avascular necrosis of the femoral head in hiv-infecfed ... - Bone & Joint

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(Ash- erson et al 1989). We report two cases in HIV-infected patients, in whom hypertriglyceridaemia and anticardi- olipin antibodies were found respectively.
BRIEF

160

AVASCULAR

XAVIER

NECROSIS

CHEVALIER,

OF

BRUNO

THE

REPORTS

FEMORAL

LARGET-PIET.

HEAD

PHILIPPE

IN

HERNIGOU,

HIV-INFECFED

ROMAIN

GHERARDI

Osteonecrosis be associated

of the femoral head with other conditions,

is uncommon including

and may hypertri-

total hip arthroplasty one-year follow-up.

glyceridaemia

(Lee,

Parson

and,

Discussion. chaemic

often, erson patients, olipin Case

Corcoran

and

1980)

addict, gave a 20-month difficulties in walking.

(Center

for Disease

Control

1986).

femoral head. MRI His total lymphocyte T4 cells/mm3. to 2.30 mmol/l

He had

Hypertriglyceridaemia (normal, 0.70 to

right femoral head. 1600/mm3 with 250

1.70).

ranged Levels

cholesterol, fasting glucose, and uric acid Electrophoresis of haemoglobin showed no The patient was treated by left total hip which was still satisfactory after a two-year

drug and

addict, increasing

man,

of

intake, or other chronic left hip were limited and osteonecrosis of the left

showed a normal count was

2. A 27-year-old

no history

also

gave a two-year history difficulty in walking.

an

from 2.27 of serum

were normal. abnormality. replacement, follow-up.

patient

was

successfully

treated

by right

Correspondence ©l993

British

030l-620X/93/l

JBoneJoint Received

Head

R68

Surg[Br] 13 February

Society

ofBone

and

Joint

160. 13 July

1992

Surgery

(Canoso,

Zon

and

Groopman

is due to HIV anticardiolipin

itself (Grunfeld et al 1989). Low levels of antibodies are frequently detected in HIV-infected patients (Canoso et al 1987). Antiphospholipid antibodies are a well-recognised risk factor for venous and arterial thrombosis, and an association osteonecrosis

the

so-called

‘primary’

has

syndrome

anti-

been

reported

et al 1989).

ological added necrosis.

and

antibody

be linked

may

that

osteonecrosis

to HIV-associated

disturbances. to

No benefits commercial article.

the

list

in any party

of

of the femoral metabolic

HIV

infection

risk

factors

form have been related directly

and

must for

head immun-

therefore

avascular

be bone

received or will be received or indirectly to the subject

from a of this

REFERENCES Asherson RA, Khamashta MA, Ordi-Ros J, et al. antiphospholipid syndrome : major clinical and tures. Medicine 1989; 68 :366-74.

RT, associated 495-8.

of

lAM)

with

LI,

Groopman

HTLV-HI

JE. infection.

for Disease Control. Classification system lymphotropic virus type III, lymphoneuropathy-associated infections. Ann mt Red 1986; 10:234-7.

Ficat

RP. Idiopathic and treatment.

94010

The “primary” serological fea-

Anticardiolipin Br J Haematol

Center

to Dr X. Chevalier. Editorial

an isspecific

found in case 2. Hypertriglyceridaemia is more common in HIVinfected patients than in the seronegative population and is found in asymptomatic subjects, which suggests that it

Canoso X. Chevalier, MD, Registrar in Rheumatology B. Larget-Piet, MD, PhD, Professor of Rheumatology and Department P. Hernigou. MD, PhD, Professor of Surgical Orthopaedics R. Gherardi, MD, PhD, Professor of Pathology H#{244}pitalHenri Mondor, 51 Avenue du Mal de Lattre de Tassigny, Cr#{233}teil,France.

is probably Although no

1987),

We conclude

was

at

identified in most patients, or conditions have been local trauma, barotrauma,

antibodies

anticardiolipin

(Asherson

abuse, or corticosteroid therapy; he III of the disease. was restricted, and osteonecrosis of head was evident on radiographs. Early the left femoral head was also detected bone scan and CT scans. His total was 3200 mm3 with 960 T4 cells/mm3. antibodies (IgG) were present at 126 20 IU/l). Haemoglobin electrophoresis

The

can be factors include

complications

chronic alcoholism, sickle-cell anaemia, systemic lupus erythematosus, steroid therapy, and haemodialysis (Ficat 1985). Known metabolic risk factors include hypertriglyceridaemia (Lee et al 1980), present in case 1 , and

phospholipid

of right groin pain, There was no history

no further

Aseptic osteonecrosis disease (Lee et al 1980).

between

HIV-seropositive

of trauma, alcohol also was at stage Hip movement the right femoral osteonecrosis of both by 99mTc lymphocyte count Anticardiolipin IU/l (normal, < normal.

with

aetiological factor many precipitating identified. These

history of groin pain and recent He was at stage III of the disease

trauma, alcohol abuse, steroid infection. Movements of his radiography showed a typical

Case

less

the presence of antiphospholipid antibodies (Ashet al 1989). We report two cases in HIV-infected in whom hypertriglyceridaemia and anticardiantibodies were found respectively. 1. A 26-year-old man, an HIV-seropositive drug

PATIENTS

for

bone necrosis of the femoral head : early J Bone Joint Surg [Br] 1985 : 67-B :3-9.

Grunfeld C, Kotler DP, Hamadeh acquired immunodeficiency

R, et al. Hypertriglyceridemia syndrome. Am J Med 1989;

antibodies 1987 ; 6: human

Tvirus

diagnosis in the 86:27-31.

$2.00

1993; 75-B: 1992; Accepted

Lee

CK, Corcoran aseptic necrosis 3 :651-5.

SF, Parson

JR.

of the

femoral

THE

JOURNAL

Hyperlipidemia head in adults.

OF BONE

AND

and idiopathic Orthopaedics 1980;

JOINT

SURGERY