Park CW, et al. J Korean Med Sci. 2020 Oct;35(42):e379. https://doi.org/10.3346/jkms.2020.35.e379

Non-traumatic osteonecrosis of the femoral head (ONFH) is a plausible complication in brain tumor patients. Frequent use of corticosteroid therapy, chemotherapy, and oxidative stress for managing brain tumors may be associated with the development of ONFH. However, there is little knowledge on the prevalence and risk factors of ONFH from brain tumor. This study aimed to investigate the prevalence and risk factors of ONFH in patients with primary brain tumors. This retrospective cohort study included data from consecutive patients between December 2005 and August 2016 from a tertiary university hospital in South Korea. A total of 73 cases of ONFH were identified among 10,674 primary brain tumor patients. After excluding subjects (25 out of 73) with missing data, history of alcohol consumption or smoking, history of femoral bone trauma or surgery, comorbidities such as systemic lupus erythematosus (SLE), sickle cell disease, cancer patients other than brain tumor, and previous diagnosis of contralateral ONFH, we performed a 1:2 propensity score-matched, case–control study (ONFH group, 48; control group, 96). Risk factors of ONFH in primary brain tumor were evaluated by univariate and multivariate logistic regression analyses. The prevalence of ONFH in patients with surgical resection of primary brain tumor was 683.9 per 100,000 persons (73 of 10,674). In this cohort, 55 of 74 patients (74.3%) underwent THA for ONFH treatment. We found that diabetes was an independent factor associated with an increased risk of ONFH in primary brain tumor patients (OR = 7.201, 95% CI, 1.349–38.453, p = 0.021). There was a significant difference in univariate analysis, including panhypopituitarism (OR = 4.394, 95% CI, 1.794–11.008, p = 0.002), supratentorial location of brain tumor (OR = 2.616, 95% CI, 1.245–5.499, p = 0.011), and chemotherapy (OR = 2.867, 95% CI, 1.018–8.069, p = 0.046). This study demonstrated that the prevalence of ONFH after surgical resection of primary brain tumor was 0.68%. Diabetes was an independent risk factor for developing ONFH, whereas corticosteroid dose was not. Routine screening for brain tumor-associated ONFH is not recommended; however, a high index of clinical suspicion in these patients at risk may allow for early intervention and preservation of the joints.

Background: Sciatic neuropathy can result from pressure, injury, or inflammation around the sciatic nerve. In rare instances, sciatic neuropathy is caused by an intraneural ganglion cyst (IGC) originating from the hip joint. However, an effective treatment modality for this condition has not yet been established. The purpose of the present study was to evaluate the clinical and radiographic outcomes of hip arthroscopy for the treatment of IGCs involving the sciatic nerve. Methods: We reviewed the records on a consecutive series of hip arthroscopy procedures that had been performed by a single surgeon for the treatment of sciatic IGCs between July 2016 and February 2022. Thirteen Asian patients (13 hips) with symptomatic sciatic neuropathy were included. During arthroscopic surgery, IGCs were decompressed by enlarging their periarticular connection. Magnetic resonance imaging (MRI) and electrodiagnostic evaluation were routinely performed. The visual analog scale (VAS) for pain and modified Harris hip score (mHHS) were used for clinical evaluations. The mean age at the time of surgery was 57 years (range, 23 to 72 years), and the mean duration of follow-up was 41 months (range, 24 to 87 months). Results: The mean VAS score decreased from 8.3 preoperatively to 1.9 at the latest evaluation (p < 0.001). Satisfactory pain relief was reported by 12 patients (92%), including 9 patients (69%) who had complete remission. Four of the 6 patients with sensory impairment and 3 of the 4 patients with motor weakness reported complete recovery. The mean mHHS improved from 51.5 to 94.1 (p < 0.001). In MRI comparisons, the mean largest diameter and length of IGCs decreased from 2.6 to 0.5 cm (p < 0.001) and from 6.8 to 0.6 cm (p < 0.001), respectively. IGCs completely disappeared on MRI in 9 patients (69%). The latest electrodiagnostic studies confirmed improvement in all 12 patients with preoperative abnormalities. One patient (8%) with symptomatic recurrence was successfully treated with revision arthroscopic decompression. Conclusions: In patients with sciatic neuropathy, the possibility of IGCs arising from the hip should be considered. Our findings suggest that arthroscopic hip surgery is a less-invasive and more-effective treatment for relieving neuropathic pain and neurological deficits associated with sciatic IGCs. Level of Evidence: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.