ACR Appropriateness Criteria Osteonecrosis of the Hip

Murphey, Mark D.; Roberts, Catherine C.; Bencardino, Jenny T.; Appel, Marc; Arnold, Erin; Chang, Eric Y.; Dempsey, Molly; Fox, Michael G.; Fries, Ian Blair; Greenspan, Bennett S.; Hochman, Mary G.; Jacobson, Jon A.; Mintz, Douglas N.; Newman, Joel S.; Rosenberg, Zehava Sadka; Rubin, David A.; Small, Kirstin M.; Weissman, Barbara N.

doi:10.1016/j.jacr.2015.10.033

Cited by 32 publications

(18 citation statements)

References 61 publications

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“…Arthralgia of the hips [19] and knees [20] is a very common complaint in the outpatient setting, often requiring diagnostic imaging studies [21–23]. Primary ON [6] is not a common cause of arthralgia [24], and the diagnosis and therapy of ON remains poorly understood by many clinicians.…”

Section: Discussionmentioning

confidence: 99%

Case report: primary osteonecrosis associated with thrombophilia-hypofibrinolysis and worsened by testosterone therapy

et al. 2017

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BackgroundFamilial and acquired thrombophilia are often etiologic for idiopathic hip and jaw osteonecrosis (ON), and testosterone therapy (TT) can interact with thrombophilia, worsening ON.Case presentationCase 1: A 62-year-old Caucasian male (previous deep venous thrombosis), on warfarin 1 year for atrial fibrillation (AF), had non-specific right hip-abdominal pain for 2 years. CT scan revealed bilateral femoral head ON without collapse. Coagulation studies revealed Factor V Leiden (FVL) heterozygosity, 4G/4G plasminogen activator inhibitor (PAI) homozygosity, high anti-cardiolipin (ACLA) IgM antibodies, and endothelial nitric oxide (NO) synthase (eNOS) T786C homozygosity (reduced conversion of L-arginine to NO, required for bone health). Apixaban 5 mg twice daily was substituted for warfarin; and L-arginine 9 g/day was started to increase NO. On Apixaban for 8 months, he became asymptomatic. Case 2: A 32-year-old hypogonadal Caucasian male had 10 years of unexplained tooth loss, progressing to primary jaw ON with cavitation 8 months after starting TT gel 50 mg/day. Coagulation studies revealed FVL heterozygosity, PAI 4G/4G homozygosity, and the lupus anticoagulant. TT was discontinued. Jaw pain was sharply reduced within 2 months.ConclusionsIdiopathic ON, often caused by thrombophilia-hypofibrinolysis, is worsened by TT, and its progression may be slowed or stopped by discontinuation of TT and, thereafter, anticoagulation. Recognition of thrombophilia-hypofibrinolysis before joint collapse facilitates anticoagulation which may stop ON, preserving joints.

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Section: Discussionmentioning

confidence: 99%

Case report: primary osteonecrosis associated with thrombophilia-hypofibrinolysis and worsened by testosterone therapy

et al. 2017

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“…nevertheless, Hip prognosis can be markedly enhanced after early medical diagnosis, prior to articular collapse [24] Neither laboratory tests nor radiographic findings can either suggest or confirm the presence of avascular necrosis (AVN). However, the American College of Radiology (ACR) recommends pelvis and hips x-ray of the first and upmost proper diagnostic tool for patients at risk for AVN who typically present with hip pain [25] .Yet if the results outcome were normal or showing femoral head lucencies doubtful for osteonecrosis, then MRI of the hips without contrast should follow [25] Moreover, Median thigh or groin discomfort with limitation of hip movement in patients less than 50 years of age ought to raise the suspicion of osteonecrosis. Generally, Early stages of the illness can typically be asymptomatic, and some patients present after articular surface collapse has already happened.…”

Section:  Diagnosis and Classificationmentioning

confidence: 99%

Review of Current Concepts Femoral of Head Osteonecrosis

Alqahtani

Korkoman

Al-Gelban

et al. 2018

Egyptian Journal of Hospital Medicine

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Background: The avascular necrosis (AVN) or osteonecrosis of the femur head (ONFH), an illness with several etiological factors, impacts young populace and otherwise handled prompt, causes the collapse of femur head eventually requiring hip arthroplasty. Objective: the present article aims to provide an overview of epidemiology, pathophysiology of osteonecrosis along with diagnosis methods and non-surgical in early stages and surgical treatment methods. Methodology: Comprehensive search of the literature was conducted in the following databases; PubMed, and SciVerse Scopus for studies published before November 2017. The PubMed database was searched using an algorithm comprising relevant MeSH terms including "Osteoporosis", "femoral head osteonecrosis" AND "management" "diagnosis". Conclusion: Osteonecrosis is a destructive pathology that eventually results in bone death through loss of blood to the bone, it involves almost every bone including the femoral head while early start of osteoarthritis could ultimately demand hip arthroplasty when non-operative procedures and joint-sparing treatments fail. Nevertheless, recent technological advances in surgical treatment methods have improved outcomes and should help patients recover from this functionally debilitating joint disease.

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“…Anahtar sözcükler: Legg-Calvé-Perthes; MR görüntüleme; diffüzyon ağırıklı görüntüleme; perfüzyon görüntüleme Legg-Calvé-Perthes (LCP) disease refers to the osteonecrosis of the femoral head of childhood with unknown etiology [1] . Magnetic resonance (MR) imaging is a technique that can be used for early diagnosing, staging and evaluating the treatment.…”

Section: Legg-calvé-perthes Hastalığında Mr Görüntülemementioning

confidence: 99%

“…Legg-Calvé-Perthes hastalığı (LCP) nedeni bilinmeyen ço-cukluk çağı femur başı osteonekrozudur. [1] Manyetik rezonans (MR) görüntüleme, LCP'nin erken tanısı, evresini ortaya koymada ve tedaviyi değerlendirmede kullanılabi-len bir tekniktir. MR bulguları, hastalığın farklı evrelerine göre değişkenlik gösterebilmektedir.…”

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