011: Zeitschrift Für Orthopädie und Unfallchirurgie
K Froelich, A Radeloff, C Köhler, R Mlynski, J Müller, R Hagen, N H Kleinsasser
In 2003, osteonecrosis of the jaw was described as an intraoral complication of bisphosphonate therapy. More recently, cases of avascular necrosis of the hip were reported in patients with long-lasting bisphosphonate therapy. Thus, it was the aim of the present study to analyze cases of benign osteonecrosis of the external ear canal and to retrospectively identify a possible relationship to long-lasting bisphosphonate therapy. 13 patients with osteonecrosis of the external ear canal operated on between 2005 and 2009 were included...
August 2011: European Archives of Oto-rhino-laryngology
Sanjay Agarwala, Satyajit B Shah
Although all the recent reports of the use of bisphosphonates in avascular necrosis of femoral head (AVNFH) have been encouraging, none has studied long-term effects of this novel therapy. We therefore performed a 10-year follow-up study of 40 patients (53 hips) of AVNFH treated with 3-year-long oral alendronate therapy. Rates of clinical failure defined as need for further surgical intervention, of radiologic progression for the Ficat-Arlet scale, and of collapse of femoral head showed marked reduction even at 10 years as compared to the historical data available for natural history of hips with untreated AVNFH...
October 2011: Journal of Arthroplasty
Ramesh Kumar Sen
In osteonecrosis the success of interventions that forestall or prevent femoral head collapse and maintain hip function would represent a substantial achievement in the treatment of this disease. A review of recent literature regarding bisphosphonate, anticoagulant, and vasodilators and biophysical modalities have demonstrated efficacy in reducing pain and delaying disease progression in early stage osteonecrosis. Though it has been considered still insufficient, to support their routine use in the treatment or prevention of osteonecrosis of the hip...
January 2009: Indian Journal of Orthopaedics
S Agarwala, S Shah, V R Joshi
The use of bisphosphonates in the treatment of avascular necrosis of the femoral head is an encouraging but relatively new option with most published data being derived from small trials with limited follow-up. We present a clinicoradiological analysis of 395 hips with avascular necrosis which were treated with oral alendronate for three years with a mean follow-up of four years (1 to 8). Our results show an improvement in the clinical function, a reduction in the rate of collapse and a decrease in the requirement for total hip replacement, compared with the findings of other studies in which no treatment was given...
August 2009: Journal of Bone and Joint Surgery. British Volume
Eneida Machado Alves, Adriano Tanajura Angrisani, Mittermayer B Santiago
Osteonecrosis is a progressive clinical condition with significant morbidity, which primarily affects weight-bearing joints and is characterized by the death of the bone, or part of it, because of insufficient circulation. The hip is the most common compromised joint. In osteonecrosis of the femoral head (ONFH), the collapse of the femoral head is a result of mechanically weak bone submitted to a load of weight, and can be associated with incapacitating pain and immobility. Both nonsurgical and surgical treatment options have been used with differing levels of success, and nonoperative treatment modalities such as bisphosphonates, statins, anticoagulants, and extracorporeal shock wave therapy (ESWT) for early-stage disease have been described, but exact indications have not been established yet...
November 2009: Clinical Rheumatology
V H H P Straten, M J A M Franssen, A A den Broeder, M Obradov, F H J van den Hoogen
We report the first case of regional migratory osteoporosis (RMO) in a patient with ankylosing spondylitis (AS). This middle-aged man suffered from an acute onset of knee pain that increased on weight bearing, followed by ankle pain. The diagnosis of RMO was confirmed using magnetic resonance imaging (MRI), after exclusion of other causes of knee pain. MRI revealed a large area of bone marrow oedema without a zone of demarcation or subchondral fracture with a demonstration of shifting marrow oedema on the follow-up MRI scan from the medial femur condyl to the tibia plateau lateral and then to the distal tibia epiphysis...
January 2009: Scandinavian Journal of Rheumatology
G Mouzopoulos, M Stamatakos, C Kouvaris, D Mouzopoulos, M Tzurbakis
We present a rare case of bilateral subcapital hip fracture as a first sign of multiple myeloma in a young man. Right femoral neck fracture was treated by three Asnis screws and the left one by hemiarthroplasty. In order to avoid implant failure, we used zoledronic acid, a bisphosphonate compound, instead of methacrylate cement. After an 18-month follow-up, there was no evidence of avascular necrosis, no implant failure and no periprothetic fracture.
September 2007: European Journal of Cancer Care
I H Tarner, R Dinser, U Müller-Ladner
Avascular necrosis (AVN) of the hip is one of the unsolved problems in orthopedics, especially with regard to drug therapy. Only a few studies exist using a long-term approach with vasodilating agents such as prostaglandins, anticoagulants, hormones, as well as lipid lowering and bone protective drugs such as bisphosphonates. However, using these medications several studies have demonstrated a significant reduction in pain, in the destruction of the femoral head as well as in overall disability. This resulted in a reduced need for joint replacement in patients with AVN and to a substantial improvement in quality of life...
May 2007: Der Orthopäde
Ashraf Badros, Dianna Weikel, Andrew Salama, Olga Goloubeva, Abraham Schneider, Aaron Rapoport, Robert Fenton, Natalie Gahres, Edward Sausville, Robert Ord, Timothy Meiller
PURPOSE: To describe the clinical, radiologic, and pathologic features and risk factors for osteonecrosis of the jaw (ONJ) in multiple myeloma (MM) patients. PATIENTS AND METHODS: A retrospective review of 90 MM patients who had dental assessments, including 22 patients with ONJ. There were 62 men; the median age was 61 years in ONJ patients and 58 years among the rest. Prior MM therapy included thalidomide (n = 67) and stem-cell transplantation (n = 72). Bisphosphonate therapy included zoledronate (n = 34) or pamidronate (n = 17) and pamidronate followed by zoledronate (n = 33)...
February 20, 2006: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
S Agarwala, D Jain, V R Joshi, A Sule
OBJECTIVE: To study the efficacy of alendronate, in the treatment of avascular necrosis (AVN) of the hip. METHODS: Sixty patients with AVN of the hip (100 hips with AVN) were studied. The follow-up period ranged from 3 months to 5 yr. The most common cause of AVN was steroids. Parameters studied were walking time, standing time, pain and disability on a visual analogue scale (VAS), range of motion of the hip, X-ray and MRI of the hip. All patients were treated with alendronate 10 mg/day (or 70 mg/week) along with 500-1000 mg of daily calcium and vitamin D supplements, and were advised to avoid weight-bearing...
March 2005: Rheumatology
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