Epidemiology of Traumatic and Nontraumatic Osteonecrosis

Jacobs, Bernard

doi:10.1097/00003086-197801000-00005

Cited by 109 publications

(86 citation statements)

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“…ON, especially of the femoral head, in association with chronic alcoholism is fairly common. The incidence rate among alcoholics may not be as high as expected with the incidence of 5.3% in medically treated alcoholics (28,29). Radiographic and pathologic characteristics of ON in patients with aplastic anemia are not unique, being evident in cases of bony necrosis due to other causes.…”

Section: Discussionmentioning

confidence: 87%

Osteonecrosis of the Hip in Patients with Aplastic Anemia

et al. 2002

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The incidence and clinical and magnetic resonance imaging features of osteonecrosis of the hip were evaluated in patients with aplastic anemia. Two hundred and forty-one patients with aplastic anemia were examined using MR imaging of bone marrow during the five years from 1994 to 1998. Osteonecrosis of the hip was observed on MR imaging in nineteen (15 males and 4 females, mean age 35 yr) of the 241 patients. It was present in both hips in 14 patients, and there were five cases with unilateral occurrence, with a total of 33 involved hips. All except for five hips with associated bone marrow edema revealed increased fatty marrow conversion in the proximal femoral metaphysis. In nine patients, osteonecrosis was detected without any pain. Five patients already had osteonecrosis before any medication was administered. Twelve patients received antilymphocyte globulin, and seven patients received a low dose of steroids before the MR diagnosis of osteonecrosis. Osteonecrosis of the hip frequently develops in patients with aplastic anemia (7.9%), associated with fatty marrow conversion of the proximal femoral metaphysis.

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Section: Discussionmentioning

confidence: 87%

Osteonecrosis of the Hip in Patients with Aplastic Anemia

et al. 2002

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“…Hypertrophy and proliferation of fat cells, diminished hematopoiesis, lipid deposition in osteocytes, fatty degeneration of osteocytes, marrow necrosis, and thinner and sparse trabeculae are histopathologic changes occurring in the early stages of steroid-and alcohol-induced ON of the femoral head [9,19,22,23,36,47,50,57]. Several hypotheses have been proposed in the literature, including the increased size and number of fatty cells, increased intraosseous pressure, fatty degeneration of osteocytes, fat embolism, and extraosseous arterial occlusion due to abnormal changes in histologic features, hemodynamics, metabolism, and biochemical features within the femoral head [1,10,17,23,24,35,39,48].…”

Section: Discussionmentioning

confidence: 99%

Preventive Effects of Puerarin on Alcohol-induced Osteonecrosis

Wang

Yin

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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Alcohol can induce adipogenesis by bone marrow stromal cells and may cause osteonecrosis of the femoral head. Currently, there are no medications available to prevent alcohol-induced osteonecrosis. We hypothesized puerarin, a Chinese herbal medicine with antioxidative and antithrombotic effects, can prevent alcohol-induced adipogenesis and osteonecrosis. Both bone marrow stromal cells (in vitro) and mice (in vivo) were treated either with ethanol or with ethanol and puerarin, with an untreated group serving as a control. In the in vitro study, the number of adipocytes, contents of triglycerides, and levels of PPARc mRNA expression were decreased and alkaline phosphatase activity, contents of osteocalcin, and levels of osteocalcin mRNA expression were increased in cells treated with both alcohol and puerarin, compared with cells treated with alcohol only. In the in vivo study, marrow necrosis, fat cell hypertrophy and proliferation, thinner and sparse trabeculae, diminished hematopoiesis, and increased empty osteocyte lacunae in the subchondral region of the femoral head were observed in mice treated with alcohol. However, no such changes were seen in femoral heads of mice treated with alcohol and puerarin. The data suggest puerarin can inhibit adipogenic differentiation by bone marrow stromal cells both in vitro and in vivo and prevents alcohol-induced osteonecrosis in this model.

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“…Nowadays avascular necrosis (AVN) continues to present a challenging clinical problem because it affects mostly middle-aged patients in their active phase of living. Another aggravating factor is that in 30-70% of the patients both hips are involved, with a peak incidence at 40 years of age [8]. In contrast to traumatic causes such as subcapital fracture or hip dislocation leading to vascular disruption and acutely deficient perfusion of the femoral head, the exact aetiology of AVN remains obscure [3,13].…”

Section: Introductionmentioning

confidence: 99%

Avascular necrosis of the femoral head: inter- and intraobserver variations of Ficat and ARCO classifications

Schmitt‐Sody¹,

Kirchhoff²,

Mayer³

et al. 2007

International Orthopaedics (SICO

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Diagnosis of avascular necrosis (AVN) of the femoral head depends on the combination of clinical symptoms and evaluation of radiographs and/or magnetic resonance imaging (MRI). To evaluate the evolution of AVN, the Ficat and the Association Research Circulation Osseous (ARCO) classification are commonly used to assess both imaging modalities. For comparison reasons, these classifications need to be reliable and reproducible to provide sufficient therapy options for the patient. Therefore, the aim of our study was to evaluate the interobserver reliability and the intraobserver reproducibility of these classifications. Patients with suspected AVN were examined using either radiographs or radiographs and MRI. The radiographs and/or MR images were reviewed initially and at 3 months by two general orthopaedic surgeons, two orthopaedic residents, and two general radiologists using the Ficat classification for radiographs and MR images as well as the ARCO classification for MR images only. In all, 38 patients (54 hips) were enrolled. There were 10 patients who presented with radiographs and 28 patients with radiographs and MR scans. Paired comparisons revealed a mean interobserver kappa reliability coefficient of 0.39 for the first and of 0.32 for the second review using the Ficat classification for radiographs, whereas for the MR images a mean of 0.39 in the first and of 0.34 in the second reading resulted. The MRI evaluation using the ARCO classification resulted in a mean interobserver reliability coefficient of 0.37 in the first and of 0.31 in the second reading. The mean kappa value for intraobserver reproducibility using the Ficat classification was 0.52 for radiographs and 0.50 for MR images, whereas a reproducibility of 0.43 resulted for the ARCO classification. This study showed poor interobserver reliability and fair intraobserver variability, diminishing any meaningful comparison of studies using the Ficat as well as the ARCO classification. Thus, the Ficat and ARCO staging systems are still not sufficient to reliably assess the status of AVN alone.Résumé Le diagnostic des nécroses vasculaires de la tête fémorale (AVN) dépend de l'analyse des signes cliniques et de l'évaluation des signes radiographiques ainsi que de l'IRM. Afin d'évaluer l'évolution de l'ostéonécrose de la hanche selon la classification de la Ficat et la classification ARCO, ces examens d'imagerie sont habituellement utilisés. Le but de notre étude est d'évaluer la fiabilité de ces différents paramètres inter et intra observateurs. Matériel et méthode : les patients suspects d'ostéonécrose de la hanche ont été examinés sur le plan radiographique et sur le plan IRM. Les radiographies et les images IRM ont été évaluées initialement trois mois après par deux chirurgiens orthopé-distes, deux résidents en orthopédie et deux radiologues en utilisant la classification du Ficat et la classification ARCO pour les images IRM. Résultats : 38 patients (54 hanches) ont été inclus dans cette étude. 10 patients n'ont bénéficié

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Epidemiology of Traumatic and Nontraumatic Osteonecrosis

Cited by 109 publications

References 0 publications

Osteonecrosis of the Hip in Patients with Aplastic Anemia

Osteonecrosis of the Hip in Patients with Aplastic Anemia

Preventive Effects of Puerarin on Alcohol-induced Osteonecrosis

Avascular necrosis of the femoral head: inter- and intraobserver variations of Ficat and ARCO classifications

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