1/4. Idiopathic osteonecrosis of the hip during pregnancy: outcome in a subsequent gestation.BACKGROUND: Idiopathic osteonecrosis of the hip is a serious complication of pregnancy, but there is little information available regarding its recurrence in a subsequent gestation. CASE: A woman with a history of pregnancy-related osteonecrosis, successfully treated with conservative therapy, presented for preconceptual counseling. Because a literature search uncovered only one applicable case, the patient was managed empirically. Her subsequent pregnancy was uneventful with no recurrence. CONCLUSION: Although idiopathic osteonecrosis of the hip during pregnancy is uncommon, it is important to establish the outcome in subsequent pregnancies. Avoidance of vigorous physical activity, measures to limit edema, and low-dose aspirin therapy were successful in this patient.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/4. Hyperlipidaemia a risk factor for femoral head osteonecrosis (Legg-Calv -Perthes-like disease) in children with AIDS: case report.Although treatment of children infected with hiv with protease inhibitors has improved the survival of these patients, various adverse side effects have been reported, including metabolic abnormalities, such as hyperlipidaemia. We describe a case of hip osteonecrosis in an adolescent with AIDS who was being treated with protease inhibitors. There is a possible relation with hyperlipidemia. F.M.G., white, 11 years old, AIDS A2, started to receive AZT and DDI when he was 7 years old. In April 1999, the patient had a significant increase in viral load and so the antiretroviral therapy was switched to d4T, 3TC and ritonavir. Triglyceride plasma levels reached 460mg/dl after this switch and were always above the reference value. In December 1999, the patient complained of pain in the right hip. On physical examination, he had limited movement of this joint. magnetic resonance imaging of the right hip showed flattening, deformity and fragmentation of the femoral head, compatible with osteonecrosis. Few cases of femoral head osteonecrosis have been associated with hiv infection, in the absence of the classic risk factors for osteonecrosis. Metabolic risk factors include hypertriglyceridaemia. The immunological disorders that occur in the hiv infection may predispose the patient to avascular osteonecrosis and metabolic disorders, particularly hypertriglyceridemia, while the use of protease inhibitors, may be considered an additional risk factor for osteonecrosis. Given the importance of premature diagnosis and to avoid complications of osteonecrosis, we recommend evaluation of musculoskeletal symptoms in children receiving protease inhibitors.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/4. Articular cartilage changes in avascular necrosis: an arthroscopic evaluation.Treatment methods for osteonecrosis (avascular necrosis) are wide and varied. When untreated, progression of the disease is common and may dictate femoral head replacement. However, before femoral head collapse, some patients have mechanical joint symptoms (locking, buckling, clicking) that are unaddressed by femoral head drilling alone. Radiographic examinations in these patients usually are nondiagnostic. patients with these clinical criteria were evaluated arthroscopically. Between 1993 and 2000, seven patients were identified with known documented or radiographic diagnosis of avascular necrosis who had hip arthroscopy. Each patient's preoperative history, physical examination, plain radiographs, magnetic resonance imaging scans, and operative notes were reviewed from a prospectively-derived database. The duration and onset of symptoms were identified carefully. Case histories are presented on five of these patients. Articular cartilage changes were recorded and correlated to the preoperative radiologic studies. hip arthroscopy is a minimally invasive, highly effective, joint-preserving surgery in the young patient with mechanical symptoms (locking, catching, buckling) and early avascular necrosis. Treatable lesions include loose bodies, synovitis, chondral flaps, and labral tears. In addition, accurate staging can be accomplished through direct observation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/4. The stubborn hip: idiopathic avascular necrosis of the hip.OBJECTIVE: To highlight the unusually indolent course of avascular necrosis in this patient, the risk factors of which chiropractors should be aware, the necessity of and means to an early diagnosis, the limitations of plain film radiographs, as well as the current medical treatments. CLINICAL FEATURES: A 27-year-old male professional soccer player had a tight and achy right hip for approximately 6 years, a condition that increased with physical activity. His active range of motion was limited by 25% in extension and abduction, and all resisted ranges of motion produced pain. After an equivocal radiograph and bone scan, magnetic resonance imaging revealed a subchondral defect located on the superior aspect of the right femoral head, consistent with avascular necrosis of the femoral head. Intervention and Outcome: Presurgical management included Cybex testing, massage, myofascial release, interferential current, muscle strengthening, and muscle balancing exercises 3-5 times per week for 5 months. The patient underwent a curette procedure. Six weeks later, he returned to the chiropractic office for postsurgical rehabilitation, in which he is still involved today. He has made progress with respect to flexibility, strength, and muscle coordination. CONCLUSIONS: Idiopathic avascular necrosis of the hip is a clinical entity characterized by pain in the hip made worse with activity and at night, which may radiate to the groin, back, or thigh. Often, physical exam and radiographic findings are equivocal, at which point advanced imaging such as magnetic resonance imaging should be ordered to identify the disease in its earliest stages.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |