Steroid induced avascular necrosis of femoral head in three patients with ulcerative colitis

Abstract

Steroid induced avascular necrosis of femoral head (ANF) in three patients with ulcerative colitis (UC) was reported. The ages of the patients (two females and one male) were 24, 30, and 55 years. Two had total colitis and one had left-sided colitis. They were treated with prednisolone for recurrent active disease. The duration from onset of UC to onset of ANF were 15, 31, and 48 months. After the onset of ANF, two received steroids continuously for active disease. Total proctocolectomy with ileal pouch-anal canal anastomosis was carried out for their colonic disease in our hospital. Cumulative prednisolone doses were 9.8 and 11 grams, when they underwent colectomy. Postoperatively, one needed total hip replacement for her collapsed right femoral head. In the third patient, steroids were tapered after ANF was diagnosed. The disease remained in remission there after, and her pain was gradually relieved by protection of weight bearing. Cumulative prednisolone dose was 30 grams. UC patients with long-term or high dose steroid therapy have high risk of ANF, which must be recognized and treated at an early stage.