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Core decompression for osteonecrosis of the femoral head in systemic lupus erythematosus
M A Mont1, A C Fairbank, M Petri
1Orthopaedic Department, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Insights
Corticosteroid-associated osteonecrosis of the femoral head progresses more often in late-stage disease and with larger lesions, irrespective of the cause. Early diagnosis and treatment are crucial for better outcomes in osteonecrosis patients.
Area of Science:
- Orthopedics
- Rheumatology
- Radiology
Background:
- Corticosteroid use is a significant risk factor for osteonecrosis of the femoral head.
- Systemic lupus erythematosus (SLE) is a common condition associated with corticosteroid-induced osteonecrosis.
- Core decompression is a surgical intervention for managing osteonecrosis.
Purpose of the Study:
- To identify demographic and radiologic risk factors for disease progression in patients with corticosteroid-associated osteonecrosis of the femoral head.
- To compare disease progression between patients with SLE and those with other corticosteroid-related conditions.
- To evaluate the long-term outcomes of core decompression in managing osteonecrosis.
Main Methods:
- A cross-sectional study involving 50 patients (79 hips) with corticosteroid-associated osteonecrosis of the femoral head.
- Patients underwent core decompression and were followed for an average of 12 years.
- Comparison between hips in patients with SLE and those with other corticosteroid indications, with matched subgroup analysis.
Main Results:
- Overall, 53% of hips had satisfactory outcomes after core decompression.
- Hips in patients with SLE had a higher conversion rate to total hip replacement (68%) compared to other corticosteroid users (33%).
- Late stage (Stage III) and extensive radiographic lesions (>200 degrees) were major risk factors for disease progression, independent of the underlying diagnosis.
Conclusions:
- Disease progression in corticosteroid-associated osteonecrosis of the femoral head is primarily linked to the stage and extent of the lesion at presentation, not the specific cause.
- Prompt diagnosis and timely intervention are essential for optimizing treatment efficacy in osteonecrosis.
- Core decompression outcomes may vary, with higher failure rates in advanced disease stages.
Abstract:
A cross sectional study was performed to try to identify various demographic and radiologic risk factors for disease progression in 50 patients (79 hips) with corticosteroid associated osteonecrosis of the femoral head who had a core decompression. Thirty-one of the hips were in 18 patients who had systemic lupus erythematosus and were compared with the remaining group of 48 hips in 32 patients who were taking corticosteroids for other reasons. All patients in the study had been taking greater than 30 mg of prednisone for at least 2 weeks at least 6 months before the onset of osteonecrosis. Patients underwent a core decompression and were then observed for an average of 12 years (range, 4-18 years). Overall, 42 of the 79 hips (53%) had satisfactory outcomes. Of the 31 hips in patients with systemic lupus erythematosus, 21 (68%) were converted to a total hip replacement. In the patients without systemic lupus erythematosus taking corticosteroids, 16 of 48 hips (33%) progressed to arthroplasty. A subset of 25 hips from each group (systemic lupus erythematosus and without systemic lupus erythematosus) were matched for age, gender, prednisone dose, Ficat and Arlet Stage, and length of followup. The matched group without systemic lupus erythematosus had 44% survival (11 of 25 hips), which was not statistically different when compared with the 36% survival (9 of 25 hips) found in the systemic lupus erythematosus group. The major risk factors for disease progression were late stage of disease (Stage III) at presentation and radiographic extent of the lesion (>200 degrees), regardless of diagnosis. None of the factors that have been found to be associated with osteonecrosis in patients with systemic lupus erythematosus could be associated with disease progression. Because cause seems to be less significant than the onset and extent of the disease, the clinician should make the diagnosis of osteonecrosis as promptly as possible so that treatment can be started at the earliest possible time, when it will be most efficacious.