TITLE:
Factors Associated with Aseptic Osteonecrosis in Hospital Settings in Yaounde, Cameroon
AUTHORS:
Madeleine Singwé-Ngandeu, Amina Al-Maye Bit Younouss, Bernard Chetcha Chemeni, Ibrahima Farikou, Magloire Biwole Sida, Paul Olivier Koki Ndombo
KEYWORDS:
Osteonecrosis, Sickle Cell Disease, Risk Factor, Femoral Head
JOURNAL NAME:
Open Journal of Rheumatology and Autoimmune Diseases,
Vol.5 No.1,
February
10,
2015
ABSTRACT: Introduction: Osteonecrosis is the cellular death of the various components of bone. It mostly affects the femoral head, and its real incidence is unknown. Many causative factors may be involved in its genesis. In Sub-Saharan Africa, it affects mainly young patients and the S and C hemoglobinopathies are the most affected backgrounds. Objective: To determine factors associated with aseptic osteonecrosis of the femoral head in hospital settings in Yaounde, Cameroon. Methodology: It was a cross-sectional multicentric study on 29,474 files of black Cameroonian patients seen during consultation or admission, within a five-year period, carried at the Central Hospital, the National Center for Rehabilitation of Handicaped Persons and at the FROT Clinic in Yaounde, Cameroon. Files of patients with aseptic osteonecrosis of the femoral head (1 file = 1 patient) were enrolled. The diagnosis was retained solely based on clinical and radiologic criteria. Magnetic resonance imaging, tomodencitometry and/or bone scintigraphy were also considered when available. Classification of lesions obeyed Ficat-Arlet criteria. Patients’ files with little information and hip diseases other than aseptic osteonecrosis were excluded. Results: Fifty-one cases (0.17%) of aseptic osteonecrosis were recruited; among them, there are 28 males (55%) and 23 females (45%). Their mean age was 38.9 ± 16.4 years (extremes: 7 and 78 years). Those aged 21 to 30 years represented 25.5% of cases. Pain and loss of function were present in all patients. The lesion occurred in the right hip in 22 cases (41.1%), and left hip in 13 cases (25.5%); 16 patients (31.4%) had both hip affected. X-ray was performed for all patients. Radiologic lesions were at Stage IV in 2 cases (3.9%), III for 44 cases (86.3%), and II in 5 cases (9.8%). Factors associated with aseptic osteonecrosis were observed in 29 patients and their frequencies were as follows: sickle cell disease: n = 12 (25.3%); trauma: n = 10 (19.6%); alcoholism: n = 3 (5.9%); athletic practice: n = 3 (5.9%); and 2 patients (3.9%) were on treatment with steroid. HIV infection occurred in 2 cases (1.9%); dyslipidemia, hyperuricemia and systemic lupus erythematosus were diagnosed in 1 case (1.9%) each. Conclusion: The relative incidence of aseptic osteonecrosis of the femoral head in hospital settings in Yaounde is 0.17% and mostly young adults are affected. Lesions are discovered at an advanced radiographic stage and sickle cell disease is the first associated factor.