Abstract
Avascular necrosis (AVN) of the hips is associated with significant disability, and the majority of established cases require major surgery. In a retrospective analysis of 185 patients with systemic lupus erythematosus (SLE) 13 (7%) were found to have AVN. Of these, six had Raynaud's phenomenon, all had been on corticosteroids, and one had digital vasculitis. The mean duration of corticosteroid therapy was two years (range four months to five years). Five patients developed AVN two to 10 years after discontinuing steroids. The mean duration of disease at the onset of AVN was 6.85 years (range 1-19 years), and the mean age at onset of AVN was 31 years. Ten patients had severe multisystem involvement. None of the patients abused alcohol. Surgery was performed on 11 hips. Three had total hip replacement for stages 3 and 4 and seven had core decompression for stages 1 and 2. AVN progressed in two (28%) of these patients. In another patient core decompression failed for technical reasons. She subsequently required total hip replacement. The early detection of AVN to avoid the need for major surgery is stressed.
Highlights
650 Kalla, Learmonth, Klemp presence or absence of Raynaud's phenomenon and of vasculitis; the therapy administered, with particular reference to the total dose and duration of corticosteroid therapy; the onset of Avascular necrosis (AVN) in relation to corticosteroid therapy and to the duration of disease; the presence of diseases known to be associated with AVN such as diabetes mellitus, hyperlipidaemia, and pancreatitis; alcohol consumption
Of the other two patients, one had a butterfly rash and a positive LE cell preparation, and the other had nephritis, pancytopenia, and psychosis. In nine of these 13 patients (69%) AVN developed before the age of 40 years
The observations in early studies of a high prevalence of AVN in young patients with systemic lupus erythematosus (SLE), and of the strong association of AVN with corticosteroid therapy have been confirmed in several subsequent series.[48 17]
Summary
The records of 185 patients attending the Lupus Clinic at Groote Schuur Hospital during a 12 year period from March 1972 to March 1984 were studied retrospectively. The following data were recorded in those who developed AVN: overall severity of the disease, based on the nature and number of organs involved, the need for corticosteroid or immunosuppressive therapy, and the periods of activity; the. 15 The number and nature of surgical procedures performed were recorded and the results of these procedures evaluated. Radiological involvement of one hip has been followed by a 9Tc bone scan to assess the contralateral hip. If this was positive intraosseous pressure studies, both resting and stress, were performed. Raised pressures were treated by core decompression, as described by Hungerford and Zizic
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