RISK FACTORS: Gaucher disease - especially likely as a postoperative infection, Diabetes mellitus, Alcoholism - the most frequent cause, Type II or IV hyperlipemia, Cortisone therapy (may be seen with Cushing disease), Obesity, Oral contraceptives
RISK FACTORS
β’ Gaucher disease - especially likely as a postoperative infection
β’ Diabetes mellitus
β’ Alcoholism - the most frequent cause
β’ Type II or IV hyperlipemia
β’ Cortisone therapy (may be seen with Cushing disease)
β’ Obesity
β’ Oral contraceptives
β’ Organ transplant, especially kidney
β’ Pregnancy
β’ Decompression sickness (bends)
β’ Chronic pancreatitis
β’ Crohn disease
β’ Myeloproliferative disorders
β’ Radiation treatment
β’ Rheumatoid arthritis
GENERAL MEASURES
. The following conditions are ones that are amenable to treatment in order to decrease the accompanying
incidence of osteonecrosis:
. Alcoholism - abstinence is obvious, but quite difficult to attain
. Dysbarism - new tables of decompression, if followed, will lower osteonecrosis incidence of divers
. Transplant patients - decreased doses of cortisone and regulation of calcium and phosphorous metabolism
. Sickle cell disease - treat a crisis vigorously with hydration, possible exchange transfusion and oxygenation, especially hyperbaric oxygen
SURGICAL MEASURES Bone grafts, arthroplasty, allografts and arthrodesis may be used, dependent upon the joint involved. Young, non-obese patients with sufficient bone support, who undergo total hip arthroplasty, should be considered for a ceramicon-ceramic prosthesis system as a technical solution to the need for reducing wear debris production and subsequent osteolysis leading to surgical revision.
ACTIVITY As tolerated
DIET No special diet
PATIENT EDUCATION The patient should be instructed in the use of crutches and/or canes when the lower extremity is involved. Proper use of a walking cane can decrease the pressure on the femoral head 20-30% when walking.
DRUG(S) OF CHOICE
. NSAIDs - consistent with the underlying disease may be used for painful episodes
. Acetaminophen - 500 mg qid can be quite helpful in alleviating symptoms
. Biosphosphonates
. Alendronate (Fosamax) 10mg qd or 70mg weekly
. Risedronate (Actonel) 5mg qd or 35mg weekly
. Calcium supplementation 500-1,000 mg qd
. Vitamin D supplementation 400-800 IU qd
ALTERNATIVE DRUGS Other H2-receptor antagonists in patients with a history of peptic ulcer disease
PATIENT MONITORING X-rays should be made every 12-18 months, more frequently if symptoms become more severe
PREVENTION/AVOIDANCE Early diagnosis and treatment of underlying disease
POSSIBLE COMPLICATIONS
β’ Progression of disease
β’ The progression of osteonecrosis leads to osteoarthritis of the involved joint to a varying degree. Arthroplasty
of the hip carries a much poorer prognosis than osteoarthritis alone. It should be postponed as long as
possible.
EXPECTED COURSE/PROGNOSIS
Gaucher disease is associated with a high risk of infection following surgery