Association of Thrombophilic Factors in Pathogenesis of Osteonecrosis of Femoral Head in Indian Population
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ORIGINAL ARTICLE
Association of Thrombophilic Factors in Pathogenesis of Osteonecrosis of Femoral Head in Indian Population Tushar N. Rathod1 · M. B. Tayade2 · Shrimati D. Shetty3 · Pratap Jadhav4 · Ashwin Hemant Sathe1 · Shubhranshu S. Mohanty1 Received: 2 April 2020 / Accepted: 19 June 2020 / Published online: 2 July 2020 © Indian Orthopaedics Association 2020
Abstract Purpose Role of heritable blood clotting disorders, both thrombophilias and hypofibrinolysis in causing avascular necrosis (AVN) of femoral head have been studied in regions like Europe and U.S.A. This study was done to investigate the role of heritable thrombophilias in ethnic Indian population. Materials and Methods A case control study of 150 patients (100 cases and 50 age and sex matched controls) of Indian Ethnicity with clinico-radiographically documented idiopathic AVN of femoral head was done after ethics committee approval. DNA was extracted from the blood and PCR analysis was used to study heritable thrombophilic gene mutation (G1691A Factor V Leiden). Enzyme-linked immunosorbent assay (ELISA)-based assays, were utilized to measure antigen levels of protein C, antithrombin III levels and protein S. Results Nine cases out of 100 showed deficiency of Protein C (9%) while no control showed deficiency of Protein C (p value: 0.028—significant, Odds ratio: 9.791) Ten cases showed deficiency of Protein S (10%) in study population as compared to one case (2%) in control population (p value: 0.038—significant, Odds ratio: 5.44). ATIII deficiency was more prevalent in control group i.e. 22% compared to 11% in study group. Factor V mutation was present in 3% cases as compared to one (2%) in control group. (p value is 0.393—not significant). Conclusion Difference in thrombophilic mutations in various populations indicates possible effect of ethnicity on genetic profile in the development of AVN. This risk stratification will enable in near future early diagnosis and possible role of antithrombotics in disease prevention. Keywords Avascular necrosis (AVN) · Osteonecrosis · Factor V mutation · Protein C · Protein S · Antithrombin III (AT III)
Introduction Vaso-occlusion leading to infarction of articular surfaces and subchondral collapse of femoral head, results in arthritis of hip joint. Osteonecrosis primarily occurs in the third to fifth decade of life and unfortunately most of these patients need
hip arthroplasty as mainstay of treatment which has finite survival rate in long term. This has significant social and economic implications on family and in turn on the society [1]. Femoral head osteonecrosis (FHO) is an ischemic bone disorder that can lead to joint degeneration and is associated 1
Tushar N. Rathod [email protected]
Department of Orthopedics, Seth G. S. Medical College and KEM Hospital, 6th Floor, New Multi‑Storeyed Building, Parel, Mumbai 400012, India
2
Shrimati D. Shetty [email protected]
Department of General Surgery, Sir J.J. Group of Hospitals, Mumbai, India
3
Pratap Jadhav [email protected]
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