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Li S, Wang J, Ma R, Zhao C, Gao Z, Quan X, Zhang Q. Analysis of the efficacy of drilling decompression autologous bone marrow and allogeneic bone grafting in the treatment of HIV-positive patients with early osteonecrosis of the femoral head. BMC Musculoskelet Disord 2023; 24:902. [PMID: 37990216 PMCID: PMC10661564 DOI: 10.1186/s12891-023-07039-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/12/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE To investigate the efficacy of treating patients with HIV-positive osteonecrosis of the femoral head using drilled decompression autologous bone marrow and allogeneic bone grafting. METHODS 40 patients (44 hips) with early osteonecrosis of the femoral head treated by drilling decompression autologous bone marrow and allogeneic bone grafting since October 2015 were retrospectively analyzed, among which 20 patients (24 hips) were HIV-positive patients with early osteonecrosis of the femoral head, 16 males and 4 females, age 22-43 years, average 39.6 ± 10.18 years, and 20 patients (20 hips) in the same period HIV-negative early osteonecrosis of the femoral head patients, 13 males and 7 females, aged 48-78 years, mean 63.50 ± 7.94 years were negative controls. General information including ARCO stage, Harris score, VAS score, hematological indexes including CD4+ T lymphocyte count, and HIV viral load was recorded for all patients before surgery. All patients were operated on by drilling and decompression of the necrotic area, harvesting autologous iliac bone marrow with allogeneic bone, and bone grafting through the decompression channel. The patients were followed up regularly at 6, 12, and 24 months after surgery and annually thereafter, and the repair of the necrotic femoral head was observed by reviewing the frontal and lateral X-ray, CT or MRI of the hip joint, and the complications and functional recovery of the hip joint was counted and compared between the two groups. RESULTS All patients were followed up, and the ARCO stages in the HIV-positive group were stage I 2 hips, stage IIA 6 hips, stage IIB 8 hips, stage IIC 6 hips, and stage III 2 hips, with a follow-up time of 12 to 60 months and a mean of 24.6 months. In the negative control group, there were 3 hips in ARCO stage I, 7 hips in stage IIA, 5 hips in stage IIB, 3 hips in stage IIC, and 2 hips in stage III, and the follow-up time ranged from 13 to 62 months, with an average of 24.8 months. The Harris score and VAS score of the hip in both groups improved significantly at 6 months postoperatively compared with those before surgery (P < 0.001). The difference between the Harris score of the hip in the positive group at 24 months postoperatively compared with that at 6 months postoperatively was statistically significant, but the VAS score at 24 months postoperatively compared with that at 6 months postoperatively was not statistically significant. In the negative group, there was no statistically significant difference in the Harris score and VAS score of the hip at 24 months postoperatively compared with those at 6 months postoperatively. In the positive group, there was a trend of continuous increase in hip BMD from the beginning of the postoperative period (P < 0.001). There was no statistically significant difference between the negative group and the positive group at the 24 months postoperatively follow-up except for the Harris score, which was statistically significant (P < 0.001), and the VAS score, which was statistically insignificant. At the 24 months postoperatively follow-up, patients in both groups had good recovery of hip function, and no complications such as vascular and nerve injury and fracture occurred during the perioperative period and follow-up period, and no complications related to incisional infection and pulmonary infection occurred during hospitalization. CONCLUSION The treatment of early HIV-positive osteonecrosis of the femoral head patients with autologous bone marrow and allogeneic bone grafting by drilling and decompression to remove the tissue in the necrotic area of the femoral head can effectively stop the process of osteonecrosis of the femoral head and promoting femoral head repair in HIV-positive patients is a safe and effective method for treating HIV-positive patients with early osteonecrosis of the femoral head, and can effectively delay or postpone total hip replacement in patients.
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Affiliation(s)
- Shengtao Li
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Jie Wang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing, 100015, China
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Workers Stadium South Road, Chaoyang District, Beijing, 100020, China
| | - Rui Ma
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Changsong Zhao
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Zhengrong Gao
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Xuemin Quan
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Qiang Zhang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing, 100015, China.
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Salimi M, Mirghaderi P, Mosalamiaghili S, Mohammadi A, Salimi A. Joint replacement and human immunodeficiency virus. World J Virol 2023; 12:1-11. [PMID: 36743660 PMCID: PMC9896588 DOI: 10.5501/wjv.v12.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/19/2022] [Accepted: 12/08/2022] [Indexed: 01/18/2023] Open
Abstract
The incidence of human immunodeficiency virus (HIV)-infected cases that need total joint replacement (TJR) is generally rising. On the other hand, modern management of HIV-infected cases has enabled them to achieve longevity while increasing the need for arthroplasty procedures due to the augmented dege-nerative joint disease and fragility fractures, and the risk of osteonecrosis. Although initial investigations on joint replacement in HIV-infected cases showed a high risk of complications, the recent ones reported acceptable outcomes. It is a matter of debate whether HIV-infected cases are at advanced risk for adverse TJR consequences; however, the weak immune profile has been associated with an increased probability of complications. Likewise, surgeons and physicians should be aware of the complication rate after TJR in HIV-infected cases and include an honest discussion of the probable unwelcoming complication with their patients contemplating TJR. Therefore, a fundamental review and understanding of the interaction of HIV and arthroplasty are critical.
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Affiliation(s)
- Maryam Salimi
- Department of Orthopedic Surgery, Shiraz University of Medical Sciences, Shiraz 71936-13311, Iran
| | - Peyman Mirghaderi
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran 7138433608, Iran
| | | | - Ali Mohammadi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz 7136587666, Iran
| | - Amirhossein Salimi
- Department of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd 7156893040, Iran
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How Do Drugs Affect the Skeleton? Implications for Forensic Anthropology. BIOLOGY 2022; 11:biology11040524. [PMID: 35453723 PMCID: PMC9030599 DOI: 10.3390/biology11040524] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/21/2022] [Accepted: 03/18/2022] [Indexed: 01/10/2023]
Abstract
Simple Summary Forensic anthropologists analyze human remains to assist in the identification of the deceased, predominantly by assessing age-at-death, sex, stature, ancestry and any unique identifying features. Whilst methods have been established to create this biological profile of the skeleton, these may be influenced by a number of factors. This paper, for the first time, provides an overview from a reading of the clinical and pharmacological literature to explore whether the intake of drugs can affect the skeleton and whether these may have implications for forensic anthropology casework. In effect, drugs such as tobacco, heroin, and prescription medications can alter bone mineral density, can increase the risk of fractures, destroy bone and changes to the dentition. By considering how drugs can affect the skeleton, forensic anthropologists can be aware of this when attempting to identify the deceased. Abstract Forensic anthropologists rely on a number of parameters when analyzing human skeletal remains to assist in the identification of the deceased, predominantly age-at-death, sex, stature, ancestry or population affinity, and any unique identifying features. During the examination of human remains, it is important to be aware that the skeletal features considered when applying anthropological methods may be influenced and modified by a number of factors, and particular to this article, prescription drugs (including medical and non-medical use) and other commonly used drugs. In view of this, this paper aims to review the medical, clinical and pharmacological literature to enable an assessment of those drug groups that as side effects have the potential to have an adverse effect on the skeleton, and explore whether or not they can influence the estimation of age-at-death, sex and other indicators of the biological profile. Moreover, it may be that the observation of certain alterations or inconsistencies in the skeleton may relate to the use of drugs or medication, and this in turn may help narrow down the list of missing persons to which a set of human remains could belong. The information gathered from the clinical and medical literature has been extracted with a forensic anthropological perspective and provides an awareness on how several drugs, such as opioids, cocaine, corticosteroids, non-steroidal anti-inflammatory drugs, alcohol, tobacco and others have notable effects on bone. Through different mechanisms, drugs can alter bone mineral density, causing osteopenia, osteoporosis, increase the risk of fractures, osteonecrosis, and oral changes. Not much has been written on the influence of drugs on the skeleton from the forensic anthropological practitioner perspective; and this review, in spite of its limitations and the requirement of further research, aims to investigate the current knowledge of the possible effects of both prescription and recreational drugs on bones, contributing to providing a better awareness in forensic anthropological practice and assisting in the identification process of the deceased.
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Maamar el Asri M, García Martínez A, Tobalina Segura M, Blanco Martín E, Pariente Rodrigo E. Necrosis avascular de ambas cabezas femorales en un paciente VIH+. Semergen 2019; 45:e11-e12. [DOI: 10.1016/j.semerg.2018.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 02/06/2018] [Accepted: 02/08/2018] [Indexed: 10/27/2022]
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Novikov D, Anoushiravani AA, Chen KK, Wolfson TS, Snir N, Schwarzkopf R. Total Hip Arthroplasty in Human Immunodeficiency Virus-Positive Patients: A Concise Follow-Up at 10 to 14 Years. J Arthroplasty 2019; 34:522-526. [PMID: 30503321 DOI: 10.1016/j.arth.2018.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/28/2018] [Accepted: 11/01/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Advancements in the management of human immunodeficiency virus (HIV) now permit HIV-positive patients to have longer life spans, increasing their cumulative risk of developing an advanced degenerative joint disease, necessitating total hip arthroplasty (THA). The purpose of this study was to provide an extended follow-up on a previously published study on a cohort of HIV-positive THA recipients in an effort to confirm the safety and longevity of THA in this population. METHODS This study is a follow-up on a previous study comprised of 41 hips in 31 HIV-positive THA recipients. At this follow-up, 5 patients from the original cohort required contralateral THA. Postoperative complications were recorded up to the patient's last follow-up date. A survivorship analysis was performed using the Kaplan-Meier method with revision THA as the end point. RESULTS Since the last report, 2 additional hips were revised (one for aseptic loosening and one for a periprosthetic fracture), and 5 patients underwent contralateral THA. This resulted in a total of 5 (13.8%) hips requiring revision THA at the latest follow-up. The mean follow-up interval for the original cohort and for the contralateral 5 hips was 78.9 ± 50.2 months and 54.6 ± 45.3 months, respectively. Kaplan-Meier survivorship analysis with revision THA for any reason as the end point demonstrated survivorship of 93% (2 years), 90% (5 years), and 81% (10 and 14 years) after primary THA, respectively. CONCLUSION Our study suggests that it is possible to achieve a low incidence of postoperative infection in HIV-positive THA recipients. In addition, our study demonstrates that non-hemophiliac HIV-positive patients have comparable revision rates to previously published reports on HIV-negative patients of similar age, underscoring the clinical efficacy of highly active antiretroviral therapy.
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Affiliation(s)
- David Novikov
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY
| | - Afshin A Anoushiravani
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY
| | - Kevin K Chen
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY
| | - Theodore S Wolfson
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY
| | - Nimrod Snir
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY
| | - Ran Schwarzkopf
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY
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Severe bilateral knee osteonecrosis in a young man with human immunodeficiency virus. Radiol Case Rep 2019; 14:208-212. [PMID: 30425776 PMCID: PMC6231295 DOI: 10.1016/j.radcr.2018.10.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 10/27/2018] [Accepted: 10/27/2018] [Indexed: 11/29/2022] Open
Abstract
We present a young man with a background Human Immunodeficiency virus (HIV) who presented with bilateral knee pain and reduced mobility. Subsequent imaging of the knees demonstrated florid osteonecrosis (ON), which was managed conservatively. ON is seen more commonly in HIV patients than the general population, however the underlying mechanism for this association is remains unclear. An awareness of this disease is imperative to appropriately identify and manage such patients.
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Green KR, Hernandez-Jimenez JM, Isache CL, Jacob R. Avascular necrosis: a growing concern for the HIV population. BMJ Case Rep 2018; 2018:bcr-2017-221678. [PMID: 29880618 DOI: 10.1136/bcr-2017-221678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 33-year-old woman with history of HIV presented with 4 months of gradually progressing right hip pain and was found to have avascular necrosis (AVN) of both femoral heads. She had no other risk factors for AVN including sickle cell disease, systemic lupus erythematosus, prolonged steroid used or trauma. She initially failed conservative management and ultimately had bilateral hip core decompressions. After decompression therapy, the left femoral head collapsed and patient underwent a left total hip arthroplasty. Her postsurgical course was complicated by the left sciatic nerve neuropathy for which she is currently being managed with duloxetine. She has yet to follow-up with her orthopaedic surgeon for further evaluation.
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Affiliation(s)
- Kevin R Green
- Department of Internal Medicine, University of Florida Health, Jacksonville, Florida, USA
| | | | - Carmen Liliana Isache
- Department of Internal Medicine, University of Florida Health, Jacksonville, Florida, USA
| | - Rafik Jacob
- Department of Internal Medicine, University of Florida Health, Jacksonville, Florida, USA
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Dimitriou D, Ramokgopa M, Pietrzak JRT, van der Jagt D, Mokete L. Human Immunodeficiency Virus Infection and Hip and Knee Arthroplasty. JBJS Rev 2018; 5:e8. [PMID: 28953137 DOI: 10.2106/jbjs.rvw.17.00029] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Modern management of human immunodeficiency virus (HIV) infection has afforded patients longevity while increasing the burden of arthroplasty procedures because of the increased risk of osteonecrosis, fragility fractures, and degenerative joint disease. Early publications on hip and knee arthroplasty in HIV-positive patients reported a high risk of complications, although some more recent publications demonstrated acceptable outcomes. Despite the widespread nature of the HIV pandemic, there is a paucity of literature addressing outcomes following joint arthroplasty in infected patients. We pooled available studies to obtain the best evidence regarding the safety of total hip and knee arthroplasty procedures in HIV-positive patients. The studies identified were heterogeneous, precluding a meta-analysis. However, we performed a review of the literature focusing on complications and outcomes. METHODS Twenty-one published English-language articles involving 6,516,186 joints were identified by a systematic review as suitable for inclusion in the study. The articles were analyzed for complication and prosthesis survivorship rates and relative risks. RESULTS An overall complication rate of 3.3% was found across the 19 articles that provided such data. HIV-positive patients had a significantly elevated risk of periprosthetic joint infection, at 7.6%, compared with HIV-negative patients, at 3.3% (relative risk = 2.28, 95% confidence interval = 2.14 to 2.43). Eleven articles were suitable for analysis of prosthesis survivorship, and survivorship rates did not differ significantly between HIV-positive and negative patients. CONCLUSIONS Total hip and total knee arthroplasty appear to be safe procedures with acceptable outcomes in HIV-positive patients. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Dimitrios Dimitriou
- Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
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Dimitriou D, Ramokgopa M, Pietrzak JR, van der Jagt D, Mokete L. Human Immunodeficiency Virus Infection and Hip and Knee Arthroplasty. JBJS Rev 2017. [DOI: 10.2106/jbjs.rvw.17.00029
bcc:009247.186-259147.186.fea35.19420.2@bxss.me] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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Choi HR, Steinberg ME, Y Cheng E. Osteonecrosis of the femoral head: diagnosis and classification systems. Curr Rev Musculoskelet Med 2015; 8:210-20. [PMID: 26088795 DOI: 10.1007/s12178-015-9278-7] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Osteonecrosis of femoral head is a rare but disabling condition that usually results in progressive femoral head collapse and secondary arthritis necessitating total hip arthroplasty if not treated appropriately in early stages. However, early diagnosis is challenging as the onset of disease is insidious and the symptoms and signs are usually minimal and nonspecific until it becomes advanced. Of several diagnostic modalities, magnetic resonance imaging (MRI) is considered the imaging method of choice with the highest sensitivity and specificity, while detection of potential risk factors is very important as well. Many investigators have developed several different classification systems; however, there still is controversy regarding the optimal classification system. Diagnostic methods and the evolution of different classification systems will be reviewed in this paper.
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Affiliation(s)
- Ho-Rim Choi
- Department of Orthopaedic Surgery, University of Minnesota Medical School, 2450 Riverside Avenue, Minneapolis, MN, 55454, USA,
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Tornero E, García S, Larrousse M, Gallart X, Bori G, Riba J, Rios J, Gatell JM, Martinez E. Total hip arthroplasty in HIV-infected patients: a retrospective, controlled study. HIV Med 2012; 13:623-9. [DOI: 10.1111/j.1468-1293.2012.01017.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2012] [Indexed: 11/29/2022]
Affiliation(s)
- E Tornero
- Department of Orthopedic and Trauma Surgery; Hospital Clínic; Barcelona; Spain
| | - S García
- Department of Orthopedic and Trauma Surgery; Hospital Clínic; Barcelona; Spain
| | - M Larrousse
- Department of Infectious Diseases; Hospital Clínic; Barcelona; Spain
| | - X Gallart
- Department of Orthopedic and Trauma Surgery; Hospital Clínic; Barcelona; Spain
| | - G Bori
- Department of Orthopedic and Trauma Surgery; Hospital Clínic; Barcelona; Spain
| | - J Riba
- Department of Orthopedic and Trauma Surgery; Hospital Clínic; Barcelona; Spain
| | - J Rios
- Laboratory of Biostatistics & Epidemiology (UAB); Statistics and Methodology Support Unit; IDIBAPS; Hospital Clinic; Barcelona; Spain
| | - JM Gatell
- Department of Infectious Diseases; Hospital Clínic; Barcelona; Spain
| | - E Martinez
- Department of Infectious Diseases; Hospital Clínic; Barcelona; Spain
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Park J, Jun K, Kim MJ, Jung Y, Lee MJ, Kim NJ, Oh MD. Avascular Necrosis of Femoral Head in HIV-infected Patients: Case Reports and Review of the Literature. Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.6.508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Jinyong Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kangil Jun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min Jae Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Younghee Jung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Myung Jin Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Osteonecrosis of the femoral head in patients with type 1 human immunodeficiency virus infection: clinical analysis and review. Clin Rheumatol 2009; 28:815-23. [DOI: 10.1007/s10067-009-1156-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 02/16/2009] [Accepted: 02/25/2009] [Indexed: 02/06/2023]
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Woodmansey KF, White RK, He J. Osteonecrosis related to intraosseous anesthesia: report of a case. J Endod 2008; 35:288-91. [PMID: 19166792 DOI: 10.1016/j.joen.2008.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Revised: 10/26/2008] [Accepted: 11/02/2008] [Indexed: 11/28/2022]
Abstract
Intraosseous anesthesia is an effective and increasingly used technique with few reported complications. The technique uses a specialized drill to perforate the osseous cortex where local anesthetic can then be deposited to anesthetize teeth. It has been reported that separation of the perforation drills from their plastic bases can occur because of the friction generated during osseous perforation. Prolonged rotation of the perforator drills in the bone can also cause excessive heat, which can lead to bone necrosis. This report describes a case of focal osteonecrosis subsequent to intraosseous anesthesia and discusses possible etiologies of this sequela.
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Affiliation(s)
- Karl F Woodmansey
- Department of Graduate Endodontics, Baylor College of Dentistry, Dallas, TX 75246, USA.
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Richardson J, Hill AM, Johnston CJC, McGregor A, Norrish AR, Eastwood D, Lavy CBD. Fracture healing in HIV-positive populations. ACTA ACUST UNITED AC 2008; 90:988-94. [DOI: 10.1302/0301-620x.90b8.20861] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Highly active anti-retroviral therapy has transformed HIV into a chronic disease with a long-term asymptomatic phase. As a result, emphasis is shifting to other effects of the virus, aside from immunosuppression and mortality. We have reviewed the current evidence for an association between HIV infection and poor fracture healing. The increased prevalence of osteoporosis and fragility fractures in HIV patients is well recognised. The suggestion that this may be purely as a result of highly active anti-retroviral therapy has been largely rejected. Apart from directly impeding cellular function in bone remodelling, HIV infection is known to cause derangement in the levels of those cytokines involved in fracture healing (particularly tumour necrosis factor-α) and appears to impair the blood supply of bone. Many other factors complicate this issue, including a reduced body mass index, suboptimal nutrition, the effects of anti-retroviral drugs and the avoidance of operative intervention because of high rates of wound infection. However, there are sound molecular and biochemical hypotheses for a direct relationship between HIV infection and impaired fracture healing, and the rewards for further knowledge in this area are extensive in terms of optimised fracture management, reduced patient morbidity and educated resource allocation. Further investigation in this area is overdue.
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Affiliation(s)
- J. Richardson
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - A. M. Hill
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - C. J. C. Johnston
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - A. McGregor
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - A. R. Norrish
- Tropical Surgery Research and Training Unit, Beit CURE Hospital, P. O. Box 36391, Lusaka, Zambia
| | - D. Eastwood
- Department of Orthopaedics, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK
| | - C. B. D. Lavy
- Nuffield Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford 0X3 7LD, UK
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de Larrañaga G, Bottaro E, Martinuzzo M, Figueroa R, Iglesias Varela ML, Perés Wingeyer S, Forastiero R, Adamczuk Y, Corti M, Puga L, Benetucci J. Thrombophilia in human immunodeficiency virus-infected patients with osteonecrosis: Is there a real connection? The first case-control study. Clin Appl Thromb Hemost 2007; 15:340-7. [PMID: 18160564 DOI: 10.1177/1076029607310217] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Several reports have described an increased incidence of osteonecrosis in human immunodeficiency virus-infected patients (HIV+), but the cause has not been established. The association between thrombophilia and osteonecrosis in HIV+ was studied. A case-control study in HIV+, 19 cases and 38 controls, was designed. Magnetic resonance imaging was made in both groups to confirm or exclude hip osteonecrosis. The extensive tests of thrombophilia were measured, and the clinical data were recorded, nadir of CD4(+) cell count and well-known risk factors for osteonecrosis. Thrombophilia has been frequently found both in patients with and without osteonecrosis (thrombophilia, 68.4% vs 60.5%), but no specific thrombophilia tests were significantly associated with osteonecrosis. A low nadir of CD4(+) (<60 cells/microL) and corticoid use were significantly (P < .05) associated with osteonecrosis. In multivariate analysis, only nadir of CD4(+) <60 cells/microL remained a predictor of osteonecrosis (odds ratio = 7.33; 95% confidence interval, 1.80-29.82, P = .005). Thrombophilia might have a limited role in the development of osteonecrosis in HIV+. Nadir of CD4(+) <60 cells/microL and corticoid use were main factors.
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Affiliation(s)
- Gabriela de Larrañaga
- Hemostasis and Thrombosis Laboratory, Hospital of Infectious Diseases F. J. Muñiz, Buenos Aires, Argentina.
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Morse CG, Mican JM, Jones EC, Joe GO, Rick ME, Formentini E, Kovacs JA. The incidence and natural history of osteonecrosis in HIV-infected adults. Clin Infect Dis 2007; 44:739-48. [PMID: 17278070 DOI: 10.1086/511683] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Accepted: 11/13/2006] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Osteonecrosis is increasingly recognized as a debilitating complication of human immunodeficiency virus (HIV) infection, but the natural history has not been well described. We previously documented a high prevalence (4.4%) of magnetic resonance imaging (MRI)-documented osteonecrosis of the hip in a cohort of 339 asymptomatic HIV-infected patients. The present study was designed to determine the incidence of newly diagnosed osteonecrosis in this cohort and to describe the natural history of osteonecrosis in HIV-infected patients. METHODS Asymptomatic HIV-infected patients with a previous hip MRI negative for osteonecrosis underwent follow-up MRI. Patients with asymptomatic or symptomatic osteonecrosis were enrolled in a natural history study, which included serial MRIs and a physiotherapy follow-up. RESULTS Two hundred thirty-nine patients underwent a second MRI a median of 23 months after the initial MRI. Osteonecrosis of the femoral head was diagnosed in 3 patients (incidence, 0.65 cases per 100 person-years). During the period of January 1999 through April 2006, symptomatic hip osteonecrosis developed in 13 clinic patients (incidence, 0.26 cases per 100 person-years). Among 22 patients enrolled with symptomatic hip osteonecrosis, 18 had bilateral involvement of the femoral heads, and 7 had osteonecrosis involving other bones. Two (11%) of 18 asymptomatic patients and 13 (59%) of 22 symptomatic patients underwent total hip replacement. The percentage of involvement of the weight-bearing surface of the femoral head and the rate of progression to total hip replacement was significantly greater (P<.001) in symptomatic patients than in asymptomatic patients. CONCLUSIONS HIV-infected patients are at approximately 100-fold greater risk of developing osteonecrosis than the general population. Disease progression is slower in asymptomatic patients than in symptomatic patients. Given the high frequency of total hip replacement in symptomatic patients, studies to assess preventive and treatment strategies are essential.
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Affiliation(s)
- Caryn G Morse
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, Maryland 20892-1662, USA.
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Abstract
The etiology of osteonecrosis of the hip may have a genetic basis. The interaction between certain risk factors and a genetic predisposition may determine whether this disease will develop in a particular individual. The rationale for use of joint-sparing procedures in the treatment of this disease is based on radiographic measurements and findings with other imaging modalities. Early diagnosis and intervention prior to collapse of the femoral head is key to a successful outcome of joint-preserving procedures. The results of joint-preserving procedures are less satisfactory than the results of total hip arthroplasty for femoral heads that have already collapsed. New pharmacological measures as well as the use of growth and differentiation factors for the prevention and treatment of this disease may eventually alter our treatment approach, but it is necessary to await results of clinical research with long-term follow-up of these patients.
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Affiliation(s)
- Michael A Mont
- Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
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Colmegna I, Koehler JW, Garry RF, Espinoza LR. Musculoskeletal and autoimmune manifestations of HIV, syphilis and tuberculosis. Curr Opin Rheumatol 2006; 18:88-95. [PMID: 16344624 DOI: 10.1097/01.bor.0000197994.27579.d2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The HIV pandemic continues to increase at an alarming rate, and is the leading cause of death worldwide from a single pathogen. The number of HIV-1-infected individuals currently exceeds 40 million, the majority of whom live in the developing countries of Asia, sub-Saharan Africa and south America. In the past 5 years, there has concurrently been an increase in the reported cases of tuberculosis and primary and secondary syphilis. This review addresses the musculoskeletal and autoimmune manifestations associated with HIV, syphilis and tuberculosis infections or their treatments. RECENT FINDINGS During HIV infection the immune system becomes dysfunctional because of the coexistence of immunodeficiency and immune hyperactivity, and a disregulated production or activity of cytokines. Some of these mechanisms explain the development of rheumatic manifestations associated with HIV infection. Highly active antiretroviral therapy changes the course of HIV infection and the spectrum of the HIV-associated rheumatic manifestations. New syndromes such as the immune reconstitution inflammatory syndrome have emerged. HIV, tuberculosis and syphilis infections offer special epidemiological, clinical, and therapeutic challenges. SUMMARY These observations highlight the complexity and multiplicity of the interactions between the pathogen and host that could result in the development of rheumatic manifestations.
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Affiliation(s)
- Ines Colmegna
- Section of Rheumatology, Department of Medicine, Louisiana State University Health Sciences Center, Tulane University Health Sciences Center, New Orleans, Louisiana 70112, USA
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John Wiley & Sons, Ltd.. Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2005. [DOI: 10.1002/pds.1027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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