Extract
To The Editor: I would like to congratulate Mr. Salerno and Mr.
Hermann on their excellent review, "Efficacy and Safety of Steroid Use
for Postoperative Pain Relief. Update and Review of the Medical
Literature" (2006;88:1361-1372), regarding steroid use to decrease
postoperative pain. There is, however, one aspect of the use of these
medications which I believe needs to be emphasized. Working in a center with
an interest in osteonecrosis of the femoral head, I have seen an alarming
number of young individuals with this condition following the short-term use
of a steroid medication1. Often these unfortunate patients are
prescribed steroids for what could be considered to be nebulous indications at
best (i.e., undiagnosed skin rash or poison ivy). While the cause-effect
relationship remains controversial, it is my firm belief that even short-term
use of a steroid medication will, in a small but consistent percentage of
patients, result in the subsequent development of (often bilateral)
osteonecrosis of the femoral head—a devastating complication in a young
individual. This is a fact that must be considered when deciding to administer
these medications.
To The Editor: I would like to congratulate Mr. Salerno and Mr.
Hermann on their excellent review, "Efficacy and Safety of Steroid Use
for Postoperative Pain Relief. Update and Review of the Medical
Literature" (2006;88:1361-1372), regarding steroid use to decrease
postoperative pain. There is, however, one aspect of the use of these
medications which I believe needs to be emphasized. Working in a center with
an interest in osteonecrosis of the femoral head, I have seen an alarming
number of young individuals with this condition following the short-term use
of a steroid medication1. Often these unfortunate patients are
prescribed steroids for what could be considered to be nebulous indications at
best (i.e., undiagnosed skin rash or poison ivy). While the cause-effect
relationship remains controversial, it is my firm belief that even short-term
use of a steroid medication will, in a small but consistent percentage of
patients, result in the subsequent development of (often bilateral)
osteonecrosis of the femoral head—a devastating complication in a young
individual. This is a fact that must be considered when deciding to administer
these medications.