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Clinical Orthopaedics and Related Research®

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01-05-2010 | Clinical Research

Subchondral Insufficiency Fracture of the Femoral Head may be Associated with Hip Dysplasia: A Pilot Study

Authors: Kohei Ishihara, MD, Keita Miyanishi, MD PhD, Hidetoshi Ihara, MD, Seiya Jingushi, MD PhD, Takehiko Torisu, MD PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 5/2010

Abstract

Background

Subchondral insufficiency fracture of the femoral head occurs mainly in elderly patients with osteoporosis. Spontaneous resolution is observed after nonoperative treatment in some patients whereas other show progressive joint destruction requiring THA. Several studies report the occurrence of subchondral insufficiency fracture of the femoral head in dysplastic hips.

Questions/purposes

We asked whether the extent of hip dysplasia or osteoporosis was greater in patients with subchondral insufficiency fracture of the femoral head than in normal control subjects.

Patients and Methods

We compared the clinical and imaging findings of 13 patients with subchondral insufficiency fractures of the femoral head and 12 patients scheduled for TKA with asymptomatic hips. Age, gender, and body mass index were comparable in the two groups.

Results

Higher mean Sharp angles, lower acetabular head indices, lower center-edge angles, and higher acetabular roof angles in patients with subchondral insufficiency fracture of the femoral head than in those with asymptomatic hips suggested a greater degree of hip dysplasia. Bone mineral density and serum levels of Type I collagen cross-linked N-telopeptide and bone alkaline phosphatase were similar in the two groups.

Conclusions

We speculate an excessive amount of stress on the acetabular edge from dysplasia may be associated with the occurrence of subchondral insufficiency fracture of the femoral head.

Bangil M, Soubrier M, Dubost JJ, Rami S, Carcanagues Y, Ristori JM, Bussiere JL. Subchondral insufficiency fracture of the femoral head. Rev Rhum Engl Ed. 1996;63:859–861.PubMed

Genda E, Konishi N, Hasegawa Y, Miura T. A computer simulation study of normal and abnormal hip joint contact pressure. Arch Orthop Trauma Surg. 1995;114:202–206.CrossRefPubMed

Groh MM, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med. 2009;2:105–117.CrossRefPubMed

Haene RA, Bradley M, Villar RN. Hip dysplasia and the torn acetabular labrum: an inexact relationship. J Bone Joint Surg Br. 2007;89:1289–1292.CrossRefPubMed

Hagino H, Okano T, Teshima R, Nishi T, Yamamoto K. Insufficiency fracture of the femoral head in patients with severe osteoporosis: report of 2 cases. Acta Orthop Scand. 1999;70:87–89.CrossRefPubMed

Heyman CH, Herndon CH. Legg-Perthes disease: a method for the measurement of the roentgenographic result. J Bone Joint Surg Am. 1950;32:767–778.PubMed

Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 2002;359:1929–1936.CrossRefPubMed

Konishi N, Mieno T. Determination of acetabular coverage of the femoral head with use of a single anteroposterior radiograph: a new computerized technique. J Bone Joint Surg Am. 1993;75:1318–1333.PubMed

Leunig M, Podeszwa D, Beck M, Werlen S, Ganz R. Magnetic resonance arthrography of labral disorders in hips with dysplasia and impingement. Clin Orthop Relat Res. 2004;418:74–80.CrossRefPubMed

10.

Lin YK, Tien YC, Lin SY. Hip ganglion cyst associated with developmental dysplasia of hip in a child: a case report. Acta Orthop Scand. 2002;73:109–110.CrossRefPubMed

11.

Massie WK, Howorth MB. Congenital dislocation of the hip. Part I. Method of grading results. J Bone Joint Surg Am. 1950;32:519–531.PubMed

12.

Mavcic B, Pompe B, Antolic V, Daniel M, Iglic A, Kralj-Iglic V. Mathematical estimation of stress distribution in normal and dysplastic human hips. J Orthop Res. 2002;20:1025–1030.CrossRefPubMed

13.

Miyanishi K, Hara T, Hamada T, Maekawa M, Tsurusaki S, Moro-Oka TA, Kamo Y, Jingushi S, Torisu T. Co-occurrence of subchondral insufficiency fracture of the femoral head and contralateral femoral neck fracture in a rheumatic patient receiving steroid treatment. Mod Rheumatol. 2008;18:619–622.CrossRefPubMed

14.

Motomura G, Yamamoto T, Miyanishi K, Shirasawa K, Noguchi Y, Iwamoto Y. Subchondral insufficiency fracture of the femoral head and acetabulum: a case report. J Bone Joint Surg Am. 2002;84:1205–1209.CrossRefPubMed

15.

Nishizawa Y, Nakamura T, Ohta H, Kushida K, Gorai I, Shiraki M, Fukunaga M, Hosoi T, Miki T, Chaki O, Ichimura S, Nakatsuka K, Miura M; Committee on the Guidelines for the Use of Biochemical Markers of Bone Turnover in Osteoporosis. Japan Osteoporosis Society Guidelines for the use of biochemical markers of bone turnover in osteoporosis (2004). J Bone Miner Metab. 2005;23:97–104.CrossRefPubMed

16.

Orimo H, Hayashi Y, Fukunaga M, Sone T, Fujiwara S, Shiraki M, Kushida K, Miyamoto S, Soen S, Nishimura J, Oh-Hashi Y, Hosoi T, Gorai I, Tanaka H, Igai T, Kishimoto H; Osteoporosis Diagnostic Criteria Review Committee: Japanese Society for Bone and Mineral Research. Diagnostic criteria for primary osteoporosis: year 2000 revision. J Bone Miner Metab. 2001;19:331–337.CrossRefPubMed

17.

Rafii M, Mitnick H, Klug J, Firooznia H. Insufficiency fracture of the femoral head: MR imaging in three patients. AJR Am J Roentgenol. 1997;168:159–163.PubMed

18.

Sharp IK. Acetabular dysplasia: the acetabular angle. J Bone Joint Surg Br. 1961;43:268–272.

19.

Tsumura H, Kaku N, Ikeda S, Torisu T. A computer simulation of rotational acetabular osteotomy for dysplastic hip joint: does the optimal transposition of the acetabular fragment exist? J Orthop Sci. 2005;10:145–151.CrossRefPubMed

20.

Yamamoto T, Bullough PG. Subchondral insufficiency fracture of the femoral head: a differential diagnosis in acute onset of coxarthrosis in the elderly. Arthritis Rheum. 1999;42:2719–2723.CrossRefPubMed

21.

Yamamoto T, Bullough PG. The role of subchondral insufficiency fracture in rapid destruction of the hip joint: a preliminary report. Arthritis Rheum. 2000;43:2423–2427.CrossRefPubMed

22.

Yamamoto T, Schneider R, Bullough PG. Subchondral insufficiency fracture of the femoral head: histopathologic correlation with MRI. Skeletal Radiol. 2001;30:247–254.CrossRefPubMed

23.

Yamamoto T, Takabatake K, Iwamoto Y. Subchondral insufficiency fracture of the femoral head resulting in rapid destruction of the hip joint: a sequential radiographic study. AJR Am J Roentgenol. 2002;178:435–437.PubMed

24.

Yasunaga Y, Ochi M, Terayama H, Tanaka R, Yamasaki T, Ishii Y. Rotational acetabular osteotomy for advanced osteoarthritis secondary to dysplasia of the hip. J Bone Joint Surg Am. 2006;88:1915–1919.CrossRefPubMed

Title: Subchondral Insufficiency Fracture of the Femoral Head may be Associated with Hip Dysplasia: A Pilot Study
Authors: Kohei Ishihara, MD
Keita Miyanishi, MD PhD
Hidetoshi Ihara, MD
Seiya Jingushi, MD PhD
Takehiko Torisu, MD PhD
Publication date: 01-05-2010
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 5/2010
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-009-1213-z

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Springer Medicine

Subchondral Insufficiency Fracture of the Femoral Head may be Associated with Hip Dysplasia: A Pilot Study

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

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