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At least 19 recordsLinked to original sources
PubMed1979

Incidence and pathogenesis of alcohol-induced osteonecrosis of the femoral head.

Anteroposterior pelvic roentgenograms of 790 patients admitted for treatment of alcoholism were examined for evidence of osteonecrosis of the femoral head. Laboratory data on these patients, obtained shortly after admission, demonstrated that average serum cholesterol levels were within normal limits and average serum triglyceride levels were moderately elevated only in those individuals classified as having a severe addition to alcohol. Non-juxta-articular radiographic abnormalities of the femoral head, neck and shaft were common but no changes were observed which were considered to be early indications of structural insufficiency. Two patients had advanced idiopathic bilateral osteonecrosis of the femoral head. One of these patients had undergone one total hip replacement prior to his current admission. This study indicates that there is a very low incidence of osteonecrosis among alcoholics (less than 0.3%). However, alcoholism may lead to osteonecrosis in certain predisposed individuals. A combination of several factors such as systemic fat embolism, elevated circulating levels of inflammatory fatty acids or prostaglandins, and osteoporosis and Charcot-like effects, which are also associated with corticosteroid-induced osteonecrosis, seem to be involved and may contribute, as well, to other instances of femoral head osteonecrosis.

Adult↗
PubMed1978

Spontaneous osteonecrosis of the knee and medial meniscal tears.

Several factors may play a role in the etiology of "spontaneous" osteonecrosis of the medial femoral condyle. Corticosteroids are known to induce osteonecrosis, and 45% of the patients in this study received steroids parenterally or by intra-articular injection. Another factor, heretofore given little attention, is the association of medial meniscal tears and "spontaneous" osteonecrosis. Twenty-one (78%) of 27 knees examined by arthrography demonstrated meniscal tears. Stress concentration over the edge of the meniscal fragment may result in ischemic necrosis of the femoral condyle. Early detection of a medial meniscal tear by arthrography in older patients and prompt treatment may be important in avoiding the late changes of "spontaneous" osteonecrosis.

Adolescent↗
PubMed1979

Osteonecrosis after renal transplantation in children.

Osteonecrosis occurred in nine of thirty-six children following renal transplantation. The distal femoral condyle was the most common location but the femoral head was the most symptomatic and required total hip replacement in three of five patients. Total steroid dosage did not correlate with the development of osteonecrosis. There were no cases of osteonecrosis in patients under the skeletal age of ten years or in patients who did not have rejection reactions. In three children non-progressive focal lesions developed, similar to those of osteochondritis dissecans.

Adolescent↗
PubMed1979

Arthroscopy in spontaneous osteonecrosis of the knee.

Eight knees with spontaneous osteonecrosis were investigated through arthroscopy, and in seven the intra-articular findings were rechecked at arthrotomy performed one to two weeks later. Anbormalities in the articular cartilage were observed in detail under arthroscopy that could not be seen in roentgenograms. In the early stage of osteonecrosis, flattening and fissures in the articular surfaces, with and without formation of a cartilage flap, were useful findings in choosing intra-articular surgical procedures. In the late stage, free bodies such as cartilage plates in the joint and regeneration with fibro-cartilaginous tissue over the necrotic lesion were also important in selecting surgical treatment. In addition to roentgenographic classification of developmental stages in osteonecrosis, arthroscopy is necessary in differentiating osteoarthroses, in observing the articular surface of the femoral condyles, and in determining the stage of disease when roentgenography provided insufficient information to justify intra-articular procedures such as drilling and bone grafting.

Aged↗
PubMedDate not supplied

Dysbaric osteonecrosis. Etiological and pathogenetic concepts.

Dysbaric osteonecrosis appears to be independent of decompression sickness. The 2 conditions, however, may share etiologic and pathogenetic factors. The incidence of osteonecrosis is influenced by the number of hyperbaric exposures, extent of pressure, decompression profile and possibly by the rate of compression and degree of obesity. Though etiology and pathogenesis are unclear, osteonecrosis is probably due to ischemia, with gas bubbles causing direct or indirect circulatory impairment. In vitro experiments, as well as human and animal studies, suggest multiple pathogenetic mechanisms: intraosseous vessel compression by extravascular bubbles; vessel obstruction by bubbles, fibrin thrombi, platelet aggregates, clumped erythrocytes or coalesced lipids; and narrowing of arterial lumina by bubble-induced myointimal thickening. Obstructing materials, whether autochthonous or embolic, may result from blood-bubble interface reactions. Rheologic changes and blood flow redistribution could play contributing roles. It seems likely that multiple pathogenetic factors act in concert or sequentially. Proposed nonischemic changes, such as hyperoxic injury gas-induced osmosis, or autoimmunity, lack sufficient supporting evidence. The peculiar vulnerability of bone may be related to gas supersaturation of the fatty marrow; sensitivity to extravascular gas pressure because of tissue rigidity; poor vascularization; and the presence of uranium 238 which promotes nucleation and subsequent gas bubble formation.

Animals↗
PubMed1975

[Osteochondritis dissecans and osteonecrosis of the lower end of the femur. Value of bone marrow functional exploration].

The authors report the results of 19 functional investigations carried out for osteochondritis in 11 cases, and osteonecrosis of the knee in 8 cases. The 8 cases of osteonecrosis all had hemodynamic disorders with increased pressure in the bone marrow and stasis due to circulatory obstruction. On the other hand, 5 cases of osteochondritis out of the 11 explored had no disturbance of marrow blood supply. However, of the 6 cases of osteochondritis with vascular disorders, there were 5 who had some other reason which might explain the disorder blood supply within the bone. It thus seems that one may contrast two types of disease: -One, characterized by an intra-osseous circulatory disorder for which one might reserve the terms osteonecrosis, which occurs in patients aged over 60 years, but which may be observed in juvenile forms. - The other, characterised by the absence of any hemodynamic disturbance and in which the foreign body seems to result from a very localised disorder which does not affect the bone marrow blood supply. One may use here the term, osteochondritis. We propose to substitute this physiopathological classification for the classical division based on age and on X-rays. Investigation of the blood supply of the bone, permits, as with strontium, early diagnosis at a pre-radiological stage.

Adolescent↗
PubMed1977

18F scintigraphy in the early diagnosis of osteonecrosis of the femoral head in chronic hemodialysis and transplantation.

Osteonecrosis of the femoral head results in an increased uptake of 18F due to a reparative reaction in the necrotic area and its surroundings. Twenty hemodialysis and twenty-seven post-transplant patients were studied serially. In the hemodialysis group, nine patients had positive scintigraphs and eleven had negative studies. All were asymptomatic. In the transplant group, twelve were positive and fifteen were negative. Four patients with positive scans later developed unequivocal clinical and radiographic evidence of osteonecrosis. Patients with negative scans have been asymptomatic and without radiological abnormalities. Age, sex, duration of dialysis, bone mineral densitometry, total steroid dose, duration of hospitalization after transplantation, and serum chemistries were not different in positive and negative patients. All patients on alternate-day steroids have negative scans. A positive 18F scintigraph antedates the occurrence of clinical and radiological findings of osteonecrosis.

Adult↗
PubMed1979

Clinical and radiological features of osteonecrosis in systemic lupus erythematosus.

Symptomatic osteonecrosis occurred in 8 out of 68 patients with systemic lupus erythematosus. Multiple joints were involved in 3 patients, and weight-bearing joints were most frequently affected. Osteonecrosis tended to occur early in the disease, and the patients had all received corticosteroids. Symptoms tended to occur when the disease had progressed from an active phase into one of clinical and serological quiescence. In weight-bearing joints classical radiological changes were often absent at the onset of symptoms.

Adolescent↗
PubMed1977

Osteonecrosis following renal allotransplantation. A quantitative histological study of iliac bone.

Morphometric and dynamic studies of bone obtained by biopsy from a standard locality on the iliac crest were carried out in 10 patients with and 7 patients without radiological signs of osteonecrosis. All the patients had normally functioning kidney transplants. The results obtained in the two groups were compared and both groups were compared with a series of noraml subjects where the age and sex distribution was the same. In the group of patients with osteonecrosis, the reduction in the amount of cancellous bone was found to be highly significant as compared with that in normal subjects and with that in the other group of patients. Apart from the reduction in bone, changes in all patients were characterized by an increased amount of osteoid and a low rate of mineralization, determined by double labelling with tetracycline. As there were no changes in the width of osteoid seams indicating osteomalacia, it is suggested that these patients suffered from a severe corticosteroid osteopenia.

Adult↗
PubMedDate not supplied

Management of osteonecrosis in sickle-cell anemia and its genetic variants.

Osteonecrosis secondary to sickling disorders differs from most other forms of osteonecrosis, because vaso-occlusive episodes generally involve many other organs. For this reason optimum management and care of these patients requires a team approach. The spectrum of clinical symptoms and bone involvement varies widely from one patient to another, even among patients with the same abnormal hemoglobin patterns. Although the efficacy of conservative therapeutic measures has not been definitely established, these may be all that can be offered because of the patient's other problems. Before contemplating surgery, the surgical and anesthetic risks should be evaluated and measures taken to prevent complications. The varus osteotomy, Chiari pelvic osteotomy, prosthetic or total hip replacement, and the Neer shoulder prosthesis may benefit a limited number of carefully selected patients.

Adolescent↗
PubMedDate not supplied

Experience with steroid-induced avascular necrosis of the shoulder and etiologic considerations regarding osteonecrosis of the hip.

Nineteen of 97 patients with steroid-induced osteonecrosis had a lesion involving the head of the humerus, on one or both sides. The lesion usually began as a subchondral osteolytic area which often progresses to collapse. Articular cartilage separated from subchondral bone, either becoming detached as a free cap or at a later stage reattaching. Present evidence suggests that osteonecrosis of the femoral or humeral head should properly be classified as either traumatic (macrovascular injury) or embolic (microvascular injury) in nature. In 14 patients conservative treatment resulted in satisfactory function with only intermittent symptoms, and including pendulum exercises and avoidance of abduction, particularly against resistance. Five patients required replacement of 6 humeral head replacement arthroplasties with Neer's prosthesis.

Female↗
PubMed1978

Osteonecrosis of the knee. A clinicopathological study in twenty-eight patients.

Specimens from thirty-four knees in twenty-eight patients with histologically proved osteonecrosis were reviewed. Twelve knees had the clinical diagnosis of so-called idiopathic osteonecrosis; eight, osteoarthrosis; and fourteen, rheumatoid arthritis. Pathologically, the necrosis was localized in the subchondral region of the medial femoral condyle in 67 per cent of the knees. There were pathological fracture and collapse and fragmentation of the necrotic segment leading to marked deformities in most cases. The response to necrosis consisted of histiocytic resorption of necrotic material and formation of granulation tissue and reactive new bone surrounding it. The response was relatively less prominent in the knees with degenerative joint disease and rheumatoid arthritis.

Aged↗
PubMedDate not supplied

The treatment of osteonecrosis of the hip with fresh osteochondral allografts and with the muscle pedicle graft technique.

Osteonecrosis of the hip in Stages 1 and 2 are treated by conservative measures such as rest, aspirin, and a cane. If activities of daily living are impaired or stronger analgesics become necessary the muscle pedicle graft is advised. Fresh osteochondral grafts are utilized to resurface the head of the femur in Stages 3 and 4 in vigorous patients below the age of 60 when strong analgesics are required to relieve pain. A total hip arthroplasty is the treatment of choice for all patients in Stage 5 or those beyond the age of 60 in Stages 3 and 4. Five patients have had allografts; all are doing well. Three have been followed over 2 years, one over one and one-half years, and the other over 6 months. Twenty-three patients have had muscle pedicle grafts. The results have been good in the 8 patients in Stages 1 and 2. Only 5 of the 15 patients with osteonecrosis in Stages 3 and 4 have had good results.

Adult↗
PubMedDate not supplied

Epidemiology of traumatic and nontraumatic osteonecrosis.

In reviewing the epidemiology of traumatic and nontraumatic osteonecrosis the only common denominator appears to be that of circulatory compromise. Causative mechanisms seem to be quite distinct. A number of factors may predispose to postfracture hip necrosis, i.e. the type of fracture, the quality of reduction and union of the fracture. For postdislocation necrosis, causative factors include the type of dislocation as well as the timing and nature of the reduction. For nontraumatic osteonecrosis, an array of consistently associated systemic disorders appears to be largely linked by frequent lipid elevations. Alcoholism and corticosteroid use account for the bulk of cases and there is consistent predisposition to males and bilateral involvement. Multifocal lesions attest to the systemic basis for this form of necrosis.

Adult↗
PubMed1976

[Induced hyperlipemia test during femur head osteonecrosis].

The authors studied disturbances of lipid clearance in cases of aseptic osteonecrosis of the femoral head by means of an induced intravenous hyperlipemia test. With reference to investigations in 19 patients, the authors first draw attention to the frequency of ethylism and of fatty degeneration of the liver (13 patients). A significant decrease was noted in the coefficient of lipid clearance in the 19 patients. This was particularly marked when fatty degeneration of the liver was present. The etiological role of these anomalies should be considered, as fatty degeneration and hyperlipaemia may also be found in other pathological conditions responsible for primary osteonecrosis of the femoral head (corticotherapy).

Adult↗
PubMed1979

[Symptoms and therapy of spontaneous osteonecrosis of the medial femoral condyle in elder patients (author's transl)].

The author reports on symptoms, therapy and results of a follow-up of 17 patients with the rare disease of osteonecrosis of the medial femoral condyle. The therapy depends on the extend of the necrosis, the axis of the leg and the results of scintigraphy or scintimetry and arthrography or arthroscopy. Small necroses can be treated conservatively, but in case of a genu varum a valgus-osteotomie should be performed. Bigger necroses are bored or bolted combined with a valgus-osteotomie, if necessary. Extensive osteonecroses can only be treated by partial endoprosthesis or autologue bone-cartilage-transplantation.

Aged↗
PubMed2026

A Novel Long Noncoding RNA-LNC000133 Associated With Steroid-Induced Osteonecrosis of the Femoral Head Promotes Osteoblast Differentiation Through Bone Marrow Mesenchymal Stem Cells-Derived Exosomes Pathway: A Bioinformatics Validation and Detailed Mechanistic Study.

Steroid-induced osteonecrosis of the femoral head (SONFH) is a debilitating disease caused by glucocorticoid abuse, characterized by complex pathogenesis and unclear molecular mechanisms. Dysfunction of bone marrow mesenchymal stem cells (BMSCs) and their exosome-mediated signalling is a key contributor to SONFH, although the precise mechanisms remain to be elucidated. In this study, the differential expression profiles of long noncoding RNAs (lncRNAs), microRNAs (miRNAs) and messenger RNAs (mRNAs) in exosomes derived from human BMSCs (hBMSCs) obtained from patients with SONFH compared to controls with femoral neck fractures were identified. Through next-generation sequencing, a novel lncRNA, LNC000133, associated with SONFH was discovered. Using Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis and competing endogenous RNA (ceRNA) network construction, the LNC000133/miR-362-5p/TGF-β3/SMAD3/BMP2 signalling axis was established. The definitive expression, localization and full-length sequence of LNC000133 in BMSCs were subsequently validated by Northern blot, quantitative real-time polymerase chain reaction (qRT-PCR), fluorescence in situ hybridization (FISH) and rapid amplification of cDNA ends (RACE). Most notably, mechanistic studies demonstrated that LNC000133-modified BMSCs-derived exosomes were efficiently taken up by osteoblasts, which promoted proliferation and osteogenic differentiation by targeting the miR-362-5p/TGF-β3/SMAD3/BMP2 signalling pathway.

Humans↗
PubMed1978

Osteonecrosis in Hodgkin's disease.

Four patients suffering from Hodgkin's disease developed osteonecrosis following therapy and both femoral heads were involved in each case. Retrospective review of abdominal radiographs taken for follow-up lymphography demonstrated that the earliest radiological changes in bone were evident between five and 18 months after treatment was started and between six and 21 months before the onset of symptoms. The clinical implications are discussed.

Adult↗