Total Talar Replacement with Ceramic Implant in Combination with Tibial Component of Ankle Endoprosthesis: A Case Report

Background. Surgical treatment of patients with talus posttraumatic aseptic necrosis and its consequences usually includes tibiotalocalcaneal arthrodesis with various foot joints according to additional indications. This type of surgical treatment has number of significant disadvantages: traumatic surgical technique, permanent loss of movement in functionally significant joints, high risk of non-union, high frequency of residual deformities, the need for long periods of limb immobilization. The question arises: how to overcome the existing disadvantages and improve the results of talus posttraumatic aseptic necrosis treatment? A potential solution to this problem is the total talus endoprosthetics. Clinical case. A 64-year-old patient came to the clinic complaining of pain and deformity of the right foot and ankle area. After the examination, talus posttraumatic aseptic necrosis was diagnosed. The patient underwent ankle joint arthroplasty using total talus ceramic endoprosthesis in combination with the tibial component of the ankle joint endoprosthesis, a course of rehabilitation treatment was performed. Results. The VAS and AOFAS scales indicators showed a significant improvement both in the pain decrease (from 75 mm before surgery to 10 mm after), and in the functional state according to AOFAS by 2.2 times (from 36 to 80 points 20 months after surgery). By the last follow-up the patient could take more than 8000 steps a day. Conclusion. Considering the good clinical result achieved, the ankle joint arthroplasty using total talus ceramic endoprosthesis in combination with the tibial component of the ankle joint endoprosthesis can be considered a promising method of treatment of this severe pathology.

Avascular Necrosis of Left Femoral Head Following Trivial Trauma and the Need for Early Magnetic Resonance Imaging

Trivial Trauma is one of the causes of avascular necrosis of the femoral head. Even trivial trauma can cause loss of blood supply to the femoral head and results in ischemia and aseptic necrosis. A 68 year old male patient came with 2 month history of left hip pain. X-ray pelvis (fig-1) with both hips which was taken immediately after the trauma, showed no significant bony abnormality and patient was managed conservatively with analgesics. Patient had persisting pain for 2 months which increased in severity and patient developed difficulty walking. Therefore a Magnetic Resonance Imaging (MRI) L hip (fig-2) was done and which showed avascular necrosis grade III of left femoral head. Total hip replacement was then carried out for the patient and patient improved symptomatically. Earlier MRI imaging following trauma could have resulted in early diagnosis and intervention to prevent progression of the disease and salvage the femoral head.

Osteonecrosis of the humeral head in a human immunodeficiency virus-infected patient under tenofovir disoproxil fumarate–emtricitabine–lopinavir/ritonavir for 10 years: a case report

Background Human immunodeficiency virus-infected patients are 100 times more likely to develop aseptic osteonecrosis compared with the general population. While 90% of cases concern the femoral head, the involvement of humeral bone remains rare. Case presentation We report a case of aseptic osteonecrosis of the left humeral head complicating antiretroviral therapy in a female, 46-year-old, Bissau-Guinean human immunodeficiency virus-infected patient received in a context of progressive pain in the left shoulder followed by limitation of articular movements. Standard x-ray of the shoulder allowed us to make the diagnosis by showing a typical image of osteonecrosis. The treatment was medical combined with physiotherapy. Conclusions Aseptic osteonecrosis should be systematically looked for in human immunodeficiency virus patients on antiretroviral treatment. In addition to femoral head aseptic necrosis, the involvement of the humeral bone should also be considered.

Association between Genetic Polymorphisms of MIR3142HG and the Risk of Steroid-Induced Osteonecrosis of the Femoral Head in the Population of Northern China

<b><i>Background:</i></b> Steroid-induced osteonecrosis of the femoral head (ONFH) is aseptic necrosis of the femoral head caused by glucocorticoid use. Once necrotic femoral head necrosis occurs, it irreversibly affects the quality of life seriously. Studies have shown that the susceptibility to steroid-induced ONFH is likely to be related to the variation of miRNA-coding genes. Therefore, this study aimed was to investigate the effect of <i>MIR3142HG</i> on steroid-induced ONFH. <b><i>Methods:</i></b> Agena MassARRAY was used to genotype <i>MIR3142HG</i> gene rs1582417, rs2431689, rs7727155, and rs17057846 in 199 patients and 725 healthy people. A genetic model and haplotype analysis were used to evaluate the relationship between the <i>MIR3142HG</i> polymorphism and the risk of steroid-induced ONFH. The odds ratio and 95% confidence intervals were obtained through logistic regression to assess the influence of gene polymorphisms on the occurrence of steroid-induced ONFH. <b><i>Results:</i></b> The consequences show that rs7727115 is a protective factor, it could reduce the risk of steroid-induced ONFH, and rs1582417 could increase the risk of steroid-induced ONFH. In the genetic model, rs1582417 was associated with increased risk of alcohol-induced ONFH in dominant model and log-additive model. rs7727115 showed a decreased risk in codominant model, dominant model, and log-additive model. In addition, rs2431689 is related to HDL-C (<i>p</i> = 0.012) and ApoA1 (<i>p</i> = 0.010) levels, and rs17057846 (<i>p</i> = 0.024) is related to ApoB levels. Thelinkage analysis indicated 3 single-nucleotide polymorphisms (rs2431689, rs7727115, and rs17057846) in <i>MIR3142HG</i> with significant chain imbalance. In addition, haplotype “GGG” of <i>MIR3142HG</i> was found out and is harmful for steroid-induced ONFH. <b><i>Conclusion:</i></b> Our results first confirm that the genetic polymorphism of <i>MIR3142HG</i> is associated with steroid-induced ONFH susceptibility in Chinese Han population.

Headache, Uveitis, and Leptomeningeal Enhancement

A 35-year-old man sought care for a severe, acute-onset, pounding, bifrontal headache, photopsias, and nausea for 1 day. Initially, bilateral red eyes developed, and within 24 hours he had central blurred vision problems in the left eye. He reported that objects had a yellow tint with the left eye and looked “wavy” supranasally. An emergent evaluation documented bilateral red eyes, and an initial diagnosis of bilateral panuveitis was given. By 48 hours after symptom onset, he started vomiting. He also was feeling feverish and off-balance. He reported no tinnitus or hearing loss, any change in color of his eyelashes or eyebrows, alopecia, poliosis, or cognitive difficulties. An initial work-up for infectious processes was negative. Given the patient’s ethnic background, including Chinese, Japanese, and Filipino origin, and typical findings of uveomeningitis, he was diagnosed with probable Vogt-Koyanagi-Harada syndrome. There is no specific diagnostic test for this entity, and the diagnosis remains reliant on a combined interpretation of clinical and ancillary testing. The patient was kept on oral prednisone daily, and azathioprine was initiated, as well as prophylaxis against Pneumocystis carinii pneumonia and gastrointestinal tract hemorrhage. During the tapering phase of prednisone, liver function test abnormalities were found, so azathioprine was discontinued. At 1-year follow-up, he had some mild skin flaking and weight gain from the corticosteroid therapy but no other symptoms, despite having discontinued azathioprine for 3 months. He continued to taper off prednisone. He had development of bilateral hip pain; imaging showed bilateral aseptic hip necrosis. A decision was made to initiate tumor necrosis factor (TNF)-α‎ inhibitors. He lost all the weight gained and recovered from the aseptic necrosis of the hip to be able to continue running. The final diagnosis was recurrent Vogt-Koyanagi-Harada syndrome. Vogt-Koyanagi-Harada syndrome is an idiopathic inflammatory disease with panuveitis and neurologic involvement in the form of aseptic meningitis and/or hearing loss. Although the full spectrum of the disorder may involve many skin changes and additional findings, most patients have incomplete disease because they are urgently treated with corticosteroids and the disorder is steroid responsive.

Corrective Intertrochanteric Osteotomy of the Femur for Aseptic Necrosis of the Femoral Head after Bloodless Reduction of Congenital Dislocation in School-Age Children

The immediate results of treatment of 72 children aged 7 to 12 years with aseptic necrosis of the femoral head after bloodless reduction of congenital hip dislocation were analyzed. When treating patients, the following types of surgical treatment were used:extra-articular or open centering of the femoral head with intertrochanteric-torsion-varizing or devarizing and rotational osteotomy of the femur with bringing down the greater trochanter in the caudal direction. In all patients, pain and lameness disappeared, internal rotation of the lower extremities when walking, and the range of motion in the hip joint improved. Improved radiometric parameters characterizing the ratio of the acetabulum and the head of the femur and the angular values of the hip joint and proximal femur.

Aseptic necrosis of the femoral head in the course of haemophilia; a different clinical and radiological course compared to typical Legg-Calve-Perthes disease (twenty years of follow-up) – case report

The authors analyse the course of aseptic necrosis of the femoral head in a 7-year-old boy with haemophilia A (factor VIII level - 0%) caused by massive haemarthrosis into the hip joint (joint tamponade). The patient’s clinical and radiological symptoms differed from those in classic LCP disease, and now, after 20 years, the consequences of necrosis do not confirm typical Perthes disease (LCP). Significant shortening (about 5 cm) of the limb and the X-ray image of the proximal end of the femur resemble the consequences of severe necrosis of the femoral head in the treatment of an infant with developmental dysplasia of the hip (DDH). The study presents necrosis of the femoral head in the course of haemophilia due to its extremely rare occurrence as opposed to haemophilic arthropathy typical for this disease. This description may also contribute to considerations on the etiopathology of LCP disease.

Nonpsychotic mental disorders in patients with aseptic necrosis of the femoral head (literature review)

Recently it has been reported of significant progress in the providing of surgical care to patients with aseptic necrosis of the femoral head. Given the unity of mental and somatic factors, as well as data on the interaction of mental factors and other chronic diseases of the hip joint, there is a significant link between non-psychotic mental disorders and aseptic necrosis of the femoral head. The aim of this review was to present current data on psychiatric disorders in patients of this category. Prolonged stress exposure, in particular due to pain, with activation of the sympathoadrenal system on the one hand and maintaining a high level of anxiety due to neurotic mechanisms of psychological protection on the other hand can lead to joint damage due to reduced sympathetic nerve fibers. Available data for incidence of anxiety and depression in Chinese patients show that almost every fifth patient has clinically significant symptoms. The stage of the disease (the need for surgical treatment) and comorbid diseases significantly increase the risk of anxiety and depression. Considerable attention is paid to the patient’s alcohol consumption problems and the relationship between alcohol abuse and the occurrence of aseptic necrosis. The presence of restrictions in movements influent not only to the physical, but also to the mental components of the quality of life. Physical and mental discomfort, pain, low quality of life are factors that reduce the willingness to participate in preventive measures, which ultimately leads to the need for more radical surgical intervention. Evaluation by a mental health professional before hip surgery allows for better results in the delayed recovery period.