Current treatment options for ONFH include conservative treatment, core decompression, vascularized bone grafting, and total hip arthroplasty.Generally, http://www.selleckchem.com/products/MG132.html patients with autoimmune diseases receive high-dose corticosteroids early in the course of the disease. The corticosteroid dose of these patients is subsequently gradually decreased to a maintenance dose (daily prednisolone-equivalent dose is 10mg or below) as clinical improvement is achieved. Maintenance doses of corticosteroids can be given for three months to several years. For some patients, ONFH was first recognized when they were receiving maintenance doses of corticosteroids for their autoimmune diseases. Most of these patients should receive operation immediately, because it is easier to get the satisfactory prognosis at the early stage of ONFH [3, 4].
After operation, maintaining continuous treatment of the primary disease does not permit cessation of corticosteroid in most of them. However, corticosteroids have harmful impact on the femoral head at many aspects. Takano-Murakami et al. found that supraphysiologic doses of glucocorticoids suppressed osteoblast proliferation and the recruitment of osteoclast precursors . Corticosteroids also promote bone marrow stromal cells to develop into adipocytes, while increasing the size of fat cells [6, 7]. Drescher et al. believed that methylprednisolone enhances contraction of the femoral head’s lateral epiphyseal arteries and reduces femoral head blood flow . In this case, the adverse impact of corticosteroids on the femoral head might still exist after operation.
It is widely accepted that high dose of corticosteroids can lead to ONFH. However, there are no reports on whether maintenance doses of corticosteroids affect operation outcomes in patients with corticosteroid-induced ONFH.Free vascularized fibular grafting (FVFG) is an effective method of halting progression of osteonecrosis and promoting bone regeneration at necrotic foci and provides good outcomes for patients with ONFH at early stage [9, 10]. This study was performed to compare the FVFG outcomes in patients who had received maintenance doses of corticosteroids with patients who had not received corticosteroids treatment after FVFG and determine the effect of postoperative corticosteroids on FVFG outcomes.2. Materials and Methods2.1.
Patient SelectionWe retrospectively reviewed the records of patients with corticosteroid-induced ONFH who received FVFG in our hospital from 2000 to 2010. Diagnoses of ONFH were based on history, clinical evaluation, and imaging modalities including anteroposterior and frog-leg lateral radiographs as well as magnetic AV-951 resonance imaging (MRI). The Steinberg classification was used to evaluate radiographs, and ONFH was classified by stages from 0 to VI . Patients with stages II, III, and IV of ONFH were performed with FVFG.