[Aseptic necrosis of the femur head. Its role in the evolution of the arthrotic transformation of the hip joint].
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Biomedical subjects
Publications and source records attributed to R Lagier.
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An investigation of three groups from ancient populations (Neolithic, Early Middle Ages, Middle Ages) was performed on 273 adult skeletons. Despite unequal preservation of the remains, a study of a series of large joints and spinal segments permitted some conclusions: rheumatoid arthritis, ankylosing spondylitis, and osteoarthrosis of large joints (hip, knee, shoulder) were not found. The main findings were: osteoarthrosis in spinal zygapophyseal joints (particularly at cervical level); intervertebral osteochondrosis (particularly at the cervical and lumbar levels); Schmorl's nodes (particularly at the thoracic and lumbar levels); enthesopathic osteophytes (particularly in the spine, iliac crest, patella, and calcaneus). Such deformities seemed more frequent in the Middle Ages than in the Neolithic period.
A case of rapidly evolving osteoarthrosis of the right hip in a 65 year-old woman, as the presenting feature of ochronosis is described and literature reviewed. This unusual presentation may have been precipitated by an acute mechanical overload.
Fifteen blood parameters were studied in 73 men and 97 women divided into four groups: 66 blood donors; 36 aged subjects with various cerebral, cardiovascular or infectious illnesses; 43 patients with femoral neck fracture; 25 patients with severe hip osteoarthrosis. The parameters measured were: serum total proteins, albumin, total, alpha 1, alpha 2, beta and gamma globulins, total calcium, phosphates, alkaline phosphatase, creatinine, bilirubin, hemoglobin, 25 OHD3 and 1.25(OH)2D3. Each group differed significantly from the others, with regard to age and also to pathological conditions. Among the more discriminant variables, albumin was retained as the main parameter reflecting the nutritional status related to skeleton quality. Significantly higher albumin values were found for the hip osteoarthrosis patients (i.e., in a condition associated with well known bone solidity).
Three cases of sternocostoclavicular hyperostosis (SCCHO) or pustulotic arthro-osteitis (PAO) associated with plantar pustulosis are presented. Two of them were associated with psoriasis vulgaris although the pustulosis was of a different histological type in each case. Anatomo-pathological study of two of these three cases shows that this hyperostosis is secondary to an inflammatory osteomedulloperiosteal remodelling suggesting an infectious origin which remains to be proven. The relationship of this syndrome with some seronegative spondylarthropathies cannot, however, be excluded.
The changes seen in vertebral hyperostosis are due to a slow ossification of the perivertebral connective tissue causing osteophytic spurs and/or bridging of intervertebral ankylosis. The same changes seen in man are also seen in all land and aquatic mammals. This confrontation of comparative pathology emphasizes certain essential points in common. There is a relation between the vertebral hyperostosis and local anatomic and physiologic conditions linked to a ligament insertions. It occurs in bipodisis or tetrapodisis as well as in an aquatic environment. It must be distinguished from an osteoarthritic intervertebral remodeling and the evolution of its bone tissue is dissociated from that of the adjacent vertebral bone tissue. It is frequently observed in relation to general conditions (aging -- diabetes in man -- dietary imbalance in the animal). This example emphasizes the interest that comparative pathology can have for the rheumatologist.
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