Therapy » Aseptic necrosis in the practice of a therapist – treatment efficacy based on one-year period of observation

Aseptic necrosis in the practice of a therapist – treatment efficacy based on one-year period of observation

DOI: https://dx.doi.org/10.18565/therapy.2025.1.81-94

Gaydukova I.Z., Petukhova A.A., Bombina M.V., Bandurko E.P., Inamova O.V., Mazurov V.I.
1) I.I. Mechnikov North-West state medical university of the Ministry of Healthcare of Russia, Saint Petersburg; 2) V.A. Nasonova Clinical Rheumatology Hospital No. 25, Saint Petersburg

Abstract. Aseptic necrosis (AN) of bones has been considered for a long time as a disease that is treated surgically. Introduction of magnetic resonance imaging into practice has made it possible to detect AN at early stages, when conservative treatment is appropriate, which, however, has not been sufficiently studied.
The aim: to evaluate the dynamics of the efficacy of AN treatment carried out during a year in real clinical practice.
Material and methods. Observational non-interventional study included 90 patients ≥ 18 years old with a diagnosis of aseptic necrosis. During therapy, pain was assessed over a year using a 10-point numerical rating scale (NRS), patient and physician satisfaction with treatment (PASS/PhASS indexes), mobility of the affected limb, need for surgery, and the efficacy of therapy.
Results. The average age of the participants was 55.3 ± 12.9 years, the proportion of male individuals was 52.22%. Treatment included limitation of axial stress, therapeutic exercises, physiotherapy, use of non-steroidal anti-inflammatory drugs, symptomatic slow acting drugs for osteoarthritis (SYSADOA), vitamin D3, bisphosphonates or denosumab or teriparatide, lipid-lowering, osteotropic therapy (drugs containing calcium carbonate/osteogenon and cholecalciferol / alfacalcidol), antiplatelet agents or anticoagulants intake. During the treatment, 50% of patients who were adherent to treatment achieved a decrease of pain by ≥ 2 points on the NRS, an increase in motor activity within 6–12 months, and there was no need for surgical invasion. In case of failure to comply with treatment recommendations and/ or seeking medical care at stages 3–4 of AN, a progressive worsening of the clinical course of AN was observed (6.25% of adherent patients). In 10% of cases, this led to the need for total joint replacement (n = 90). The treatment effect did not depend on patient’s gender, localization, or type of AN.
Conclusion. In the course of conservative treatment of AN for 6-12 months, 50% of patients achieved an improvement in the course of the disease. Significant initial radiographic changes and low compliance with treatment reduced the probability of success of conservative therapy.

Keywords: symptomatic slow-acting anti-osteoarthritis drugs (SYSADOA), treatment of aseptic necrosis, aseptic necrosis, teriparatide, osteonecrosis, osteoarthritis, bisphosphonates, nonsteroidal anti-inflammatory drugs

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Literature

1. Проект клинических рекомендаций. Асептический некроз костей (остеонекроз). Ассоциация травматологов-ортопедов России, Медицинская ассоциация по остеонекрозу, Ассоциация ревмоортопедов. 2020. Доступ: https://storage.yandexcloud.net/ator/media/КР остенекроз авг 2020.pdf (дата обращения – 12.02.2025). (Draft clinical guidelines. Аseptic necrosis of bone (osteonecrosis). Association of Traumatologists and Orthopedists of Russia, Medical Association for Osteonecrosis, Association of Rheumoorthopedists. 2020. URL: https://storage.yandexcloud.net/ator/media/КР остенекроз авг 2020.pdf (date of access – 12.02.2025) (In Russ.)).

2. Lee M.S., Hsieh P.-H., Shih C.-H., Wang C.-J. Non-traumatic osteonecrosis of the femoral head – from clinical to bench. Chang Gung Med J. 2010; 33(4): 351–60. PMID: 20804664.

3. 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.

4. 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.

5. Lohiya A.Jr., Dhaniwala N., Dudhekar U. et al. A comprehensive review of treatment strategies for early avascular necrosis. Cureus. 2023; 15(12): e50510.

https://dx.doi.org/10.7759/cureus.50510. PMID: 38226130. PMCID: PMC10788237.

6. 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://doi.org/10.3346/jkms.2021.36.e177. PMID: 34155839. PMCID: PMC8216992.

7. Ko Y.S., Ha J.H., Park J.W. et al. Updating osteonecrosis of the femoral head. Hip Pelvis. 2023; 35(3): 147–56.

https://doi.org/10.5371/hp.2023.35.3.147. PMID: 37727298. PMCID: PMC10505838.

8. Li M., Shao Z., Zhu H., Zhang Y. The diagnosis and treatment of septic hip with osteonecrosis of the femoral head. J Orthop Surg Res. 2024; 19(1): 46.

https://doi.org/10.1186/s13018-023-04518-6. PMID: 38195515. PMCID: PMC10775663.

9. Albers A., Carli A., Routy B. et al. Treatment with acetylsalicylic acid prevents short to mid-term radiographic progression of nontraumatic osteonecrosis of the femoral head: A pilot study. Can J Surg. 2015; 58(3): 198–205.

https://doi.org/10.1503/cjs.016814. PMID: 26011853. PMCID: PMC4447515.

10. Saad F. New research findings on zoledronic acid: Survival, pain, and anti-tumour effects. Cancer Treat Rev. 2008; 34(2): 183–92.

https://doi.org/10.1016/j.ctrv.2007.10.002. PMID: 18061356.

11. 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.

12. 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.

13. Государственный реестр лекарственных средств Минздрава России. Инструкция по медицинскому применению препарата Форстео®. РУ: П N015927/01 от 12.05.2011. Доступ: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=84979df5-d408-4d11-a38f-4f39d86a0c3d (дата обращения – 12.02.2025). (State register of medicines of the Ministry of Healthcare of Russia. Instructions for medical use of the drug Forsteo®. Registration certificate: П N015927/01 from 05/12/2011. URL: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=84979df5-d408-4d11-a38f-4f39d86a0c3d (date of access – 12.02.2025) (In Russ.)).

14. Claben T., Becker A., Landgraeber S. et al. Long-term clinical results after Iloprost treatment for bone marrow edema and avascular necrosis. Orthop Rev (Pavia). 2016; 8(1): 6150.

https://doi.org/10.4081/or.2016.6150. PMID: 27114807. PMCID: PMC4821225.

15. Pountos I., Giannoudis P.V. The role of Iloprost on bone edema and osteonecrosis: Safety and clinical results. Expert Opin Drug Saf. 2018; 17(3): 225–33.

https://doi.org/10.1080/14740338.2018.1424828. PMID: 29315006.

16. Chotanaphuti T., Thongprasert S., Laoruengthana A. Low molecular weight heparin prevents the progression of precollapse osteonecrosis of the hip. J Med Assoc Thai. 2013; 96(10): 1326–30. PMID: 24350415.

17. Glueck C.J., Freiberg R.A., Wissman R., Wang P. Long term anticoagulation (4–16 years) stops progression of idiopathic hip osteonecrosis associated with familial thrombophilia. Adv Orthop. 2015; 2015: 138382.

https://doi.org/10.1155/2015/138382. PMID: 25709842. PMCID: PMC4325553.

18. Matthews A.H., Davis D.D., Fish M.J., Stitson D. Avascular Necrosis. 2023. In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing. 2024. PMID: 30725692.

19. Lee W.Q., Lie H.M., Lie D.T.T. Diagnosis and treatment of avascular necrosis of the humeral head: Current concepts. J ISAKOS. 2023; 8(2): 108–13.

https://doi.org/10.1016/j.jisako.2022.11.002. PMID: 36435432.

20. Hsu H., Nallamothu S.V. Hip Osteonecrosis. 2023. In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing. 2025. PMID: 29763129.

21. Лила А.М., Алексеева Л.И., Бабаева А.Р. с соавт. Возможности фармакологического лечения остеоартрита: фокус на симптоматические медленно действующие препараты (SYSADOA) и индивидуальные особенности пациента. Резолюция международного совещания экспертов. Современная ревматология. 2019; 13(4): 143–147. (Lila A.M., Alekseeva L.I., Babaeva A.R. et al. Pharmacological treatment options for osteoarthritis: focus on symptomatic slow-acting drugs for osteoarthritis (SYSADOA) and individual patient characteristics: Resolution of the international expert meeting. Sovremennaya revmatologiya = Modern Rheumatology Journal. 2019; 13(4): 143–147 (In Russ.)).

https://doi.org/10.14412/1996-7012-2019-4-143-147. EDN: MBAXCN.

22. Лила А.М., Алексеева Л.И., Таскина Е.А. с соавт. Клинические рекомендации (проект) по диагностике и лечению первичного остеоартрита для специалистов первичного звена (врачей-терапевтов, врачей общей практики). Терапия. 2023; 9(1): 7–22. (Lila A.M., Alekseeva L.I., Taskina E.A. et al. Clinical guidelines (project) for the diagnostics and treatment of primary osteoarthritis for primary care specialists (general practitioners, therapists). Terapiya = Therapy. 2023; 9(1): 7–22 (In Russ.)).

https://doi.org/10.18565/therapy.2023.1.7-22. EDN: OQUJDQ.

23. Гайдукова И.З., Трофимов Е.А., Насруллаева А.А., Морозова К.П. Выбор методов лечения мужчины с множественными асептическими некрозами головок трубчатых костей. Терапия. 2023; 9(5): 104–112. (Gaydukova I.Z., Trofimov E.A., Nasrullaeva A.A., Morozova K.P. Choice of treatment methods for a male patient with multiple aseptic necrosis of the heads of tubular bones. Terapiya = Therapy. 2023; 9(5): 104–112 (In Russ.)).

https://doi.org/10.18565/therapy.2023.5.104-112. EDN: CZCTAU.

24. Гайдукова И.З., Мусийчук М.М., Бомбина М.В. с соавт. Случай многоочагового асептического некроза костей с вторичным остеоартритом и глюкокортикоидным остеопорозом у взрослой пациентки с ювенильным дебютом системной красной волчанки – факторы риска и современная тактика терапевтического лечения. РМЖ. Медицинское обозрение. 2024; 8(7): 406–412. (Gaydukova I.Z., Musiychuk M.M., Bombina M.V. et al. Case of multi-focal osteonecrosis with secondary osteoarthritis and glucocorticoid-induced osteoporosis in an adult patient with juvenile-onset systemic lupus erythematosus – risk factors and modern treatment tactics. Russkiy meditsisnkiy zhurnal. Meditsinskoye obozreniye = Russian Medical Journal. Medical Review. 2024; 8(7): 406–412 (In Russ.)).

https://doi.org/10.32364/2587-6821-2024-8-7-6. EDN: GNWFZR.

25. Драпкина О.М., Мазуров В.И., Мартынов А.И. с соавт. Консенсус для врачей по ведению пациентов с бессимптомной гиперурикемией в общетерапевтической практике. Кардиоваскулярная терапия и профилактика. 2024; 23(1): 89–104. (Drapkina O.M., Mazurov V.I., Martynov A.I. et al. Consensus statement on the management of patients with asymptomatic hyperuricemia in general medical practice. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2024; 23(1): 89–104 (In Russ.)).

https://doi.org/10.15829/1728-8800-2024-3737. EDN: WXKMIG.

26. Мазуров В.И., Беляева И.Б., Мясоедов А.А., Шиманьски Д.А. Оптимизация медикаментозного лечения остеонекроза головки бедренной кости, развившегося после новой коронавирусной инфекции: результаты сравнительного наблюдательного проспективного исследования в условиях реальной клинической практики. Эффективная фармакотерапия. 2023; 19(42): 6–16. (Mazurov V.I., Belyaeva I.B., Myasoedov A.A., Shimansky D.A. Optimization of drug treatment of osteonecrosis of the femoral head that developed after a new coronavirus infection: Results of a comparative observational prospective study in real-life clinical practice. Effektivnaya farmakoterapiya = Effective Pharmacotherapy. 2023; 19(42): 6–16 (In Russ.)).

https://doi.org/10.33978/2307-3586-2023-19-42-6-16. EDN: XCEXXO.

27. Клинические рекомендации. Коксартроз. Ассоциация ревматологов России, Ассоциация травматологов-ортопедов России, общероссийская общественная организация «Ассоциация реабилитологов России». Рубрикатор клинических рекомендаций Минздрава России. 2024. ID: 870_1. Доступ: https://cr.minzdrav.gov.ru/preview-cr/870_1 (дата обращения – 12.02.2025). (Clinical guidelines. Coxarthrosis. Association of Rheumatologists of Russia, Association of Orthopedic Traumatologists of Russia, All-Russian public organization “Association of Rehabilitologists of Russia”. Rubricator of clinical guidelines of the Ministry of Healthcare of Russia. 2024. ID: 870_1. URL: https://cr.minzdrav.gov.ru/preview-cr/870_1 (date of access – 12.02.2025) (In Russ.)).

28. Государственный реестр лекарственных средств Минздрава России. Инструкция по медицинскому применению лекарственного препарата Алфлутоп®. РУ: П N012210/01 от 09.07.2007. Доступ: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=53825d50-8a31-4a3e-926d-76f9794cc4f0 (дата обращения – 12.02.2025). (State register of medicines of the Ministry of Healthcare of Russia. Instructions for medical use of the drug Alflutop®. Registration certificate: П N012210/01 from 07/09/2007. URL: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=53825d50-8a31-4a3e-926d-76f9794cc4f0 (date of access – 12.02.2025) (In Russ.)).

About the Autors

Inna Z. Gaydukova, MD, Dr. Sci. (Medicine), deputy director of the Research Institute of Rheumatology, professor of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care with a course in hematology and transfusiology named after E.E. Eichwald of I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia, rheumatologist at V.A. Nasonova Clinical Rheumatology Hospital No. 25. Address: 191015, Saint Petersburg, 41 Kirochnaya St.
E-mail: ubp1976@list.ru
ORCID: https://orcid.org/0000-0003-3500-7256. Scopus Author ID: 55237525900. eLibrary SPIN: 3083-7996
Alena A. Petukhova, MD, resident of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care with a course in hematology and transfusiology named after E.E. Eichwald of I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia. Address: 191015, Saint Petersburg, 41 Kirochnaya St.
E-mail: alenaarifovna@mail.ru
ORCID: https://orcid.org/0000-0001-7696-981X
Marina V. Bombina, MD, rheumatologist at V.A. Nasonova Clinical Rheumatology Hospital No. 25. Address: 191015, Saint Petersburg, 41 Kirochnaya St.
E-mail: m.v.bombina@mail.ru
ORCID: https://orcid.org/0009-0008-1423-6141
Ekaterina P. Bandurko, student of the Faculty of general medicine, secretary of the students scientific society of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care with a course in hematology and transfusiology named after E.E. Eichwald of I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia. Address: 191015, Saint Petersburg, 41 Kirochnaya St.
E-mail: filonenckok@yandex.ru
ORCID: https://orcid.org/0000-0002-3561-4745. eLibrary SPIN: 9895-9119
Oksana V. Inamova, MD, PhD (Medicine), deputy director of the Research Institute of Rheumatology, assistant at the Department of therapy, rheumatology, examination of temporary disability and quality of medical care with a course in hematology and transfusiology named after E.E. Eichwald of I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia, chief physician of V.A. Nasonova Clinical Rheumatology Hospital No. 25. Address: 191015, Saint Petersburg, 41 Kirochnaya St.
E-mail: ovig74@mail.ru
ORCID: https://orcid.org/0000-0001-9126-3639. eLibrary SPIN: 8841-5496
Vadim I. Mazurov, MD, Dr. Sci. (Medicine), professor, academician of RAS, vice president of RSMSIM, principal scientific advisor and director of the Research Institute of Rheumatology, head of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care with a course in hematology and transfusiology named after E.E. Eichwald of I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia, head of Autoimmune center of V.A. Nasonova Clinical Rheumatology Hospital No. 25, chief freelance specialist – rheumatologist of the Healthcare Committee of the Government of Saint Petersburg, Honored Worker of Science of the Russian Federation. Address: 191015, Saint Petersburg, 41 Kirochnaya St.
E-mail: maz.nwgmu@yandex.ru
ORCID: https://orcid.org/0000-0002-0797-2051. Scopus Author ID: 16936315400. eLibrary SPIN: 6823-5482

Aseptic necrosis in the practice of a therapist – treatment efficacy based on one-year period of observation

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