Avascular necrosis of the femoral head after single steroid intra-articular injection

Abstract

Femoral head avascular bone necrosis (AVN) is the loss of blood supply to the bone tissue of femoral head that results in cellular death. This condition causes a significant limitation in patient daily life activities and has a poor functional outcome. Long-term steroid intake was established as a cause of AVN. However, few cases reported femoral head AVN post-single steroid intra-articular injection. We review all cases of AVN that results from single intra-articular steroid injection and present a case of femoral head AVN developed in a 78-year-old male. The patient, who was not known to have any medical illness, presented complaining of mild left hip pain for 4 months with long distant ambulation and weight standing. He was diagnosed to have left hip joint osteoarthritis for which he received intra-articular steroid injection 2 months prior visiting our orthopedics center. MRI of the pelvis revealed AVN of the femoral head. He underwent total hip arthroplasty. The pathological examination confirmed the diagnosis of AVN. To best of our knowledge, this is the fifth case of AVN of femoral head AVN after single intra-articular steroid injection. We reviewed all cases of AVN of femoral head after single steroid injection. Intra-articular steroid injection can cause femoral head AVN, and the patient receiving these injections should be aware about this rare but significant complication that results in poor functional outcome and significant morbidity.

Autologous Biologic Treatment with Fat, Bone Marrow Aspirate and Platelet Rich Plasma Is an Effective Alternative to Total Knee Arthroplasty for Patients with Moderate Knee Arthrosis

“…Until now, there has been no effective treatment for knee arthrosis. Corticosteroid injections are widely used but damage cartilage [ 2 , 3 ], predispose to often devastating infection after TKA [ 4 , 5 ], are often associated with severe complications, such as stress fracture and avascular necrosis [ 6 , 7 , 8 , 9 ], and have been shown to accelerate arthrosis and increase the incidence of TKA [ 2 , 9 ]. Nonsteroidal anti-inflammatory medicines (NSAID) drugs are also widely used, but have high toxicity rates [ 10 ].…”

Risk factors for multi-joint disease in patients with glucocorticoid-induced osteonecrosis

“…We would require a greater number of subjects in our cohort to investigate whether the risk may be greater in individuals who receive injections at the different joints. While there are reports of patients who develop ON after glucocorticoid injections without any IV or oral exposure [25,26], we may not have detected a relationship because the amount of glucocorticoid from these routes relative to the oral exposure in our cohort was quite small. The use of inhaled steroids was higher among patients with MJON which may suggest that the systemic absorption of inhaled glucocorticoids, although small in relation to oral or intravenous GCs, does contribute meaningfully to total exposure and the development of MJON.…”

Autologous Mesenchymal Stem Cell Treatment is Consistently Effective for the Treatment of Knee Osteoarthritis: The Results of a Systematic Review of Treatment and Comparison to a Placebo Group

“…The short-term results of treatment with HA and corticosteroids require more frequent treatment, thereby increasing the risks of adverse events from treatment. Corticosteroids have been shown to accelerate the progression of osteoarthritis [ 4 , 5 ] and predispose to serious problems after joint replacement [ 6 , 7 , 8 , 9 , 10 , 11 ]. This study demonstrates that a single treatment of AMSCI can produce significant clinical improvement that can last at least 2 years.…”

“…HA has a variable effect, with low efficacy in many patients and a short (6-month) duration of effect [ 3 ]. Corticosteroid injections can damage cartilage [ 4 , 5 ], predispose to serious problems after a joint replacement [ 6 , 7 , 8 , 9 , 10 , 11 ], and have been shown to increase the incidence of joint replacement [ 4 , 10 ]. Therefore, there is an urgent need for a non-surgical treatment that is safe and more effective than these options.…”