Materiały źródłowe

• #1 Avascular necrosis (osteonecrosis) – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/symptoms-causes/syc-20369859

  Avascular necrosis is the death of bone tissue due to a lack of blood supply. Also called osteonecrosis, it can lead to tiny breaks in the bone and cause the bone to collapse. The process usually takes months to years. […] Anyone can be affected. But the condition is most common in people between the ages of 30 and 50. […] Avascular necrosis occurs when blood flow to a bone is interrupted or reduced. Reduced blood supply can be caused by: […] Risk factors for developing avascular necrosis include: […] Medical conditions associated with avascular necrosis include: […] Untreated, avascular necrosis worsens. Eventually, the bone can collapse. Avascular necrosis also causes bone to lose its smooth shape, possibly leading to severe arthritis. […] To reduce the risk of avascular necrosis and improve general health:

• #2 Clinical manifestations and diagnosis of osteonecrosis (avascular necrosis of bone) – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-osteonecrosis-avascular-necrosis-of-bone/print

  Osteonecrosis, also known as aseptic necrosis, avascular necrosis (AVN), atraumatic necrosis, and ischemic necrosis, is a pathologic process that is associated with numerous conditions and therapeutic interventions. […] The exact incidence and prevalence of osteonecrosis are unknown. In the United States, nontraumatic osteonecrosis of the femoral head is newly diagnosed in an estimated 10,000 to 20,000 patients each year and is the underlying diagnosis in approximately 10 percent of all total hip replacements (THR). […] Studies in other countries have found approximately 2200 to 3800 incident cases in Japan and more than 6900 incident cases requiring surgery in South Korea. […] Another report from China estimated that the prevalence of osteonecrosis of the femoral head in patients over age 15 was approximately 8.12 million.

• #3 Avascular necrosis – Wikipedia

  https://en.wikipedia.org/wiki/Avascular_necrosis

  Avascular necrosis usually affects people between 30 and 50 years of age; about 10,000 to 20,000 people develop avascular necrosis of the head of the femur in the US each year. […] About 15,000 cases occur per year in the United States.

• #4 Clinical manifestations and diagnosis of osteonecrosis (avascular necrosis of bone) – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-osteonecrosis-avascular-necrosis-of-bone

  Osteonecrosis, also known as aseptic necrosis, avascular necrosis (AVN), atraumatic necrosis, and ischemic necrosis, is a pathologic process that is associated with numerous conditions and therapeutic interventions. […] The exact incidence and prevalence of osteonecrosis are unknown. In the United States, nontraumatic osteonecrosis of the femoral head is newly diagnosed in an estimated 10,000 to 20,000 patients each year and is the underlying diagnosis in approximately 10 percent of all total hip replacements. […] Studies in other countries have found approximately 2200 to 3800 incident cases in Japan and more than 6900 incident cases requiring surgery in South Korea. Another report from China estimated that the prevalence of osteonecrosis of the femoral head in patients over age 15 was approximately 8.12 million.

• #5 Femoral Head Avascular Necrosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK546658/

  Avascular necrosis of the femoral head is a type of osteonecrosis due to disruption of blood supply to the proximal femur. There are approximately 10000 to 20000 new cases reported each year in the United States alone. […] The incidence of avascular necrosis of the femoral head within the United States is estimated to occur at a rate between 20000 to 30000 new cases each year, contributing to 10% of the approximately 250000 total hip arthroplasties performed annually. […] Overall, this condition is more prevalent in men than women, with studies estimating ratios from 3 to 1 to 5 to 1.

• #6

  https://journals.lww.com/jaaosglobal/fulltext/2022/05000/osteonecrosis_of_the_femoral_head.2.aspx

  Osteonecrosis is a progressive disorder in which lack of sufficient blood supply leads to cell death, fracture, and collapse of the affected area. […] Researchers estimate that 20,000 new cases of osteonecrosis are diagnosed in the United States each year. […] The incidence of osteonecrosis in the United States has been estimated at 20000 to 30000 cases per year, affecting primarily young adults between the ages of 20 to 40 years. […] Recent analysis has shown that although the number of THAs done for osteonecrosis has increased between 2001 and 2010 (from 54.2 per 100,000 hospital admission to 60.6 per 100,000 hospital admission), the percentage of THAs done for osteonecrosis has decreased from 9.7% to 8.3%, likely because of the rapid increase in osteoarthritis necessitating THA.

• #7 Avascular Necrosis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/333364-overview

  The frequency of AVN depends on the site involved. The most common site is the hip; other locations include the carpals, talus, femur, metatarsal, mandible, and humerus. In the United States, approximately 15,000 new cases of AVN are reported each year. AVN accounts for more than 10% of total hip replacement surgeries performed in the United States. Osteonecrosis of the jaw associated with bisphosphonate has also been well studied and reported. […] In most countries, the incidence and prevalence of AVN are not well reported. A Japanese survey estimated that 2500-3300 cases of AVN of the hip occur each year; of these, 34.7% were due to corticosteroid use, 21.8% to alcohol abuse, and 37.1% to idiopathic mechanisms. […] AVN has no racial predilection except for cases associated with sickle cell disease and hemoglobin S and SC disease, which predominantly occur in people of African and Mediterranean descent. […] With the exception of AVN associated with systemic lupus erythematosus, AVN is more common in men, with an overall male-to-female ratio of 8:1. […] AVN is a disease of middle age that most often occurs during the fourth or fifth decade of life and is bilateral in more than half of cases.

• #8

  https://link.springer.com/article/10.1007/s00198-018-04826-2

  This study estimated the incidence of osteonecrosis in a Swedish, nationwide cohort of older adults. Osteonecrosis was approximately 10 times more common than in previous studies. The strongest risk factors were dialysis, hip fracture, osteomyelitis, and organ transplantation, but only hip fractures could have contributed substantially to the disease burden. […] The 10-year risk of osteonecrosis was 0.4% (n=13,425), and the incidence rate was 4.7 cases/10000 person-years (95% confidence interval [CI], 4.6 to 4.7 cases). The strongest risk factors for osteonecrosis were hip fracture (SIR, 7.98; 95% CI, 7.69-8.27), solid organ transplantation (SIR, 7.14; 95% CI, 5.59-8.99), dialysis (SIR, 6.65; 95% CI, 5.62-7.81), and osteomyelitis (SIR, 6.43; 95% CI, 5.70-7.23). […] The current study showed a history of hip fracture in 22% of older adults diagnosed with osteonecrosis at any skeletal site.

• #9

  https://link.springer.com/article/10.1007/s00198-018-04826-2

  Among older adults in Sweden, the incidence of osteonecrosis was 4.7 cases/10000 person-years. The strongest risk factors for osteonecrosis were dialysis, osteomyelitis, hip fracture, and solid organ transplantation. […] In sum, this nationwide study of older adults in Sweden showed that osteonecrosis was approximately 10 times more common than a small number of previous population-based studies have suggested. The strongest risk factors for osteonecrosis were dialysis, osteomyelitis, hip fracture, and solid organ transplantation.

• #10

  https://www.orthobullets.com/recon/5006/hip-osteonecrosis

  Hip Osteonecrosis, also known as avascular necrosis of the hip, represents a condition caused by reduced blood flow to the femoral head secondary to a variety of risk factors such as a traumatic event, sickle cell disease, steroid use, alcoholism, autoimmune disorders, and hypercoagulable states. […] Incidence: 20,000 new cases per year in the United States accounts for 10% of total hip arthroplasties performed. […] average age at presentation is 35 to 50. […] bilateral hips involved 80% of the time. […] 3% of patients with osteonecrosis have multifocal involvement.

• #11 Femoral Head Avascular Necrosis: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/86568-overview

  AVN of the femoral head is a debilitating disease that usually leads to osteoarthritis of the hip joint in relatively young adults (mean age at presentation: 38 y). The disease prevalence is unknown, but estimates indicate that 10,000-20,000 new cases are diagnosed in the United States per year. […] Furthermore, it is estimated that 5-18% of the more than 500,000 total hip arthroplasties performed annually are for osteonecrosis of the femoral head.

• #12

  https://step2.medbullets.com/orthopedics/122015/avascular-necrosis-of-the-bone-osteonecrosis

  Avascular necrosis typically occurs in the anterolateral femoral head. […] The demographics of avascular necrosis are dependent on the cause of osteonecrosis, for example, systemic lupus erythematosus associated with osteonecrosis is more likely to be seen in women.

• #13 Osteonecrosis of the Knee: An Overview

  https://www.hss.edu/conditions_osteonecrosis-of-the-knee-overview.asp

  Osteonecrosis is a Latin term for bone death and the condition is also referred to as avascular necrosis (or AVN). […] Women are more commonly affected, typically three times that of males, and it is more common in those 60+ years of age. […] The conditions that are associated with osteonecrosis of the knee are: Obesity, Sickle cell anemia, Thalassemia, Lupus, Kidney transplant and dialysis patients, Patients with HIV, Patients with fat storage diseases such as Gaucher disease, and Patients who receive steroid treatment for various medical conditions. […] In thalassemia and sickle cell anemia, the avascular necrosis is a result of a change of shape of the blood cells, which cause them to clump and block off the small, microvessels in the bone. […] Another common association with osteonecrosis is that of high alcohol intake. Alcoholics are at higher risk for developing osteonecrosis, again occurring in the hip, knee, and elsewhere.

• #14 Avascular Necrosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537007/

  Osteonecrosis is most common in the hip but is also seen in the humerus, knee, and talus and is rarely seen in the smaller bones of the wrist, such as the lunate. While the jaw can be affected, this review focuses on more common forms presented to an orthopedic surgeon. […] Ten percent of total hip arthroplasties in the United States are due to AVN and typically affect ages 30 to 65. Males tend to be more affected by ON overall, but autoimmune conditions affecting women, like lupus, are also significant. […] Osteonecrosis is most common in the hip but is also seen in the humerus, knee, and talus and is rarely seen in the smaller bones of the wrist, such as the lunate. While the jaw can be affected, this review focuses on more common forms presented to an orthopedic surgeon. […] Ten percent of total hip arthroplasties in the United States are due to AVN and typically affect ages 30 to 65. Males tend to be more affected by ON overall, but autoimmune conditions affecting women, like lupus, are also significant.

• #15

  https://step1.medbullets.com/msk/114096/avascular-necrosis-of-the-bone-osteonecrosis

  Epidemiology […] incidence […] typically occurs in the anterolateral femoral head. […] demographics […] dependent on the cause of osteonecrosis […] e.g., systemic lupus erythematosus associated with osteonecrosis is more likely to be seen in women.

• #16 Epidemiology of Osteonecrosis in the USA | Radiology Key

  https://radiologykey.com/epidemiology-of-osteonecrosis-in-the-usa/

  Anatomical location Frequency (%) Hip 200 (99) Knee 179 (87) Shoulder 146 (72) Ankle 71 (35) Elbow 17 (8) Wrist 8 (4) Calcaneus 6 (3) Tarsal navicular 2 (1) Cuneiform 1 (0.5) Cuboid 1 (0.5) Metacarpal head 1 (0.1) […] In summarizing the epidemiology of osteonecrosis in the USA, it is evident that the prevalence and incidence vary according to the risk factor of disease and the population being studied. Traumatic osteonecrosis is associated with specific fractures, and the incidence depends upon many factors such as age, displacement, type of fracture, and method of treatment. Nontraumatic ONFH can be idiopathic but is usually associated with corticosteroid usage, ethanol abuse, systemic lupus erythematosus, barotrauma, or marrow packing disorders such as sickle cell disease and Gauchers disease. The proportion of patients with steroid-related ONFH is increasing as solid organ and bone marrow transplantation are becoming more commonplace.

• #17 Osteonecrosis | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816037/all/Osteonecrosis?q=Alternative+Complementary+Medicine+and

  Predominant age: 3rd to 5th decades. […] Predominant sex: varies depending on comorbidities and etiology. […] 10,000 to 20,000 new cases per year in the United States. […] Osteonecrosis is the most common cause for total hip replacement in young adults. […] Disease is bilateral in at least 50% of all nontraumatic cases and in 75-95% of cases associated with steroid use. […] Hip: occurs in 10% of undisplaced femoral neck fractures, 15-30% of displaced femoral neck fractures, and 10% of hip dislocations. […] Jaw: Over the past 10 years, ONJ has been reported in 5% of cancer patients receiving high-dose IV bisphosphonates. […] Glucocorticoid-induced osteonecrosis develops in 9-40% of patients on long-term therapy. […] Osteonecrosis occurs during early postoperative period in 20-25% of patients after renal transplant.

• #18 Osteonecrosis (ON) – Musculoskeletal and Connective Tissue Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/osteonecrosis/osteonecrosis-on

  Osteonecrosis is a focal infarct of bone that may be caused by specific etiologic factors or may be idiopathic. […] In the United States, osteonecrosis affects approximately 20,000 new patients annually. […] Nontraumatic osteonecrosis affects men more often than women and occurs primarily in patients between ages 30 and 50 years. […] The most common factors causing or contributing to nontraumatic osteonecrosis are corticosteroid use (particularly with prolonged use and/or higher doses) and excessive alcohol consumption. […] About 20% of cases of osteonecrosis are idiopathic. […] The contribution of corticosteroid use to the risk of osteonecrosis is increased when the dose of prednisone or an equivalent corticosteroid is 20 mg/day for several weeks or months, or the cumulative dose is 2000 mg.

• #18 Osteonecrosis (ON) – Musculoskeletal and Connective Tissue Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/osteonecrosis/osteonecrosis-on

  Medication-related osteonecrosis of the jaw has been reported in patients who have received bisphosphonate therapy (particularly with IV administration) and other antiresorptive agents. […] The term „spontaneous osteonecrosis of the knee” (SONK) is a misnomer. […] Osteonecrosis should be suspected in patients with unexplained nontraumatic pain in the hip, knee, or shoulder and after certain fractures if pain persists or worsens. […] Smaller lesions may heal spontaneously, but most larger lesions, especially in the hip, progress without treatment. […] Surgical treatment is often indicated to limit progression and/or relieve symptoms, particularly for osteonecrosis of the hip.

• #19 Epidemiology and risk factors associated with avascular necrosis in patients with autoimmune diseases: a nationwide study

  https://www.kjim.org/journal/view.php?number=170657

  Avascular necrosis (AVN) is a clinical condition characterized by the death of bone components due to interruption in the blood supply. This study aimed to investigate the epidemiology and determine the risk factors for AVN in patients with autoimmune diseases. A total of 490/49,636 patients (1.0%) developed symptomatic AVN. The systemic lupus erythematosus patients had a higher risk of AVN compared to other autoimmune diseases. AVN was positively correlated with male sex (p 0.001), alcoholism (p 0.001), mean daily prednisolone dosage 7.51 to 30 mg (p 0.001) and 30 mg (p 0.001), and total cumulative prednisolone dose 0 g to 5 g (p = 0.002). However, AVN was inversely correlated with cumulative duration of hydroxychloroquine exposure 0.6 years (p0.001). Male sex, systemic lupus erythematosus, alcoholism, mean daily corticosteroid 7.5 mg and a total cumulative dose of corticosteroid 0 to 5 g were independently associated with the development of AVN in autoimmune patients. While hydroxychloroquine use 0.6 years conferred significant protection against the development of AVN. Clinicians should regularly assess patients with risk factors to enable the early diagnosis of AVN. A nationwide epidemiology survey performed in Japan by Fukushima et al. in 2005, reported that systemic glucocorticoid therapy and alcoholism contributed to 51% and 31% of AVN cases, respectively. The incidence of AVN was significantly higher in patients with systemic lupus erythematosus (SLE) compared with other rheumatic diseases. The current study revealed that the patients with SLE had the highest risk of AVN compared with other non-SLE autoimmune diseases, which is consistent with most other population-based studies conducted in Western countries. The results of the present study demonstrated that the HRs for AVN in the patients taking medium and high doses of daily corticosteroids were 8.723-fold and 34.034-fold higher, respectively. A total cumulative dose of corticosteroids 0 to 5 g also increased the HR of AVN onset. AVN is a disease that causes bone death due to vascular compromise of the affected bones, and ultimately leads to destruction of the joints and loss of function. The management of AVN depends on its severity, and treatment outcomes are inversely correlated with the disease stage at the time of treatment initiation. It is important to diagnose AVN early to help prevent disability. The majority of previous studies have demonstrated that renal involvement was a risk factor for AVN onset in SLE patients. The present study is the first large-scale nationwide population-based cohort study of AVN occurrence in patients with autoimmune diseases.

• #20 Prevalence and risk factors of osteonecrosis of the femoral head in patients with ANCA-associated vasculitis: a multicentre cohort study | RMD Open

  https://rmdopen.bmj.com/content/9/1/e002787

  Eighteen per cent of AAV patients developed ONFH after the remission induction therapy (RIT), indicating that not a few AAV patients develop ONFH. […] Seventy-six per cent of ONFH joints were in precollapse stages (stage 2), whereas 24% of ONFH joints were in collapse stages (stage 3). Moreover, 56% of the precollapse stage joints were already at risk of future collapse (large necrotic lesions; type C-1). […] Prednisolone dose of 20 mg/day on day 90 of RIT was identified as an independent risk factor for ONFH in AAV patients. […] A rapid reduction of glucocorticoids in 90 days after RIT and early detection of precollapse ONFH by MRI screening are important for decreasing and intervening ONFH development in AAV patients. […] We showed that 17.7% of AAV patients developed ONFH after RIT, which is a little lower prevalence rate compared with that of SLE patients.

• #20 Prevalence and risk factors of osteonecrosis of the femoral head in patients with ANCA-associated vasculitis: a multicentre cohort study | RMD Open

  https://rmdopen.bmj.com/content/9/1/e002787

  Objective We aimed to determine the prevalence and risk factors for osteonecrosis of the femoral head (ONFH) in a multicentre cohort of patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). […] Among 186 AAV patients, 33 (18%) were diagnosed with ONFH. […] Prednisolone dose of 20 mg/day on day 90 of RIT was an independent risk factor for ONFH in AAV patients (OR 1.072, 95% CI 1.017 to 1.130, p=0.009). […] Eighteen per cent of AAV patients developed ONFH, and two-thirds of the ONFH joints were already in collapse stages or at risk of future collapse. […] A rapid reduction of glucocorticoids in RIT and early detection of precollapse ONFH by MRI may decrease and intervene ONFH development in AAV patients. […] No data are available yet about the prevalence and risk factors of osteonecrosis of the femoral head (ONFH) in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV), although neutrophil extracellular traps formation and vasculitis have been implicated in the pathophysiology of ONFH.

• #21 Prevalence and risk factors of osteonecrosis of the femoral head in patients with ANCA-associated vasculitis: a multicentre cohort study | RMD Open

  https://rmdopen.bmj.com/content/9/1/e002787

  We also showed that the prednisolone dose of 20 mg/day on day 90 of RIT was an independent risk factor for ONFH development in AAV patients, suggesting that a rapid reduction in prednisolone dose to 20 mg/day in the first 90 days would decrease the incidence rate of ONFH in AAV patients. […] Our results suggest that a rapid reduction of glucocorticoids in RIT and early MRI screening for detecting precollapse ONFH are important for decreasing and intervening ONFH development in AAV patients.

• #22 Asymptomatic multifocal avascular necrosis, a commonly overlooked finding in patients with systemic lupus erythematosus | BMC Rheumatology | Full Text

  https://bmcrheumatol.biomedcentral.com/articles/10.1186/s41927-024-00440-4

  In patients with Systemic lupus erythematosus (SLE), osteonecrosis of various joints is a debilitating complication associated with the disease and its treatment, in which a considerable proportion of osteonecrosis may be asymptomatic. […] The occurrence of osteonecrosis in SLE is relatively common. Symptomatic osteonecrosis has been estimated to affect around 10 percent of SLE patients, while the prevalence of asymptomatic osteonecrosis is much higher, affecting more than one-third of individuals. […] Our research provides further evidence of the high incidence of asymptomatic osteonecrosis in individuals with SLE due to the nature of the disease and the frequent use of high-dose corticosteroids. […] Among patients with SLE, disease activity and the administration of corticosteroids are the main risk factors for the development of osteonecrosis.

• #23 Epidemiology and risk factors for avascular necrosis in childhood systemic lupus erythematosus in a Taiwanese population | Scientific Reports

  https://www.nature.com/articles/s41598-020-71923-w

  Childhood-onset systemic lupus erythematosus (SLE) is associated with greater disease activity, more aggressive course, and high rates of organ damage. The prolonged use of corticosteroids in childhood SLE contributes to increased morbidity, including avascular necrosis (AVN). […] Thirty-nine patients (2.6%) developed symptomatic AVN during a mean follow-up of 4.62.5 years. […] In multivariate analysis, the risk of AVN was higher in the patients with a daily prednisolone dose between 7.5 mg and 30 mg (HR 7.435, 95% CI 2.88219.178, p0.001) and over 30 mg (HR 9.366, 95% CI 2.22539.418, p=0.002) than in those with a dose7.5 mg/day. […] AVN was inversely correlated with the use of hydroxychloroquine627 days (HR 0.335, 95% CI 0.1620.694, p=0.003). […] Avascular necrosis (AVN) is a disorder in which bone death occurs due to interrupted blood supply, and it can result in significant morbidity and mortality.

• #24 Epidemiology and risk factors for avascular necrosis in childhood systemic lupus erythematosus in a Taiwanese population | Scientific Reports

  https://www.nature.com/articles/s41598-020-71923-w

  Our results showed that the children with AVN had a significantly higher prevalence of LN (48.7% vs. 33.1%; p=0.041). […] In conclusion, AVN occurred in 2.6% of the children with SLE in this study. A high daily dose of prednisolone was associated with a significant risk of AVN, whereas the use of hydroxychloroquine conferred an advantage.

• #25 Avascular Necrosis (Osteonecrosis) | Cooper University Health Care

  https://www.cooperhealth.org/services/avascular-necrosis-osteonecrosis

  Avascular necrosis is most common in people between the ages of 30 and 60, and is often associated with drinking too much alcohol, long-term steroid use, injury such as bone fracture or joint dislocation, and conditions such as blood coagulation disorders. […] The most common causes of avascular necrosis include: Bone fracture or joint dislocation, Damage to blood vessels from such conditions as blood clots or inflammation, Long-term use of certain medicines, such as corticosteroids, Excessive, long-term use of alcohol, Certain blood disorders. […] While each person may experience this disease differently, these are the most common AVN symptoms: Little to no joint pain in the initial/early stages, Gradually increasing joint pain; at first, it may occur only when putting weight on the affected joint, then be present even at rest, As AVN progresses, the bone and surrounding joint surface may collapse, causing a dramatic increase in pain, Joint stiffness may limit range of motion in the affected joint, Disabling osteoarthritis may develop in the affected joint, Limited range of motion due to pain. […] Specific treatment depends on the extent of your AVN, the location and amount of bone affected, the underlying cause, your overall health, and your preferences.

• #26 Avascular necrosis | Johns Hopkins HIV Guide

  https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545016/all/Avascular_necrosis

  In the general population in the U.S., ethanol use and glucorticoid use account for the majority of cases of avascular necrosis (AVN). In particular, glucocorticoid use in the setting of systemic lupus erythematosis and organ transplantation has been associated with AVN. Other associated conditions include sickle cell disease, trauma, and radiation. […] In people with HIV (PWH), the incidence of AVN has been reported to be about 45 to 100 times greater than in the general population. […] The principal mechanism contributing to AVN is compromised local blood flow, with resultant necrosis. […] The pathophysiology of AVN in PWH is felt to be multifactorial, but the complete pathophysiology is unknown. Risk factors include traditional risk factors, such as glucocorticoids and dyslipidemia, HIV infection, nadir CD4 cell count, and prior AIDS-defining illness. […] The direct role of ART is controversial.

• #27

  https://link.springer.com/article/10.1007/s00198-009-1003-1

  We conducted a casecontrol study to examine osteonecrosis (ON) incidence, patient characteristics, and selected potential risk factors using two health record databases in the UK. Statistically significant risk factors for ON included systemic corticosteroid use, hospitalization, referral or specialist visit, bone fracture, any cancer, osteoporosis, connective tissue disease, and osteoarthritis. […] This study provides further perspective on the descriptive epidemiology of ON. Studies utilizing more recent data may further elucidate the understanding of ON key predictors. […] Significant predictors of ON at any skeletal site included use of systemic corticosteroids in the previous 2 years, hospitalization, referral or specialist visit, bone fracture, any cancer, osteoporosis, connective tissue disease, and osteoarthritis within the past 5 years. Bisphosphonate use was not a significant predictor of ON.

• #28 Osteonecrosis of the Hip – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/osteonecrosis-of-the-hip

  Osteonecrosis is also called avascular necrosis (AVN) or aseptic necrosis. Although it can occur in any bone, osteonecrosis most commonly affects the hip. More than 20,000 people each year enter hospitals for treatment of osteonecrosis of the hip. In many cases, both hips are affected by the disease. […] Osteonecrosis can affect anyone, but it is more common in people between the ages of 40 and 65. Men develop osteonecrosis of the hip more often than women. […] It is important to diagnose osteonecrosis early, because some studies show that early treatment is associated with better outcomes. […] Core decompression prevents osteonecrosis from progressing to severe arthritis and the need for hip replacement in some cases. This depends upon the stage and size of the osteonecrosis at the time of the procedure.

• #28 Osteonecrosis of the Hip – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/osteonecrosis-of-the-hip

  When osteonecrosis is diagnosed after collapse of the bone, core decompression is not usually successful in preventing further collapse. In this situation, the patient is best treated with a total hip replacement. Total hip replacement is successful in relieving pain and restoring function in the majority of patients with osteonecrosis.

• #29 Diagnosis of Acute or Subacute Avascular Necrosis | CDA-AMC

  https://www.cda-amc.ca/diagnosis-acute-or-subacute-avascular-necrosis

  According to the urgency classifications developed by the Saskatchewan Ministry of Health, MRI, a comparator of 99mTc-based bone imaging, should be completed within two to seven days for patients with suspected AVN in any joint or bone. Early diagnosis and treatment increases the likelihood of joint preservation. Imaging results have a moderate impact on the management of the condition or the effective use of health care resources.

• #30 Osteonecrosis of the femoral head: pathophysiology and current concepts of treatment in: EFORT Open Reviews Volume 4 Issue 3 (2019)

  https://eor.bioscientifica.com/view/journals/eor/4/3/2058-5241.4.180036.xml

  The Canadian, Swedish and Australian registries have demonstrated that this diagnosis accounts for about 2.8% to 6% of all primary total hip replacements. Early diagnosis is therefore critical as it affects essentially the young and middle-aged population and because a progression of the disease to a collapse of the femoral head is seen in up to 80% of patients if left untreated. In addition, this condition may affect both hips in 40% to 70% of cases, depending on the series published.

• #31 Worldwide research trends on femur head necrosis (2000–2021): a bibliometrics analysis and suggestions for researchers

  https://atm.amegroups.org/article/view/109914/html

  Osteonecrosis of the femoral head (ONFH) is a common and stubborn disease. […] The disability rate of the disease is high, and there are more than 8 million patients with nontraumatic ONFH in China. […] At present, it is generally believed that vascular occlusion is the main pathogenesis of nontraumatic femoral head necrosis, but there is also a theory involving thrombosis. […] Avascular necrosis of the femoral head is a common and refractory disease in the orthopedic field. It is mainly caused by venous stasis of the femoral head and impaired arterial blood supply, which causes the death of bone cells and bone marrow, resulting in bone tissue necrosis and subsequent repair obstacles, resulting in structural changes and collapse of the femoral head. […] This bibliometric analysis showed that the number of papers published in ONFH research has fluctuated slightly over the past 22 years. The general trend, however, is the publication of a greater number of articles over time, and thus the research into ONFH has good prospects.

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