Osteonecrosis of Bilateral Distal Femurs in a Pregnant Patient Following Antenatal Betamethasone (original) (raw)
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Bilateral osteonecrosis of the femoral head after pregnancy
Archives of Orthopaedic and Trauma Surgery, 2005
Published cases of non-traumatic avascular necrosis of the femoral head associated with pregnacy are rare. We report a case of a 41-year-old woman who suddenly complained of bilateral hip pain 3 weeks after delivery by Caesarean section. For a problem of sterility, she had been treated with human menopausal gonadotropin and human chorionic gonadotropin (hMG-hCG). Initial radiographs of both hip joints
Acta chirurgica iugoslavica, 2014
Osteonecrosis of the femoral head (aseptical, avascular or ischemic) is a condition of difficult deteriorisation of bone structure, which can be temporary or transit and with irreversible character. Aseptic necrosis of the femoral head during pregnancy is uncommon finding and presents a diagnostic challenge. It requires a multidisciplinary approach in order to determine whether the osteonecrosis is a complication of previous pathological condition or is an entity related to pregnancy and postpartal period. We present a case of a 32 year old female in 38th week of pregnancy who was admitted with diagnosis of aseptic necrosis of the femoral head. The aim of this report is to show the importance of early recognition of osteonecrosis of the femoral head in the early postpartal period, in order to prevent severe damage and the most severe complication-spontaneous (pathological) fracture of the femur.
Obstetrics & Gynecology, 2008
OBJECTIVE-To compare markers of maternal bone metabolism between women who received a single compared with multiple courses of antenatal corticosteroids. METHODS-This is an analysis of serum samples from apreviously reported randomized, placebocontrolled, multicenter trial. Women at risk for preterm delivery after an initial course of corticosteroids were randomly assigned to weekly courses of betamethasone (active) or placebo. Serum levels of carboxy terminal propeptide of type I procollagen (PICP) and cross-linked carboxy terminal telopeptide of type I collagen (ICTP) were measured to assess the rate of bone formation and resorption, respectively, at three time points. The placebo group (n=93) was compared with the active group, receiving four or more courses of betamethasone (n=112).
Obstetrics & Gynecology, 2009
Objective-To estimate the effect of single and recurrent doses of antenatal corticosteroids on fetal bone metabolism. Study Design-A secondary analysis of a cohort of pregnant women from a previously reported randomized, placebo-controlled, multi-center trial of women at risk for preterm delivery who received weekly courses of betamethasone (active) or placebo after an initial course of corticosteroids. Umbilical cord serum levels of carboxy terminal pro-peptide of type I pro-collagen (PICP) and cross-linked carboxyterminal telopeptide of type I pro-collagen (ICTP) were measured to assess the rate of fetal bone formation and resorption, respectively. Analysis was stratified according to number of repeat antenatal study courses of betamethasone or placebo (1-3 vs. ≥ 4 courses not including the initial course). Results-Of the 251 umbilical cord serum samples, the median serum ICTP levels, but not PICP levels, were significantly lower with repeat betamethasone exposure compared to placebo (55 vs. 57.9 mcg/L, respectively, p=0.01). In the fetuses exposed to ≥ 4 repeat study courses, there was a significant decrease in median ICTP levels between repeat betamethasone exposure and placebo (53.4 vs. 58.6 mcg/L, respectively, p=0.04) but there was no difference between groups in the fetuses exposed to 1-3 repeat study courses (57.4 vs. 56.7 mcg/L, respectively, p= 0.29). Conclusion-Levels of umbilical cord serum markers of bone resorption but not formation are reduced in fetuses exposed to repeat courses of antenatal betamethasone. Up to 4 courses of antenatal betamethasone do not appear to affect fetal bone metabolism.
Risk factors and pathogenesis of steroid-induced osteonecrosis of femoral head -A scoping review
Steroid induced osteonecrosis of the femoral head is commonly seen in clinical practice, but yet not fully understood. It is intriguing why only some cases develop and others escape from it. We did an extensive and up to date literature review on it, with the aim to identify its incidence, associated risk factor and pathogenesis. We found that the incidence ranged from 03 to 40%, and was more with associated risk factors. Several risk factors were identified, which included higher dose and prolonged duration of steroid consumption, and underlying disease for which the steroids were given. Pathogenesis of this disease is complex and not yet fully understood. Awareness about this condition and associated risk factors should help the clinicians in identifying the cases who are prone to develop osteonecrosis with the use of steroids.
Osteonecrosis of the femoral head associated with pregnancy
Archives of Orthopaedic and Trauma Surgery, 1999
We performed a retrospective analysis of 212 patients (299 hips) with slipped capital femoral epiphysis (SCFE) over a 9-year period to assess the incidence of osteonecrosis of the femoral head. Risk factors for the occurrence of osteonecrosis and the influence of treatment on the development of osteonecrosis were determined. Osteonecrosis occurred in 4 hips with unstable SCFE (4/27) and did not occur in hips with stable SCFE (0/272). The proportion of hips in which osteonecrosis developed was significantly higher among the unstable hips (4/27 vs. 0/272, p < 0.0001). Among those with an unstable hip, younger age at presentation was a predictor of a poorer outcome. Magnitude of the slip, magnitude of reduction, and chronicity of the slip were not predictive of a poorer outcome in the unstable group. In situ fixation of the minimally or moderately displaced "unstable" SCFE demonstrated a favorable outcome. We have identified the hip at risk as an unstable SCFE. The classification of hips as unstable if the epiphysis is displaced from the metaphysis or if the patient is unable to walk is most useful in predicting a hip at risk for osteonecrosis.
Corticosteroid-induced Knee Osteonecrosis and Accompanying Femoral Head Osteonecrosis
Corticosteroid-induced Knee Osteonecrosis and Accompanying Femoral Head Osteonecrosis
Amaç: Bu çalışmadaki amacımız kortikosteroid tedavisi alan ve artralji şikayeti olan hastalarda diz ON'nin (ON) manyetik rezonans görüntüleme (MRG) ile prevalansını ve görüntüleme bulgularını araştırmaktır. Ayrıca MRG altın standart olarak kabul edildiğinde diz ON'de düz radyografinin tanısal performansını göstermeyi ve bu hastalarda eşlik eden femur başı ON'nin prevalansını araştırmayı amaçladık. Yöntemler: Kortikosteroid alımı öyküsü ve diz ağrısı olan 136 hastaya ait 162 diz grafisi ve MRG tetkiki ON varlığı açısından retrospektif olarak değerlendirildi. ON'si olan hastalarda lokalizasyon, maksimum dominant lezyon boyutu, lezyonun çokluğu, kemik ödemi varlığı, çift hat işareti ve subkondral tutulum değerlendirildi. Kalça MRG uygulanan hastalarda eşlik eden femur başı ON'si de araştırıldı. Bulgular: MRG'de 28 hastaya ait 37 dizde ON vardı. Diz eklemi ON tanısında düz grafinin duyarlılık ve özgüllüğü sırasıyla %29,73 ve %98,40 idi. Otuz bir dizde çok sayıda lezyon vardı ve 24 dizde subkondral boşluk etkilenmekteydi. Lezyonların çoğunda çift çizgi işareti ve kemik iliği ödemi mevcuttu. Diz ON'si olan 28 hastanın sadece 16'sında kalça eklemi MRG yapılmıştı ve bu hastaların 5'inde (%31,3) femur başı ON'si vardı. Sonuç: Düz radyografi diz ON tanısı için düşük duyarlılığa ve yüksek özgüllüğe sahiptir. Kortikosteroid kaynaklı ON çok odaklı olma eğilimindedir ve kortikosteroid tedavisi sırasında diz ON'si olan hastaların önemli bir kısmında kalça eklemi ON'si vardır. Anahtar Kelimeler: Manyetik rezonans görüntüleme, düz radyografi, osteonekroz, kortikosteroid, diz, kalça Introduction: The aim of this study was to investigate the prevalence and magnetic resonance imaging (MRI) findings of knee osteonecrosis (ON) in patients with arthralgia who received corticosteroid therapy. We also aimed to demonstrate the diagnostic performance of plain radiography in knee ON when MRI is accepted as the gold standard and to investigate the prevalence of accompanying femoral head ON in patients who underwent hip MRI. Methods: One hundred and sixty-two knee X-rays and MRI examinations of 136 patients with knee pain and a history of corticosteroid intake were retrospectively evaluated for the presence of ON. Localization, maximum size of dominant lesion, multiplicity of lesions, presence of bone edema, double-line sign and subchondral extension were evaluated in patients with ON. Accompanying femoral head ON was also investigated in patients who underwent hip MRI. Results: MRI revealed ON in 37 knees of 28 patients. The sensitivity and specificity of plain radiography in the diagnosis of knee joint ON was 29.73% and 98.40%, respectively. There were multiple lesions in 31 knees and subchondral space was affected in 24 knees. The double-line sign and bone marrow edema were present in most of the lesions. Of the 28 patients with knee ON, only 16 had hip joint MRI and five of these patients (31.3%) had femoral head ON. Conclusion: Plain radiography has low sensitivity but high specificity for the diagnosis of knee ON. Corticosteroid-induced ON tends to be multifocal, and a significant proportion of patients with knee ON during corticosteroid therapy have ON of the hip joint.
To present a case of bilateral extensive steroid-associated osteonecrosis (SAON) of femur, tibia and patella that was successfully managed with combined antiresorptive and anabolic bone agents. Case presentation: A 38-year-old female patient encountered an aggressive coronavirus disease 2019 (COVID-19) infection and was given systemic steroids for six months. The patient then began to experience bilateral lower limb pain. Tenderness over the knee joint margins was found, as well as tenderness of the lower end of the femur, upper tibia, and patella on both sides. The initial plain x-ray of the lower limb bones revealed subtle areas of sclerosis at the proximal metaphysis of tibial bones. The patient did not improve despite stopping steroids and repeated courses of simple analgesics, and the pain became progressive and more intense, to the point where the patient was unable to bear any weight and became wheel chair bound. Magnetic resonance imaging (MRI) was done revealing extensive osteonecrotic lesions involving the distal metaphysis of the femur with posterior extension into the medial and lateral condyles abutting the articular surfaces. Two anti-osteoporotic drugs were used; alendronate, used weekly to inhibit osteoclastic activity and limit the progression of the osteonecrotic lesions and teriparatide, an anabolic agent that increases osteoblasts, resulting in new trabecular and cortical bone growth. Clinical improvement, pain and ambulation, occurred after one month of initiation of treatment and follow up MRI study after 10 months showed marked radiological improvement. Conclusion: Combined antiresorptive and anabolic bone agents remarkably reversed SAON.
Multiple Joint Osteonecrosis in a Patient on Long-term Intranasal Corticosteroids
JAAOS: Global Research and Reviews, 2020
We present the first report of bilateral knee and left ankle osteonecrosis in a 58-year-old female patient on long-term intranasal corticosteroids. Initially, our patient presented with progressive disabling knee pain with normal radiographs. The patient was presumed to have mild degenerative joint disease; therefore, she was treated conservatively. Then, the patient developed severe left ankle pain, and she was thought to have L5/S1 radiculopathy; therefore, she underwent epidural steroid injection that did not provide any benefit. However, extensive bilateral osteonecrosis of the medial tibial plateau in addition to osteonecrosis of the talus bone of left ankle were later diagnosed by MRI. The patient underwent staged bilateral total knee arthroplasty. In conclusion, the diagnosis of osteonecrosis might be challenging because of overlapping clinical presentation with other disorders particularly in the early stage of the disease with normal radiographs. Therefore, a high index of suspicion and thorough history with supplemental MRI imaging are essential for the assessment of patients presented with atypical refractory joint pain particularly in the presence of risk factors.