A 12-year follow-up study of combined treatment of post-severe acute respiratory syndrome patients with femoral head necrosis

Liu, Tiansheng; Ma, Jinchao; Su, Bin; Wang, Hao; Wang, Qi; Ma, Xinlong

Osteonecrosis of the femoral head (ONFH) is a refractory disease in orthopedics practice and can be divided into traumatic and non-traumatic types. Major reasons causing non-traumatic ONFH include hormone abuse, ethanol overdosage, congenital and other unknown factors. In the spring of 2003, the severe acute respiratory syndrome (SARS) broke out in most cities of China, and the patients who recovered from SARS suffered mostly from the refractory disease -ONFH. The incidence of ONFH is ∼60%-70% after SARS treatment, and ONFH mostly occurred in bilateral sides. 1 It is thought that post-SARS ONFH is mainly caused by the application of high dosage of glucocorticoid hormones during SARS treatment, though some studies indicated that other reasons might be applicable in those cases. 2,3 SARS could be one independent risk factor causing ONFH, 4, 5 perhaps via mediation by S proteins. 6 Due to unclear pathogenesis and mechanism of SARS, there has been no definitive treatment strategy for ONFH. Major treatment approaches include non-surgery (drugs, hyperbaric oxygen, extracorporeal shock wave, pulsed electromagnetic treatment, decreased loading, and proper breaking and retraction) and surgery (medullary decompression of femur, bone transplant without vessels, osteotomy, autograft bone transplantation with vessels, and artificial joint replacement). [8] [9] [10] Here, we retrospectively studied the long-term efficacies of the combined treatment (non-surgery) for 37 post-SARS patients suffering from ONFH between the end of 2003 and the end of 2015.