Factors Associated with Aseptic Osteonecrosis in Hospital Settings in Yaounde, Cameroon


Introduction: Osteonecrosis is the cellular death of the various components of bone. It mostly affects the femoral head, and its real incidence is unknown. Many causative factors may be involved in its genesis. In Sub-Saharan Africa, it affects mainly young patients and the S and C hemoglobinopathies are the most affected backgrounds. Objective: To determine factors associated with aseptic osteonecrosis of the femoral head in hospital settings in Yaounde, Cameroon. Methodology: It was a cross-sectional multicentric study on 29,474 files of black Cameroonian patients seen during consultation or admission, within a five-year period, carried at the Central Hospital, the National Center for Rehabilitation of Handicaped Persons and at the FROT Clinic in Yaounde, Cameroon. Files of patients with aseptic osteonecrosis of the femoral head (1 file = 1 patient) were enrolled. The diagnosis was retained solely based on clinical and radiologic criteria. Magnetic resonance imaging, tomodencitometry and/or bone scintigraphy were also considered when available. Classification of lesions obeyed Ficat-Arlet criteria. Patients’ files with little information and hip diseases other than aseptic osteonecrosis were excluded. Results: Fifty-one cases (0.17%) of aseptic osteonecrosis were recruited; among them, there are 28 males (55%) and 23 females (45%). Their mean age was 38.9 ± 16.4 years (extremes: 7 and 78 years). Those aged 21 to 30 years represented 25.5% of cases. Pain and loss of function were present in all patients. The lesion occurred in the right hip in 22 cases (41.1%), and left hip in 13 cases (25.5%); 16 patients (31.4%) had both hip affected. X-ray was performed for all patients. Radiologic lesions were at Stage IV in 2 cases (3.9%), III for 44 cases (86.3%), and II in 5 cases (9.8%). Factors associated with aseptic osteonecrosis were observed in 29 patients and their frequencies were as follows: sickle cell disease: n = 12 (25.3%); trauma: n = 10 (19.6%); alcoholism: n = 3 (5.9%); athletic practice: n = 3 (5.9%); and 2 patients (3.9%) were on treatment with steroid. HIV infection occurred in 2 cases (1.9%); dyslipidemia, hyperuricemia and systemic lupus erythematosus were diagnosed in 1 case (1.9%) each. Conclusion: The relative incidence of aseptic osteonecrosis of the femoral head in hospital settings in Yaounde is 0.17% and mostly young adults are affected. Lesions are discovered at an advanced radiographic stage and sickle cell disease is the first associated factor.

Share and Cite:

Singwé-Ngandeu, M. , Younouss, A. , Chemeni, B. , Farikou, I. , Sida, M. and Ndombo, P. (2015) Factors Associated with Aseptic Osteonecrosis in Hospital Settings in Yaounde, Cameroon. Open Journal of Rheumatology and Autoimmune Diseases, 5, 12-16. doi: 10.4236/ojra.2015.51003.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Hernigou, P. (2006) Ostéonécroses non traumatiques des épiphyses de l’adulte EMC. Elsevier SAS, Paris.
[2] Blum, A., Bressler, F., Deneuville, M., Pere, P., Chary-Valckenaere, I., Grignon, B. and Regent, D. (1996) Osteonécrosesépiphysaires de l’adulte. EMC 5 Elsevier, Paris, Radiodiagnostic-Neuroradiologie-Appareil Locomoteur, 16 p.
[3] Jeandel, P., Chouc, P.Y. and Laroche, R. (1991) Rhumatologie en Afrique noire, certitudes, perspectives et inconnues. Médecine d’Afrique Noire, 38, 53-61.
[4] Rufai Bologun, A., Obalum, D.C., Giwa, S.O., Adekoka-Cole, T.O., Chidiebere Ogo, N. and Enweluzo, G.O. (2010) Spectrum of Musculo-Skeletal Disorders in Sickle Cell Disease in Lagos, Nigeria. Journal of Orthopaedic Surgery and Research, 5, 2.
[5] Jean-Baptiste, G. and De Ceulaer, K. (2003) Actualités des manifestations rhumatologiques des hémoglobinopathies. Revue Du Rhumatisme, 70, 157-161.
[6] Levasseur, R. (2008) Mechanisms of Osteonecrosis. Joint Bone Spine, 75, 634-642.
[7] Ouédraogo, D., Ouédraogo, T., Kaboré, F., Zan, A., Kafando, H., Nacoulma, E., Tieno, H. and Drabo, J. (2010) Quels sont les facteurs de risque associés à l’ONATF chez le sujet noir africain du Burkina Faso?
[8] Anie, K.A., Egunjobi, F.E. and Akinyanju, O.O. (2010) Psychosocial Impact of Sickle Cell Disorder: Perspectives from a Nigerian Setting. Global Health, 6, 2.
[9] Koo, K.-H., Kim, R., Kim, Y.-S., Ahn, I.-O., Cho, S.-H., Song, H.-R., Park, Y.-S., Kim, H. and Wang, G.-J. (2002) Risk Period for Developing Osteonecrosis of the Femoral Head in Patients on Steroid Treatment. Clinical Rheumatology, 21, 299-303.
[10] Wang, Y.S., Yin, L., Li, Y.B., Liu, P.L. and Cui, Q.J. (2008) Preventive Effects or Puerarin on Alcohol-Induced Osteonecrosis. Clinical Orthopaedics and Related Research, 466, 1059-1067.
[11] Ngos, J.A. (2003) Complications de l’appareil locomoteur dans la drépanocytose homozygote à l’age adulte à Yaoundé. Thèse de doctorat en médecine, Université de Yaoundé I, Yaoundé.
[12] Tchuisseu Ngankem, I.A., Ndumbe, P.M., Doualla, M.S. and Messomo P.A. (2007) Prévalence des manifestations rhumatologiques dans l’infection à VIH/SIDA au Cameroun. Sidanet, 4, 1015.
[13] Ficat, R.P. and Arlet, J. (1980) Ischemia and Necrosis of Bone. Williams and Wilkins, Baltimore, 171-182.
[14] Hamilton, T.W., Goodman, S.M. and Figgie, M. (2009) SAS Weekly Rounds: Avascular Necrosis. HSS Journal, 5, 99-113.
[15] Lafforgue, P. (2009) Ostéonécrose de la tête fémorale. Revue du Rhumatisme, 76, 166-172.
[16] Collet, P. (2005) Manifestations ostéoarticulaires des anémies. EMC Elsevier Masson SAS, Paris, Appareil Locomoteur.
[17] Akinyoola, A.L., Adediran, I.A., Asaleye, C.M. and Bolarinwa, A.R. (2009) Risk Factors for Osteonecrosis of the Femoral Head in Patients with Sickle Cell Disease. International Orthopaedics, 33, 923-926.
[18] Oniankitan, O., Tagbor, K.C., Koffi-Tessio, V.E.S., Kakpovi, K. and Mijiyawa, M. (2009) Profil sémiologique de l’ONATF chez les sujets porteurs des hémoglobines AA et AS. La Tunisie médicale, 87, 776-777.
[19] Lafforgue, P. (2006) Pathophysiology and Natural History of Avascular Necrosis of Bone. Joint Bone Spine, 73, 500-507.
[20] Chagnaud, C., Dehaut, F.-X. and Kousmenko-Deturmeny, A. (2009) Fractures de contrainte de la région de la hanche. Revue du Rhumatisme, 76, 180-187.
[21] Yombi, J.C., Vandercam, B., Dunja, W., Dubuc, J.E., Vincent, A. and Docquier, P.L. (2009) Osteonecrosis of the Femoral Head in Patients with Type 1 Human Immunodeficiency Virus Infection: Clinical Analysis and Review. Clinical Rheumatology, 28, 815-823.
[22] Mulliken, B.D., Renfrew, D.L., Brand, R.A. and Whitten, C.G. (1994) The Prevalence and Natural History of Early Osteonecrosis of the Femoral Head. Iowa Orthopaedic Journal, 14, 115-119.
[23] Uea-Areewongsa, P., Chaiamunuay, S., Narongroeknawin, P. and Asavatanabodee, P. (2009) Factors Associated with Osteonecrosis in Thai Lupus Patients. A Case Control Study. Journal of Clinical Rheumatology, 15, 345-349.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.