Bilateral corticosteroid-induced osteonecrosis of the femoral head detected at a 6-week interval.

Kazuhiko Sonoda,Goro Motomura,Yusuke Kubo,Takuaki Yamamoto,Yukihide Iwamoto,Kazuyuki Karasuyama,Satoshi Hamai

doi:10.1186/s40064-015-1458-9

Kazuhiko Sonoda, Goro Motomura + Show 5 more

Open Access

https://doi.org/10.1186/s40064-015-1458-9

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Journal: SpringerPlus	Publication Date: Nov 2, 2015
Citations: 6	License type: CC BY 4.0

Affiliation: Kyushu University

Abstract

Introduction Corticosteroid-induced osteonecrosis of the femoral head (ONFH) often affects both femoral heads. Such bilateral ONFH cases are generally detected concurrently on magnetic resonance imaging (MRI). On the other hand, in unilateral cases, it is rare that contralateral ONFH is subsequently detected. We herein report a case in which bilateral ONFH was detected in both femoral heads by repeated MRI examination at an interval of 6 weeks.Case descriptionA 34-year-old man with purpura nephritis was started on corticosteroid therapy with prednisolone at 30 mg/day. Eight months after the initiation of corticosteroid therapy, he complained of left hip pain with no antecedent triggering activity. MRI obtained 8.5 months after the initiation of corticosteroid therapy showed the findings of osteonecrosis of the left femoral head, while no abnormalities were detected in the right femoral head. On the second MRI obtained 10 months after the initiation of corticosteroid treatment, however, osteonecrosis of the right femoral head was newly detected without an increase of the corticosteroid dose.ConclusionsThis case may indicate that corticosteroid-induced bilateral ONFH do not always develop at the same time.

Highlights

Corticosteroid-induced osteonecrosis of the femoral head (ONFH) often affects both femoral heads
magnetic resonance imaging (MRI) obtained 8.5 months after the initiation of corticosteroid therapy showed the findings of osteonecrosis of the left femoral head, while no abnormalities were detected in the right femoral head
This case may indicate that corticosteroid-induced bilateral ONFH do not always develop at the same time

Summary

Background

Nontraumatic osteonecrosis of the femoral head (ONFH) is considered to be the result of an ischemic event, leading to the death of osteocytes. Corticosteroid-induced ONFH has been reported to develop early (1–2 months) after starting high-dose corticosteroid therapy, and the probability of affecting both femoral heads is considered to be approximately 80 % (Shigemura et al 2012) In these bilateral cases, ONFH can be detected on magnetic resonance imaging (MRI) concurrently in the majority of cases (Oinuma et al 2001; Fukushima et al 2010). For the purpose of evaluating the indications of osteotomy, he underwent MRI again 6 weeks after the initial MRI This time, a low-intensity band newly appeared in the right femoral head on T1-weighted images (Fig. 4). The patients started to perform active range of motion exercise 5 days after the operation and began to use wheelchairs at the same time His left hip was maintained non-weight-bearing status until 5 week after the operation, followed by partial weight-bearing walking using two crutches.

Discussion and evaluation

Conclusions