There has been an increasing trend in its diagnosis. Osteonecrosis of the femoral head in an adolescent on long. Osteonecrosis of femoral head is a rare but disabling condition that usually results in progressive femoral head collapse and secondary arthritis necessitating total hip arthroplasty if not treated appropriately in early stages. Avascular necrosis avn, or more correctly osteonecrosis, is a generic term referring to the ischemic death of the constituents of bone. The disease typically affects epiphyseal bone on the convex side of a joint, likely due to the lack of collateral circulation, and most commonly affects the femoral head, followed by the distal femur, proximal humerus and talus. Jan 01, 2011 orthopedics osteonecrosis, also known as avascular necrosis or ischemic necrosis of the femoral head, is a pathologic process that results from interruption of blood supply to the bone. Ficat and arlet classification of avascular necrosis of. Este procedimiento fue descrito con detalle por primera vez por meyers et al. Resena sobre conceptos actuales osteonecrosis no traumatica. Dec 21, 20 treatment of osteonecrosis of the femoral head with implantation of autologous bonemarrow cells.
Treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell infusion. Arriculos potential pathogenetic factors have recently been found to mutually interact with the gut microbiota, raising the hypothesis of a link between microbiome alterations and als pathogenesis. The disease is characterized by apoptosis of bone cells bone marrow and bone forming cellsresulting in head collapse with a subsequent lesion of the overlying cartilage, and therefore flattening of the rounded surface shape of the head articulating with the acetabulum, provoking, eventually. Osteonecrosis, also known as aseptic necrosis, avascular necrosis avn, atraumatic necrosis, and ischemic necrosis, is a pathologic process that has been associated with numerous conditions and therapeutic interventions. Gradually joint pain may develop which may limit the ability to move.
The main risk factors are bone fractures, joint dislocations, alcoholism, and the use of high dose. Treatment of osteonecrosis of the femoral head with implantation of autologous bonemarrow cells. Osteonecrosis of the femoral head onfh is the end point of a variety of disease processes resulting in decreased blood flow and, ultimately, cellular death within the femoral head. Avascular necrosis of the femoral head in hiv infected. 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. Because bone cells need a steady blood supply, osteonecrosis can lead to destruction of the knee joint and arthritis. Survival rates were similar being 90% in hemiresurfacing arthroplasty group and at 93% in tha group. It is currently not proven that patients with idiopathic osteonecrosis of the femoral head a specific type of destruction of the hip joint need surgery less often, or experience less pain or increased mobility of the joint if they receive hyperbaric oxygen therapy hbot in addition to conventional treatment. Osteonecrosis of the knee is a painful condition that occurs when the blood supply to a section of the femur thighbone or tibia shinbone is disrupted. In regards to osteonecrosis of the femoral head, the mean age at presentation is 38 years.
It typically affects relatively young, active people between 20 and 40 years and regularly follows an unrelenting course resulting in. Stem cell treatment for avascular necrosis of the femoral head. Stem cell treatment for avascular necrosis of the femoral. Osteonecrosis of the femoral head is a disabling clinical entity affecting young adults that usually leads to destruction of the hip joint. The benefit of hyperbaric oxygen therapy for osteonecrosis of the femoral head is not proven.
Tratamiento quirurgico carlos casanova morote, rene mendoza martinez hospital provincial clinico quirurgico docente manuel ascunse domenech, camaguey, cuba. The ihdi is here to help you find answers to your questions when dealing with hip dysplasia. This paper aims to introduce different hip replacement techniques for onfh and elaborate characteristics of each technique. Avascular necrosis avn of the femoral head is a progressive disease that predominantly affects younger patients. Most sites of involvement have an eponym associated with avascular necrosis of that area, and these sites are discussed. Osteonecrosis of the femoral head orthopaedicsone articles.
In patients in whom there is direct damage to bone vasculature eg, femoral neck fracture or direct injury of bone or. We report an usual case report of a 10yearold male who developed ipsilateral femoral head osteonecrosis after long. According to the literature, about 5%12% of hip arthroplasties are performed for the treatment of this condition per annum. Va hospital reno abstract case presentation figures. Answers to your questions about developmental dysplasia of the hip ddh, also known as hip dysplasia, in humans. Complications may include collapse of the bone or nearby joint surface risk factors include bone fractures, joint dislocations, alcoholism, and the use. Remains untreated, about 7080% of the patients progress to secondary hip arthritis. Rarely, osteonecrosis affects the jaw see separate chapter for details on osteonecrosis of the jaw. The physiopathology of avascular necrosis of the femoral. Both operative and nonoperative treatments have been described with variable success rate. Iqwig publishes final report therapy should be applied only.
Other common sites include the humerus the bone of the upper arm, knees, shoulders, ankles and the jaw. Sep 18, 2015 osteonecrosis on of the femoral head onfh is the final common pathway of a series of derangements that result in a decrease in blood flow to the femoral head fh leading to cellular death, fracture, and collapse of the articular surface1,2. Sickle cell disease is a risk factor for interrupting the blood supply of the femur and developing osteonecrosis of femoral head. However, the link between osteonecrosis and inhaled corticosteroids is less researched and understood.
The physiopathology of avascular necrosis of the femoral head. A high index of suspicion is necessary for the diagnosis due to the insidious onset of the bone infarcts and the lack of specific clinical signs at the early stages. Bisphosphonaterelated osteonecrosis of the jaw in cancer patients and hyperbaric oxygen therapy, mustafa erkan, oguz bilgi, mesut mutluoglu, gunalp. Illuminations illuminations 1002 patterns of osteonecrosis in the femur a early osteonecrosis of the adult femoral head produces a superolateral rim of sclero sis extending to the articular surface. Osteonecrosis of the femoral head, a disease primarily affecting young adults, is often associated with collapse of the articular surface and subsequent arthrosis. Avascular necrosis of the femoral head in hiv infected patients. Hip dysplasia or ddh is normally diagnosed in babies however it can develop later on. Hemiresurfacing arthroplasty this procedure involves the replacement of femoral head surface only using appropriately sized prosthetic. Abstract fiftysix cases of total hip ds in ankylotic or arthrodetic hips were studied.
Osteonecrosis on of the femoral head onfh is the final common pathway of a series of derangements that result in a decrease in blood flow to the femoral head fh leading to cellular death, fracture, and collapse of the articular surface1,2. Osteonecrosis of femoral head onfh is a disabling condition of young individuals with illdefined etiology and pathogenesis. Avascular necrosis most commonly affects the ends of long bones such as the femur the bone extending from the knee joint to the hip joint. Osteonecrosis of the femoral head linkedin slideshare. Osteonecrosis usually occurs between the ages of 20 and 50 years.
Osteonecrosis of bilateral femoral heads after short term. The physiopathology of the femoral head bone necrosis is similar for children and for adults. It typically affects relatively young, active people between 20 and 40 years and regularly follows. Avascular necrosis of the femoral head is a frequent condition with an insidious presentation. Orthopedics osteonecrosis, also known as avascular necrosis or ischemic necrosis of the femoral head, is a pathologic process that results from interruption of blood supply to the bone. Avn has a wide variety of causes and can affect nearly any bone in the body. A pathological fracture of the right femoral neck associated with osteonecrosis of the right femoral head and a stress fracture of the contralateral femoral neck occurred in a 47yearold man. Current concepts on osteonecrosis of the femoral head. Osteonecrosis of the femoral head onfh is the end point of a variety of disease processes resulting in decreased blood flow and, ultimately, cellular death within the. Osteonecrosis of the femoral head onfh usually affects young adults in the third and fourth decades of life.
Avascular necrosis avn of the femoral head is an emerging complication in hiv infected patients. Patterns of osteonecrosis in the femur a early osteonecrosis of the adult femoral head produces a superolateral rim of sclerosis extending to the articular surface. Jun 19, 2015 osteonecrosis of femoral head is a rare but disabling condition that usually results in progressive femoral head collapse and secondary arthritis necessitating total hip arthroplasty if not treated appropriately in early stages. Features consistent of bilateral femoral head avascular necrosis. A relationship between the development of osteonecrosis of the femoral head and systemic corticosteroids has been well established in the literature, particularly in adults. Bones and bone marrow need steady blood supply to stay healthy. Arthroplasty in femoral head osteonecrosis able to perform highimpact exercise while 20% of patients had severe groin pain in the 7year followup. Avascular necrosis avn, also called osteonecrosis or bone infarction, is death of bone tissue due to interruption of the blood supply. The french orthopedic surgeon paul rp ficat 19171986 4 in association with professor jacques arlet devised a system of staging idiopathic avascular necrosis of femoral head in the late 1970s based on two fundamental concepts 2.
14 428 452 1244 86 616 561 7 193 618 611 1422 732 769 1219 1437 1433 369 852 1162 495 1063 503 799 1517 1402 912 506 1380 1468 413 1124 209 532 189 631 895 823 888 378 457 1188 128 176