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

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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.

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Inna Gaydukova

I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia; V.A. Nasonova Clinical Rheumatology Hospital No. 25

编辑信件的主要联系方式.
Email: ubp1976@list.ru
ORCID iD: 0000-0003-3500-7256
SPIN 代码: 3083-7996
Scopus 作者 ID: 55237525900

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, rheumatologist

俄罗斯联邦, 191015, Saint Petersburg, 41 Kirochnaya St.; 190068, Saint Petersburg, 30 Bol`shaya Pod`yacheskaya St.

Alena Petukhova

I.I. Mechnikov North-West state medical university of the Ministry of Healthcare of Russia

Email: alenaarifovna@mail.ru
ORCID iD: 0000-0001-7696-981X

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

俄罗斯联邦, 191015, Saint Petersburg, 41 Kirochnaya St.

Marina Bombina

V.A. Nasonova Clinical Rheumatology Hospital No. 25

Email: m.v.bombina@mail.ru
ORCID iD: 0009-0008-1423-6141

MD, rheumatologist

俄罗斯联邦, 190068, Saint Petersburg, 30 Bol`shaya Pod`yacheskaya St.

Ekaterina Bandurko

V.A. Nasonova Clinical Rheumatology Hospital No. 25

Email: filonenckok@yandex.ru
ORCID iD: 0000-0002-3561-4745
SPIN 代码: 9895-9119

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

俄罗斯联邦, 190068, Saint Petersburg, 30 Bol`shaya Pod`yacheskaya St.

Oksana Inamova

I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia; V.A. Nasonova Clinical Rheumatology Hospital No. 25

Email: ovig74@mail.ru
ORCID iD: 0000-0001-9126-3639
SPIN 代码: 8841-5496

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, chief physician

俄罗斯联邦, 191015, Saint Petersburg, 41 Kirochnaya St.; 190068, Saint Petersburg, 30 Bol`shaya Pod`yacheskaya St.

Vadim Mazurov

I.I. Mechnikov North-West State Medical University of the Ministry of Healthcare of Russia; V.A. Nasonova Clinical Rheumatology Hospital No. 25

Email: maz.nwgmu@yandex.ru
ORCID iD: 0000-0002-0797-2051
SPIN 代码: 6823-5482
Scopus 作者 ID: 16936315400

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, head of Autoimmune center, chief freelance specialist – rheumatologist of the Healthcare Committee of the Government of Saint Petersburg, Honored Worker of Science of the Russian Federation

俄罗斯联邦, 191015, Saint Petersburg, 41 Kirochnaya St.; 190068, Saint Petersburg, 30 Bol`shaya Pod`yacheskaya St.

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2. Fig. 1. The main diagnosis in patients included in the study with a verified diagnosis of "secondary aseptic necrosis"

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3. Fig. 2. Concomitant diseases in patients included in the study with a verified diagnosis of aseptic necrosis

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4. Fig. 3. Drug therapy for aseptic necrosis in patients included in the study

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5. Fig. 4. Relative number of patients included in the study who achieved different effects from conservative treatment of aseptic necrosis

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