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Bilateral avascular necrosis of the Femoral Head in Renal Transplant Recipient: A Case Report

Open Journal of Nephrology 2024年第2期14卷 253-261页

作者： Imane Saidi Moulay Omar Lamrani Naima Ouzeddoun Tarik Bouattar Department of Nephrology-Dialysis-Renal Transplantation IbnSina University Hospital Rabat Morocco Faculty of Medicine and Pharmacy Mohammed V University Rabat Rabat Morocco Department of Traumatology IbnSina University Hospital Rabat Morocco

Osteoarticular complications are common after renal transplantation. The complications may result from the bone condition prior to transplantation or the iatrogenic effects of the treatments administered. These complications lead to significant morbidity and mortality, in addition to chronic pain and functional impairment. We report the clinical case of bilateral avascular necrosis (AVN) of the femoral head in a kidney transplant recipient. Clinical Case: 53-year-old male with a history of chronic hypertension. He underwent chronic hemodialysis for 12 months and was treated with Entecavir for chronic hepatitis B. The patient received a kidney transplant from a non-related living donor. Induction therapy included Thymoglobulin along with tapered corticosteroids, reaching a dose of 5 mg/day after 3 months, Mycophenolate mofetil (2 g/day), and Tacrolimus adjusted based on residual levels. There was good recovery of renal graft function. After six months, the patient reported bilateral hip pain and functional impairment of both lower limbs. Pelvic X-rays showed signs suggestive of bilateral AVN of the femoral heads. The diagnosis was confirmed by MRI. The patient underwent right hip drilling and total left hip replacement (THR). A right THR was performed a year later. Conclusion: AVN constitutes a frequent cause of morbidity and mortality after RT. The pathophysiology of osteonecrosis remains complex and multifactorial. We emphasize the importance of conducting a thorough assessment of bone health in patients both before and after RT.

关键词： avascular necrosis Femoral Head Osteoarticular Complications Renal Transplant

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Bilateral pericapsular end nerve blocks for steroid-induced avascular necrosis following COVID-19 infection requiring bilateral total hip replacement

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World Journal of Anesthesiology 2024年第1期13卷 1-8页

作者： Somita Christopher Sweety Dutta Thota Venkata Sanjeev Gopal Department of Anaesthesiology Care HospitalsHyderabad 500025India

BACKGROUND Osteonecrosis or avascular necrosis(AVN)of the hip was one of the dreaded complications of coronavirus disease 2019(COVID-19),which emerged in patients who received steroid therapy.Corticosteroids have been a mainstay in the treatment protocol of COVID-19 patients.Popular corticosteroid drugs used in patients suffering from COVID-19 were intravenous(IV)or oral dexamethasone,methylprednisolone or hydrocortisone.The use of such high doses of corticost-eroids has shown very positive results and has been lifesaving in many cases.Still,long-term consequences were drug-induced diabetes,osteoporosis,Cushing syndrome,muscle wasting,peripheral fat mobilization,AVN,hirsutism,sleep disturbances and poor wound healing.A significant number of young patients were admitted for bilateral total hip replacements(THR)secondary to AVN following steroid use for COVID-19 treatment.AIM To assess the efficacy of bilateral pericapsular end nerve group(PENG)blocks in patients posted for bilateral THR post-steroid therapy after COVID-19 infection and assess the time taken to first ambulate after surgery.METHODS This prospective observational study was conducted between January 2023 and August 2023 at Care Hospitals,Hyderabad,India.Twenty young patients 30-35 years of age who underwent bilateral THR were studied after due consent over 8 months.All the patients received spinal anaesthesia for surgery and bilateral PENG blocks for postoperative analgesia.RESULTS The duration of surgery was 2.5 h on average.Seventeen out of twenty patients(85%)had a Visual Analog Score(VAS)of less than 2 and did not require any supplementation.One patient was removed from the study,as he required re-exploration.The remaining two patients had a VAS of more than 8 and received IV morphine post-operatively as a rescue analgesic drug.Fifteen out of seventeen patients(88.2%)could be mobilized 12 h after the procedure.CONCLUSION Osteonecrosis or AVN of the hip was one of the dreaded complications of COVID-19,which surfaced in patients who received steroid

关键词： avascular necrosis Pericapsular end nerve group block Analgesia Hip replacement COVID-19 Steroids

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avascular necrosis of the first metatarsal head in a young female adult:A case report and review of literature

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World Journal of Clinical Cases 2021年第25期9卷 7445-7452页

作者： Ronald Wing Hei Siu Jeremy Ho Pak Liu Gene Chi Wai Man Michael Tim Yun Ong Patrick Shu Hang Yung Department of Orthopaedics and Traumatology Faculty of MedicineThe Chinese University of Hong KongHong Kong 999077China The Lui Che Woo Institute of Innovative Medicine Faculty of MedicineThe Chinese University of Hong KongHong Kong 999077China

BACKGROUND This case study describes an atypical presentation of avascular necrosis(AVN)of the first metatarsal head,which is largely unfounded in the literature.CASE SUMMARY A healthy 24-year-old female initially presented with pain at the first metatarsophalangeal joint(MTPJ)and was diagnosed with AVN by physical examination and magnetic resonance imaging.The patient demonstrated atypically poor progress in recovery,despite being in otherwise good health and being of young age,with no history of corticosteroid or alcohol use.The patient also did not have any history or clinical features of autoimmune disease or vasculitis,such as systemic lupus erythematosus.The patient was managed with conservative treatment for 18 mo,which allowed for gradual return of full range of motion of the first MTPJ and subsiding pain,permitting the patient to return to highintensity sports training and full weight-bearing.Throughout her recovery,many differential diagnoses were ruled out through specific investigations leading to further reinforcement of the diagnosis of AVN of the 1st metatarsal head.CONCLUSION Atypical AVN may occur with no predisposing risk factors.Treatment is mainly conservative,with unclear guidelines in literature on management.

关键词： avascular necrosis Osteonecrosis Metatarsal head Atypical avascular necrosis Young Female Foot and ankle Sports medicine Case report

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Vascular endothelial growth factor gene transfection to enhance the repair of avascular necrosis of the femoral head of rabbit

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Chinese Medical Journal 2003年第10期116卷 1544-1548页

作者：杨操杨述华杜靖远李进许伟华熊宇芳 Department of Orthopedics Union HospitalTongji Medical CollegeHuazhong University of Science & Technology Department of Biochemistry Tongji Medical CollegeHuazhong University of Science & Technology

Objective To explore a new method for the therapy of avascular necrosis of the femoral head. Methods The recombinant plasmid pCD-hVEGF 165 was mixed with collagen and was implanted in the necrotic femoral head. The expression of vascular endothelial growth factor (VEGF) was examined by RNA dot hybridization and immunohistochemical techniques. Repair of the femoral head was observed by histological and histomorphometric analysis.Results The expression of VEGF was detected in the femoral head transfected with the VEGF gene. The femoral head transfected with the VEGF gene showed a significant increase in angiogenesis 2 and 4 weeks after gene transfection and a significant increase in bone formation 6 and 8 weeks after gene transfection on histomorphometric analysis ( P necrosis could be accelerated accordingly,thus providing a potential method for therapy of osteonecrosis.

关键词： vascular endothelial growth factor gene transfection avascular necrosis femoral head

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De Garengeot hernia with avascular necrosis of the appendix: A case report

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World Journal of Clinical Cases 2021年第36期9卷 11355-11361页

作者： Min-Quan Yao Bing-Hong Yi Yong Yang Xiao-Qi Weng Jin-Xing Fan Yu-Peng Jiang Departments of Gastrointestinal Surgery Tongxiang First People’s HospitalJiaxing 314500Zhejiang ProvinceChina

BACKGROUND An incarcerated hernia is a common cause of acute abdominal pain.There are various types of incarcerated hernias,including incarcerated hernias of the appendix.These hernias are often complicated by appendiceal inflammation,necrosis,and suppuration,which affect the outcome of surgical repair.A De Garengeot hernia is a femoral hernia that contains the appendix.This type of hernia has a low incidence.When a De Garengeot hernia is clinically suspected,emergency surgical treatment should be performed as soon as possible.CASE SUMMARY A 59-year-old man was admitted to the hospital with a painful right inguinal mass that had suddenly developed 6 hours earlier.Physical examination revealed a 4 cm×2 cm palpable mass in the right groin.The mass was hard and could not be reduced due to tenderness.It did not descend into the scrotum.B-ultrasound revealed an incarcerated hernia.During surgery,the hernia was found to contain the appendix,which exhibited distal avascular necrosis.A De Garengeot hernia was diagnosed according to the classification criteria of this type of inguinal hernia.Laparoscopic reduction of the incarcerated hernia,appendectomy,and small-incision femoral hernia repair were performed in the emergency department,and cefuroxime was administered as anti-infection therapy for 2 d postoperatively.After treatment,the patient had no abdominal pain or infection and was discharged on postoperative day 4.He had no recurrence of the inguinal hernia after 16 months of follow-up.CONCLUSION De Garengeot hernias have a low incidence and are difficult to diagnose.Laparoscopy is useful for their diagnosis and treatment.

关键词： De Garengeot hernia Incarcerated hernia avascular necrosis Femoral hernia Laparoscopy Case report

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Tibiocalcaneal fusion using Ilizarov external fixator in total talar extrusion:A case report

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Chinese Journal of Traumatology 2023年第6期26卷 339-343页

作者： Shukriah Aqilah Zakaria Mohd Saiful Adzuwan Mat Rodi Department of Orthopaedics Traumatology and RehabilitationInternational Islamic University of MalaysiaKuantan25200PahangMalaysia Department of Orthopaedics Hospital Sultanah Nur ZahirahKuala Terengganu20400TerengganuMalaysia

Talar extrusions are the rare extreme case of talar fractures and dislocations which are associated with high-energy trauma.Given the rarity of talar extrusion,no proper treatment protocol has been established.The earlier treatment outcomes have been poor due to the high rate of infection and avascular necrosis.However,more recent literature advised reimplanting the talus whenever practical,and providing with meticulous cleaning of the talus.In the presence of infection and severe trauma,tibiocalcaneal fusion achieved by the Ilizarov external fixator can be an effective salvage method.

关键词： avascular necrosis Talar extrusion Tibiocalcaneal fusion Ilizarov method

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Development of an internally braced prosthesis for total talus replacement

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World Journal of Orthopedics 2017年第3期8卷 221-228页

作者： Markus Regauer Mirjam Lange Kevin Soldan Steffen Peyerl Sebastian Baumbach Wolfgang Bocker Hans Polzer Klinik für Allgemeine Unfall und Wiederherstellungschirurgie Klinikum der Ludwig-Maximilians-Universitat München Stryker GmbH

Total loss of talus due to trauma or avascular necrosis,for example,still remains to be a major challenge in foot and ankle surgery with severely limited treatment options.Implantation of a custom made total talar prosthesis has shown promising results so far.Most important factors for long time success are degree of congruence of articular surfaces and ligamentous stability of the ankle.Therefore,our aim was to develop an optimized custom made prosthesis for total talus replacement providing a high level of primary stability.A custom made hemiprosthesis was developed using computed tomography and magnetic resonance imaging data of the affected and contralateral talus considering the principles and technology for the development of the S.T.A.R.prosthesis(Stryker).Additionally,four eyelets for fixation of artificial ligaments were added at the correspondent footprints of the most important ligaments.Two modifications can be provided according to the clinical requirements:A tri-articular hemiprosthesis or a bi-articular hemiprosthesis combined with the tibial component of the S.T.A.R.total ankle replacement system.A feasibility study was performed using a fresh frozen human cadaver.Maximum range of motion of the ankle was measured and ligamentous stability was evaluated by use of standard X-rays after application of varus,valgus or sagittal stress with 150 N.Correct implantation of the prosthesis was technically possible via an anterior approach to the ankle and using standard instruments.Malleolar osteotomies were not required.Maximum ankle dorsiflexion and plantarflexion were measured as 22-0-28 degrees.Maximum anterior displacement of the talus was 6 mm,maximum varus tilt 3 degrees and maximum valgus tilt 2 degrees.Application of an internally braced prosthesis for total talus replacement in humans is technically feasible and might be a reasonable procedure in carefully selected cases with no better alternatives left.

关键词： Ankle avascular necrosis Total loss of talus Prosthesis Hemiprosthesis InternalBrace Talus replacement

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Acetabular Development Following Salter’s Innominate Osteotomy for the Treatment of Developmental Dysplasia of the Hip: Long Term Follow-Up

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Open Journal of Orthopedics 2016年第4期6卷 78-85页

作者： Yalçin Turhan Bülent Kiliç Murat Demiroğlu Esat Uygur Korhan Özkan Abdullah Eren Department of Orthopaedics and Traumatology School of Medicine Duzce University Duzce Turkey Department of Health Sciences Gelisim University Istanbul Turkey Department of Orthopaedics and Traumatology School of Medicine Medeniyet University Istanbul Turkey Division of Orthopaedics and Traumatology Emsey Hospital Istanbul Turkey Department of Orthopaedics and Traumatology School of Medicine Istanbul Bilim University Istanbul Turkey

Aim: To investigate the long term results of the patients followed till the skeletal maturity and treated with Salter innominate osteotomy. Patients and Methods: 85 hips of 63 patients whom were operated by the same surgeon between the years 1985 and 1991 were evaluated retrospectively. 34 hips of 25 patients who did not have enough follow-up or did not reach skeletal maturity at their last radiographic control were excluded from the study. So, 51 hips of 38 patients were included into our study. Mean age of the patients at the time of operation was 3 years 2 months (1.5 - 11 years), mean follow-up time was 16 years 6 months (10 - 23 years) and mean age at the last control was 19 years 7 months (15 - 27 years). Results: The overall clinical results were favorable (excellent or good) in 48 hips (94.1%) according to the modified McKay clinical evaluation scale. avascular necrosis was evaluated with the Kalamchi-McEven classification at the last follow up and 45 hips (88.2%) had no avascular necrosis. The radiographic results were assessed by the Severin classification system and 10 hips (19.6%) were stage 1a;10 hips (19.6%) were stage 1b;and 30 hips (58.8%) were stage 2. Upon the analysis of our radiographic results according to Stulberg classification system, we found out that only 2 (3.9%) of our patients were Stulberg stage 5, whereas 36 cases (70.6%) were Stulberg stage 1 and 2 (spherical congruency). According to Croft’s classification of hips for degenerative changes, 36 (70.6%) patients were stage 0;6 (11.8%) patients were stage 1;5 (9.8%) patients were stage 2 and 4 patients (8.7%) were stage 3. Conclusion: When appropriate soft tissue balance is provided, the complications of Salter Innominate Osteotomy are decreased and thus, it provides an excellent functional and radiological result.

关键词： DDH Salter Innominate Osteotomy avascular necrosis Remodeling

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Revision of Outcomes and Complications Following Open Reduction, and Zigzag Osteotomy Combined with Fibular Allograft for Developmental Dysplasia of the Hip in Children

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Open Journal of Orthopedics 2016年第7期6卷 184-200页

作者： Nguyen Ngoc Hung Vietnam National Hospital for Pediatrics Hanoi Vietnam

Background: Reports of the efficacy of open reduction and Zigzag Osteotomy combined Fibular Allograft (ZOFA) for developmental dysplasia of the hip. The purposes of this study were to evaluate the long-term outcomes and complications after surgery. Methods: We performed a retrospective match-controlled study in which 158 patients had 181 hips with developmental dysplasia of the hip. Radiographs were found of acetabular index, height of dislocation, Tönnis grade, abduction angle in the spica cast, and Severin grade. At final follow-up, deformity of femoral head or neck or acetabulum was evaluated according to the Severin. avascular necrosis was rated according to Kalamchi. Clinical evaluation was made according to modified McKay criteria. Results: Between 2009 and 2012, 133 girls (84.2%) and 25 boys (15.8%) with developmental dysplasia of the hip underwent open reduction and ZOFA;135 (85.4%) were unilateral, and 23 (14.6%) were bilateral. Patients were divided into 2 groups: group 1 included 54 patients (62 hips) aged 12 months - ≤18 months and group 2 included 84 patients (119 hips), aged >18 months - ≤36 months. According to Tönnis system: type 3 appeared in 127 hips (70.2%), and Type 4 in 54 hip (29.8%). The anterior approach was used to expose inner table of the ilium and ZOFA in all cases. Acetabular index was improved;preoperation was 42.95°, and latest follow-up 17.26°. The Kirschner Wires (KW) were not used to fix the fibular allograft at the pelvic osteotomy site. All of the fibular allografts were completely incorporated in mean time of 14 weeks (range, 12 weeks - 17 weeks) post-surgery. Clinical evaluation according to modified McKay criteria: satisfactory result (excellent and good) was achieved in 141 hips (77.9%). avascular necrosis (AVN) happened in 61 hips (33.7%), redislocation in 18 hips (9.9%), coxa vara in 4 hips (2.2%), trendelenburg gait in 4 hips (2.2%), and supracondylar femoral fractures in 2 hips (1.1%). Conclusions: On the basis of this study, ZOFA was strength and graft was no

关键词： DDH Redislocation Revision Surgery Hip Dysplasia Bone Allograft Salter’s Osteotomy avascular necrosis

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髋骨切骨术治疗先天性髋关节脱位的长期随访和对手术的改进

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中华小儿外科杂志 1989年第4期10卷 195-197+253+257页

作者：彭明惺胡廷泽周锡华周素华韦福康罗启成华西医科大学附属第一医院小儿外科

作者报告23年来用髋骨切骨术治疗先天性髋关节脱位214例(264个髋关节).经长期随访,疗效满意,但也存在一些问题.分析再脱位原因,发现男性明显高于女性.提出了髋骨切骨术的改进措施与可行性.

关键词：髋骨切骨术术治疗先天性髋关节脱位长期随访手术改进措施 Follow up Hip operation femoral head avascular necrosis results clinically 疗效满意 function children 再脱位 hips age

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