PMID- 26728612
OWN - NLM
STAT- Publisher
DA  - 20160105
LR  - 20160106
IS  - 1432-5195 (Electronic)
IS  - 0341-2695 (Linking)
DP  - 2016 Jan 5
TI  - A prospective cohort study of the clinical presentation of non-traumatic
      osteonecrosis of the femoral head: spine and knee symptoms as clinical
      presentation of hip osteonecrosis.
AB  - PURPOSE: To study the clinical presentation of femoral head osteonecrosis (ONFH).
      Publications dedicated to this aspect of ONFH are rare. Our aim was to
      systematically collect and describe the clinical data. METHODS: A prospective
      survey was conducted in a cohort of ONFH recruited from a dedicated clinic for
      osteonecrosis. The history of symptoms, medical management, and physical findings
      were obtained from 88 patients suffering from 125 ONFH. Subgroups were formed:
      bilateral versus unilateral ONFH, radiological stages 1-2 (pre-fractured) versus 
      fractured stage 3 versus stage 4. RESULTS: ONFH was bilateral in 63 %, especially
      in corticosteroid users and in sickle-cell cases. These patients were younger but
      had similar BMIs compared to the unilateral cases. The pain was mechanical in 79 
      % of hips and inflammatory in 21 %. Acute pain at the onset was present in 55 %
      of hips. The localization of this pain was variable, including in the groin, the 
      buttocks, or diffused in the lower limbs. A limp was present in 50 % of the
      patients, only when one hip was painful. The physical examination of the hip was 
      normal in 31 %, especially in stages 1-2 (55 %). The diagnosis delay was 12
      months, with inadequate medical management in 51 % of patients. CONCLUSIONS: In
      ONFH cases, no typical clinical pattern was found. The clinical presentation was 
      very variable, sometimes having spine or knee symptoms with a normal physical
      examination of the hip. ONFH should be systematically suspected in cases of onset
      of pain in the pelvis, buttocks, groin, and lower limbs.
FAU - Hauzeur, Jean-Philippe
AU  - Hauzeur JP
AD  - Department of Rheumatology, CHU Sart Tilman, B35, University of Liege, 4000,
      Liege, Belgium. jean-philippe@hauzeur.org.
FAU - Malaise, Michel
AU  - Malaise M
AD  - Department of Rheumatology, CHU Sart Tilman, B35, University of Liege, 4000,
      Liege, Belgium. michel.malaise@ulg.ac.be.
FAU - de Maertelaer, Viviane
AU  - de Maertelaer V
AD  - Department of Biostatistics and Medical Informatics SBIM & IRIBHM, School of
      Medicine, Universite Libre de Bruxelles, Brussels, Belgium. vdemaert@ulb.ac.be.
LA  - ENG
PT  - JOURNAL ARTICLE
DEP - 20160105
TA  - Int Orthop
JT  - International orthopaedics
JID - 7705431
OTO - NOTNLM
OT  - Clinical feature
OT  - Diagnosis
OT  - Femoral head
OT  - Hip
OT  - Osteonecrosis
OT  - Symptoms
EDAT- 2016/01/06 06:00
MHDA- 2016/01/06 06:00
CRDT- 2016/01/06 06:00
PHST- 2015/09/18 [received]
PHST- 2015/12/14 [accepted]
PHST- 2016/01/05 [aheadofprint]
AID - 10.1007/s00264-015-3079-x [doi]
AID - 10.1007/s00264-015-3079-x [pii]
PST - aheadofprint
SO  - Int Orthop. 2016 Jan 5.