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The Cochrane Database of Systematic... Dec 2019Avascular necrosis of bone is a frequent and severe complication of sickle cell disease and its treatment is not standardised. This is an update of a previously... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Avascular necrosis of bone is a frequent and severe complication of sickle cell disease and its treatment is not standardised. This is an update of a previously published Cochrane Review.
OBJECTIVES
To determine the impact of any surgical procedure compared with other surgical interventions or non-surgical procedures, on avascular necrosis of bone in people with sickle cell disease in terms of efficacy and safety.
SEARCH METHODS
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register, comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Additional trials were sought from both ongoing trial registries and the reference lists of papers identified by the search strategy. Date of the most recent search of the Group's Haemoglobinopathies Trials Register: 17 September 2019.
SELECTION CRITERIA
Randomized clinical trials comparing specific therapies for avascular necrosis of bone in people with sickle cell disease.
DATA COLLECTION AND ANALYSIS
Each author independently extracted data and assessed trial quality. The quality of the evidence was assessed using GRADE. Given only one trial was identified, meta-analyses were not possible.
MAIN RESULTS
One trial (46 participants) was eligible for inclusion. After randomization eight participants were withdrawn, mainly because they declined to participate in the trial. Data were analysed for 38 participants at the end of the trial. After a mean follow-up of three years, hip core decompression and physical therapy did not show clinical improvement when compared with physical therapy alone using the score from the original trial (an improvement of 18.1 points for those treated with intervention therapy versus an improvement of 15.7 points with control therapy). We are very uncertain whether there is any difference between groups regarding major complications (hip pain, risk ratio 0.95 (95% confidence interval 0.56 to 1.60; vaso-occlusive crises, risk ratio 1.14 (95% confidence interval 0.72 to 1.80; very low quality of evidence); and acute chest syndrome, risk ratio 1.06 (95% confidence interval 0.44 to 2.56; very low quality of evidence)). This trial did not report results on mortality or quality of life.
AUTHORS' CONCLUSIONS
We found no evidence that adding hip core decompression to physical therapy achieves clinical improvement in people with sickle cell disease with avascular necrosis of bone compared to physical therapy alone. However, we highlight that our conclusion is based on one trial with high attrition rates. Further randomized controlled trials are necessary to evaluate the role of hip-core depression for this clinical condition. Endpoints should focus on participants' subjective experience (e.g. quality of life and pain) as well as more objective 'time-to-event' measures (e.g. mortality, survival, hip longevity). The availability of participants to allow adequate trial power will be a key consideration for endpoint choice.
Topics: Anemia, Sickle Cell; Humans; Osteonecrosis; Physical Therapy Modalities; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 31803937
DOI: 10.1002/14651858.CD004344.pub7 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Nov 2022To review the research progress of pathogenesis and genetics of alcohol-induced osteonecrosis of the femoral head (AIONFH). (Review)
Review
OBJECTIVE
To review the research progress of pathogenesis and genetics of alcohol-induced osteonecrosis of the femoral head (AIONFH).
METHODS
The relevant domestic and foreign literature in recent years was extensively reviewed. The pathogenesis, the relationship between gene polymorphism and susceptibility, the related factors of disease progression, and the potential therapeutic targets of AIONFH were summarized.
RESULTS
AIONFH is a refractory orthopedic disease caused by excessive drinking, seriously affecting the daily life of patients due to its high disability rate. The pathogenesis of AIONFH includes lipid metabolism disorder, endothelial dysfunction, bone homeostasis imbalance, and . Gene polymorphism and non-coding RNA are also involved. The hematological and molecular changes involved in AIONFH may be used as early diagnostic markers and potential therapeutic targets of the disease.
CONCLUSION
The pathogenesis of AIONFH has not been fully elucidated. Research based on genetics, including gene polymorphism and non-coding RNA, combined with next-generation sequencing technology, may provide directions for future research on the mechanism and discovery of potential therapeutic targets.
Topics: Humans; Femur Head; Femur Head Necrosis; Osteonecrosis; Ethanol; RNA, Untranslated
PubMed: 36382462
DOI: 10.7507/1002-1892.202206072 -
Orthopaedics & Traumatology, Surgery &... Feb 2011Femoral neck fracture puts at risk functional prognosis in young patients and can be life-threatening in the elderly. The present study reviews methods of femoral head... (Review)
Review
Femoral neck fracture puts at risk functional prognosis in young patients and can be life-threatening in the elderly. The present study reviews methods of femoral head vascularity assessment following neck fracture, to address the following issues: what is the risk of osteonecrosis? And what, in the light of this risk, is the best-adapted treatment to avoid iterative surgery? Femoral head vascularity depends on retinacular vessels and especially the lateral epiphyseal artery, which contributes from 70 to 80% of the femoral head vascular supply. Fracture causes vascular lesions, which are in turn the prime cause of necrosis. Other factors combine with this: hematoma tamponade effect, reduced joint space and increased pressure due to lower extremity positioning in extension/internal rotation/abduction during surgery. Head deformity is not due to direct cell death but to the repair process originating from the surrounding living bone. In post-traumatic necrosis, proliferation rapidly invades the head, with significant osteogenesis. Pathologic fractures occur at the boundary between the new and dead bone. Many techniques have been reported to help assess residual hemodynamics and risk of necrosis. Some are invasive: superselective angiography, intra-osseous oxygen pressure measurement, or Doppler-laser hemodynamic measurement; others involve imaging: scintigraphy, conventionnal or dynamic MRI. The future seems to lie with dynamic MRI, which allows a new classification of femoral neck fractures, based on a non-invasive assessment of femoral head vascularity.
Topics: Early Diagnosis; Femoral Neck Fractures; Femur Head Necrosis; Humans; Prognosis
PubMed: 21087905
DOI: 10.1016/j.otsr.2010.06.014 -
Hormone Research in Paediatrics 2019Skeletal abnormalities are common in children and adolescents diagnosed and treated for a malignancy. The spectrum ranges from mild pain to debilitating osteonecrosis... (Review)
Review
Skeletal abnormalities are common in children and adolescents diagnosed and treated for a malignancy. The spectrum ranges from mild pain to debilitating osteonecrosis and fractures. In this review, we summarize the impact of cancer therapy on the developing skeleton, provide an update on therapeutic strategies for prevention and treatment, and discuss the most recent advances in musculoskeletal research. Early recognition of skeletal abnormalities and strategies to optimize bone health are essential to prevent long-term skeletal sequelae and diminished quality of life in childhood cancer survivors.
Topics: Adolescent; Cancer Survivors; Child; Child, Preschool; Female; Fractures, Bone; Humans; Male; Musculoskeletal Development; Neoplasms; Osteonecrosis; Quality of Life
PubMed: 30481777
DOI: 10.1159/000494809 -
Anticancer Research 2006Intravenous bisphosphonates are the current standard of care for the treatment of hypercalcemia of malignancy and for the prevention of skeletal complications associated...
BACKGROUND
Intravenous bisphosphonates are the current standard of care for the treatment of hypercalcemia of malignancy and for the prevention of skeletal complications associated with bone metastases. Recently, retrospective case studies have reported an association between long-term bisphosphonate therapy and osteonecrosis of the jaws.
PATIENTS AND METHODS
The data for twelve patients, referred to either an oral and maxillofacial surgeon or to an oral medicine specialist for the management of clinically apparent chronic oral osteonecrosis of unknown etiology, were reviewed. All had received cancer-related therapy simultaneously with bisphosphonate management.
RESULTS
The typical presenting symptoms were pain and exposed bone at the site of a previous tooth extraction. In most patients, the lesions initially occurred after dental extraction or other odontostomatological procedures, while five had a spontaneous event. Biopsy of the involved area showed the presence of necrotic lacunae, with infiltration of lymphocytes and histiocytes. In nine cases, there was histological or cytological diagnosis of suspicious osteomyelitis. No correlation was observed between the intraoral lesions and myelosuppression secondary to antineoplastic therapy.
CONCLUSION
Based on the patients' respective histories, clinical presentations and responses to surgical and antibiotic treatments, it appears that the pathogenesis of this osteonecrotic process is most consistent with localized vascular insufficiency. In our opinion, the mechanism by which bisphosphonates compromise bone vascularity may be related to their effect on the osteoclasts. The potent bisphosphonate-mediated inhibition of osteoclast function serves to decrease bone resorption and inhibit normal bone turnover remodeling, resulting in microdamage accumulation and a reduction in some mechanical properties of the bone.
Topics: Aged; Biopsy; Diphosphonates; Female; Humans; Male; Mandibular Diseases; Middle Aged; Osteonecrosis; Tooth Extraction
PubMed: 16886642
DOI: No ID Found -
Orthopaedic Surgery Mar 2022To explore the use of wrist arthroscopy for treatment of aseptic necrosis of lunate bone and its curative effect.
OBJECTIVE
To explore the use of wrist arthroscopy for treatment of aseptic necrosis of lunate bone and its curative effect.
METHODS
From March 2012 to January 2016, 12 patients with aseptic necrosis of lunate bone underwent necrotic lunate bone extirpation assisted by wrist arthroscopy, and the scaphocapitate joint treated with fusion-stabilization were selected. Among these patients, 10 patients were male and two patients were female. The age of these patients ranged from 25 to 42 years old, with an average age of 32 years old. These lesions were located in the right hand in eight patients, and in the left hand in four patients. Lichtman stage: stage IIIA in two patients, and stage IIIB in 10 patients. All patients were diagnosed by anterior lateral radiographs and magnetic resonance imaging (MRI). From the second day after the surgery, patients underwent active motion for the metacarpophalangeal joint and interphalangeal joints. When the X-ray film indicated that the fracture had healed, patients began to resume their daily activities and work. After surgery, the plain films of all planes, including the axial plane of the scaphoid, were taken every month, until fracture healing. All patients were followed up for a mean duration of 8 months, and the Mayo wrist score was used to assess the range of motion of the wrist joint and grip force during the follow-ups for objective function evaluation.
RESULTS
Fracture healing was obtained in all patients within 9-12 weeks after the operation, and average healing time was 10 weeks. The duration of follow-up ranged between 6-14 months, and the mean duration was 8 months. According to the modified Mayo wrist score, the objective function of the wrist joint was evaluated as follows: flexion and extension range of the wrist joint was 40°-110°, with an average of 105°, which was 80% of that of the unaffected side. Radioulnar deviation was 45°-80°, with an average of 55°, which was 82% of that of the unaffected side. Grip force was 25-48 kg, with an average of 40 kg, which was 84% of that of the unaffected side. The modified Mayo wrist score was good in eight patients, acceptable in three patients, and poor in one patient.
CONCLUSIONS
Wrist arthroscopy is an effective and feasible tool for the treatment of aseptic necrosis of the lunate bone, and the right kind of surgical procedure should be selected for different stages of the disease, and wrist arthroscopy is applied timely, in order to achieve the desired therapeutic effect.
Topics: Adult; Arthroscopy; Female; Humans; Lunate Bone; Male; Osteonecrosis; Range of Motion, Articular; Scaphoid Bone; Wrist; Wrist Joint
PubMed: 34939331
DOI: 10.1111/os.13003 -
Indian Pediatrics Apr 2004Patients on corticosteroid therapy, specially for a long period are likely to develop many adverse effects related to the therapy. A physician should be conversant with... (Review)
Review
Patients on corticosteroid therapy, specially for a long period are likely to develop many adverse effects related to the therapy. A physician should be conversant with these to ensure early detection, management and prevention, where possible. Thus, all patients on a long-term corticosteroid therapy should have a baseline and 3 monthly assessments for weight, height, blood pressure and other clinical features of Cushing's syndrome. A 2 hours postprandial blood sugar and serum electrolyte estimation should also be included. Ophthalmic evaluation for glaucoma and cataract should be carried out at 6 monthly intervals and densitometry annually for early detection of osteopenia. In addition, a high index of suspicion should be maintained for timely detection of infections, avascular bone necrosis, myopathy and pseudotumor cerebri.
Topics: Child; Cushing Syndrome; Gastrointestinal Tract; Glaucoma; Glucocorticoids; Humans; Hyperglycemia; Osteonecrosis
PubMed: 15123863
DOI: No ID Found -
Biomaterials Apr 2020Magnesium (Mg)-based biometal attracts clinical applications due to its biodegradability and beneficial biological effects on tissue regeneration, especially in...
Magnesium (Mg)-based biometal attracts clinical applications due to its biodegradability and beneficial biological effects on tissue regeneration, especially in orthopaedics, yet the underlying anabolic mechanisms in relevant clinical disorders are lacking. The present study investigated the effect of magnesium (Mg) and vitamin C (VC) supplementation for preventing steroid-associated osteonecrosis (SAON) in a rat experimental model. In SAON rats, 50 mg/kg Mg, or 100 mg/kg VC, or combination, or water control was orally supplemented daily for 2 or 6 weeks respectively. Osteonecrosis was evaluated by histology. Serum Mg, VC, and bone turnover markers were measured. Microfil-perfused samples prepared for angiography and trabecular architecture were evaluated by micro-CT. Primary bone marrow cells were isolated from each group to evaluate their potentials in osteoblastogenesis and osteoclastogenesis. The mechanisms were tested in vitro. Histological evaluation showed SAON lesions in steroid treated groups. Mg and VC supplementation synergistically reduced the apoptosis of osteocytes and osteoclast number, and increased osteoblast surface. VC supplementation significantly increased the bone formation marker PINP, and the combination significantly decreased the bone resorption marker CTX. TNFα expression and oxidative injury were decreased in bone marrow in Mg/VC/combination group. Mg significantly increased the blood perfusion in proximal tibia and decreased the leakage particles in distal tibia 2 weeks after SAON induction. VC significantly elevated the osteoblast differentiation potential of marrow cells and improved the trabecular architecture. The combination supplementation significantly inhibited osteoclast differentiation potential of marrow cells. In vitro study showed promoting osteoblast differentiation effect of VC, and anti-inflammation and promoting angiogenesis effect of Mg with underlying mechanisms. Mg and VC supplementation could synergistically alleviate SAON in rats, indicating great translational potentials of metallic minerals for preventing SAON.
Topics: Animals; Ascorbic Acid; Dietary Supplements; Magnesium; Osteonecrosis; Rats; Steroids
PubMed: 32045781
DOI: 10.1016/j.biomaterials.2020.119828 -
Family Practice Aug 2021COVID-19 is an emergent infection, the long-term complications of which are still under study. While hypercoagulability is a common feature in severe cases, the...
BACKGROUND
COVID-19 is an emergent infection, the long-term complications of which are still under study. While hypercoagulability is a common feature in severe cases, the incidence of ischemic complications such as osteonecrosis remains unknown. Previous studies on SARS-CoV1 found an increase in osteonecrosis 3-36 months after infection, and it is still unclear if this was related to the use of corticosteroids or to the virus itself.
METHODS
We introduce a 78-year-old woman who complained of right knee pain and swelling a month after COVID-19 infection onset. Her knee radiography showed no significant changes compared to previous ones. MRI, on the other hand, found osteonecrosis in the internal femoral condyle. No coagulation abnormalities were found in blood tests.
RESULTS
While knee replacement should be her main treatment, it will be long delayed due to the pandemic. In the meantime, we increased her tapentadol and salicylic acid doses and gave her home exercises to improve functionality.
CONCLUSION
In the follow-up after COVID-19, any muscular or joint pain with unusual characteristics should be carefully examined.
Topics: Aged; COVID-19; Female; Humans; Knee Joint; Osteonecrosis; SARS-CoV-2
PubMed: 34448481
DOI: 10.1093/fampra/cmab063 -
The Oncologist Nov 2009Bisphosphonate-associated osteonecrosis of the jaw (BONJ) is a complication of long-term bisphosphonate (BP) use. Given the beneficial effects of BP on bone quality in... (Review)
Review
Bisphosphonate-associated osteonecrosis of the jaw (BONJ) is a complication of long-term bisphosphonate (BP) use. Given the beneficial effects of BP on bone quality in patients with cancer or osteoporosis, it is of great importance to understand the risk as it relates to time to event or cumulative dose until the onset of disease. Because there is no information on the lowest toxic dose from clinical trials, here we report on a review of 71 case series published since 2003. We calculated the weighted mean time to event, as well as the minimum reported time and dose for zoledronate, pamidronate, and oral bisphosphonates. The mean time to BONJ after zoledronate treatment was calculated at 1.8 years and the minimum was 10 months; after pamidronate, the mean time was 2.8 years and the minimum was 1.5 years; and after oral BP therapy, the mean time was 4.6 years and the minimum was 3 years. Zoledronic acid seems to be the most potent among the nitrogen-containing BPs. Factors that seem to affect BONJ and time to event were invasive dental procedures and other comorbid factors such as advanced age, rheumatoid arthritis, diabetes, use of corticosteroids, vitamin D deficiency, and more. Understanding the pathophysiology of the disease requires further research.
Topics: Diphosphonates; Humans; Jaw Diseases; Osteonecrosis; Time Factors
PubMed: 19897878
DOI: 10.1634/theoncologist.2009-0115