DOCSLIB.ORG

PATIENT FACT SHEET Osteonecrosis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
PATIENT FACT SHEET Osteonecrosis PATIENT FACT SHEET Osteonecrosis Osteonecrosis is a painful condition that involves the Osteonecrosis usually occurs between the ages of 20 death of bone cells due to decreased blood flow. It is and 50 years. Bones and bone marrow need steady also called avascular necrosis (AVN) or aseptic necrosis. blood supply to stay healthy. Decreased blood flow It is a painful condition most commonly occurring in causes bone cells to die. Corticosteroid use, heavy the hips or knees, and is often more symptomatic with drinking, lupus and severe trauma or injury may cause CONDITION any weight-bearing activities, such as walking. In some osteonecrosis. cases, the bone at the hip (femoral head) may collapse. Rarer causes of osteonecrosis include HIV, DESCRIPTION Shoulders, hands and feet are less often affected. Rarely, decompression disease (“the bends”), blood disorders osteonecrosis affects the jaw (see separate chapter for such as sickle cell anemia, radiation therapy, and details on osteonecrosis of the jaw). organ transplant. An early sign of osteonecrosis is local pain in the Diagnosis of osteonecrosis begins with an x-ray of the affected bone or joint. Hip osteonecrosis may cause painful area. Other imaging tests such as bone scans or pain in the groin. Pain from hip or knee osteonecrosis magnetic resonance imaging (MRI) may be needed. MRI may be worse during weight-bearing or walking. Nearby is effective for early osteonecrosis detection, particularly joints may develop osteoarthritis. when the x-rays do not reveal change. SIGNS/ SYMPTOMS Treatment of early osteonecrosis includes pain collapse may need total joint replacement of the hip or medications and modifying activity to reduce weight- knee. Another option is bone grafting surgery, where bearing on affected joints. Patients with worsening dead bone is removed and replaced with healthy bone osteonecrosis may have core decompression surgery to from another part of the body to restore blood flow. remove bone from the affected area and restore blood flow. Some studies show short-term bisphosphonate COMMON In more advanced cases of osteonecrosis, osteotomy treatment may slow, improve or prevent bone collapse in surgery may remove dead bone and reposition bone the hip or knee. TREATMENTS to support the weight-bearing joint. Patients with bone Steps to prevent osteonecrosis include reducing Smoking and alcohol consumption raise the risk corticosteroid doses, and avoiding heavy drinking and of osteonecrosis, and are adjustable risk factors the use of tobacco. If patients must take corticosteroids, to lower risk. they should take the smallest possible dose for the CARE/ shortest time necessary. MANAGEMENT TIPS Updated March 2019 by Marcy Bolster, MD, and reviewed by the American College of Rheumatology Committee on Communications and Marketing. This information is provided for general education only. © 2019 American College of Rheumatology Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition. www.ACRPatientInfo.org.
Load more

Recommended publications
  • Pediatric Trauma Imaging from Head To
    High yield pediatric imaging Pediatric Trauma and other Pediatric Emergencies Lynn Ansley Fordham, MD, FACR, FAIUM, FAAWR UNC School of Medicine Department of Radiology Division Chief Pediatric Radiology Overview • Discuss epidemiology of pediatric trauma • Discuss unique aspects of skeletal trauma and fractures in children • Look at a few example of fractures • Review other common pediatric emergencies • Some Pollev Pollev.com\lynnfordham • Lots cases Keywords for PACs case review • PTF • TUBES AND LINES • Pre call cases peds Who to page for peds 2am Thursday morning? Faculty call shift 5pm to 8 am, for midnight to 8am, use prior day schedule Etiology of Skeletal Trauma in Children Significance of pediatric injuries • injuries 40% deaths in 1-4 year olds • injuries 90% deaths in 5-19 year olds Causes of Mortality in Childhood • MVA most common in all age groups • pedestrian (vs. auto 5-9) • bicycle • firearms • fires • drowning/ near drowning Causes of Morbidity in Childhood • falls – most common cause of injury in children • non-fatal MVAs • bicycle related trauma • trampolines • near drowning • other non-fatal injuries Trends over time • Decrease in death rates due to unintentional injuries – Carseats – Bicycle helmets • Increase in homicide rate • Increase in suicide rate MVA common injuries • depends on impact and seatbelt status • spine – craniocervical junction – thoracolumbar spine • pelvis • extremities • sternum rare in children Pediatric Fractures • Fractures related to the physis (growth plate) – Use Salter Harris classification
    [Show full text]
  • Rheumatology?
    WHAT IS RHEUMATOLOGY? diseases affect nearly 50 million Americans and can cause joint and organ destruction, severe pain, disability and even death. Inflammatory rheumatic diseases with arthritis cause more disability in America than heart disease, cancer or diabetes. How can a Rheumatologist help? Most rheumatologic conditions previously led to severe disability and even death in many patients. Evidence-based medical treatment of rheumatological disorders is currently helping patients with rheumatism lead a near-normal life. Medications such as Methotrexate and Tumor necrosis factor inhibitors have had a significant impact on patients with Rheumatoid Arthritis (RA), and today patients with RA can lead a pain free and productive life. Rheumatology facts by numbers: • Over 7 million American adults suffer from inflam- matory rheumatic diseases; 1.3 million adults have rheumatoid arthritis; and 161,000 to 322,000 adults have lupus. • 8.4 percent of women will develop a rheumatic dis- heumatology is a rapidly ease during their lifetime. Women are 2 to 3 times R evolving subspecialty in more likely to be diagnosed with RA, and 10 times internal medicine and more likely to develop lupus than men. pediatrics which includes the pathogenesis, diagnosis, and • 5 percent of men in the U.S. will develop a rheu- management of over 100 complex inflammatory and matic disease during their lifetime. connective tissue diseases. Rheumatologists care for a wide • Osteoporosis and low bone mass are currently esti- array of patients – from children to senior citizens, see mated to be a major public health threat for almost diseases like Rheumatoid Arthritis, Systemic Lupus 44 million U.S.
    [Show full text]
  • 2017 American College of Rheumatology/American Association
    Arthritis Care & Research Vol. 69, No. 8, August 2017, pp 1111–1124 DOI 10.1002/acr.23274 VC 2017, American College of Rheumatology SPECIAL ARTICLE 2017 American College of Rheumatology/ American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty SUSAN M. GOODMAN,1 BRYAN SPRINGER,2 GORDON GUYATT,3 MATTHEW P. ABDEL,4 VINOD DASA,5 MICHAEL GEORGE,6 ORA GEWURZ-SINGER,7 JON T. GILES,8 BEVERLY JOHNSON,9 STEVE LEE,10 LISA A. MANDL,1 MICHAEL A. MONT,11 PETER SCULCO,1 SCOTT SPORER,12 LOUIS STRYKER,13 MARAT TURGUNBAEV,14 BARRY BRAUSE,1 ANTONIA F. CHEN,15 JEREMY GILILLAND,16 MARK GOODMAN,17 ARLENE HURLEY-ROSENBLATT,18 KYRIAKOS KIROU,1 ELENA LOSINA,19 RONALD MacKENZIE,1 KALEB MICHAUD,20 TED MIKULS,21 LINDA RUSSELL,1 22 14 23 17 ALEXANDER SAH, AMY S. MILLER, JASVINDER A. SINGH, AND ADOLPH YATES Guidelines and recommendations developed and/or endorsed by the American College of Rheumatology (ACR) are intended to provide guidance for particular patterns of practice and not to dictate the care of a particular patient. The ACR considers adherence to the recommendations within this guideline to be volun- tary, with the ultimate determination regarding their application to be made by the physician in light of each patient’s individual circumstances. Guidelines and recommendations are intended to promote benefi- cial or desirable outcomes but cannot guarantee any specific outcome. Guidelines and recommendations developed and endorsed by the ACR are subject to periodic revision as warranted by the evolution of medi- cal knowledge, technology, and practice.
    [Show full text]
  • Natural Coral As a Biomaterial Revisited
    American Journal of www.biomedgrid.com Biomedical Science & Research ISSN: 2642-1747 --------------------------------------------------------------------------------------------------------------------------------- Research Article Copy Right@ LH Yahia Natural Coral as a Biomaterial Revisited LH Yahia1*, G Bayade1 and Y Cirotteau2 1LIAB, Biomedical Engineering Institute, Polytechnique Montreal, Canada 2Neuilly Sur Seine, France *Corresponding author: LH Yahia, LIAB, Biomedical Engineering Institute, Polytechnique Montreal, Canada To Cite This Article: LH Yahia, G Bayade, Y Cirotteau. Natural Coral as a Biomaterial Revisited. Am J Biomed Sci & Res. 2021 - 13(6). AJBSR. MS.ID.001936. DOI: 10.34297/AJBSR.2021.13.001936. Received: July 07, 2021; Published: August 18, 2021 Abstract This paper first describes the state of the art of natural coral. The biocompatibility of different coral species has been reviewed and it has been consistently observed that apart from an initial transient inflammation, the coral shows no signs of intolerance in the short, medium, and long term. Immune rejection of coral implants was not found in any tissue examined. Other studies have shown that coral does not cause uncontrolled calcification of soft tissue and those implants placed under the periosteum are constantly resorbed and replaced by autogenous bone. The available porestudies size. show Thus, that it isthe hypothesized coral is not cytotoxic that a damaged and that bone it allows containing cell growth. both cancellous Thirdly, porosity and cortical and gradient bone can of be porosity better replacedin ceramics by isa graded/gradientexplained based on far from equilibrium thermodynamics. It is known that the bone cross-section from cancellous to cortical bone is non-uniform in porosity and in in vitro, animal, and clinical human studies.
    [Show full text]
  • Avascular Necrosis As a Part of ‘Long COVID-19’ Sanjay R Agarwala,1 Mayank Vijayvargiya,2 Prashant Pandey2
    Case report BMJ Case Rep: first published as 10.1136/bcr-2021-242101 on 2 July 2021. Downloaded from Avascular necrosis as a part of ‘long COVID-19’ Sanjay R Agarwala,1 Mayank Vijayvargiya,2 Prashant Pandey2 1Orthopaedics, PD Hinduja SUMMARY I or II, 92%–97% of the patients do not require National Hospital, Mumbai, ’Long COVID-19’ can affect different body systems. At surgery and can be managed with bisphosphonate Maharashtra, India present, avascular necrosis (AVN) as a sequalae of ’long therapy. Hence, it is crucial to diagnose AVN early 2Orthopaedics, PD Hinduja COVID-19’ has yet not been documented. By large- scale to decrease the morbidity and the requirement of National Hospital and Medical surgery. Research Centre, Mumbai, use of life- saving corticosteroids in COVID-19 cases, Here, we report three cases of symptomatic AVN Maharashtra, India we anticipate that there will be a resurgence of AVN cases. We report a series of three cases in which patients of the femoral head after being treated for COVID- Correspondence to developed AVN of the femoral head after being treated 19. This is the first case report of AVN as sequalae Dr Sanjay R Agarwala; for COVID-19 infection. The mean dose of prednisolone of ‘long COVID-19’. drsa2011@ gmail.com used in these cases was 758 mg (400–1250 mg), which is less than the mean cumulative dose of around 2000 CASE PRESENTATION Accepted 23 May 2021 mg steroid, documented in the literature as causative for Case 1 AVN. Patients were symptomatic and developed early A- 36- year old male patient was diagnosed with AVN presentation at a mean of 58 days after COVID-19 COVID-19 on 6 September 2020, for which the diagnosis as compared with the literature which shows patient was admitted in intensive care at another that it generally takes 6 months to 1 year to develop AVN hospital because of dropping saturation.
    [Show full text]
  • Stage-Related Results in Treatment of Hip Osteonecrosis with Core-Decompression and Autologous Mesenchymal Stem Cells
    Acta Orthop. Belg., 2015, 81, 406-412 ORIGINAL STUDY Stage-related results in treatment of hip osteonecrosis with core-decompression and autologous mesenchymal stem cells Pietro PERSIANI, Claudia DE CRISTO, Jole GRACI, Giovanni NOIA, Michele GURZÌ, Ciro VILLANI From Universitary Department of Anatomic, Histologic, Forensic and Locomotor Apparatus Sciences, Section of Locomotor Apparatus Sciences, Policlinico Umberto I, Sapienza University of Rome Our aim is to analyse the clinical outcome of a series thetic hip replacement. Therapy with glucocorti- of patients affected by avascular necrosis of the femo- coids and alcohol abuse are some of the main known ral head and treated with core-decompression tech- causative factors (21). Several pathophysiological nique and autologous stromal cells of the bone mechanisms were formulated about this pathology, marrow. including fat emboli, microvascular occlusion of We enrolled in our study 29 patients with 31 hips in epiphysis vessels and micro fracture of trabecular total affected by avascular necrosis of the femoral 13,18 head. bone ( ). An early diagnosis and a continuous The clinical and radiological outcome has been monitoring of patients with risk factors (corticoste- assessed through self-administered questionnaires roids therapy, alcoholism, or irradiated patients) are (HHS, VAS and SF12) X-ray and Magnetic Reso- very important in order to highlight the AVNFH nance. typical alteration as early as possible. Of all the examined hips, 25 showed a relief of the The treatment of osteonecrosis is one of the most symptoms and a resolution of the osteonecrosis, 11 of controversial subjects in the orthopaedic literature. these were at Stage I and 14 at Stage II.
    [Show full text]
  • Rheuma.Stamp Line&Box
    Arthritis Mutilans: A Report from the GRAPPA 2012 Annual Meeting Vinod Chandran, Dafna D. Gladman, Philip S. Helliwell, and Björn Gudbjörnsson ABSTRACT. Arthritis mutilans is often described as the most severe form of psoriatic arthritis. However, a widely agreed on definition of the disease has not been developed. At the 2012 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), members hoped to agree on a definition of arthritis mutilans and thus facilitate clinical and molecular epidemiological research into the disease. Members discussed the clinical features of arthritis mutilans and defini- tions used by researchers to date; reviewed data from the ClASsification for Psoriatic ARthritis study, the Nordic psoriatic arthritis mutilans study, and the results of a premeeting survey; and participated in breakout group discussions. Through this exercise, GRAPPA members developed a broad consensus on the features of arthritis mutilans, which will help us develop a GRAPPA-endorsed definition of arthritis mutilans. (J Rheumatol 2013;40:1419–22; doi:10.3899/ jrheum.130453) Key Indexing Terms: OSTEOLYSIS ANKYLOSIS PENCIL-IN-CUP SUBLUXATION FLAIL JOINT ARTHRITIS MUTILANS Psoriatic arthritis (PsA) is an inflammatory musculoskeletal gists as a severe destructive form of PsA, a precise disease specifically associated with psoriasis. Moll and definition has not yet been universally accepted. The earliest Wright defined PsA as “psoriasis associated with inflam- definition of arthritis mutilans was provided
    [Show full text]
  • Rheumatology Connections
    IN THIS ISSUE Uncommon Manifestations of SLE 3 | PACNS or RCVS? 6 | Psychosocial Burden of PsA 9 Advances in IL-6 Biology 10 | AHCT for Systemic Sclerosis 12 | PET in Large Vessel Vasculitis 14 Rheumatology Connections An Update for Physicians | Summer 2018 112236_CCFBCH_18RHE1077_ACG.indd 1 7/10/18 2:06 PM Dear Colleagues, Welcome to another issue of Rheumatology Con- From the Chair of Rheumatic nections. I think you’ll find our title perfectly apt as and Immunologic Diseases you browse these articles, full of connections to an array of other specialties, to our patients and to our clinical, scientific and educational missions. Dr. Chatterjee’s collaboration with the Department of Medical Oncology and Hematology for treating severe systemic sclerosis is but one example of the relevance of our field across disciplines (p. 12). Cleveland Clinic’s Rheumatology This issue also features a study of psychosocial fac- Program is ranked among the top tors in psoriatic arthritis co-authored by Dr. Husni 2 in the nation in U.S. News & and a colleague in the Neurological Institute (p. 9). World Report’s “America’s Best Our connections to neurology become even clearer Hospitals” survey. as Drs. Calabrese and Hajj-Ali offer guidance on distinguishing between a neurological condition and the more fatal, less common rheumatologic one that it mimics (p. 6). Rheumatology Connections, published by We are always searching for ways to transcend Cleveland Clinic’s Department of Rheumatic disciplinary boundaries to provide better patient care. Our multidisciplinary style of caring for patients was and Immunologic Diseases, provides information critical in a case co-authored with a colleague in pathology and Drs.
    [Show full text]
  • Clinical Management of Severe Acute Respiratory Infections When Novel Coronavirus Is Suspected: What to Do and What Not to Do
    INTERIM GUIDANCE DOCUMENT Clinical management of severe acute respiratory infections when novel coronavirus is suspected: What to do and what not to do Introduction 2 Section 1. Early recognition and management 3 Section 2. Management of severe respiratory distress, hypoxemia and ARDS 6 Section 3. Management of septic shock 8 Section 4. Prevention of complications 9 References 10 Acknowledgements 12 Introduction The emergence of novel coronavirus in 2012 (see http://www.who.int/csr/disease/coronavirus_infections/en/index. html for the latest updates) has presented challenges for clinical management. Pneumonia has been the most common clinical presentation; five patients developed Acute Respira- tory Distress Syndrome (ARDS). Renal failure, pericarditis and disseminated intravascular coagulation (DIC) have also occurred. Our knowledge of the clinical features of coronavirus infection is limited and no virus-specific preven- tion or treatment (e.g. vaccine or antiviral drugs) is available. Thus, this interim guidance document aims to help clinicians with supportive management of patients who have acute respiratory failure and septic shock as a consequence of severe infection. Because other complications have been seen (renal failure, pericarditis, DIC, as above) clinicians should monitor for the development of these and other complications of severe infection and treat them according to local management guidelines. As all confirmed cases reported to date have occurred in adults, this document focuses on the care of adolescents and adults. Paediatric considerations will be added later. This document will be updated as more information becomes available and after the revised Surviving Sepsis Campaign Guidelines are published later this year (1). This document is for clinicians taking care of critically ill patients with severe acute respiratory infec- tion (SARI).
    [Show full text]
  • Acute Chest Syndrome, Avascular Necrosis of Femur, and Pulmonary Embolism All at Once: an Unexpected Encounter in the First-Ever Admission of a Sickle Cell Patient
    Open Access Case Report DOI: 10.7759/cureus.17656 Acute Chest Syndrome, Avascular Necrosis of Femur, and Pulmonary Embolism All at Once: An Unexpected Encounter in the First-Ever Admission of a Sickle Cell Patient Akhilesh Annadatha 1 , Dhruv Talwar 1 , Sourya Acharya 1 , Sunil Kumar 1 , Vivek Lahane 1 1. Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed University), Wardha, IND Corresponding author: Dhruv Talwar, [email protected] Abstract Acute chest syndrome (ACS) is defined as the radiological appearance of pulmonary infiltrates with fever or respiratory symptoms like chest pain, breathlessness, and cough in a patient with sickle cell disease (SCD). It is also a very common cause of mortality in sickle cell patients, if not identified in early stages and treated aggressively. Radiological image is similar to bacterial pneumonia, so sickle cell disease with a radiological picture similar to pneumonia and associated respiratory symptoms is known as acute chest syndrome. Pneumonia and infarction have been implicated in pathogenesis. The reason for the appearance of acute chest syndrome in patients with SCD is not established but some triggers like sepsis, presence of vaso- occlusive crises have been noted. When there is a block in the blood supply to the bone, patients with sickle cell disease may also develop avascular necrosis of the neck of the femur causing narrowing of joint and collapse of the bone. Patients with sickle cell disease have a baseline hypercoagulable state thereby predisposing the patient to develop deep vein thrombosis and pulmonary embolism. Here, we present a case of a 25-year-old SCD patient with a fairly stable course of the disease.
    [Show full text]
  • Symptomatic Middle Ear and Cranial Sinus Barotraumas As a Complication of Hyperbaric Oxygen Treatment
    İst Tıp Fak Derg 2016; 79: 4 KLİNİK ARAŞTIRMA / CLINICAL RESEARCH J Ist Faculty Med 2016; 79: 4 http://dergipark.ulakbim.gov.tr/iuitfd http://www.journals.istanbul.edu.tr/iuitfd SYMPTOMATIC MIDDLE EAR AND CRANIAL SINUS BAROTRAUMAS AS A COMPLICATION OF HYPERBARIC OXYGEN TREATMENT HİPERBARİK OKSİJEN TEDAVİSİ KOMPLİKASYONU: SEMPTOMATİK ORTA KULAK VE KRANYAL SİNUS BAROTRAVMASI Bengüsu MİRASOĞLU*, Aslıcan ÇAKKALKURT*, Maide ÇİMŞİT* ABSTRACT Objective: Hyperbaric oxygen therapy (HBOT) is applied for various diseases. It is generally considered safe but has some benign complications and adverse effects. The most common complication is middle ear barotrauma. The aim of this study was to collect data about middle ear and cranial sinus barotraumas in our department and to evaluate factors affecting the occurrence of barotrauma. Material and methods: Files of patients who had undergone hyperbaric oxygen therapy between June 1st, 2004, and April 30th, 2012, and HBOT log books for the same period were searched for barotraumas. Patients who were intubated and unconscious were excluded. Data about demographics and medical history of conscious patients with barotrauma (BT) were collected and evaluated retrospectively. Results: It was found that over eight years and 23,645 sessions, 39 of a total 896 patients had BT; thus, the general BT incidence of our department was 4.4%. The barotrauma incidence was significantly less in the multiplace chamber (3.1% vs. 8.7%) where a health professional attended the therapies. Most barotraumas were seen during early sessions and were generally mild. A significant accumulation according to treatment indications was not determined. Conclusion: It was thought that the low barotrauma incidence was related to the slow compression rate as well as training patients thoroughly and monitoring them carefully.
    [Show full text]
  • Bilateral Diaphragm Paralysis and Sleep Apnoea Without Diurnal Respiratory Failure
    Thorax: first published as 10.1136/thx.43.1.75 on 1 January 1988. Downloaded from Thorax 1988;43:75-77 Bilateral diaphragm paralysis and sleep apnoea without diurnal respiratory failure J R STRADLING, A R H WARLEY From the Osler Chest Unit, Churchill Hospital, OxJord This is a case history of a patient with isolated bilateral increased at 3 6 kPa (27 mm Hg) and was presumed to be due diaphragm paralysis. It is presented because it offers insight to basal atelectasis. into possible mechanisms of the respiratory failure which Two months later overnight oximetry was performed usually develops in this condition. (Biox 2A). The awake semirecumbent arterial oxygen satura- tion (Sao2) was 93%. Most of the night was spent with a Case report stable Sao2 ofabout 92%. During three periods of 20 minutes there were regular recurrent dips in Sao, (rate 45/hour) to The patient, now 40 years old, presented in 1973 with about 80% (lowest 69%), presumed to be associated with mesangiocapillary glomerulonephritis (hypocompliment- rapid eye movement (REM) sleep. At this stage no further aemic with C3 nephritic factor) and subsequently developed action was taken except to advise sleeping propped up. progressive renal failure. In 1978 classical neuralgic amyotro- Two full sleep studies were performed 12 and 18 months phy (brachial neuritis) occurred in both arms and remitted later. They gave similar results. The patient's height and over the next three months, his sister having had similar weight at this time were 1-9 m and 94 kg respectively. Awake episodes some years before. Four months later he underwent values of Pao, and Paco, in the semirecumbent posture were a successful cadaver renal transplant.
    [Show full text]