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Amyloidosis of the Femoral Neck: An Unusual Cause of Pathologic Fracture. Arthroplast Today 2022; 16:73-77. [PMID: 35662992 PMCID: PMC9160656 DOI: 10.1016/j.artd.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/20/2022] Open
Abstract
The deposition of amyloid within human tissue can be detrimental to the proper functioning of multiple organ systems. While the infiltration of the amyloid protein within the musculoskeletal soft tissues can lead to compressive neuropathies, tendon irritation or rupture, and joint stiffness, pathologic fracture as a result of amyloid deposition in bone is a rare manifestation of amyloidosis. We present a case of pathologic fracture of the femoral neck from amyloid deposition in a 59-year-old male on chronic hemodialysis who was found to have lytic lesions in his proximal femur. At the time of hemiarthroplasty, histopathologic analysis of a femoral head sample revealed apple-green birefringence of the deposits under polarized light, consistent with amyloid deposition. Clinicians should have a high index of suspicion for the atypical presentation of amyloidosis in a patient on chronic hemodialysis with lytic bone lesions.
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Portales-Castillo I, Yee J, Tanaka H, Fenves AZ. Beta-2 Microglobulin Amyloidosis: Past, Present, and Future. KIDNEY360 2020; 1:1447-1455. [PMID: 35372889 DOI: 10.34067/kid.0004922020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/21/2020] [Indexed: 11/27/2022]
Abstract
Almost half a century has elapsed since the first description of dialysis-related amyloidosis (DRA), a disorder caused by excessive accumulation of β-2 microglobulin (B2M). Within that period, substantial advances in RRT occurred. These improvements have led to a decrease in the incidence of DRA. In many countries, DRA is considered a "disappearing act" or complication. Although the prevalence of patients living with RRT increases, not all will have access to kidney transplantation. Consequently, the number of patients requiring interventions for treatment of DRA is postulated to increase. This postulate has been borne out in Japan, where the number of patients with ESKD requiring surgery for carpal tunnel continues to increase. Clinicians treating patients with ESKD have treatment options to improve B2M clearance; however, there is a need to identify ways to translate improved B2M clearance into improved quality of life for patients undergoing long-term dialysis.
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Affiliation(s)
- Ignacio Portales-Castillo
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Jerry Yee
- Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, Michigan
| | - Hiroshi Tanaka
- Division of Nephrology, Department of Medicine, Mihara Red Cross Hospital, Mihara, Japan
| | - Andrew Z Fenves
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Nishi S, Yamamoto S, Hoshino J, Takaichi K, Naiki H. The features of bone articular lesions in dialysis-related amyloidosis (DRA) and criteria for the clinical diagnosis of DRA. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0205-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Fukunishi S, Nishio S, Takeda Y, Fukui T, Fujihara Y, Okahisa S, Yoshiya S. Treatment strategy for amyloid hip arthropathy in long-term hemodialysis patients. J Orthop Sci 2017; 22:898-904. [PMID: 28595800 DOI: 10.1016/j.jos.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 05/02/2017] [Accepted: 05/08/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND The number of hemodialysis patients has been progressively increasing in our country. On the other hand, chronic hip arthropathy associated with long-term hemodialysis is a devastating problems affecting patients' quality of life. In our previous study, we proposed a classification system for radiological abnormalities seen in hemodialysis-related hip lesions. The purpose of the study was to propose the surgical strategy for hip disorders caused by long-term hemodialysis. METHODS Patients with a history of hemodialysis for more than 10 years, 191 hip lesions in 165 consecutive patients who visited our institute due to hip symptoms. Various abnormalities were identified in 116 out of 191 hips. A retrospective assessment of the patient record and radiographs was performed for the included subjects examining the natural course of the disease process as well as the results of surgical treatment. RESULTS Seventy-six hip lesions (69.0%) were conservatively managed at the time of the initial visit. Surgeries were performed for 75 hips (64.7%) during the study period. Among those, surgical treatment was indicated for 40 hips at the time of the initial visit. On the other hand, surgeries were performed for 35 hips during the subsequent follow-up period due to progression of the disease process. CONCLUSIONS Based on the analysis of our surgical experiences by the retrospective chart review, we have established a flowchart of the treatment strategy for chronic hip arthropathy in long-term hemodialysis patients. STUDY DESIGN This study is retrospective clinical study.
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Affiliation(s)
- Shigeo Fukunishi
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Japan.
| | - Shoji Nishio
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Japan
| | - Yu Takeda
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Japan
| | - Tomokazu Fukui
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Japan
| | - Yuki Fujihara
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Japan
| | - Shohei Okahisa
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Japan
| | - Shinichi Yoshiya
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Japan
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Cho YJ, Chun YS, Rhyu KH, Park YK, Ryu KN, Park JS, Liang H, Jung GY, Shin WJ. Amyloid Arthropathy of the Hip Joint Associated with Multiple Myeloma: A Case Report. Hip Pelvis 2016; 28:127-31. [PMID: 27536655 PMCID: PMC4972887 DOI: 10.5371/hp.2016.28.2.127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/10/2016] [Accepted: 03/11/2016] [Indexed: 12/14/2022] Open
Abstract
Amyloidosis is a disease characterized by the deposition of non-soluble fibrous protein in multiple tissues with a number of possible causes. This protein deposition can occur in any tissue, yet is most commonly seen in kidneys, heart, and gastrointestinal tracts. However, invasion to bone tissues is not often reported. The deposition of amyloid proteins in bone tissues may result in joint pain and pathological fractures; it is important to elucidate the causes and detect early to determine prognosis and treat optimally. In the present case report, with relevant literature review, the authors report a case of total hip arthroplasty in an amyloidosis patient.
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Affiliation(s)
- Yoon Je Cho
- Department of Orthopedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Young Soo Chun
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Kee Hyung Rhyu
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Yong Koo Park
- Department of Pathology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Kyung Nam Ryu
- Department of Radiology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Ji Seon Park
- Department of Radiology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Huo Liang
- Department of Orthopedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Gwang Young Jung
- Department of Orthopedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Won Ju Shin
- Department of Orthopedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
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Abstract
A 59-year-old woman presented with worsening bilateral hip pain for 6 months. She had been receiving hemodialysis for 12 years.
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Radiological classification of hip arthropathy associated with long-term haemodialysis. Hip Int 2011; 21:457-62. [PMID: 21818745 DOI: 10.5301/hip.2011.8559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2011] [Indexed: 02/04/2023]
Abstract
Various types of hip lesion associated with long-term haemodialysis have been observed. We present a new radiological classification system of haemodialysis-related hip arthropathy. In total, 103 hip lesions were analyzed in 84 patients undergoing haemodialysis for more than ten years. The hip lesions were classified into 3 types; Type I--cystic type with further subdivisions based on cyst location, Type II--arthritic type, and Type III--deformity of the femoral head. Surgery was performed on 60 hips. We believe our classification system assists decision making on behalf of these patients.
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Parrón Cambero R, Rivera I, Santacruz Arévalo A. Amiloidosis de cadera. Presentación de un caso y revisión de la bibliografía. Rev Esp Cir Ortop Traumatol (Engl Ed) 2011. [DOI: 10.1016/j.recot.2011.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Amyloidosis of the hip. Presentation of a case and a review of the literature. Rev Esp Cir Ortop Traumatol (Engl Ed) 2011. [DOI: 10.1016/j.recote.2011.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Fukunishi S, Yoh K, Yoshiya S. Bone graft for large bone cysts of the femoral neck in patients on hemodialysis. Clin Orthop Relat Res 2007; 461:175-9. [PMID: 17806151 DOI: 10.1097/blo.0b013e31804ec057] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Pathologic fracture of the femoral neck from an amyloid bone cyst in patients on long-term hemodialysis causes substantial morbidity. For patients with a bone cyst occupying more than 1/2 of the neck width, we have performed prophylactic internal fixation with an autogenous iliac bone graft. We describe our surgical technique and present clinical results from consecutively surgically treated patients. We determined whether our procedure successfully induced healing of the bone cyst, thus preventing a problematic sequel of fracture. From 1990 to 2003, 14 hips in 12 patients were treated, and the clinical results from these patients were retrospectively reviewed. One patient died 3 months after surgery; the remaining patients were followed for at least 3 years. In those 11 patients, bony healing was achieved in all cases with no recurrence of the cystic lesion. Considering the comparatively unsatisfactory results of internal fixation for pathologic fracture and THA for patients receiving long-term hemodialysis, our procedure gives surgeons another option for treating this difficult problem.
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Affiliation(s)
- Shigeo Fukunishi
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
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Sakabe T, Imai R, Murata H, Fujioka M, Iwamoto N, Ono T, Kubo T. Life expectancy and functional prognosis after femoral neck fractures in hemodialysis patients. J Orthop Trauma 2006; 20:330-6. [PMID: 16766936 DOI: 10.1097/00005131-200605000-00006] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To identify whether differences exist in the outcomes between patients undergoing hemodialysis and elderly nonhemodialysis patients with a femoral neck fracture. DESIGN Retrospective review. SETTING Level 1 trauma center. PATIENTS/INTERVENTIONS A total of 71 femoral neck fractures in 62 patients undergoing hemodialysis treated nonoperatively or operatively. MAIN OUTCOME MEASUREMENTS Clinical outcomes were analyzed to identify factors that may be correlated with life expectancy and functional prognosis. RESULTS The overall survival rates in this study at 1-year and 5-years postfracture were found to be 89.8% and 51.5%, respectively. There were significant correlations among the survival rate, patients' age, type of treatment, prefracture ambulation status, and prefracture activities of daily living status. However, using multivariate analysis, the only significant predictor of life expectancy was prefracture ambulation status. As for functional prognosis, the rates of total ambulation recovery and total activities of daily living recovery at 1-year postfracture were 50.0% and 71.2%, respectively. Both patients' age and age at the onset of hemodialysis may contribute considerably to functional prognosis in patients undergoing hemodialysis after femoral neck fracture. CONCLUSIONS The present study suggests that the clinical outcomes of patients with femoral neck fractures who undergo hemodialysis are considerably superior to those of previous studies. In addition, when those fractures are treated surgically with specific management in patients undergoing hemodialysis, it may be possible to expect a life expectancy and functional prognosis similar to elderly nonhemodialysis patients with hip fractures.
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Affiliation(s)
- Tomoya Sakabe
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kyoto, 602-8566, Japan.
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Chang SW, Murphy KPJ. Percutaneous CT-guided Cementoplasty for Stabilization of a Femoral Neck Lesion. J Vasc Interv Radiol 2005; 16:889-90. [PMID: 15947056 DOI: 10.1016/s1051-0443(07)60698-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Kay J, Bardin T. Osteoarticular disorders of renal origin: disease-related and iatrogenic. Best Pract Res Clin Rheumatol 2000; 14:285-305. [PMID: 10925746 DOI: 10.1053/berh.2000.0066] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Osteoarticular disorders significantly limit the quality of long-term survival with chronic renal failure. beta 2M amyloidosis is a complication of chronic renal failure that has been recognized mostly in patients receiving long-term haemodialysis. Patients with beta 2M amyloidosis typically present with the triad of shoulder periarthritis, carpal tunnel syndrome, and flexor tenosynovitis of the hands. Other musculoskeletal manifestations of beta 2M amyloidosis include destructive spondyloarthropathy, cervico-occipital pseudotumours, bone cysts, and pathological fractures. At present, only renal transplantation may slow or halt the progession of beta 2M amyloidosis. Crystal-induced arthropathy, most commonly caused by basic calcium phosphate crystals, is an important cause of acute joint inflammation in the patient with renal failure. The incidence of bone and joint infection is increased in patients undergoing dialysis. Haemodialysis and peritoneal dialysis are also associated with an erosive or destructive arthropathy of finger joints, which is not explained by local amyloid deposition.
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Affiliation(s)
- J Kay
- Department of Internal Medicine, Lahey Clinic Medical Center, Burlington, Massachusetts, USA
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Shiota E, Maekawa M, Ohtani M. Analysis of synovial fluid components of hydrarthrosis in long-term hemodialysis patients. J Orthop Sci 1999; 4:171-5. [PMID: 10370156 DOI: 10.1007/s007760050089] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The synovial fluid components in long-term hemodialysis patients (HD; 43 knees in 43 patients) were investigated and compared with those in patients with osteoarthritis (OA; 21 knees in 21 patients) and rheumatoid arthritis (RA; 26 knees in 26 patients). The average ages in the three groups were, respectively, 60.7 years (range, 34-79 years), 63.2 years (range, 48-88 years), and 59.7 years (range, 37-76 years). The duration of hemodialysis in the HD group averaged 14.0 years (range, 4-24 years). The concentrations of hyaluronic acid, protein, and isomers of chondroitin sulfate (chondroitin 6-sulfate [C6S] and chondroitin 4-sulfate [C4S]) in the synovial fluid, and its viscosity were measured. Differences in each of the parameters were investigated according to disease clinical stage, roentgenological grade, and periods of dialysis in the HD group. The viscosity of the synovial fluid and the concentration of hyaluronic acid in HD patients were similar to those in OA patients; however, the C6S/C4S ratio in the synovial fluid of HD patients was similar to that in RA patients. The latter finding suggests that synovitis may be present in the hydrarthrosis of HD patients. The cause of this synovitis in HD patients remains to be elucidated.
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Affiliation(s)
- E Shiota
- Department of Orthopaedic Surgery, Chikushi Hospital, Fukuoka University, Chikushino, Fukuoka 818-8502, Japan
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Affiliation(s)
- A M Parfitt
- Division of Endocrinology and Metabolism and Center for Osteoporosis and Metabolic Bone Disease, University of Arkansas for Medical Sciences, Little Rock 72205-7199, USA
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