(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
