Blood perfusion uneven in femoral head osteonecrosis: Doppler flowmetry and intraosseous pressure in 12 cases

Lausten, Gunnar Schwarz; Arnoldi, Carl C.

doi:10.3109/17453679308993686

Cited by 24 publications

(14 citation statements)

References 14 publications

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“…In patients with non-traumatic necrosis of the femoral head, the blood flow as estimated by laser doppler flowmetry was lower in the necrotic area than in the remaining part of the femoral head. 6 We conclude that treatment with high-dose methylprednisolone reduces blood flow in both cortical and cancellous bone selectively in the pig. There appears to be an overall reduction in the RBF in the epiphysis of the femoral head with no tendency to uneven distribution.…”

Section: Discussionmentioning

confidence: 72%

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Selective reduction of bone blood flow by short-term treatment with high-dose methylprednisolone

Drescher

Schneider

Becker

et al. 2001

The Journal of Bone and Joint Surgery. British volume

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T reatment with corticosteroids is a risk factor for non-traumatic avascular necrosis of the femoral head, but the pathological mechanism is poorly understood. Short-term treatment with high doses of methylprednisolone is used in severe neurotrauma and after kidney and heart transplantation. We investigated the effect of such treatment on the pattern of perfusion of the femoral head and of bone in general in the pig.We allocated 15 immature pigs to treatment with high-dose methylprednisolone (20 mg/kg per day intramuscularly for three days, followed by 10 mg/kg intramuscularly for a further 11 days) and 15 to a control group. Perfusion of the systematically subdivided femoral head, proximal femur, acetabulum, humerus, and soft tissues was determined by the microsphere technique. Blood flow in bone was severely reduced in the steroid-treated group. The reduction of flow affected all the segments and the entire epiphysis of the femoral head. No changes in flow were found in non-osseous tissue. Short-term treatment with high-dose methylprednisolone causes reduction of osseous blood flow which may be the pathogenetic factor in the early stage of steroid-induced osteonecrosis.

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Section: Discussionmentioning

confidence: 72%

“…5 In patients with FHN, uneven blood flow with a lower flow within the necrotic sequester has been described. 6 Our aim was to investigate in pigs the effect of treatment with high-dose methylprednisolone on blood flow in bone in general and on the pattern of regional perfusion of the epiphysis of the femoral head.…”

mentioning

confidence: 99%

Selective reduction of bone blood flow by short-term treatment with high-dose methylprednisolone

Drescher

Schneider

Becker

et al. 2001

The Journal of Bone and Joint Surgery. British volume

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“…Blood flow was found to be uneven in osteonecrotic femoral heads of patients as elicited by Doppler flowmetry [23]. Thus, uneven blood flow does not seem to be present under or directly after steroid administration, although it appears to be a feature of F H N and the repair processes.…”

Section: Phasementioning

confidence: 84%

Femoral head blood flow reduction and hypercoagulability under 24 h megadose steroid treatment in pigs

DRESCHER¹

2004

Journal of Orthopaedic Research

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The pathogenesis of corticosteroid-induced femoral head necrosis is assumed to be ischemia. The purpose of this study was to investigate the perfusion pattern of the femoral head and plasma coagulability during 24 h corticosteroid megadose treatment, as recommended by the National Acute Spinal Cord Injury Studies (NASCIS), in the awake big animal model. Blindedly, 9 animals underwent megadose methylprednisolone infusion (30 mg/kg intravenously as a n initial bolus, followed by 5.4 mglkglh for further 23 h) while 9 animals served as placebo treated controls. Regional blood flow of the systematically subdivided femoral head, proximal femur, acetabulum, and soft tissue hip regions was investigated by the microsphere technique at steady state (phase I), after the initial bolus infusion (phase 2), and after the completed treatment (phase 3). Plasma coagulability was examined in phases 1 and 3. Blood flow of the femoral head epiphysis and metaphyseal cancellous bone was unchanged after one hour of steroid infusion, but decreased after the completed treatment at 24 h in the experimental group. Femoral head blood flow reduction was global without a tendency to more pronounced blood flow decrease in any subregion. Plasma fibrinogen was significantly higher after 24 h of steroid infusion than in the placebo control group. 24 h high dose methylprednisolone treatment causes femoral head blood flow reduction and hypercoagulability of plasma in the normal awake immature pig. These findings may be pathogenetic factors in the early stage of steroid-induced osteonecrosis.

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“…The calculated blood flow values for the humerus, femur, and tibia of the rabbit are within the range of values reported in the literature. 19,32,36,70 Mean bone blood flow at each measurement was highest in the humerus (approximately 16 mL/minute/100 g) followed by the femur (approximately 13 mL/minute/100 g) and the tibias (approximately 8 mL/minute/100 g). These data are in contrast to the results of Shim et al 55 who measured blood flow in long bones of the rabbit by means of 85 Sr clearance and found blood flow values of approximately 10 mL/minute/100 g in the femur, tibia, and humerus.…”

Section: Discussionmentioning

confidence: 98%

Microspheres Accurately Predict Regional Bone Blood Flow

Anetzberger¹,

Thein²,

Becker³

et al. 2004

Clinical Orthopaedics &Amp; Related Research

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Even though the microsphere method frequently is used to determinate bone blood flow, validation of this technique for bone blood flow measurement is incomplete. The method is based on the principle that injected microspheres are distributed with the arterial blood and trapped in the capillaries because of their diameter (15 µm). The number of spheres lodged in an organ is proportional to its blood flow. The number of radioactive or fluorescent microspheres in a specific organ is determined indirectly by measuring radioactivity or fluorescence intensity in the organ. In this study the reliability and precision of the microsphere method for determining bone blood flow was established using radioactive and fluorescent microspheres. Six female, anesthetized New Zealand rabbits received left ventricular injections of pairs of fluorescent and/or radioactive microspheres. The humerus, femur, and tibia were dissected in a standardized manner and blood flow was determined in each sample. Comparison of relative blood flow values showed an excellent correlation between radioactive and fluorescent microspheres. The percentage difference and variation between two simultaneously injected sets of microspheres was minimal for radioactive microspheres (0.8% ± 9.6%) and for fluorescent microspheres (0.2% ± 11.4%). Regional bone blood flow in different regions of the femur, tibia, or humerus ranged from 2.2-28.1 mL/minute/100 g, but there was no significant difference between right and left bone samples of the same region after repeated measurement. Radioactive and fluorescent microspheres allow precise determination of regional bone blood flow.

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Blood perfusion uneven in femoral head osteonecrosis: Doppler flowmetry and intraosseous pressure in 12 cases

Cited by 24 publications

References 14 publications

Selective reduction of bone blood flow by short-term treatment with high-dose methylprednisolone

Selective reduction of bone blood flow by short-term treatment with high-dose methylprednisolone

Femoral head blood flow reduction and hypercoagulability under 24 h megadose steroid treatment in pigs

Microspheres Accurately Predict Regional Bone Blood Flow

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