Osteonecrosis: Death of a bone or part of a bone, either atraumatic or posttraumatic.Femur Head Necrosis: Aseptic or avascular necrosis of the femoral head. The major types are idiopathic (primary), as a complication of fractures or dislocations, and LEGG-CALVE-PERTHES DISEASE.Bisphosphonate-Associated Osteonecrosis of the Jaw: Necrotic jaws or other maxillofacial skeleton necrosis associated with bisphosphonate use (see BISPHOSPHONATES). Injury, dental procedures, and trauma can trigger the necrotic process.Jaw DiseasesFemur Head: The hemispheric articular surface at the upper extremity of the thigh bone. (Stedman, 26th ed)Diphosphonates: Organic compounds which contain P-C-P bonds, where P stands for phosphonates or phosphonic acids. These compounds affect calcium metabolism. They inhibit ectopic calcification and slow down bone resorption and bone turnover. Technetium complexes of diphosphonates have been used successfully as bone scanning agents.Bone Density Conservation Agents: Agents that inhibit BONE RESORPTION and/or favor BONE MINERALIZATION and BONE REGENERATION. They are used to heal BONE FRACTURES and to treat METABOLIC BONE DISEASES such as OSTEOPOROSIS.Jaw: Bony structure of the mouth that holds the teeth. It consists of the MANDIBLE and the MAXILLA.Maxillary DiseasesHumerus: Bone in humans and primates extending from the SHOULDER JOINT to the ELBOW JOINT.Methylprednisolone: A PREDNISOLONE derivative with similar anti-inflammatory action.Hip Joint: The joint that is formed by the articulation of the head of FEMUR and the ACETABULUM of the PELVIS.Mandibular DiseasesTooth Extraction: The surgical removal of a tooth. (Dorland, 28th ed)Metal-on-Metal Joint Prostheses: Types of prosthetic joints in which both wear surfaces of the joint coupling are metallic.Bone Transplantation: The grafting of bone from a donor site to a recipient site.Glucocorticoids: A group of CORTICOSTEROIDS that affect carbohydrate metabolism (GLUCONEOGENESIS, liver glycogen deposition, elevation of BLOOD SUGAR), inhibit ADRENOCORTICOTROPIC HORMONE secretion, and possess pronounced anti-inflammatory activity. They also play a role in fat and protein metabolism, maintenance of arterial blood pressure, alteration of the connective tissue response to injury, reduction in the number of circulating lymphocytes, and functioning of the central nervous system.Osteocytes: Mature osteoblasts that have become embedded in the BONE MATRIX. They occupy a small cavity, called lacuna, in the matrix and are connected to adjacent osteocytes via protoplasmic projections called canaliculi.Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee.Fibula: The bone of the lower leg lateral to and smaller than the tibia. In proportion to its length, it is the most slender of the long bones.Alendronate: A nonhormonal medication for the treatment of postmenopausal osteoporosis in women. This drug builds healthy bone, restoring some of the bone loss as a result of osteoporosis.Osteotomy: The surgical cutting of a bone. (Dorland, 28th ed)Orthopedic Procedures: Procedures used to treat and correct deformities, diseases, and injuries to the MUSCULOSKELETAL SYSTEM, its articulations, and associated structures.Dromaiidae: A family of flightless, running BIRDS, in the order Casuariiformes. The emu is the only surviving member of the family. They naturally inhabit forests, open plains, and grasslands in Australia.Dental Prophylaxis: Treatment for the prevention of periodontal diseases or other dental diseases by the cleaning of the teeth in the dental office using the procedures of DENTAL SCALING and DENTAL POLISHING. The treatment may include plaque detection, removal of supra- and subgingival plaque and calculus, application of caries-preventing agents, checking of restorations and prostheses and correcting overhanging margins and proximal contours of restorations, and checking for signs of food impaction.Blood Coagulation Disorders, Inherited: Hemorrhagic and thrombotic disorders that occur as a consequence of inherited abnormalities in blood coagulation.Arthroplasty, Replacement, Hip: Replacement of the hip joint.Epiphyses: The head of a long bone that is separated from the shaft by the epiphyseal plate until bone growth stops. At that time, the plate disappears and the head and shaft are united.Femoral Neck Fractures: Fractures of the short, constricted portion of the thigh bone between the femur head and the trochanters. It excludes intertrochanteric fractures which are HIP FRACTURES.Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques.Imidazoles: Compounds containing 1,3-diazole, a five membered aromatic ring containing two nitrogen atoms separated by one of the carbons. Chemically reduced ones include IMIDAZOLINES and IMIDAZOLIDINES. Distinguish from 1,2-diazole (PYRAZOLES).Decompression, Surgical: A surgical operation for the relief of pressure in a body compartment or on a body part. (From Dorland, 28th ed)Pulsed Radiofrequency Treatment: The application, via IMPLANTED ELECTRODES, of short bursts of electrical energy in the radiofrequency range, interspersed with pauses in delivery of the current long enough to dissipate the generated heat and avoid heat-induced tissue necrosis.Adrenal Cortex HormonesTantalum: Tantalum. A rare metallic element, atomic number 73, atomic weight 180.948, symbol Ta. It is a noncorrosive and malleable metal that has been used for plates or disks to replace cranial defects, for wire sutures, and for making prosthetic devices. (Dorland, 28th ed)Osteoradionecrosis: Necrosis of bone following radiation injury.Hip: The projecting part on each side of the body, formed by the side of the pelvis and the top portion of the femur.Knee Joint: A synovial hinge connection formed between the bones of the FEMUR; TIBIA; and PATELLA.Hip Dislocation, Congenital: Congenital dislocation of the hip generally includes subluxation of the femoral head, acetabular dysplasia, and complete dislocation of the femoral head from the true acetabulum. This condition occurs in approximately 1 in 1000 live births and is more common in females than in males.Retrospective Studies: Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.Tooth Socket: A hollow part of the alveolar process of the MAXILLA or MANDIBLE where each tooth fits and is attached via the periodontal ligament.Hip Prosthesis: Replacement for a hip joint.Ilium: The largest of three bones that make up each half of the pelvic girdle.Osteoarthritis, Hip: Noninflammatory degenerative disease of the hip joint which usually appears in late middle or old age. It is characterized by growth or maturational disturbances in the femoral neck and head, as well as acetabular dysplasia. A dominant symptom is pain on weight-bearing or motion.Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.Bone Remodeling: The continuous turnover of BONE MATRIX and mineral that involves first an increase in BONE RESORPTION (osteoclastic activity) and later, reactive BONE FORMATION (osteoblastic activity). The process of bone remodeling takes place in the adult skeleton at discrete foci. The process ensures the mechanical integrity of the skeleton throughout life and plays an important role in calcium HOMEOSTASIS. An imbalance in the regulation of bone remodeling's two contrasting events, bone resorption and bone formation, results in many of the metabolic bone diseases, such as OSTEOPOROSIS.Magnetic Field Therapy: The magnetic stimulation of specific target tissues or areas of the body for therapeutic purposes via the application of magnetic fields generated by MAGNETS or ELECTROMAGNETS.Dexamethasone: An anti-inflammatory 9-fluoro-glucocorticoid.Prosthesis Failure: Malfunction of implantation shunts, valves, etc., and prosthesis loosening, migration, and breaking.Range of Motion, Articular: The distance and direction to which a bone joint can be extended. Range of motion is a function of the condition of the joints, muscles, and connective tissues involved. Joint flexibility can be improved through appropriate MUSCLE STRETCHING EXERCISES.Follow-Up Studies: Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease.Bone Regeneration: Renewal or repair of lost bone tissue. It excludes BONY CALLUS formed after BONE FRACTURES but not yet replaced by hard bone.Arthroplasty: Surgical reconstruction of a joint to relieve pain or restore motion.Mandible: The largest and strongest bone of the FACE constituting the lower jaw. It supports the lower teeth.Technetium Tc 99m Medronate: A gamma-emitting radionuclide imaging agent used primarily in skeletal scintigraphy. Because of its absorption by a variety of tumors, it is useful for the detection of neoplasms.Reoperation: A repeat operation for the same condition in the same patient due to disease progression or recurrence, or as followup to failed previous surgery.Oral Surgical Procedures: Surgical procedures used to treat disease, injuries, and defects of the oral and maxillofacial region.Time Factors: Elements of limited time intervals, contributing to particular results or situations.Risk Factors: An aspect of personal behavior or lifestyle, environmental exposure, or inborn or inherited characteristic, which, on the basis of epidemiologic evidence, is known to be associated with a health-related condition considered important to prevent.Arthralgia: Pain in the joint.
Bisphosphonate-associated osteonecrosis of the jaw: Bisphosphonate-associated osteonecrosis of the jaw (often abbreviated as BON, BONJ, or BON of the jaw), also called bisphosphonate-related osteonecrosis of the jaw (BRONJ) (pronounced ) or bisphosphonate-induced osteonecrosis of the jaw (BIONJ), is osteonecrosis of the jaw in a person with a history of bisphosphonate use who undergoes subsequent dental surgery. It may lead to surgical complication in the form of impaired wound healing following oral and maxillofacial surgery, periodontal surgery, or endodontic therapy.ArcoZoledronic acidFish jawMethylprednisoloneHip resurfacing: 155px|right|thumb|The BHRDemineralized freeze dried bone allograft: Demineralized freeze dried bone allograft, referred to as DFDBA, is a bone graft material known for its [novo] bone formation properties.Bowers, GM, et al.OsteocyteInterosseous membrane of leg: The interosseous membrane of the leg (middle tibiofibular ligament) extends between the interosseous crests of the tibia and fibula, helps stabilize the Tib-Fib relationship and separates the muscles on the front from those on the back of the leg.Alendronic acidOsteotomyEmu oil: Emu oil is oil derived from adipose tissue harvested from certain subspecies of the emu, Dromaius novaehollandiae, a flightless bird indigenous to Australia.American Emu Association FAQColumbus Marion JoinerMinimally invasive hip resurfacing: Minimally invasive hip resurfacing (MIS) is "total or partial hip surgery that can be carried out through an incision of less than 10 cm (3.94 inches) without imparting great forces on the anatomy or compromising component positioning"Comis Orthopaedics websiteEpiphysis: The epiphysis (OED 2nd edition, 1989 as .Entry "epiphysis" in Merriam-Webster Online Dictionary.HyperintensityImidazoleSpinal decompression: Spinal decompression is the relief of pressure on one or many pinched nerves (neural impingement) of the spinal column.Tantalum(V) ethoxideOsteoradionecrosis: Osteoradionecrosis is a possible complication following radiotherapy where an area of bone does not heal from irradiation. Irradiation of bones causes damage to osteocytes and impairs the blood supply.Knee pain: Knee pain is a common complaint for many people. There are several factors that can cause knee pain.Albert Narath: Albert Narath (September 13, 1864, Vienna – August 15, 1924, Heidelberg) was an Austrian surgeon and anatomist.Gomphosis: Gomphosis, also known as the dental-alveolar joint, is a joint that binds the teeth to bony sockets (dental alveoli) in the maxillary bone and mandible. The fibrous connection between a tooth and its socket is a periodontal ligament.Inguinal ligament: The inguinal ligament (Poupart's ligament) is a band running from the pubic tubercle to the anterior superior iliac spine. Its anatomy is very important for operating on hernia patients.Electromagnetic therapyMetallosis: Metallosis is the putative medical condition involving deposition and build-up of metal debris in the soft tissues of the body.Revision using distal inflow: Revision Using Distal Inflow (RUDI) is a surgical treatment for Dialysis-associated Steal Syndrome.Temporal analysis of products: Temporal Analysis of Products (TAP), (TAP-2), (TAP-3) is an experimental technique for studyingQRISK: QRISK2 (the most recent version of QRISK) is a prediction algorithm for cardiovascular disease (CVD) that uses traditional risk factors (age, systolic blood pressure, smoking status and ratio of total serum cholesterol to high-density lipoprotein cholesterol) together with body mass index, ethnicity, measures of deprivation, family history, chronic kidney disease, rheumatoid arthritis, atrial fibrillation, diabetes mellitus, and antihypertensive treatment.
(1/476) Total knee replacement: should it be cemented or hybrid?
OBJECTIVE: To compare the complication rates associated with total knee arthroplasty against the types of fixation (hybrid or cemented), using a single total knee design (the anatomic modular knee [AMK] prosthesis). DESIGN: A prospective, nonrandomized, controlled trial. SETTING: University Hospital in London, Ont., a tertiary care teaching centre. PATIENTS: Two groups made up of 484 knees in 395 patients (89 bilateral). INTERVENTIONS: In 260 knees a hybrid configuration (cemented tibia and noncemented femur) was used (group 1). In 224 knees the femoral and tibial components were cemented (group 2). All patellae were cemented in both groups. MAIN OUTCOME MEASURES: Clinical results were assessed by The Knee Society Clinical Rating Scores at 3 months, 6 months and yearly intervals. Radiographic results were determined by 3-foot standing radiographs and at each follow-up visit standing knee radiographs, lateral and skyline views. Radiographs were analysed for alignment, presence or absence of radiolucent lines or changes in the position of the implant. All reoperations and nonoperative complications were recorded. RESULTS: At an average follow-up of 4.8 years, 8 knees (1.6%) required reoperation. An analysis of the complications leading to reoperation demonstrated no difference between the 2 groups. CONCLUSIONS: There was no difference in outcome whether the femoral component was cemented or not. Medium-term results of the AMK are excellent with a very low reoperation rate. (+info)
(2/476) Osteonecrosis of the hip in sickle-cell disease associated with tuberculous arthritis. A review of 15 cases.
We report a study of 15 cases of tuberculous hips with sickle-cell disease who presented during 1991-1993. Although the osteonecrosis was long-standing, biopsy was nearly always required to reveal the more recent tuberculous infection. Management consisted of 6 months of anti-tuberculous chemotherapy with appropriate palliative surgery 5-8 weeks after the start of drug treatment. The operative techniques which we used are described. The results were good both post-operatively, and in 12 patients followed-up at an average of 3 years. We recommend this combined management for the treatment of secondary tuberculous infections of hips previously damaged by sickle-cell disease. (+info)
(3/476) Disseminated thrombosis and bone infarction in female rats following inhalation exposure to 2-butoxyethanol.
Groups of 10 male and 10 female F344/N rats were exposed to 0, 31, 62.5, 125, 250, and 500 ppm of 2-butoxyethanol (BE) by inhalation, 6 hr/day, 5 days/wk, for 13 wk. Four moribund female rats from the 500 ppm group were sacrificed during the first 4 days of exposure, and 1 moribund female from the same group was sacrificed during week 5. Dark irregular mottling and/or loss of the distal tail were noted in sacrificed moribund rats. Similar gross lesions were noted in the terminally sacrificed females exposed to 500 ppm BE. Histologic changes noted in the day 4 sacrificed moribund rats included disseminated thrombosis involving the coccygeal vertebrae, cardiac atrium, lungs, liver, pulp of the incisor teeth, and the submucosa of the anterior section of the nasal cavity. Alterations noted in coccygeal vertebrae from the 500 ppm sacrificed moribund rats included ischemic necrosis and/or degeneration of bone marrow cells, bone-lining cells, osteocytes (within cortical and trabecular bone), and chondrocytes (both articular and growth plate), changes that are consistent with an infarction process. The moribund female rat that was sacrificed during week 5 and those female rats treated with 500 ppm and sacrificed following 13 wk of treatment lacked thrombi, but they had coccygeal vertebral changes consistent with prior infarction and transient or complete bone growth arrest. No bone lesions or thrombi were noted in the male rats treated with the same doses of BE. In conclusion, exposure to 500 ppm BE vapors caused acute disseminated thrombosis and bone infarction in female rats. Possible pathogenic mechanisms are discussed. (+info)
(4/476) Treatment of autoimmune premature ovarian failure.
There is no known immunosuppressive therapy for autoimmune premature ovarian failure that has been proven safe and effective by prospective randomized placebo-controlled study. Nevertheless, immunosuppression using corticosteroids has been used on an empirical basis for this condition. Here we present two cases of young women with premature ovarian failure who were treated with glucocorticoids in the hopes of restoring fertility. The first case illustrates the potential benefit of such therapy, and the second case illustrates a potential risk. The first patient with histologically proven autoimmune oophoritis was treated with alternate day glucocorticoid treatment. She had return of menstrual bleeding six times and ovulatory progesterone concentrations four times over a 16 week period. The second patient with presumed but unconfirmed autoimmune ovarian failure was referred to us after having been treated with a 9 month course of corticosteroids. During that treatment her menses did not resume. The corticosteroid treatment was complicated by iatrogenic Cushing syndrome and osteonecrosis of the knee. Identifying patients with autoimmune premature ovarian failure presents the opportunity to restore ovarian function by treating these patients with the proper immune modulation therapy. On the other hand, potent immune modulation therapy can have major complications. Corticosteroid therapy for autoimmune premature ovarian failure should be limited to use in placebo-controlled trials designed to evaluate the safety and efficacy of such treatment. (+info)
(5/476) Fat conversion of femoral marrow in glucocorticoid-treated patients: a cross-sectional and longitudinal study with magnetic resonance imaging.
OBJECTIVE: To study the changes in hematopoietic marrow in patients given glucocorticoid (steroid) therapy. METHODS: In a cross-sectional study, high-resolution T1-weighted magnetic resonance imaging (MRI) images of the proximal femur were obtained in an unselected series of 29 premenopausal female patients with systemic lupus erythematosus (SLE) and in a series of 29 age-matched healthy female subjects. In a longitudinal analysis, 2 MRI studies were performed 19 months apart in 11 patients with SLE (including 9 patients from the cross-sectional study who were evaluated before treatment) and in 7 patients with rheumatoid arthritis (RA). The percentage of fat marrow and the index of marrow conversion (IMC) were derived from the MRI images to estimate the degree of transformation of hematopoietic into fatty marrow in the area of the femoral neck. Values observed in the cross-sectional study and their changes over time were correlated with treatment data. RESULTS: The cross-sectional study performed in SLE patients indicated that their mean (+/- SD) percentage of fat marrow (48+/-36%) and IMC (82+/-12) were significantly more elevated than those in the healthy control subjects (18+/-16% and 75+/-6, respectively) (P<0.01). The magnitude of fat conversion correlated positively with the mean daily dose of oral prednisolone, and was higher in patients with ischemic bone lesions. The longitudinal study performed in SLE and RA patients revealed that IMC changes over time correlated positively with daily prednisolone intake (r = 0.71; P = 0.001), fat conversion occurring exclusively in patients receiving a mean prednisolone dose < or =7.5 mg/day. CONCLUSION: MRI indicates that fat conversion occurs in the proximal femur of steroid-treated patients. The magnitude of fat conversion correlates with steroid intake and is higher in patients with ischemic bone lesions. (+info)
(6/476) Unusual complications in an inflammatory abdominal aortic aneurysm.
An unusual case of an inflammatory abdominal aortic aneurysm (IAAA) associated with coronary aneurysms and pathological fracture of the adjacent lumbar vertebrae. The associated coronary lesions in cases of IAAA are usually occlusions. In the present case, it was concluded that a possible cause of the coronary aneurysm was coronary arteritis and the etiology of the pathological fracture of the lumbar vertebrae was occlusion of the lumbar penetrating arteries due to vasculitis resulting in aseptic necrosis. Inflammatory AAA can be associated with aneurysms in addition to occlusive disease in systemic arteries. The preoperative evaluation of systemic arterial lesions and the function of systemic organs is essential. (+info)
(7/476) Subchondral insufficiency fracture of the femoral head: a differential diagnosis in acute onset of coxarthrosis in the elderly.
OBJECTIVE: To document subchondral insufficiency fracture (SIF) of the femoral head and investigate its frequency. METHODS: The study was based on a retrospective review of 464 removed femoral heads (from 419 patients) with both radiologic and histologic evidence of subchondral collapse. Gross photographs, specimen radiographs, and histologic sections were reevaluated in all cases. Available clinical notes and imaging studies were also reviewed. RESULTS: Ten cases previously diagnosed as osteonecrosis were reinterpreted as SIF on a histopathologic basis. All of these patients were women over 65 years old (average age 75) with osteopenia. The initial symptom was acute onset of hip pain. Radiologically, a subchondral collapse, mainly in the superolateral segment of the femoral head, was noted. Magnetic resonance imaging, available in 3 cases, showed diffuse low intensity on T1-weighted images and high intensity on T2-weighted or fat-suppressed images. Bone scintigraphy, available in 4 cases, showed increased uptake in the femoral head. Histopathologically, a 1.0-2.5-cm long linear whitish gray zone, comprising fracture callus and granulation tissue, was found beneath the subchondral bone end plate. There was no evidence of antecedent osteonecrosis. CONCLUSION: The results of this study indicate that SIF should be included in the differential diagnosis of acute onset of coxarthrosis in the elderly. (+info)
(8/476) Use of magnetic resonance imaging to diagnose common wrist disorders.
Magnetic resonance imaging is being used more frequently to diagnose and plan treatment of wrist disorders. This article reviews the common pathologic lesions of the wrist: avascular necrosis, triangular fibrocartilage complex tears, ligamentous tears, ganglion cysts, carpal tunnel syndrome, and osteoarthritis. The typical magnetic resonance imaging characteristics of these lesions is discussed. (+info)