Kirk D. Miller, MD; Henry Masur, MD; Elizabeth C. Jones, MD, MPH; Galen O. Joe, MD; Margaret E. Rick, MD; Grace G. Kelly, MSS; JoAnn M. Mican, MD; Shuying Liu, BSN; Lynn H. Gerber, MD; William C. Blackwelder, PhD; Judith Falloon, MD; Richard T. Davey, MD; Michael A. Polis, MD, MPH; Robert E. Walker, MD; H. Clifford Lane, MD; Joseph A. Kovacs, MD
Miller KD, Masur H, Jones EC, Joe GO, Rick ME, Kelly GG, et al. High Prevalence of Osteonecrosis of the Femoral Head in HIV-Infected Adults. Ann Intern Med. 2002;137:17-25. doi: 10.7326/0003-4819-137-1-200207020-00008
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Published: Ann Intern Med. 2002;137(1):17-25.
Osteonecrosis (avascular necrosis) of the hip is an uncommon but painful and disabling condition that sometimes requires total hip replacement.
This large survey showed that an unusually high percentage of HIV-infected adults (4.4% [95% CI, 2.5% to 7.2%]) had osteonecrosis of the hip, as detected by magnetic resonance imaging.
Although screening asymptomatic HIV-infected patients is not warranted, osteonecrosis should be considered in HIV-infected patients with persistent groin or hip pain.
Shown are screening coronal T1-weighted images (left) and corresponding fat-suppressed T2-weighted images (right). A. Unilateral osteonecrosis in one patient. B and C. Bilateral osteonecrosis in two patients. In addition to having the curvilinear lesions of osteonecrosis, the patient at bottom (panel C) has increased signal in the head and neck of the left femur, consistent with edema surrounding the area of osteonecrosis. The patients in panels B and C developed symptoms after study enrollment.
Shown are high-resolution T1-weighted images (left) and corresponding fat-suppressed T2-weighted images (right). A. Coronal view of a wedge-shaped lesion of the anteromedial femoral head. B. Saggital view of a small subchondral lesion of the anterior superior aspect of the femoral head. C. Axial view of a large curvilinear lesion of the femoral head.
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