HAEMATOLOGICAL FACTORS POTENTIALLY IMPLICATED IN THE PATHOPHYSIOLOGY OF AVASCULAR NECROSIS (AVN) OF THE FEMORAL HEAD: HYPOFIBRINOLYSIS AS A CAUSE OF AVN

Abstract

Avascular necrosis is poorly understood. The etiological factors have not been fully delineated. This disease process had a huge cost impact on the health system due to surgical treatment. Patients with avascular necrosis seen at a single institution underwent DNA extraction and analysis, coagulation-related analysis and buccal smears with DNA analysis. In this patient group 60% tested positive for at least one thrombophilic or hypofibrinolysis factor. We make recommendations depending on the defect in the cascade, allowing for potential non-surgical management of osteonecrosis in patients undergoing therapy with known antagonistic medications (i.e. corticosteroids).

The etiology and pathogenesis of nontraumatic AVN need to be better elucidated.

Our study identifies the potential association of thrombophilic and hypofibrinolytic factors and osteonecrosis of the hip, particularly genetic markers as identified through DNA markers

The significance of this study:

1. Osteonecrosis is a devastating musculoskeletal condition;

2. Tends to occur in young people;

3. Treatments are suboptimal mostly palliative and not curative;

4. currently unable to identify persons at risk for AVN;

5. cannot reverse the process once AVN has developed.

60% of patients had at least one tested thrombophilic or hypofibrinolysis factor positive. Most patients never had a thrombotic event.

Genetic screening, multiple hematological paramteres were tested on patients with avascular necrosis.

1. hypercoagulability plays a role in the development of AVN of the hip, mainly at the microvascular level;

2. an impairment at the level of the fibrinolytic system through high PAI-1 levels is a potential mechanism responsible for the development of AVN;

3. a genetic predisposition is implicated, at least in part, in the development of AVN of the hip.

4. most patietns had a multifactorial problem and genetic screening and blood testing will lead to recommended therapy (medical) for those patients at risk.