Osteonecrosis of the femoral head in the peripartum period: A systematic review

• Published in: Journal of Orthopaedic Reports Vol. 4; no. 1; p. 100383
• Main Authors: Call, Catherine M., Lachance, Andrew D., McGrory, Brian J.
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01-03-2025; Elsevier
• Subjects: Femoral head; Hip; Hip arthroplasty; Osteonecrosis; Peripartum; Postpartum; Pregnancy; Pregnancy; Femoral head; Peripartum; Hip arthroplasty; Osteonecrosis; Hip; Postpartum
• ISSN: 2773-157X; 2773-157X
• DOI: 10.1016/j.jorep.2024.100383

The aim of this study is to determine which demographics, presenting symptoms, management, and outcomes are most frequently reported in patients developing osteonecrosis of the femoral head in the peripartum period, to decipher trends in risk related to pregnancy.
A systematic review was conducted on September 19, 2023 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Primary outcomes were the reported management of the condition as well as descriptive statistics of patients with condition. A total of 307 references were identified of which 37 were relevant reports describing 78 patients.
Women diagnosed with this condition most often presented with third trimester hip pain during first pregnancy. The left femoral head was most often affected and both vaginal and c-section delivery were implicated. Risk factors identified in this cohort included coagulopathy, corticosteroid use, pre-eclampsia, fertility agents, and prior oral contraceptive use. Most patients were treated surgically, following which symptoms resolved without lasting disability. Seven women underwent subsequent pregnancy; four experienced pain and advancement of their disease.
Osteonecrosis of the femoral head remains an uncommon condition that providers should be aware of in patients presenting with third trimester or postpartum hip pain. Recognition of the condition can be aided by the knowledge of demographic findings common to the patients reported in this study. A multidisciplinary approach and early detection may reduce the incidence of hip arthroplasty in young patients.
V, systematic review.