Department of Orthopaedic Surgery, Stanford University Medical Center Outpatient Center, Redwood City, CA; Department of Orthopaedic Surgery, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand.
Department of Orthopaedic Surgery, Stanford University Medical Center Outpatient Center, Redwood City, CA.
J Arthroplasty. 2020 Sep;35(9):2342-2349. doi: 10.1016/j.arth.2020.04.092. Epub 2020 May 5.
Joint preservation is more effective in early-stage osteonecrosis of the femoral head (ONFH); thus, prompt diagnosis when the femoral head is still salvageable is important. We report a 20-year retrospective study that summarizes age at presentation, etiology, and Association Research Circulation Osseous stage at diagnosis.
Our database was reviewed to identify patients younger than 65 years of age who were diagnosed with atraumatic ONFH between 1998 and 2018. Demographic characteristics of patients were evaluated and categorized into different subgroups.
Four hundred thirteen patients were identified. At initial presentation, 23% were diagnosed with early-stage ONFH, while 77% were diagnosed with late-stage ONFH. Forty-nine percent had a history of corticosteroid use, of which 13% were diagnosed with hematologic malignancy and 8% were diagnosed with lupus. Ethanol abuse, idiopathic, sickle cell disease, and human immunodeficiency virus were present in 11%, 30%, 3%, and 3%, respectively. The mean age of patients with corticosteroid use (40 ± 14 years) was significantly younger than ethanol use (46 ± 11 years, P = .014) and idiopathic causes (48 ± 11 years, P < .001), but significantly older than sickle cell disease (32 ± 11 years, P = .031). There was no difference in the age of presentation for early-stage and late-stage ONFH by etiology.
Nearly 80% of the patients presented with late-stage ONFH. Hence, we have a narrow window of opportunity for hip preservation surgery before femoral head collapse. A multidisciplinary approach to improve screening awareness for early detection by focusing on the etiologic identification and patient education might reduce the incidence of hip arthroplasty in young patients.
保髋治疗在早期股骨头坏死（ONFH）中更有效；因此，在股骨头仍可挽救时及时诊断非常重要。我们报告了一项 20 年回顾性研究，总结了发病时的年龄、病因和 Association Research Circulation Osseous 分期。
我们对数据库进行了回顾，以确定在 1998 年至 2018 年期间被诊断为非创伤性 ONFH 的年龄小于 65 岁的患者。评估了患者的人口统计学特征，并分为不同的亚组。
共确定了 413 例患者。初次就诊时，23%被诊断为早期 ONFH，而 77%被诊断为晚期 ONFH。49%有糖皮质激素使用史，其中 13%被诊断为血液恶性肿瘤，8%被诊断为狼疮。酒精滥用、特发性、镰状细胞病和人类免疫缺陷病毒分别占 11%、30%、3%和 3%。糖皮质激素使用患者的平均年龄（40 ± 14 岁）明显小于酒精使用患者（46 ± 11 岁，P =.014）和特发性病因患者（48 ± 11 岁，P <.001），但明显大于镰状细胞病患者（32 ± 11 岁，P =.031）。不同病因的早期和晚期 ONFH 的发病年龄无差异。
近 80%的患者出现晚期 ONFH。因此，在股骨头塌陷之前，我们进行髋关节保髋手术的机会窗口很窄。通过关注病因识别和患者教育来提高早期检测的筛查意识，多学科方法可能会减少年轻患者髋关节置换术的发生率。
