On Apr 26, 9:17 am, ironjustice <teamtan...@hotmail.com>
wrote:Aplastic
anemia <<

Hip surgery .. ?

"These observations are an encouragement to attempt treatment by
repeated phlebotomies"

Joint Bone Spine 2000;67(3):171-7

Phlebotomy: a treatment of ischaemic necrosis of the femoral head?
Analysis of a hypothesis.

Bouteiller G
Service de rhumatologie, center hosptialier, Auch, France.

The treatment of non-traumatic ischaemic osteonecrosis of the femoral
head (ONFH) remains problematical and there is evidently scope to seek
for a medical treatment of this disease which often leads to a
surgical procedure for hip prosthesis.
If we exclude the context of hemoglobin disorders, necrosis appears
mainly in adults, when their limb bones contain a fatty marrow.
Investigations such as intramedullary pressure measurement and
transosseous phlebography suggest a disorder of the intraosseous blood
circulation.
Various studies in animals and man have provided arguments indicating
that a kind of intraosseous 'obesity' due to hyperplasia and/or
hypertrophy of the fatty tissue of the femoral marrow play a role in
the development of necrosis.
In this respect, the blood flow of the yellow marrow is close to
ischemia, whereas red marrow flow can be very high.
In various conditions, mainly hemolytic anemias, the
femoral yellow marrow can convert to red marrow, which has also been
described in anemias induced by blood loss. If it is not thought
unreasonable to consider
ONFH an 'ischemic' disease, these observations are an encouragement to
attempt treatment by repeated phlebotomies. This procedure may locally
restore red marrow, and then an adequate blood flow which could
stabilize or even reverse
the lesions if they are diagnosed early.

Publication Types:

Review
Review, tutorial
PMID: 10875313, UI: 20331568

----------------------

Orban H, Cîrstoiu C, Adam R
Total hip arthroplasty in secondary systemic lupus erythematosus
femoral head avascular necrosis. [Journal Article]
Rom J Intern Med 2007; 45(1):123-9.

Systemic lupus erythematosus is a multisystem disease with a large
spectrum of clinical manifestations and a variable course.
Lupus is marked by both humoral and cellular immunologic
abnormalities, including multiple auto-antibodies especially anti DNA
antibodies.
Epidemiology - female predominance, occurring usually between second
and fourth decade of life, more frequently in hispanic and black
patients.
Family predominance has been noticed.
Provocative agents - ultraviolet light, viral infections, drugs and
situational stresses.
Pathogenesis - pathological features can affect a large spectrum of
internal organs and systems - osteoarticulary injuries, skin rash,
lymphadenopathy, glomerulonephritis, myocarditis, digestive system
lesions.
Musculo skeletal abnormalities include migratory arthritis, effusion
and stiffness in small and large joints.
Articular erosions are uncommon.
Skeletal abnormalities include osteopenia and osteonecrosis, due to
two pathological mechanisms: vasculitis and long term corticotherapy.
Fifteen to twenty percent of SLE patients are affected by femoral head
avascular necrosis (FHAN).
Diagnosis rests on clinical signs - hip pain, limited range of motion,
walking with a limp.; radiological findings - best grouped in Arlet-
Ficat standing system; MRI - high sensitivity, especially in
infraradiological stages.
Treatment - in incipient stages core decompression represents the best
therapeutical option.
In advanced, arthritis stages, total hip arthroplasty (THA) is the
standart treatment.
Three implant types are available: bipolar, uncemented and cemented.
An increased number of cotyloidites occurred after bipolar implants.
Emphasised osteopenia and excessive bleeding represent
contraindications for uncemented implants.
Considering all of this, cemented implants are considered, the right
choice, methacrylate cement providing strong and durable fixation of
THA implants to bone.
No meaningful differences were observed in postoperative functional
recovery between LSE patients and other etiology FHAN patients.
--------------------------------------------------------------------------------
Romanian journal of internal medicine = Revue roumaine de médecine
interne [Rom J Intern Med]

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