PATHOGENESIS/PATHOPHYSIOLOGY

THE ROLE OF THROMBOTIC AND FIBRINOLYTIC DISORDERS IN THE ETIOLOGY OF OSTEONECROSIS OF THE FEMORAL HEAD

Yong-Chan Ha, Kyung-Hoi Koo, Kwang Kon Kim
Department of Orthopaedic Surgery, Gyeong-Sang National University School of Medicine,
90 Chilam-dong, Chinju 660-702, South Korea

PURPOSE: Recent studies have suggested that thrombotic and fibrinolytic disorders; increased plasminogen activator inhibitor type I (PAI-I), increased anticardiolipin antibody immunoglobulin and decreased protein-S may be etiologic causes of osteonecrosis. A case-control study was conducted to determine whether these disorders are associated with nontraumatic osteonecrosis of the femoral head in South Korea.

METHODS: Twenty-four consecutive patients who had been diagnosed as having nontraumatic osteonecrosis of the femoral head were matched with twenty four control patients for gender, age (1-year range), and the time of presentation (1-year range). Eight of twenty-four patients had idiopathic osteonecrosis and the remaining sixteen patients secondary osteonecrosis. Thrombotic disorders were investigated for protein C activity / antigenecity, protein S activity / antigenecity, antithrombin III, anticardiolipin antibody immunoglobulin G and M, and lupus antibody. Fibrinolytic disorders were investigated for tissue plasminogen activator (tPA), plasminogen activator inhibitor type I (PAI-1), PAI-l/tPA ratio, lipoprotein(a), and plasminogen.

RESULTS: The levels of plasminogen activator inhibitor type I (PAI-1) and anticardiolipin antibody immunoglobulins were not increased in patients compared with controls. The level of protein-S was not lower in patients than that in controls. There were no significant differences in the levels of others thrombotic and fibrinolytic factors between the patients and controls.

CONCLUSION: We observed no evidence that there is any relationship between nontraumatic osteonecrosis of the femoral head and any thrombotic / fibrinolytic disorders in South Korea.