Osteoradionecrosis of the Hip, a Troublesome Complication of Radiation Therapy: Case Series and Systematic Review

Abstract

BackgroundOsteoradionecrosis of the hip is a serious complication of radiotherapy that is easily overlooked by physicians and patients in the early stages. There are relatively few reports on this subject, so there is no clear scientific consensus for the pathogenesis, early diagnosis, and clinical treatment of hip osteoradionecrosis. In this paper, we report two cases of hip osteoradionecrosis and systematically review the related literature.Case PresentationWe report two cases of hip osteoradionecrosis. One patient successfully underwent total hip arthroplasty in our hospital and recovered well postoperatively. Another patient although we offered a variety of surgical options for this patient, the patient was worried that the bone loss would lead to poor prosthesis fixation, resulting in prosthesis loosening and infection, and therefore ultimately refused surgical treatment.ConclusionWith the development of radiological techniques, the incidence of hip osteoradionecrosis is decreasing year by year, but early diagnosis and rational treatment remain challenging. The effects of non-surgical treatment are limited. Early prevention, early detection, and early intervention are crucial to delay or prevent the emergence of more serious complications.

Clinical Outcomes Among Patients Treated With Stereotactic Body Radiation Therapy to Femur Metastases for Oligometastatic Disease Control or Reirradiation: Results From a Large Single-Institution Experience

“…Osteoradionecrosis (ORN) is caused by lack of blood supply to the bone, leading to ischemic cell death and the incidence of pelvic ORN has ranged from 2.1% to 34%, depending on radiation standards and the technology applied. 30 , 31 , 32 It has been reported that high doses of radiation can increase the risk of ORN due to high calcium content of bone tissue, which absorbs 30% to 40% more radiation than the surrounding tissue and the sensitivity of bone to radiation therapy may also be increased in the context of chemotherapy. 32 , 33 , 34 Femur osteonecrosis is a rare but serious complication and has been associated with many risk factors, including mechanical stresses, genetic predisposition, corticosteroid use, alcohol intake, smoking, and other chronic diseases (renal disease, hematologic disease, inflammatory bowel disease, postorgan transplantation, hypertension, and gout).…”

Review of the Pathogenesis, Diagnosis, and Management of Osteoradionecrosis of the Femoral Head

“…ORN of the femoral head may not become noticeable until several years after RT, and patients may not always associate it with a previous history of radiation [ 5 ], which could lead to misdiagnosis. We have reported several cases of ORN patients in the past, and their treatment process of the disease was quite tortuous [ 87 ]. Symptomatic osteonecrosis of the femoral head is diagnosed at a relatively late stage, and its severity can remain constant or deteriorate over time [ 88 ].…”

Osteonecrosis

“…Complications included an aseptic loosening rate of 10% and a revision rate of 12%. Over half of all patients who had a total hip arthroplasty after radiation to the pelvis had a total hip arthroplasty performed within 4 years of completing treatment 48 . Radiation to the head may cause osteonecrosis of the mandible and extensive soft-tissue damage 49 .…”