International Orthopaedics

, Volume 42, Issue 6, pp 1203–1211 | Cite as

Hip osteonecrosis and pregnancy in healthy women

  • Philippe Hernigou
  • Sibylle Jammal
  • Jacques Pariat
  • Charles Henri Flouzat-Lachaniette
  • Arnaud Dubory
Original Paper

Abstract

Purpose

Osteonecrosis has been reported to be associated with pregnancy in the absence of other known risk factors for the disease. Few population-based data exist to support an association since the association is rare. We investigated the association of the femoral head and pregnancy to define if pregnancy was a risk factor and to define the risk period.

Methods

Using a case-crossover method design among 652 patients who were healthy (without any known cause of osteonecrosis) during or after pregnancy, we defined the periods of risk based on the timing of reported osteonecrosis and pregnancy. We compared each patient’s likelihood of osteonecrosis during a ten years period including five years antepartum, pregnancy and five years postpartum with nine month intervals for the ten year and three month intervals for the two years after gestation.

Results

For the 436 women who had only one child and one hip osteonecrosis, the incidence of osteonecrosis was 71.8% during pregnancy and the postpartum period, compared with 28.2% during the equivalent antepartum period for this population. Nine months after delivery, the risk of osteonecrosis declined progressively over time, from an odds ratio of 14.5 (95% confidence interval, 8.2—18.3) in last trimester of pregnancy. After the 27th month following onset of pregnancy, the relative risk was no more significantly different from the baseline risk observed in the antepartum period of women who had osteonecrosis before gestation. For women with several children, a subsequent pregnancy was not associated with osteonecrosis.

Conclusions

A risk of hip osteonecrosis is present during the end of pregnancy and after delivery, and appears to decrease quickly.

Keywords

Hip osteonecrosis Pregnancy Crossover study 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Montella BJ, Nunley JA, Urbaniak JR (1999) Osteonecrosis of the femoral head associated with pregnancy. J Bone Joint Surg 81-A:790–798CrossRefGoogle Scholar
  2. 2.
    Kay NR, Park WM, Bark M (1972) The relationship between pregnancy and femoral head necrosis. Br J Radiol 45:828–831CrossRefPubMedGoogle Scholar
  3. 3.
    Marya SKS, Mittal SK, Kumar S, Tuli SM, Sethi S, Bhargava SK (1990) Avascular necrosis of the femoral head in pregnancy. Ann Nat Acad Med Sci (India) 26:31–36Google Scholar
  4. 4.
    Steib-Furno S, Luc M, Pham T, Armingeat T, Porcu G, Gamerre M, Chagnaud C, Lafforgue P (2007) Pregnancy-related hip diseases: incidence and diagnoses. Joint Bone Spine 74(4):373–378CrossRefPubMedGoogle Scholar
  5. 5.
    Petrigliano FA, Lieberman JR (2007) Osteonecrosis of the hip: novel approaches to evaluation and treatment. Clin Orthop Relat Res 465:53–62PubMedGoogle Scholar
  6. 6.
    Zhang NF, Li ZR, Wei HY, Liu ZH, Hernigou P (2008) Steroid-induced osteonecrosis: the number of lesions is related to the dosage. J Bone Joint Surg (Br) 90:1239–1243CrossRefGoogle Scholar
  7. 7.
    Maclure M (1991) The case cross-over design: a method for studying transient effect on the risk of acute events. Am J Epidemiol 133:144–153CrossRefPubMedGoogle Scholar
  8. 8.
    ameli.fr - l’Assurance Maladie en ligne. Available at: http://www.ameli.fr/#
  9. 9.
    Lausten GS (1991) Osteonecrosis of the femoral head during pregnancy. Arch Orthop And Trauma Surg 110:214–215CrossRefGoogle Scholar
  10. 10.
    Myllynen P, Makela A, Kontula K (1988) Aseptic necrosis of the femoral head during pregnancy. Obstet Gynecol 71:495–498PubMedGoogle Scholar
  11. 11.
    Pellicci PM, Zolla-Pazner S, Rabhan WN, Wilson PD Jr (1984) Osteonecrosis of the femoral head associated with pregnancy. Report of three cases. Clin Orthop 185:59–63Google Scholar
  12. 12.
    Zolla-Pazner S, Pazner SS, Lanyi V, Meltzer M (1980) Osteonecrosis of the femoral head during pregnancy. JAMA 244:689–690CrossRefPubMedGoogle Scholar
  13. 13.
    Lausten GS (1991) Osteonecrosis of the femoral head during pregnancy. Arch Orthop Trauma Surg 110:214–215CrossRefPubMedGoogle Scholar
  14. 14.
    Hasegawa Y, Iwase T, Iwasada S, Kitamura S, Iwata H (1999) Osteonecrosis of the femoral head associated with pregnancy. Arch Orthop Trauma Surg 119:112–114CrossRefPubMedGoogle Scholar
  15. 15.
    Ginsberg JS, Brill-Edwards P, Bona R, Burrows R (1991) Deep vein thrombosis (DVT) during pregnancy: leg and trimester of presentation. Thromb Haemost 65:720Google Scholar
  16. 16.
    Cockett FB, Thomas ML (1965) The iliac compression syndrome. Br J Surg 52:816–821CrossRefPubMedGoogle Scholar
  17. 17.
    Cushard WG Jr, Creditor MA, Canterbury JM, Reiss E (1972) Physiologic hyperparathyroidism in pregnancy. J Clin Endocrinol Metab 34:767–771CrossRefPubMedGoogle Scholar
  18. 18.
    Goldberg S, Lewenthal H, Gottfried I, Ben-Aderet N (1966) Free 11-hydroxycorticosteroids in plasma in normal pregnancies and in cases of fetal death and missed abortion. Am J Obstet Gynecol 95:892–896CrossRefPubMedGoogle Scholar
  19. 19.
    Hellman L, Yoshida K, Zumoff B, Levin J, Kream L, Fukushima DK (1976) The effect of medroxyprogesterone acetate on the pituitary-adrenal axis. J Clin Endocrinol Metab 42:912–917CrossRefPubMedGoogle Scholar
  20. 20.
    Rosenthal HE, Slaunwhite WR Jr, Sandberg AA (1969) Transcortin: a corticosteroid-binding protein of plasma. X. Cortisol and progesterone interplay and unbound levels of these steroids in pregnancy. J Clin Endocrinol 29:352–367CrossRefGoogle Scholar
  21. 21.
    Siiteri PK, Febres E, Clemens LE, Chang RL, Gondos B, Stites D (1977) Progesterone and maintenance of pregnancy: is progesterone nature’s immunosuppressant? Ann N Y Acad Sci 2(286):384–397CrossRefGoogle Scholar
  22. 22.
    Wood TJ, Hoppe DJ, Winemaker M, Adili A (2016) Bilateral osteonecrosis of the femoral head during pregnancy following two corticosteroid injections: a case report and review of the literature. Cureus 8(4):e556PubMedPubMedCentralGoogle Scholar
  23. 23.
    Ugwonali OF, Sarkissian H, Nercessian OA (2008) Bilateral osteonecrosis of the femoral head associated with pregnancy: four new cases and a review of the literature. Orthopedics 31:183CrossRefPubMedGoogle Scholar
  24. 24.
    Vandenbussche E, Madhar M, Nich C, Zribi W, Abdallah T, Augereau B (2005) Bilateral osteonecrosis of the femoral head after pregnancy. Arch Orthop Trauma Surg 125:201–203CrossRefPubMedGoogle Scholar
  25. 25.
    Brodell JD, Burns JE Jr, Heiple KG (1989) Transient osteoporosis of the hip of pregnancy two cases complicated by pregnancy two cases complicated by pathological fracture. J Bone Joint Surg 71-A:1252–1257CrossRefGoogle Scholar
  26. 26.
    Guerra JJ, Steinberg ME (1995) Current concepts review. Distinguishing transient osteoporosis from avascular necrosis of the hip. J Bone Joint Surg 77-A:616–624CrossRefGoogle Scholar
  27. 27.
    Shifrin LZ, Reis ND, Zinman H, Besser MI (1987) Idiopathic transient osteoporosis of the hip. J Bone Joint Surg 69-B(5):769–773CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2017

Authors and Affiliations

  • Philippe Hernigou
    • 1
  • Sibylle Jammal
    • 2
  • Jacques Pariat
    • 1
  • Charles Henri Flouzat-Lachaniette
    • 3
  • Arnaud Dubory
    • 1
  1. 1.Hôpital Henri MondorUniversity Paris East (UPEC)CreteilFrance
  2. 2.Hôpital Europeen Georges PompidouParisFrance
  3. 3.Hôpital Henri MondorCreteilFrance

Personalised recommendations