Dysbarism-related osteonecrosis: proceedings of a symposium on dysbaric osteonecrosis. Beckman EL, Elliott DH, eds. Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHEW (NIOSH) Publication No. 75-153, 1974 Jan; :87-90
Clinical and epidemiological characteristics of aseptic bone necrosis were examined as they affect the general population, excluding individuals who were subjected to decompression. Fifty patients afflicted with femoral head necrosis were studied. Age played no part in the occurrence of this condition. Most patients had symptoms for an average of 18 months prior to diagnosis; some had symptoms for 5 years. In these 50 patients, a total of 86 hips were diseased. In addition to osteonecrosis, these patients shared the following factors: excessive alcohol consumption, 37; hepatic disease, 21; gout or hyperuricemia, 16; thrombocytopenia, 15; thrombocythemia, six; steroid therapy, nine; hypercholesteremia, five; and one each for hyperlipidemia, discoid lupus erythematosus, systemic lupus erythematosus, Fabry's disease, Raynaud's disease, and Gaucher's disease. Bleeding and coagulation disorders were unusually frequent. Platelet counts were made of 37 of the patients; 15 had low values and the platelets of six were elevated. The low values ranged down to 4000; elevated ones, as high as 1.5 million. Further testing revealed evidence of a bleeding or clotting disorder in 26 of the 50 patients. The presence of increased concentrations of serum uric-acid was also statistically significant in the patient population. The authors conclude that femoral head necrosis is a skeletal expression of a systemic disease, or diseases, which by a variety of different events may result in sludging, thrombosis, or hemorrhage in an area of very susceptible blood supply.