Resection arthroplasty in radiation-induced osteonecrosis of the hip

Kang, Hyung Suk; Chung, So Hak

doi:10.1016/j.jcot.2018.02.016

Cited by 4 publications

(4 citation statements)

References 19 publications

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“…However, the procedure is associated with a high rate of postoperative aseptic loosening ( Table 2 ) and subsequent acetabular failure. Loosening occurs in 44% to 52% of cemented and cementless THAs between 2 and 6 years after surgery in irradiated hips [ 98 , 106 ], although there is little difference in the aseptic loosening rate of cemented and cementless prostheses [ 107 ]. Radiation damages the function of osteoblasts and impairs vascular supply, which leads to a disorganized bony architecture, thickening of trabecular bone [ 108 ], inhibition of osteoblast proliferation, extracellular matrix formation, and poor osseointegration.…”

Section: Treatmentmentioning

confidence: 99%

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

Zhou

et al. 2023

Med Sci Monit

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Osteoradionecrosis (ORN) of the femoral head is an important issue for orthopedists and radiologists in clinical practice. With the rapid development of technological advances in radiation therapy and the improvement in cancer survival rates, the incidence of ORN is rising, and there is an unmet need for basic and clinical research. The pathogenesis of ORN is complex, and includes vascular injury, mesenchymal stem cell injury, bone loss, reactive oxygen species, radiation-induced fibrosis, and cell senescence. The diagnosis of ORN is challenging and requires multiple considerations, including exposure to ionizing radiation, clinical manifestations, and findings on physical examination and imaging. Differential diagnosis is essential, as clinical symptoms of ORN of the femoral head can resemble many other hip conditions. Hyperbaric oxygen therapy, total hip arthroplasty, and Girdlestone resection arthroplasty are effective treatments, each with their own advantages and disadvantages. The literature on ORN of the femoral head is incomplete and there is no criterion standard or clear consensus on management. Clinicians should gain a better and more comprehensive understanding on this disease to facilitate its early and better prevention, diagnosis, and treatment. This article aims to review the pathogenesis, diagnosis, and management of osteoradionecrosis of the femoral head.

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Section: Treatmentmentioning

confidence: 99%

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

Zhou

et al. 2023

Med Sci Monit

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“…While sporadic reports historically touched on problems related to the pelvic bones after definitive therapy for pelvic malignancies with radiotherapy, there is still a paucity of data about bone involvement. Any part of the bony pelvis can be involved, with the most commonly recognized being the hip acetabular joint, [27][28][29] but pubic symphysis involvement is also common and until recently has been grossly underrecognized. The first report was published in 1998 by radiologists, 30 and then finally recognized as a clinical entity by surgeons in 2002.…”

Section: Osteonecrosis Presentationmentioning

confidence: 99%

“…The management of hip joint radionecrosis is typically analgesia and physiotherapy, with total hip arthroplasty or resection arthroplasty used for definitive treatment. 28 Management of advanced pubic symphysis disease or fistulae is more complex. In the majority of cases, intravenous antibiotics, percutaneous drainage of abscess, urinary drainage with penile or suprapubic catheter, and fecal diversion (where appropriate) have been utilized as a temporizing measure or for the long-term management in surgically unfit patient.…”

Section: Managementmentioning

confidence: 99%

Pelvic Radiation Disease

Sammour

Kahokehr

2022

Clin Colon Rectal Surg

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Pelvic radiation is increasingly being used for the neoadjuvant and definitive treatment of pelvic organ malignancy. While this treatment can be highly effective, and may assist in organ sparing, it is also associated with significant toxicity and devastating adverse events that need to be considered. In broad terms, pelvic radiation disease affects both the primary target organ as well as adjacent organs and soft tissue structures, with complications that can be classified and graded according to consensus criteria. The complication grade is often modality, dose, and area dependent. The most common manifestations are proctitis, cystitis, recto-urethral fistula, ureteric stricture, and bone involvement. Toxicity can be misdiagnosed for many years, resulting in significant management delays. Complications can be difficult to prevent and challenging to treat, requiring specialized multi-disciplinary input to achieve the best possible strategy to minimize impact and improve patient quality of life.

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“…Radiation treatment for malignancy interferes with bone healing and reduces bone vascularity, potentially leading to osteonecrosis. Hyung reported on 25 patients over the course of 2 decades who required surgery for radiation-induced osteonecrosis of the hip for a total of 31 cases, of which there were 28 cases of total hip arthroplasty and 6 cases of arthroplasty failure 47 . Novikov reviewed 8 papers for a total of 232 total hip arthroplasties.…”

Section: Osteonecrosis Versionmentioning

confidence: 99%