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Bisphosphonate therapy shows efficacy against traumatic femoral head osteonecrosis in adolescents

At 38.7 months mean follow-up, 14 of 17 patients were pain-free and all patients had either a good or excellent outcome.

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Adolescents who develop femoral head osteonecrosis after trauma may benefit from treatment with bisphosphonates, according to a prospective study by Australian researchers.

Manoj Ramachandran, FRCS(Tr&Orth), and colleagues at the Children's Hospital at Westmead, Sydney, evaluated the efficacy of the drugs in 17 children treated at a mean age of 12.7 years.

To identify children with femoral head osteonecrosis, the researchers performed bone scans immediately after surgical treatment of at-risk hips. Only patients who showed ischemia were offered adjunctive bisphosphonate therapy, according to the study. The study included 12 patients with a severely unstable slip of the femoral capital epiphysis, four patients with a transcervical hip fracture and one patient with a hip dislocation.

Patients were treated with bisphosphonates for an average of 20.3 months.

The first 10 patients received 1 mg/kg of intravenous pamidronate over 3 to 4 hours every other month, which was later increased to 1.5 mg/kg on every other month.

The remaining seven patients received 0.025 mg/kg to 0.05 mg/kg of intravenous zoledronic acid, which was administered over 30 minutes after the initial diagnosis and again at 6 weeks follow-up, at 3 months and every 3 months thereafter, according to the study, published in the American edition of Journal of Bone and Joint Surgery.

"All patients were followed clinically and radiographically for a minimum of 2 years," the authors noted.

At 38.7 months mean follow-up, 14 patients were pain-free. "Clinically, all 17 patients had a good or excellent outcome," the authors wrote.

The Harris hip score averaged 91.2 points, the Iowa Hip Rating averaged 92.1 points and the Global Pediatric Outcomes Data Collection Instrument (PODCI) score averaged 91.5 points, according to the study.

"At the latest radiographic follow-up evaluation, nine hips were rated as Stulberg Class I or II; six as Stulberg Class III; and two as Stulberg Class IV. No areas of femoral head resorption were seen on the radiographs in nine of the 17 patients," the authors reported.

Most patients did have an acute-phase response after their initial bisphosphonate infusion, including fever, headache, nausea or vomiting and general malaise. However, symptoms lasted less than 72 hours and had no apparent long-term effects, the authors noted.

For more information:

• Ramachandran M, Ward K, Brown RR, et al. Intravenous bisphosphonate therapy for traumatic osteonecrosis of the femoral head in adolescents. J Bone Joint Surg Am. 2007;89-A:1727-1734.