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Results for “Avascular necrosis”

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At least 19 recordsLinked to original sources

PubMed1998

Survival analysis of hips treated with core decompression or vascularized fibular grafting because of avascular necrosis.

Avascular necrosis of the femoral head is a multifaceted process that leads to articular incongruity and subsequent osteoarthrosis of the joint. Clinicians concur that primary treatment should focus on preservation of the natural surface of the joint; however, there has not been a consensus on how best to accomplish this. While a number of therapeutic interventions have been reported, the efficacy has varied markedly and there have been few statistical comparisons. The purpose of the current study was to use statistical analysis to compare the results of two widely used procedures, vascularized fibular grafting (614 hips; 480 patients) and core decompression (ninety-eight hips; seventy-two patients), for the treatment of avascular necrosis. The patients were stratified according to age and the stage of disease, and a survival analysis was performed with total hip arthroplasty as the end point for failure. None of the eleven hips that had Ficat stage-I disease needed a total joint replacement after being treated with either regimen. Analysis of the hips that had stage-II disease revealed rates of survival, at fifty months, of 65 per cent (twenty-eight of forty-three hips) after core decompression and 89 per cent (ninety-nine of 111 hips) after vascularized fibular grafting. For the hips that had Ficat stage-III disease, the rates of survival at fifty months were 21 per cent (ten of forty-seven hips) after core decompression and 81 per cent (405 of 500 hips) after vascularized fibular grafting. Among the hips that had Ficat stage-II or III disease, the rate of eventual total joint arthroplasty after vascularized fibular grafting was significantly lower than that after core decompression (p < 0.0001). The results indicate that the increased morbidity associated with vascularized fibular grafting is justified by the associated delay in or prevention of articular collapse in hips that have stage-II or III disease.

Adult↗

PubMed1996

Avascular necrosis and the Pavlik harness. The incidence of avascular necrosis in three types of congenital dislocation of the hip as classified by ultrasound.

We analysed the incidence of avascular necrosis in 101 hips of 90 infants with congenital dislocation treated with Pavlik harness and followed up for more than one year. Using ultrasonography in the flexed-abducted position the hips were classified as type A when the femora head was displaced posteriorly, but within the socket and making contact with the posterior inner wall of the acetabulum; type B when it was in contact with the posterior margin of the acetabulum, with its centre at this level or anterior to it; and type C when it was displaced out of the socket, with its centre posterior to the posterior rim of the acetabulum. Eighty-seven hips were reduced by the harness (86%), and seven of these developed avascular necrosis (8%). All 69 hips with type-A dislocation were reduced and only one (1.4%) showed slight avascular necrosis. Eighteen (78.3%) of 23 hips with type-B dislocation were reduced, and six developed avascular necrosis (33.3%). In one hip, the femoral head was severely damaged. None of the nine hips with type-C dislocation was reduced in the harness. We concluded that the Pavlik harness is indicated for type-A but not for type-B or type-C dislocations.

Contraindications↗

PubMed1996

MRI of avascular necrosis of bone.

Avascular necrosis (AVN) is characterized by death of both trabecular bone as well as bone marrow elements. Weight-bearing bone becomes mechanically weakened and may eventually collapse, secondarily leading to osteoarthritis and debilitating pain. Early diagnosis and treatment of this entity are crucial because it affects relatively young individuals, and treatment options for advanced disease are limited. Magnetic resonance imaging (MRI) has emerged as the modality of choice for the evaluation of avascular necrosis of bone. We will discuss applications of MRI for early diagnosis, for monitoring therapy, and for its potential role in assessing individuals at risk of AVN. Although bone scintigraphy using single photon emission computed tomography (CT) may be nearly as accurate as MRI, MRI offers a more specific diagnosis in the patient who presents with hip pain of uncertain etiology. In addition, lesion size and location can be more easily assessed on magnetic resonance images, and this has been shown to relate to prognosis and need for treatment. We will review the pathophysiologic mechanisms of AVN and the current use of MRI in the diagnosis of this condition.

Contrast Media↗

PubMed2000

Prevalence rates and an evaluation of reported risk factors for osteonecrosis (avascular necrosis) in Crohn's disease.

Avascular necrosis (osteonecrosis) occurs in Crohn's disease, but the rate of this particular complication is not known. Over 20 years, 877 patients with Crohn's disease, 492 women (56.1%) and 385 men (43.9%), were evaluated with patient follow-up data available for a mean of 7.8 years. In this group, four men were seen with osteonecrosis. No woman was affected. All patients had typical radiological, magnetic resonance imaging or pathological changes of osteonecrosis involving the femoral heads, while two also had superimposed avascular necrosis involving the humeral heads. Patient ages ranged from 19 to 36 years at the time of diagnosis of their Crohn's disease, and all were white. In one patient, disease was confined to the colon, while three patients had disease involving the terminal ileum and colon. Disease behaviour in two patients was classified as penetrating because of concomitant ischiorectal abscesses, while one patient developed a metastatic colon carcinoma. Ankylosing spondylitis was present in two patients, but no other extraintestinal manifestations developed. Two patients received corticosteroids as well as parenteral nutrition during the course of their disease. Two patients did not receive corticosteroids or parenteral nutrition. Of 877 patients with Crohn's disease, 484 (55. 1%) received corticosteroids during the course of the disease, 196 (22.4%) received at least one course of parenteral nutrition, and 125 (14.3%) received both corticosteroids and parenteral nutrition. A total of 311 patients (35.5%) had at least one small intestinal resection. The overall rate of avascular necrosis in Crohn's disease was less than 0.5% but for men with Crohn's disease was about 1%. In this series, risk of osteonecrosis could not be attributed to corticosteroid use, parenteral nutrition or both forms of therapy administered together. Small intestinal resection with loss of small intestinal absorptive area was not a risk factor for the development of osteonecrosis. Avascular necrosis (or osteonecrosis) is a very rare extraintestinal osseous complication that may occur in Crohn's disease, independent of previously reported risk factors, including corticosteroids or parenteral nutrition with lipid emulsions.

Adult↗

PubMed1994

Idiopathic avascular necrosis of the scaphoid.

Idiopathic avascular necrosis of the scaphoid is a rare condition. A review of the literature shows a variety of conditions labelled as spontaneous avascular necrosis or Preiser's disease. In this paper we report on a study of eight patients with idiopathic avascular necrosis affecting only the proximal pole of the scaphoid. Seven of these patients had positive ulnar variance. The possible aetiology is discussed and the natural history has been studied. A staging system is proposed, as this helps to determine the prognosis and appropriate management. Two of our patients were managed conservatively; the others were treated successfully by partial silastic replacement of the scaphoid.

Adult↗

PubMed2006

Pathophysiology and natural history of avascular necrosis of bone.

Avascular necrosis of bone (AVN) occurs as two main variants, local and systemic. Local AVN is usually caused by trauma or microtrauma; examples include primary osteonecrosis of the medial condyle, vertebral osteonecrosis, necrosis after meniscectomy, and osteonecrosis of the mandible or small bones. Systemic AVN manifests as epiphyseal necrosis or bone infarction, which is often multifocal. Little is known about the factors that trigger AVN. One possible mechanism is intraluminal obliteration of blood vessels by microscopic fat emboli, sickle cells, nitrogen bubbles (caisson disease), or focal clotting due to procoagulant abnormalities. Extraluminal obliteration may result from elevated marrow pressure or increased marrow fat. Cytotoxicity and genetic factors may be involved also. Many factors are probably capable of inducing AVN, and combinations of factors may be required, although the final mechanism is always critical ischemia. The natural history of AVN is better understood than the early triggering factors. AVN becomes detectable 1-6 months after exposure to an easily identifiable risk factor such as high-dose glucocorticoid therapy or femoral neck fracture. Later on, AVN is uncommon even when the patient remains exposed to the risk factor. The turning point in the natural history of AVN is subchondral plate fracture, which leads to collapse of the necrotic segment of the epiphysis, usually within the first 2 years. The risk of collapse depends chiefly on the initial size and location of the necrotic segment, which can be determined accurately by magnetic resonance imaging (MRI). This natural history has obvious clinical implications.

Bone and Bones↗

PubMed1998

Avascular necrosis in systemic lupus erythematosus: clinical associations and a 47-year perspective.

Twenty-six of 488 (5%) patients with systemic lupus erythematosus followed in a private practice developed clinically evident, symptomatic avascular necrosis. Avascular necrosis was significantly associated with hypertension, pleural effusions, cerebritis, nephritis, anemia, and earlier age of disease onset. No association with anticardiolipin antibodies or thromboembolic disease was observed. Avascular necrosis is usually observed in active, severe lupus.

Adult↗

PubMed1979

Aseptic (avascular) necrosis of the femoral head in psoriasis.

Aseptic (avascular) necrosis of the femoral head associated with psoriasis is reported. The clinical histories of nine patients with avascular necrosis of the femoral head and one patient with bilateral humeral head osteonecrosis are summarized. Psoriasis was the only associated condition found in three of the patients. Only two patients had received systemic corticosteroids in significant amounts (greater than 1 gm of prednisone). Four patients had received methotrexate therapy for psoriasis. Other possible contributing factors including serum uric acid levels are discussed. Psoriasis should be added to the list of systemic diseases associated with aseptic (avascular) necrosis. Avascular necrosis of the femoral head should be considered in any patient with psoriasis and pain in the hip or thigh.

Adult↗

PubMed2004

Femoral osteotomies for avascular necrosis of the femoral head.

Avascular necrosis of the femoral head affects 10,000 to 20,000 people every year and often these patients are in their 30s and 40s. The natural history of this disease is important to understand because the rate of femoral head collapse and treatment options are related to multiple factors including the cause of the disease, its stage at initial presentation, and the size and location of the lesion. Various treatment options have been purposed for different stages of avascular necrosis of the femoral head. Nonoperative treatments include protected weightbearing, electrical stimulation, and pharmacologic treatments. Operative treatment includes core decompression with or without grafting, debridement and grafting, osteotomy, fusion, hemiresurfacing, hemiarthroplasty, and total hip arthroplasty. The purpose of the current study was to discuss the history, indications, techniques, and results of proximal femoral osteotomies for the treatment of avascular necrosis of the femoral head.

Arthroplasty, Replacement, Hip↗

PubMed2000

Vascularized island pedicle iliac bone grafting for avascular necrosis of the femoral head.

BACKGROUND: Nontraumatic avascular necrosis of the femoral head is a common disorder causing disability of the hip joint. The methods for optimally treating this disease in active young patients are still controversial. In this study we investigated the surgical outcome of vascularized pedicle iliac bone grafting for treating nontraumatic avascular necrosis of the femoral head. METHODS: Between 1994 and 1999, we treated 100 cases of avascular necrosis of the femoral head with vascularized pedicle iliac bone grafting. Thirty-nine hips in 33 patients were followed-up longer than 24 months. These patients included 30 men and 3 women, with an average age of 40 years. Steinberg's classification and Ohzono's types were used to categorize the diseased hips. The clinical results were evaluated using Charnley's modification of Merle d'Aubigne and Postel's numeric classification. RESULTS: Of the 33 patients, 82% were satisfied with their decision to have vascularized pedicle iliac bone grafting for avascular necrosis of the femoral head. No serious complications arose during this study. The average operation time for vascularized pedicle iliac bone grafting was 3.5 hours for one team. The rate of conversion to replacement arthroplasty was 10.3% (4 of 39 patients). CONCLUSION: Vascularized pedicle iliac bone grafting is a useful alternative treatment option for patients with avascular necrosis of the femoral head.

Adult↗

PubMed1989

Idiopathic avascular necrosis of the scaphoid: Preiser's disease?

Although avascular necrosis after fracture of the scaphoid is common, it rarely develops without apparent trauma. Preiser's disease is commonly associated with avascular necrosis of the scaphoid without fracture or trauma. A critical review of Preiser's original article reveals that all of his cases, as well as three of seven additional cases in the literature, were associated with fracture or trauma. Preiser's disease, therefore, should be traumatic avascular necrosis and differentiated from truly nontraumatic avascular necrosis. Five additional cases in four patients with nontraumatic avascular necrosis of the scaphoid are presented.

Aged↗

PubMed1988

Atraumatic avascular necrosis of the head of the talus: a case report.

Avascular necrosis of the talus has frequently been reported following trauma. The incidence of avascular necrosis has been reported to be as high as 50% for Hawkins Type II talar fractures and to range from 75-100% for Type III fracture-dislocations. The resultant avascular necrosis has been reported to occur primarily in the body and dome of the talus with apparent sparing of the head of the talus. The close association of trauma to avascular necrosis of the talus has been alluded to by Cobey and others. Reports of avascular necrosis of the talus, without an antecedent history of trauma, have been rare. This paper presents a case of atraumatic avascular necrosis of the talar head.

Adult↗

PubMedDate not supplied

Avascular necrosis of the radial head in children.

Avascular necrosis of the radial head is uncommon. A 20-year review of records at a Pediatric Trauma Center revealed eight cases of avascular necrosis of the radial head in children with an average of 10 years (range, 7-16 years). Symptoms of pain or restriction of elbow motion began at an average of 23 months after trauma in seven cases, and in one case, there was no history of trauma. Of the seven secondary to trauma, six resulted from a fall, and one from a torsional injury. The types of injuries associated with avascular necrosis of the radial head were two supracondylar fractures, a fracture of the lateral condyle, two fractures of the radius, a radial head dislocation that underwent a proximal radial osteotomy, and one with only an elbow contusion. The long-term results of radial head necrosis were poor, with three ultimately requiring radial head resection, and the remainder having considerable limitation of elbow motion. Loss of vascularity to the radial head is very analogous to avascular necrosis of the femoral head, with the late onset of incongruity, osteoarthritis, and hypertrophy of the head. It should be considered in any child with late-onset loss of elbow motion after trauma.

Adolescent↗

PubMed1992

Suggestions for diagnosing avascular necrosis of the hip in the 1990s.

Avascular necrosis of the hip is a serious clinical problem encountered by primary care physicians. It requires early detection for proper management and treatment. The clinician should be aware of the imaging modalities available for evaluation of patients with suspected avascular necrosis. Traditional studies include plain-film radiography, computed tomography, and planar bone scintigraphy. Magnetic resonance imaging and single-photon emission computed tomography bone scanning have been developed to such an extent that they are now the most sensitive indicators of early avascular necrosis. The authors review currently available imaging modalities and provide a practical approach to the assessment of patients with suspected avascular necrosis of the hip.

Algorithms↗

PubMed2005

The role of arthrography-guided closed reduction in minimizing the incidence of avascular necrosis in developmental dysplasia of the hip.

Avascular necrosis of the femoral head is the most serious complication after closed reduction in developmental dysplasia of the hip. Although arthrography has a well-established role in the treatment of developmental dysplasia of the hip, its use is not universal. A prospective study was conducted to compare the incidence of avascular necrosis after closed reduction in developmental dysplasia of the hip performed with and without arthrography in 85 patients, with a minimum of 5 years follow up. Arthrographic criteria were evaluated including lateralization of the femoral head and the type of limbus encountered. Hips treated by closed reduction based on arthrographic evaluation had significantly less incidence of avascular necrosis when compared with those treated by closed reduction without arthrographic guidance. Closed reduction with lateralization of more than 4 mm, and those hips with an inverted limbus were associated with an increased risk of avascular necrosis.

Female↗

PubMed2001

Postpartum multifocal avascular necrosis: what are the possible etiologies?

Avascular necrosis of bone (osteonecrosis) that is atraumatic is most frequently associated with corticosteroid excess or alcoholism and usually involves the femoral head. We report a case of multifocal avascular necrosis in a 38-year-old woman with autoimmune Addison's disease taking corticosteroid replacement therapy. The onset of joint symptoms occurred 6 months after a pregnancy complicated by acute fatty liver and disseminated intravascular coagulation. Although both knees and ankles were involved, an unusual feature is that the hips were spared. As illustrated in this patient, avascular necrosis is frequently misdiagnosed in cases of joint pain of acute onset and may occur in the context of physiologic replacement doses of corticosteroids. Etiologic factors can precede the onset of symptoms and the diagnosis by several months.

Journal Article↗

PubMed2005

The management of avascular necrosis after slipped capital femoral epiphysis.

Avascular necrosis is a serious complication of slipped capital femoral epiphysis and is difficult to treat. The reported incidence varies from 3% to 47% of patients. The aims of treatment are to maintain the range of movement of the hip and to prevent collapse of the femoral head. At present there are no clear guidelines for the management of this condition and treatment can be difficult and unrewarding. We have used examination under anaesthesia and dynamic arthrography to investigate avascular necrosis and to determine the appropriate method of treatment. We present 20 consecutive cases of avascular necrosis in patients presenting with slipped capital femoral epiphysis and describe the results of treatment with a mean follow-up of over eight years (71 to 121 months). In patients who were suitable for joint preservation (14), we report a ten-year survivorship of the hip joint of 75% and a mean Harris hip score of 82 (44 to 98).

Adolescent↗

PubMed1989

Avascular necrosis of temporomandibular joint in sickle cell disease.

Avascular necrosis of temporomandibular joint (TMJ) in sickle cell disease was not reported in patients suffering from this disease. In this report, we present a case of a young Saudi female with avascular necrosis of the left temporomandibular joint associated with avascular necrosis of head of left femur, and early changes of infarction of the humeral head of the left shoulder. Clinical examination, laboratory investigations, tomography and computerized tomography scanning, confirmed the diagnosis of sickle cell disease, and the development of avascular necrosis of the left temporomandibular joint.

Adult↗