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Multifocal osteonecrosis

D M LaPorte1, M A Mont, V Mohan

  • 1Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.

The Journal of Rheumatology
|October 21, 1998
PubMed
Summary
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Multifocal osteonecrosis affects 3% of patients, often linked to systemic diseases and corticosteroid use. Early evaluation of all joints is crucial for timely diagnosis and treatment of this condition.

Area of Science:

  • Orthopedics
  • Rheumatology
  • Radiology

Background:

  • Multifocal osteonecrosis is a rare condition affecting multiple joints.
  • Understanding its demographic, clinical, and radiographic patterns is essential for early diagnosis and treatment optimization.

Purpose of the Study:

  • To investigate the demographic, clinical, and radiographic characteristics of patients with multifocal osteonecrosis.
  • To identify factors associated with multifocal osteonecrosis to improve diagnostic and therapeutic strategies.

Main Methods:

  • Defined multifocal osteonecrosis as disease in 3 or more anatomic sites.
  • Characterized patients by demographics, disease associations, medication history (corticosteroids), presenting joints, and symptoms.
  • Utilized plain radiographs and magnetic resonance imaging (MRI) to assess lesion stage.

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Main Results:

  • 32 out of 1056 (3%) osteonecrosis patients had multifocal disease.
  • Common associations included systemic lupus erythematosus, inflammatory bowel disease, malignancy, and renal transplantation.
  • 94% had a history of corticosteroid therapy; bilateral femoral head and knee involvement were frequent. Most joints presented pre-collapse (77%).

Conclusions:

  • Patients with osteonecrosis and symptoms in other joints require thorough radiographic and MRI evaluation.
  • Evaluate hips radiographically in patients with osteonecrosis not involving the femoral head, irrespective of symptoms.
  • Evaluate other joints in patients with knee, shoulder, or ankle osteonecrosis due to high prevalence of multifocal disease.