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Extremely early stage osteonecrosis of the femoral head in a patient with hip pain secondary systemic steroid pulse therapy for Vogt-Koyanagi-Harada syndrome: A case report. Kuroda Yutaka,So Kazutaka,Goto Koji,Matsuda Shuichi International journal of surgery case reports INTRODUCTION:Osteonecrosis of the femoral head (ONFH) is a corticosteroid-associated disease that mostly cause femoral head collapse and gait disturbance. At the final stage of ONFH, the most reliable treatment is total hip arthroplasty even in young patients. Although magnetic resonance imaging (MRI) is useful for early diagnosis, initial stages are asymptomatic, with pain intensifying after femoral head collapse. PRESENTATION OF CASE:A 34-year-old female patient with rapid bilateral loss of vision was diagnosed Vogt-Koyanagi-Harada syndrome. She immediately received corticosteroid pulse therapy. While undergoing therapy, she complained of groin pain. The initial MRI of the hip did not show abnormal findings. As the right proximal thigh pain progressed, an MRI of the lumbar spine was performed. No compression of the spinal cord was observed, and right ONFH was suspected on the basis of a characteristic band image. The patient was diagnosed with Stage 1 ONFH 7 weeks after the initial symptoms. She was successfully treated by joint-preserving regenerative therapy using growth factor. After surgery, the patient completely recovered from pain. DISCUSSION:The occurrence of hip pain while receiving corticosteroid therapy was very rare. The present case was considered a result of reduction of the blood supply to the femoral head induced by hip pain that progressed to ONFH for unknown reasons. CONCLUSION:It is difficult to identify cases of corticosteroid-associated ONFH even in patients with potential risk. In this case, we could identify the patient extremely early based on the ONFH image and could provide joint-preserving regenerative therapy. 10.1016/j.ijscr.2016.06.003
Avascular necrosis after long-term glucocorticoid treatment in MELAS: a cautionary note. Choi Han Som,Lee Jae Hyun,Lee Sun Ho,Lee Young-Mock Journal of inherited metabolic disease 10.1007/s10545-017-0110-y
Bilateral osteonecrosis of the femoral head associated with corticosteroid therapy for alopecia areata: a case report and review of the literature. Kuroda Yutaka,Kawai Toshiyuki,Goto Koji,Matsuda Shuichi Therapeutics and clinical risk management Corticosteroids have been widely used for the treatment of various inflammatory diseases because they provide an acute response of immunosuppression. Numerous side effects of corticosteroids have also been known, with varying degrees of severity. Osteonecrosis of the femoral head (ONFH) is a rare and serious complication that directly inhibits walking because of femoral head collapse. However, sometimes, clinicians who consider that corticosteroids are required for primary disease do not recognize steroid-induced ONFH. The final stage of ONFH is severe osteoarthritis, requiring total hip arthroplasty. We describe a 23-year-old woman with bilateral ONFH after corticosteroid treatment for alopecia areata (AA). She was administered several intralesional corticosteroid injections to the scalp and repeated systemic corticosteroid therapy for extensive AA. While undergoing therapy, she lost her balance and complained of right groin pain when standing. The patient was subsequently diagnosed with bilateral ONFH. She recovered from AA, but she complained of persistent right hip pain, which subsequently required total hip arthroplasty. We would like to emphasize that patients on corticosteroid therapy for any common disease should be considered as having a potential risk for ONFH. An early stage detection of ONFH is crucial for its treatment. MRI evaluation warrants a higher level of accuracy in early diagnosis of ONFH for the opportunity to undergo joint-preservation surgery in patients with ONFH. 10.2147/TCRM.S164999
Patient specific instrumentation versus conventional knee arthroplasty: comparative study. Predescu Vlad,Prescura Catalin,Olaru Razvan,Savin Liliana,Botez Paul,Deleanu Bogdan International orthopaedics BACKGROUND:The key to a successful knee replacement is restoring normal kinematics with a neutral alignment, thus a hip-knee-ankle (HKA) angle of 180° (within 3° limits). Conventional TKR is proven to have excellent results but relies in extensive visual referencing of bony landmarks. Customised cutting blocks provide accurate bone cuts, also lowering the risk of fat embolism, blood loss and operating time. METHOD:We share our experience comparing two different TKA techniques using patient specific instrumentation (PSI) with the Visionaire knee and conventional instrumentation (CVI) from the same system (Genesis II Smith&Nephew). A total number of 80 knees were divided into two equal groups, 40 PSI and 40 CVI respectively, operated between April 2013 and August 2014. One female patient had bilateral TKR during this period, at six months interval, both with the PSI. RESULTS:All operated knees had varus deformity, with a mean HKA of 168° (PSI) vs 163° (CVI). We used tranexamic acid (double-dose scheme) and suction drains for 48 hours, with a mean blood drainage in the PSI group of 185 ml and Hb levels of 11.2 g/dl at three days post, compared to 260 ml and 10.7 g/dl in the CVI. Mean blood loss was 3.5 g/dl in PSI, and 4.2 g/dl in the CVI. On the long leg standing radiograph at six weeks, all knees were aligned in frontal plane, with simillar HKA values (178.9° PSI vs 178.6° CVI). Bone cuts measured intraoperatively proved to be accurate within a 1 mm limit. CONCLUSIONS:We cannot recommend PSI-TKR for a better outcome. It is an alternative to conventional and computer-assisted TKR, but further studies are needed to evaluate weather surgical or economic benefits may be achieved by choosing customised instruments. 10.1007/s00264-016-3356-3
[Curative effect analysis of ipsilateral total knee and hip arthroplasty at stage I]. Qi Jin,Sang An-Min,Qiu Wu-Yi,Wang Xu Zhongguo gu shang = China journal of orthopaedics and traumatology OBJECTIVE:To explore clinical results of ipsilateral total knee and hip arthroplasty at stage I for the treatment of ipsilateral hip and knee diseases. METHODS:From January 2008 to September 2016, 7 patients with ipsilateral knee and hip disease were treated by simultaneous total knee and hip arthroplasty at stage I, including 4 males and 3 females aged from 47 to 68 years old, the courses of disease ranged from 6 to 29 years; 3 patients with rheumatoid arthritis, 3 patients with ankylosing spondylitis, and 1 patient with senile hip and knee arthritis. Operation time, intraoperative blood loss and local wounds during hospitalization were observed and recorded, and Harris hip score and HSS knee score were used to evaluate therapeutic effects. RESULTS:Seven patients were followed up from 6 to 24 months, operative time ranged from 297 to 362 min, blood loss ranged from 300 to 780 ml. Harris hip score before operation ranged from 27.67 to 39.11, 75.32 to 85.10 at 6 months after operation; 3 patients were good and 4 patients moderate. HSS knee score before operation ranged from 40.90 to 51.36, and 73.56 to 85.33 at 6 months after operation; 1 patients were excellent and 6 patients good. No periprosthetic fracture, aseptic loosening and periprosthetic infection occurred in 7 patients. CONCLUSIONS:Ipsilateral total knee and hip arthroplasty at stage I for the treatment of hip and knee disease could restore hip and knee function as soon as possible and recover function of hip and knee to the maximum degree, make patients get down the bed earlier, effectively reduce the complications caused by long-term bedridden, and improve patient's quality and satisfaction of life. While the quality of double-joint arthroplasty at stage I need higher technical requirements which should strengthen the management of the perioperative period, and strictly grasped indications. 10.3969/j.issn.1003-0034.2019.11.018
[Osteonecrosis]. Bullough P G Annales de pathologie In orthopedic pathology, the pathologist is most commonly faced with the study of resected femoral heads for osteonecrosis. Such a study necessitates a knowledge of clinical findings, of physiopathology and chiefly of radiological findings. Osteonecrosis of the femoral head following fracture has been reported with four morphological stages which are very precisely described. In the same way, idiopathic, non traumatic, or primary osteonecrosis is covered, stressing the putative etiological factors and the most important findings of imaging. The review includes also the skeletal manifestations of decompression sickness as well as bone infarctions not associated with caisson disease, and spontaneous osteonecrosis of the knee. From the recruitment of the Hospital for Special Surgery, NY, it has been recently reported that a significant number of patients regarded as cases of osteonecrosis, either in the femoral head or in the knee, are actually cases of subchondral insufficiency fractures.
Surgical Technique of Total Knee Arthroplasty without Soft Tissue Balance. Xu Hong-Tao,Dong Jiang-Tao,Wang Juan,Gao Shi-Jun Orthopaedic surgery Total knee arthroplasty (TKA) without soft tissue balance can create a balanced knee to a mechanical axis of near neutral with bone cuts, and remove osteophytes thoroughly. In this study, the authors present detailed steps for performing TKA. The attached video demonstrates the TKA procedure. The patient is a 77-year-old man who had suffered from knee pain for 12 years. Physical examination showed the Apley test to be positive and that the range of motion (ROM) decreased. An X-ray filmed at the positive lateral of the knee joint and the double lower extremity revealed a progression of degenerative osteoarthritis with genu varum. The key point of no soft tissue release is to make a rectangular extensional space by osteotomy. In addition, the osteophytes, especially syndesmophytes, should be removed thoroughly. As a result, the ligaments can achieve ideal length and the flexion contracture can also be remedied. Moreover, in surgeries without soft tissue release, bone mass and normal tissue are retained. Patients are satisfied to the surgery not only with less blood loss, anterior knee pain and DVT, but also faster rehabilitation. In summary, TKA without soft tissue balance is an efficient procedure for patients with knee osteoarthritis which can result in good prognosis. 10.1111/os.12289
[Double hip and knee joint replacement for the treatment of rheumatoid arthritis with severe osteoporosis:a case report]. Liu Jun,Zhen Ping,Zhou Sheng-Hu,Chen Hui,Du Shan-Shan,Shi Jie,Li Xu-Sheng Zhongguo gu shang = China journal of orthopaedics and traumatology 10.3969/j.issn.1003-0034.2017.04.021
A Social Media-Promoted Educational Community of Joint Replacement Patients Using the WeChat App: Survey Study. Zhang Xianzuo,Chen Xiaoxuan,Kourkoumelis Nikolaos,Gao Ran,Li Guoyuan,Zhu Chen JMIR mHealth and uHealth BACKGROUND:Much effort has been made to optimize the results of total hip arthroplasty and total knee arthroplasty. With the rapid growth of social media use, mobile apps, such as WeChat, have been considered for improving outcomes and patient satisfaction after total hip arthroplasty and total knee arthroplasty. OBJECTIVE:We aimed to evaluate the effectiveness of a WeChat-based community as an intervention for overall patient satisfaction. METHODS:The study was conducted among discharged in-hospital patients who received hip or knee procedures in the First Affiliated Hospital of the University of Science and Technology of China from April 2019 to January 2020. An educational online social community was constructed with the WeChat app. Participants willing to join the community were enrolled in a WeChat group and received 3 months of intervention and follow-up. Those who were not willing to use the account were included in a control group and received routine publicity via telephone, mail, and brochures. The Danish Health and Medicine Authority patient satisfaction questionnaire was used to score perioperative patient education and overall satisfaction. The contents in the group chat were analyzed using natural language processing tools. RESULTS:A total of 3428 patients were enrolled in the study, including 2292 in the WeChat group and 1236 in the control group. Participants in the WeChat group had higher overall satisfaction scores than those in the control group (mean 8.48, SD 1.12 vs mean 6.66, SD 1.80, P<.001). The difference between the two groups was significant for primary surgery based on subgroup stratification. To control confounding factors and explore the effects of WeChat participation as a mediating variable between perioperative patient education and overall satisfaction, hierarchical regression was utilized. An interpatient interaction model was found in the community group chat, and it contributed to overall satisfaction. Patients in the group with more interpatient interactions were more likely to have better overall satisfaction. CONCLUSIONS:The social media-promoted educational community using WeChat was effective among joint replacement patients. Provision of more perioperative education is associated with more active patient participation in the community and therefore more patient satisfaction in terms of the overall joint procedure. Community group chat could facilitate interactions among patients and contribute to overall satisfaction. 10.2196/18763