Diagnostic criteria for non-traumatic osteonecrosis of the femoral head

Abstract

Six major and seven minor diagnostic criteria have been developed by the Japanese Investigation Committee for osteonecrosis of the femoral head (ONFH). We have carried out a multicentre study to clarify these. We studied prospectively 277 hips in 222 patients, from six hospitals, who had ONFH and other hip pathology and from whom histological material was available. We identified five criteria with high specificity: 1) collapse of the femoral head without narrowing of the joint space or acetabular abnormality on radiographs, including the crescent sign; 2) demarcating sclerosis in the femoral head without narrowing or acetabular abnormality; 3) a 'cold-in-hot' appearance on the bone scan; 4) a low-intensity band on T1-weighted images (band pattern); and 5) evidence of trabecular and marrow necrosis on histological examination. With any combination of two of these criteria, the sensitivity and specificity of the diagnosis were 91% and 99%, respectively.

Degree of corticosteroid treatment within the first 2 months of renal transplantation has a strong influence on the incidence of osteonecrosis of the femoral head

“…MRI of the hips was done made routinely in all patients preoperatively, at 3-6 weeks, at 9-12 weeks, at 24 weeks, and also 12 months after the transplantation. The presence or absence of AVN was determined based on the criteria of Sugano et al (1999). 37 patients (mean age 37 years) developed AVN and 113 patients (mean age 32 years) did not.…”

Correlation of Functional Status of Hip with Quality of Life of Patients with Osteonecrosis of Femoral Head (ONFH)

“…40-59 yrs. The mean age of patients presenting with ONFH in a series by Sugano et al [13] was about 44 years. Thus the age profile in present series is not very different from these other studies except for Cooper et al [14] who reported the mean age of 57.5yrs±18.9 in their patients.…”

“…The patient would be diagnosed as Osteonecrosis if the patient fulfilled 2 of 5 findings and did not have bone tumors or dysplasia. Staging of Osteonecrosis was done based on ARCO [13] classification. ARCO's (Association Research Circulation Osseous) international classification of Osteonecrosis has been accepted as a standard protocol for clinical research.…”

New Radiographic Index for Evaluating Acetabular Version

“…None of the acetabula had osteoarthritic changes of Grades 1 to 3 according to Tönnis grade [29]. Among the 62 hips, there were 11 hips in eight patients with idiopathic osteonecrosis of the femoral head (Stages 1-3a [27]), nine hips in nine patients with developmental dysplasia (defined by Sharp angle [23] greater than 45°or lateral center-edge angle less than 20° [31], one hip was the contralateral hip of the patient with a labral tear), 15 contralateral hips in 15 patients with osteoarthritis, eight hips in six patients without traumatic acetabular changes of fracture or dislocation, one hip in one patient with a labral tear, and 18 hips in 11 patients scheduled for TKAs (CT scans of the hip were obtained to establish the femoral functional axis for planning the TKA). The 11 hips with osteonecrosis evaluated by CT were not included in the 185 hips used in the above radiographic investigation.…”

“…During the study period, we treated a total of 192 hips with idiopathic osteonecrosis. The inclusion criteria were (1) no hip complaints and (2) noncollapsed osteonecrosis of the femoral head (Stages 1-2 [27]) because we presumed the morphologic features of the acetabulum were not influenced by the pathologic changes of osteonecrosis. We excluded seven hips because the edge of acetabular walls could not be recognized owing to sclerotic change of the femoral head by osteonecrosis.…”