Osteonecrosis de la cabeza femoral inducida por corticoides

Abstract

Objective: The present study aims to highlight the importance of femoral head osteonecrosis and its non-traumatic and preventable causes, one of the main ones being the use of long-term corticosteroid therapy. Materials and methods: An extensive analysis of the digital clinical history of the patient during his last hospitalization was carried out, which rests in the computer system of the Hospital de Especialidades FF.AA N ° 1; protecting all personal data to comply with the rules of confidentiality. Case report: A 59-year-old male patient with a significant pathological history. It is found that during the previous hospitalization (about 3 months before the last hospitalization) that the patient receives treatment for at least 58 days based on Prednisone, for diagnosis of polymyositis. Moment in which the patient did not present symptoms of hip joint injury.
Discussion: Steroid-induced avascular necrosis of the femoral head is a pathology with high morbidity and mortality. Properly investigating the patient's history is the first and most important step to reach its diagnosis. Currently the study with the
highest sensitivity-specificity to detect osteonecrosis of the femoral head is Nuclear Magnetic Resonance, and its periodic application in patients at high risk of avascular osteonecrosis can help its diagnosis in early stages. The Ficat and Arlet Classification of avascular necrosis of the femoral head is the scale currently used to grade the stage, which is the most useful for making therapeutic decisions. Treatment can be mainly divided into surgical and non-surgical treatment. The treatment will be according to the stage of the disease, between pre-collapsed and post-collapsed; being the precollapse treatment the most debated. Evidence: The level of evidence according to the "Scottish Intercollegiate Guidelines Network" is 3B as it is a Case Report. Corticosteroids are an important cause of avascular necrosis, and one of the most common locations is the femoral head.