Osteonecrosis of the Femoral Head in Patients with Hypercoagulability—From Pathophysiology to Therapeutic Implications

Osteonecrosis of the femoral head (ONFH) is a debilitating disease with major social and economic impacts. It frequently affects relatively young adults and has a predilection for rapid progression to femoral head collapse and end-stage hip arthritis. If not diagnosed and treated properly in the ear...

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Bibliographic Details
Published in:International journal of molecular sciences 2021-07, Vol.22 (13), p.6801
Main Authors: Rezus, Elena, Tamba, Bogdan Ionel, Badescu, Minerva Codruta, Popescu, Diana, Bratoiu, Ioana, Rezus, Ciprian
Format: Article
Language:English
Subjects:
Alcoholism
Anticoagulants
Arthritis
Biomedical materials
Blood platelets
Congenital diseases
Disease prevention
Economic impact
Etiology
Femur
Health services
Hypotheses
Ischemia
Mutation
Occlusion
Osteonecrosis
Pathophysiology
Patients
Polymorphism
Prophylaxis
Proteins
Quality of life
Review
Risk analysis
Risk factors
Sickle cell anemia
Thrombophilia
Thrombosis
Total hip arthroplasty
Veins & arteries
White people
Young adults
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Summary:Osteonecrosis of the femoral head (ONFH) is a debilitating disease with major social and economic impacts. It frequently affects relatively young adults and has a predilection for rapid progression to femoral head collapse and end-stage hip arthritis. If not diagnosed and treated properly in the early stages, ONFH has devastating consequences and leads to mandatory total hip arthroplasty. The pathophysiology of non-traumatic ONFH is very complex and not fully understood. While multiple risk factors have been associated with secondary ONFH, there are still many cases in which a clear etiology cannot be established. Recognition of the prothrombotic state as part of the etiopathogeny of primary ONFH provides an opportunity for early medical intervention, with implications for both prophylaxis and therapy aimed at slowing or stopping the progression of the disease. Hereditary thrombophilia and hypofibrinolysis are associated with thrombotic occlusion of bone vessels. Anticoagulant treatment can change the natural course of the disease and improve patients’ quality of life. The present work focused on highlighting the association between hereditary thrombophilia/hypofibrinolysis states and ONFH, emphasizing the importance of identifying this condition. We have also provided strong arguments to support the efficiency and safety of anticoagulant treatment in the early stages of the disease, encouraging etiological diagnosis and prompt therapeutic intervention. In the era of direct oral anticoagulants, new therapeutic options have become available, enabling better long-term compliance.
ISSN:1422-0067
1661-6596
1422-0067
DOI:10.3390/ijms22136801