Early Diagnosis of Osteonecrosis by Functional Bone Investigation

Ficat, P

doi:10.1007/978-3-642-68049-6_2

Cited by 8 publications

(8 citation statements)

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“…All patients were assessed by the senior author and received a standard preoperative workup for patients undergoing a hip arthroscopy, including standard hip radiographs and hip MRI to evaluate the extent of disease and assess for possible quiescent ONFH in the contralateral hip. Based on hip radiographs, hip MRI, and clinical presentation, each hip’s ONFH was staged using the Ficat-Alret system [9]. (Table 1) The Ficat-Alret was selected, as opposed to other classification systems such as the Steinberg system, because it is routinely used by the MSK radiologists at our institution and because most of the literature on ONFH utilizes this system allowing for easier comparison of results.…”

Section: Methodsmentioning

confidence: 99%

“…The preferred management of ONFH remains controversial and is largely dependent on the staging of the lesion. While there are several classification systems, the Ficat-Arlet staging is commonly used, with stages 0 through IIb considered precollapse, and stages III and IV considered collapsed [3, 9]. (Table 1) Management options can be categorized into observation, non-operative treatment, and operative treatment.…”

Section: Introductionmentioning

confidence: 99%

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Mid-term outcomes of arthroscopic-assisted Core decompression of Precollapse osteonecrosis of femoral head—minimum of 5 year follow-up

Nazal

Parsa

Martin

2019

BMC Musculoskelet Disord

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Background Osteonecrosis of the femoral head (ONFH) is a progressive disease that leads to collapse and the development of secondary arthritis. The preferred management of ONFH remains controversial. Arthroscopic-assisted management of ONFH is a new and evolving approach for hip preservation. We hypothesis that arthroscopy is able to improve ONFH outcomes by achieving accurate and minimally invasive decompression while successfully addressing concomitant intraarticular pathologies resulting in reliable mid-term outcomes. Methods This was a retrospective cohort analysis. All patients had atraumatic ONFH with a precollapse lesion and a minimum follow-up of 5 years. Results A total cohort of 11 hips (8 patients) was identified. The mean patient follow-up was 7 years ±1.48 years (range, 64—118 months). The Ficat-Alret classification found on preoperative imaging was Stage I—3 (27.2%), IIa—4 (36.4%), and IIb—4 (36.4%) hips. Four (36.4%) hips experienced mechanical issues, including locking, catching, and buckling. The most common concomitant pathology addressed at the time of arthroscopy, was labral repair/debridement—8 (73%), followed by microfracture—7 (64%). At final follow-up, 6 hips (54.5%) had not converted to THA. Upon further stratification, Stage I—100%, Stage IIa—75%, for a combined 87%, had not converted to THA, in contrast, 100% of hips categorized as Stage IIb had converted to THA. Ficat-Alret staging, especially Stage IIb, was significantly associated with conversion to THA. (p-value = 0.015) There were 0% major or minor complications. Conclusions To our knowledge, this is the longest reported follow-up of arthroscopic-assisted management of ONFH. Arthroscopic-assisted management is a promising surgical approach that provides safe, accurate, and minimally invasive decompression, resulting in reliable results with an acceptable conversion rate to THA. Level of evidence Level IV, Case Series.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mid-term outcomes of arthroscopic-assisted Core decompression of Precollapse osteonecrosis of femoral head—minimum of 5 year follow-up

Nazal

Parsa

Martin

2019

BMC Musculoskelet Disord

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“…Demographic data, the visual analog scale (VAS) score for pain, the Harris hip score 19 (HHS), and the radiographic stage of osteonecrosis using the Ficat and Arlet grading system 18 were recorded at the time of presentation. Follow-up was done at 3 weeks, 3 months, 6 months, 1 year, and annually thereafter.…”

Section: Outcome Measuresmentioning

confidence: 99%

A Paradigm Shift in Osteonecrosis Treatment with Bisphosphonates

Orth

Vijayvargiya

2021

JBJS Open Access

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Background: Bisphosphonates are proven to be effective in obviating the need for surgical intervention in osteonecrosis of the femoral head. However, the late onset of pain relief hampers compliance. We present the clinical and radiographic outcome of a combination therapy compared with alendronate-only therapy for the management of osteonecrosis of the femoral head. Methods: The data of patients diagnosed with osteonecrosis of the femoral head from January 2001 to January 2017 were retrospectively analyzed. The first group, the alendronate treatment group, comprised 432 hips (358 patients) diagnosed from January 2001 to January 2009 and treated with 10-mg oral alendronate daily for 3 years. The second group, the combination treatment group, comprised 442 hips (386 patients) diagnosed from February 2009 to January 2017 and treated with a combination therapy of 35-mg oral alendronate twice weekly and 5-mg intravenous zoledronic acid once annually for 3 years. Clinical assessment was performed using the Harris hip score, the visual analog scale (VAS) pain score, and the clinical failure rate. Radiographic assessment was performed for progression and collapse. Results: In the alendronate treatment group, at a mean follow-up of 129.6 months (range, 60 to 220 months), 74.5% did not require a surgical procedure, and, in the combination treatment group, at a mean follow-up of 69 months (range, 37 to 105 months), 88.9% did not require a surgical procedure. The clinical failure rate at 3 years was 4% for stage I, 11% for stage II, and 29% for stage III in the alendronate treatment group, and it was 5% for stage I, 9% for stage II, and 32% for stage III in the combination treatment group. Patients in the combination treatment group had a significantly better improvement in VAS score at 6 weeks (from 7.10 to 3.66) compared with patients in the alendronate treatment group (from 7.93 to 7.00). Conclusions: Our study shows that both oral alendronate-only therapy and bisphosphonate combination therapy retard the progression of disease, reduce the rate of collapse, and, hence, reduce the need for joint replacement surgery. However, bisphosphonate combination therapy offers earlier improvement in pain and functional scores compared with oral alendronate therapy only. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

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“…This was done using the Ficat and Arlet scale [8]. The extent of the necrotic focus was determined by measurement of the angle of the lesion in both AP and axial views, as previously reported by others [15,25].…”

Section: Radiological Assessmentmentioning

confidence: 99%

“…A number of methods of treatment for idiopathic necrosis of the head of the femur, based on the characteristics of the lesion, have been reported previously [4,5,6,8,11,12,14,16,17,18,20,22]. However, the choice of treatment for relatively young patients presenting with intermediate grade disease is still uncertain.…”

Section: Introductionmentioning

confidence: 99%

The place of intertrochanteric osteotomy in the treatment of idiopathic necrosis of the head of the femur

Cañadell

Aguilella

Azcárate

et al. 1986

International Orthopaedics

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SUMMARYThe authors present their experience of the use of intertrochanteric osteotomy for the treatment of idiopathic necrosis of the head of the femur. The results obtained from 102 osteotomies performed on 81 patients with the disease are analysed. The mean followup is 4.2 years. The results show a statistically significant clinical improvement after operation. Patients presenting with Ficat and Arlet Stage II involvement fared much better than those with more severe changes. Better results were also seen in those with a necrosis angle of less than 200°. No radiological improvement was seen although a high percentage showed no deterioration. The choice of treatment for the condition is discussed in the light of these results.

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Early Diagnosis of Osteonecrosis by Functional Bone Investigation

Cited by 8 publications

References 1 publication

Mid-term outcomes of arthroscopic-assisted Core decompression of Precollapse osteonecrosis of femoral head—minimum of 5 year follow-up

Mid-term outcomes of arthroscopic-assisted Core decompression of Precollapse osteonecrosis of femoral head—minimum of 5 year follow-up

A Paradigm Shift in Osteonecrosis Treatment with Bisphosphonates

The place of intertrochanteric osteotomy in the treatment of idiopathic necrosis of the head of the femur

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