Choice of treatment methods for a male patient with multiple aseptic necrosis of the heads of tubular bones


DOI: https://dx.doi.org/10.18565/therapy.2023.5.104-112

Gaydukova I.Z., Trofimov E.A., Nasrullaeva A.A., Morozova K.P.

1) I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia, Saint Petersburg; 2) Clinical Rheumatology Hospital No. 25, Saint Petersburg
Abstract. Aseptic bone necrosis (osteonecrosis) is an actual problem for traumatologists, orthopedists, and rheumatologists. Surgical methods for the treatment of this disease are well developed and widely used in real clinical practice. At the same time, MRI implementation makes it possible to detect aseptic necrosis at an early stage, when surgical treatment is not yet indicated, and the patient can be observed and treated by a therapist. Conservative treatment of osteonecrosis allows to stabilize the process with its outcome in osteoarthritis, which subsequently needs to be monitored by therapist and rheumatologist. The presented clinical case shows the possibility of achieving clinical stabilization of osteonecrosis of the humeral head with histologically confirmed bone restoration in damage area and subsequent formation of secondary osteoarthritis in connection with risk factors correction, an adequate motor regimen performing, use of teriparatide, SYSADOA, and intra-articular injections of hyaluronic acid in a 44-year-old male patient.
Keywords: hyaluronic acid preparations for intraarticular injection, aseptic necrosis, SYSADOA, teriparatide, osteonecrosis, osteoarthritis
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Literature

1. Ильиных Е.В., Барскова В.Г., Лидов П.И., Насонов Е.Л. Остеонекроз. Часть 1. Факторы риска и патогенез. Современная ревматология. 2013; 7(1): 17–24. [Ilyinykh E.V., Barskova V.G., Lidov P.I., Nasonov E.L. Osteonecrosis. Part 1. Risk factor and pathogenesis. Sovremennaya revmatologiya = Modern Rheumatology Journal. 2013; 7(1): 17–24 (In Russ.)]. https://dx.doi.org/10.14412/1996-7012-2013-2362. EDN: RBKAFL.


2. Лобашов В.В., Зайнутдинов А.В., Ахтямов И.Ф. Консервативное лечение асептического некроза головки бедренной кости у взрослых (обзор литературы). Гений ортопедии. 2020; 26(4): 585–592. [Lobashov V.V., Zaynutdinov A.V., Akhtyamov I.F. Conservative treatment of aseptic necrosis of the femoral head in adults (literature review). Geniy ortopedii = Orthopedic genius. 2020; 26(4): 585–592 (In Russ.)]. https://dx.doi.org/10.18019/1028-4427-2020-26-4-585-592. EDN: DUOOTU.


3. Hines J.T., Jo W.L., Cui Q. et al. Osteonecrosis of the femoral head: An updated review of ARCO on pathogenesis, staging and treatment. J Korean Med Sci. 2021; 36(24): e177. https://dx.doi.org/10.3346/jkms.2021.36.e177.


4. Petek D., Hannouche D., Suva D. Osteonecrosis of the femoral head: Pathophysiology and current concepts of treatment. EFORT Open Rev. 2019; 4(3): 85–97. https://dx.doi.org/10.1302/2058-5241.4.180036.


5. Торгашин А.Н., Родионова С.С., Шумский А.А. с соавт. Лечение асептического некроза головки бедренной кости. Клинические рекомендации. Научно-практическая ревматология. 2020; 58(6): 637–645. [Torgashin A.N., Rodionova S.S., Shumsky A.A. et al. Treatment of aseptic necrosis of the femoral head. Clinical guidelines. Nauchno-prakticheskaya revmatologiya = Scientific and practical rheumatology. 2020; 58(6): 637–645 (In Russ.)]. https://dx.doi.org/10.47360/1995-4484-2020-637-645. EDN: EWKHOY.


6. Boontanapibul K., Steere J.T., Amanatullah D.F. et al. Diagnosis of osteonecrosis of the femoral head: too little, too late, and independent of etiology. J Arthroplasty. 2020; 35(9): 2342–49. https://dx.doi.org/10.1016/j.arth.2020.04.092.


7. Arai R., Takahashi D., Inoue M. et al. Efficacy of teriparatide in the treatment of non-traumatic osteonecrosis of the femoral head: A retrospective comparative study with alendronate. BMC Musculoskelet Disord. 2017; 18(1): 24. https://dx.doi.org/10.1186/s12891-016-1379-y.


8. Дудинская Е.Н., Ткачева О.Н., Мачехина Л.В. с соавт. Применение терипаратида в лечении тяжелого остеопороза в гериатрической практике: описание клинического случая. Ожирение и метаболизм. 2019; 16(4): 80–89. [Dudinskaya E.N., Tkacheva O.N., Machekhina L.V. et al. The use of teriparatide in the treatment of severe osteoporosis in geriatric practice: A case report. Ozhireniye i metabolizm = Obesity and metabolism. 2019; 16(4): 80–89 (In Russ.)]. https://dx.doi.org/10.14341/omet10052. EDN: ZSYMNS.


9. Jiang Y., Zhao J.J., Mitlak B.H. et al. Recombinant human parathyroid hormone (1-34) [teriparatide] improves both cortical and cancellous bone structure. J Bone Miner Res. 2003; 18(11): 1932–41. https://dx.doi.org/10.1359/jbmr.2003.18.11.1932.


10. Государственный реестр лекарственных средств Минздрава России. Инструкция по медицинскому применению препарата Форстео. РУ: П N015927/01. Доступ: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=84979df5-d408-4d11-a38f-4f39d86a0c3d (дата обращения – 01.01.2022). [State Register of Medicines of the Ministry of Health of Russia. Instructions for medical use of the drug Forsteo. Registration certificate: П N015927/01. URL: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=84979df5-d408-4d11-a38f-4f39d86a0c3d (date of access – 01.01.2022) (In Russ.)].


11. Arai R., Takahashi D., Inoue M. et al. Efficacy of teriparatide in the treatment of nontraumatic osteonecrosis of the femoral head: A retrospective comparative study with alendronate. BMC Musculoskelet Disord. 2017; 18(1): 24. https://dx.doi.org/10.1186/s12891-016-1379-y.


12. Galluccio F., Matucci-Cerinic M. Efficacy of short-term teriparatide for hip osteonecrosis. J Rheumatol. 2016; 43(11): 2084–85. https://dx.doi.org/10.3899/jrheum.160190.


13. Dong Y., Li Y., Huang C. et al. Systemic application of teriparatide for steroid induced osteonecrosis in a rat model. BMC Musculoskelet Disord. 2015; 16: 163. https://dx.doi.org/10.1186/s12891-015-0589-z.


14. Беляева И.Б., Гайдукова И.З., Жугрова Е.С. с соавт. Остеоартрит. В кн.: Тактика врача-ревматолога. Практическое руководство (серия «Тактика врача»). Под ред. академика РАН В.И. Мазурова. М.: ГЭОТАР-Медиа. [Belyaeva I.B., Gaydukova I.Z., Zhugrova E.S. et al. Osteoarthritis. In: Tactics of a rheumatologist. Practical guide (series «Doctor’s tactics»). Ed. by academician of RAS Mazurov V.I. Moscow: GEOTAR-Media. 2022; pp. 56–72. (In Russ.)]. ISBN: 978-5-9704-6824-1


15. Резолюция консенсуса экспертов Российской Федерации по диагностике и лечению остеоартрита для врачей первичного звена. Терапия. 2022; 8(5): 119–128. [Resolution of the consensus of Russian Federation experts on the diagnosis and treatment of osteoarthritis for primary care physicians. Terapiya = Therapy. 2022; 8(5): 119–128 (In Russ.)]. https://dx.doi.org/10.18565/therapy.2022.5.119-128. EDN: ZMKXAD.


16. Barakat A.S., Ibrahim N.M., Elghobashy O. et al. Prevention of post-traumatic osteoarthritis after intra-articular knee fractures using hyaluronic acid: a randomized prospective pilot study. Int Orthop. 2019; 43(11): 2437–45. https://dx.doi.org/10.1007/s00264-019-04360-8.


17. Tuan S., Liou I., Su H. et al. Improvement of self-reported functional scores and thickening of quadriceps and femoral intercondylar cartilage under ultrasonography after single intra-articular injection of a novel cross-linked hyaluronic acid in the treatment of knee osteoarthritis. J Back Musculoskelet Rehabil. 2018; 31(4): 709–18. https://dx.doi.org/10.3233/BMR-170950.


18. Chareancholvanich K., Pornrattanamaneewong C., Narkbunnam R. Increased cartilage volume after injection of hyaluronic acid in osteoarthritis knee patients who underwent high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2014; 22(6): 1415–23. https://dx.doi.org/10.1007/s00167-013-2735-1.


About the Autors

Inna Z. Gaydukova, MD, professor, deputy director of the Research Institute of Rheumatology and professor of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald, I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia, rheumatologist at Clinical Rheumatology Hospital No. 25 (Saint Petersburg). Address: 191014, Saint Petersburg, 41 Kirochnaya Str. E-mail: ubp1976@list.ru. ORCID: https://orcid.org/0000-0003-3500-7256. SPIN-code: 3083-7996
Evgeny A. Trofimov, MD, deputy director of the Research institute of rheumatology and professor of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald, I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia. Address: 191014, Saint Petersburg, 41 Kirochnaya Str. E-mail: evgeniy.trofimov@szgmu.ru.
ORCID: https://orcid.org/0000-0003-3236-4485. SPIN-code: 4358-1663
Alena A. Nasrullaeva, 1st year resident (specialty «Therapy») of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald, I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia. Address: 191014, Saint Petersburg, 41 Kirochnaya Str. E-mail: alenaarifovna@mail.ru. ORCID: https://orcid.org/0000-0001-7696-981X
Kira P. Morozova, rheumatologist at Clinical Rheumatology Hospital No. 25 (Saint Petersburg). Address: 190068, Saint Petersburg, 30 Bol`shaya Pod`yacheskaya. E-mail: kiramorozoba@mail.ru.
ORCID: https://orcid.org/0000-0002-4113-3104


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