Osteonecrosis of the femoral head among rheumatology patients in Kara (Togo)

Abstract

Aim of the workTo determine the epidemiological and semiological profile of osteonecrosis of the femoral head (ONFH) during a rheumatology consultation in northern Togo. Patients and methodsThe study was conducted from April 2012 to July 2016 on the files of patients with an ONFH seen in rheumatological consultation at Kara Teaching Hospital (Togo). The diagnosis was based on plain X-ray and the lesions classified according to Arlet and Ficat. No patient performed MRI. ResultsFifty-six of 2591 patients (2.16%) had an ONFH; they were 60.71% women and 39.29% men. The mean age was 41.39±15.32years and disease duration 4.72±4.12years. None of the patients was associated with another rheumatic disease or received corticosteroids. The pain was over the greater trochanter in 30 cases, at the groin in 24 and the buttocks in 12. Low back pain was present in 27 patients and was referred to the ipsilateral knee in 28. Radiologic lesions of ONFH were overlapping with stage II in 15 patients, stage III in 20 and stage IV in 32. Involvement was unilateral in 69.64% of cases and bilateral in 30.36%. The main risk factors of ONFH were: sickle cell disease (28.57%), hypertriglyceridemia (17.85%) and hypercholesterolemia (14.28%), alcoholism (14.28%), and diabetes in two patients. 17 patients were overweight/obese and 3 were human immunodeficiency virus (HIV) positive. ConclusionONFH is frequent in northern Togo and sickle cell disease is the main risk factor. An important part of evolved forms is noted in relation with a diagnostic delay.