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01-07-2018 | Original Paper

The effect of the anterior boundary of necrotic lesion on the occurrence of collapse in osteonecrosis of the femoral head

Authors: Yusuke Kubo, Goro Motomura, Satoshi Ikemura, Kazuhiko Sonoda, Hiroyuki Hatanaka, Takeshi Utsunomiya, Shoji Baba, Yasuharu Nakashima

Published in: International Orthopaedics | Issue 7/2018

Abstract

Purpose

The location of the necrotic lesion is one of the important factors for collapse in osteonecrosis of the femoral head (ONFH). The significance of anterior localization has been little studied. This study evaluated the effects of anterior boundary of a necrotic lesion on collapse.

Methods

We reviewed the outcomes of 113 consecutive non-collapsed asymptomatic hips in 98 ONFH patients with mean follow-up of 4.7 years (2.0–11.8) after the initial magnetic resonance (MR) imaging. The presence or absence of collapse was investigated using follow-up radiographs. The location of the anterior boundary of a necrotic lesion was assessed using the anterior necrotic angle between the midline of the femoral neck shaft and the line passing from the femoral head centre to the anterior boundary on mid-oblique MR imaging. Multivariate analysis was performed to identify risk factors for collapse, and further analyses were executed according to the lateral boundary of the necrotic lesion.

Results

During the follow-up period, collapse was confirmed in 61 hips (54.0%). Multivariate analysis revealed that the anterior necrotic angle was independently associated with collapse as well as the lateral boundary of the necrotic lesion. When the lateral boundary was located at the middle third of weight-bearing portion (32 hips), that was generally categorized as a low risk of collapse, all five cases with anterior necrotic angle ≥ 79° developed collapse, whereas only one of 27 cases (3.7%) with an anterior necrotic angle < 79° developed collapse (p < 0.0001).

Conclusions

This study indicates that ONFH patients with anterior localization of a necrotic lesion can develop collapse even if the necrotic lesion is medially located.

Ohzono K, Saito M, Takaoka K, Ono K, Saito S, Nishina T, Kadowaki T (1991) Natural history of nontraumatic avascular necrosis of the femoral head. J Bone Joint Surg Br 73:68–72CrossRefPubMed

Ficat RP (1985) Idiopathic bone necrosis of the femoral head: early diagnosis and treatment. J Bone Joint Surg Br 67:3–9CrossRefPubMed

Mont MA, Hungerford DS (1995) Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am 77:459–474CrossRefPubMed

Steinberg ME, Hayken GD, Steinberg DR (1995) A quantitative system for staging avascular necrosis. J Bone Joint Surg Br 77:34–41CrossRefPubMed

Sugano N, Ohzono K, Masuhara K, Takaoka K, Ono K (1994) Prognostication of osteonecrosis of the femoral head in patients with systemic lupus erythematosus by magnetic resonance imaging. Clin Orthop Relat Res 305:190–199CrossRef

Mont MA, Zywiel MG, Marker DR, McGrath MS, Delanois RE (2010) The natural history of untreated asymptomatic osteonecrosis of the femoral head: a systematic literature review. J Bone Joint Surg Am 92:2165–2170. https://doi.org/10.2106/JBJS.I.00575 CrossRefPubMed

Sugano N, Takaoka K, Ohzono K, Matsui M, Masuhara K, Ono K (1994) Prognostication of nontraumatic avascular necrosis of the femoral head. Significance of location and size of the necrotic lesion. Clin Orthop Relat Res 303:155–164

Kang JS, Moon KH, Kwon DG, Shin BK, Woo MS (2013) The natural history of asymptomatic osteonecrosis of the femoral head. Int Orthop 37:379–384. https://doi.org/10.1007/s00264-013-1775-y CrossRefPubMedPubMedCentral

Min BW, Song KS, Cho CH, Lee SM, Lee KJ (2008) Untreated asymptomatic hips in patients with osteonecrosis of the femoral head. Clin Orthop Relat Res 466:1087–1092. https://doi.org/10.1007/s11999-008-0191-x CrossRefPubMedPubMedCentral

10.

Ito H, Matsuno T, Omizu N, Aoki Y, Minami A (2003) Mid-term prognosis of non-traumatic osteonecrosis of the femoral head. J Bone Joint Surg Br 85:796–801CrossRefPubMed

11.

Nishii T, Sugano N, Ohzono K, Sakai T, Sato Y, Yoshikawa H (2002) Significance of lesion size and location in the prediction of collapse of osteonecrosis of the femoral head: a new three-dimensional quantification using magnetic resonance imaging. J Orthop Res 20:130–136CrossRefPubMed

12.

Mitchell DG, Rao VM, Dalinka MK, Spritzer CE, Alavi A, Steinberg ME, Fallon M, Kressel HY (1987) Femoral head avascular necrosis: correlation of MR imaging, radiographic staging, radionuclide imaging, and clinical findings. Radiology 162:709–715CrossRefPubMed

13.

Meier R, Kraus TM, Schaeffeler C, Torka S, Schlitter AM, Specht K, Haller B, Waldt S, Rechl H, Rummeny EJ, Woertler K (2014) Bone marrow oedema on MR imaging indicates ARCO stage 3 disease in patients with AVN of the femoral head. Eur Radiol 24:2271–2278. https://doi.org/10.1007/s00330-014-3216-8 CrossRefPubMed

14.

Ha YC, Kim HJ, Kim SY, Kim KC, Lee YK, Koo KH (2010) Effects of age and body mass index on the results of transtrochanteric rotational osteotomy for femoral head osteonecrosis. J Bone Joint Surg Am 92:314–321. https://doi.org/10.2106/JBJS.H.01020 CrossRefPubMed

15.

Nishii T, Sugano N, Ohzono K, Sakai T, Haraguchi K, Yoshikawa H (2002) Progression and cessation of collapse in osteonecrosis of the femoral head. Clin Orthop Relat Res 400:149–157CrossRef

16.

Martz P, Maczynski A, Elsair S, Labattut L, Viard B, Baulot E (2017) Total hip arthroplasty with dual mobility cup in osteonecrosis of the femoral head in young patients: over ten years of follow-up. Int Orthop 41:605–610. https://doi.org/10.1007/s00264-016-3344-7 CrossRefPubMed

17.

Ancelin D, Reina N, Cavaignac E, Delclaux S, Chiron P (2016) Total hip arthroplasty survival in femoral head avascular necrosis versus primary hip osteoarthritis: case-control study with a mean 10-year follow-up after anatomical cementless metal-on-metal 28-mm replacement. Orthop Traumatol Surg Res 102:1029–1034. https://doi.org/10.1016/j.otsr.2016.08.021 CrossRefPubMed

18.

Ikemura S, Yamamoto T, Nakashima Y, Mawatari T, Motomura G, Iwamoto Y (2009) Transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head in patients 20 years or younger. J Pediatr Orthop 29:219–223. https://doi.org/10.1097/BPO.0b013e31819bc746 CrossRefPubMed

19.

Tabatabaee RM, Saberi S, Parvizi J, Mortazavi SM, Farzan M (2015) Combining concentrated autologous bone marrow stem cells injection with core decompression improves outcome for patients with early-stage osteonecrosis of the femoral head: a comparative study. J Arthroplast 30:11–15CrossRef

20.

Cao L, Guo C, Chen J, Chen Z, Yan Z (2017) Free vascularized fibular grafting improves vascularity compared with Core decompression in femoral head osteonecrosis: a randomized clinical trial. Clin Orthop Relat Res 475:2230–2240. https://doi.org/10.1007/s11999-017-5374-x CrossRefPubMedPubMedCentral

21.

Bullough PG, Dicarlo EF (1990) Subchondral avascular necrosis: a common cause of arthritis. Ann Rheum Dis 49:412–420CrossRefPubMedPubMedCentral

22.

Motomura G, Yamamoto T, Yamaguchi R, Ikemura S, Nakashima Y, Mawatari T, Iwamoto Y (2011) Morphological analysis of collapsed regions in osteonecrosis of the femoral head. J Bone Joint Surg Br 93:184–187. https://doi.org/10.1302/0301-620X.93B225476 CrossRefPubMed

23.

Karasuyama K, Yamamoto T, Motomura G, Sonoda K, Kubo Y, Iwamoto Y (2015) The role of sclerotic changes in the starting mechanisms of collapse: a histomorphometric and FEM study on the femoral head of osteonecrosis. Bone 81:644–648. https://doi.org/10.1016/j.bone.2015.09.009 CrossRefPubMed

Title: The effect of the anterior boundary of necrotic lesion on the occurrence of collapse in osteonecrosis of the femoral head
Authors: Yusuke Kubo
Goro Motomura
Satoshi Ikemura
Kazuhiko Sonoda
Hiroyuki Hatanaka
Takeshi Utsunomiya
Shoji Baba
Yasuharu Nakashima
Publication date: 01-07-2018
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 7/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-018-3836-8

ACC 2024 Congress

Springer Medicine

The effect of the anterior boundary of necrotic lesion on the occurrence of collapse in osteonecrosis of the femoral head

Abstract

Purpose

Methods

Results

Conclusions

ACC 2024 Congress

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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