Fate of Untreated Asymptomatic Osteonecrosis of the Femoral Head

Nam, Kwang Woo; Kim, Yong Lae; Yoo, Jeong Joon; Koo, Kyung‐Hoi; Yoon, Kang Sup; Kim, Hee Joong

doi:10.2106/jbjs.f.01582

Cited by 140 publications

(117 citation statements)

References 28 publications

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“…While there is no universal agreement in classification systems, it is well established that the prognosis is directly related to several factors: the extent of the osteonecrotic lesion [48,[62][63][64][65], the presence of a subchondral fracture [66,67], and the location of the lesion [68,69]. Most classification systems are based upon these prognostic factors.…”

Section: Prognostic Factorsmentioning

confidence: 99%

Osteonecrosis of the femoral head: diagnosis and classification systems

Choi

Steinberg

Cheng

2015

Curr Rev Musculoskelet Med

100

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Osteonecrosis of femoral head is a rare but disabling condition that usually results in progressive femoral head collapse and secondary arthritis necessitating total hip arthroplasty if not treated appropriately in early stages. However, early diagnosis is challenging as the onset of disease is insidious and the symptoms and signs are usually minimal and nonspecific until it becomes advanced. Of several diagnostic modalities, magnetic resonance imaging (MRI) is considered the imaging method of choice with the highest sensitivity and specificity, while detection of potential risk factors is very important as well. Many investigators have developed several different classification systems; however, there still is controversy regarding the optimal classification system. Diagnostic methods and the evolution of different classification systems will be reviewed in this paper.

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Section: Prognostic Factorsmentioning

confidence: 99%

Osteonecrosis of the femoral head: diagnosis and classification systems

Choi

Steinberg

Cheng

2015

Curr Rev Musculoskelet Med

100

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show abstract

“…On the other hand, not all ONFH will progress to femoral head collapse. 6 Therefore, being able to accurately predict the risk of femoral head collapse according to the disease severity and to take appropriate therapeutic measures are critical to preserve the hip joint and improve the prognosis of ONFH. 7 Studies have shown that the size and location of necrotic lesions are major factors associated with femoral head collapse.…”

Section: Advances In Knowledgementioning

confidence: 99%

Osteonecrosis of the femoral head: using CT, MRI and gross specimen to characterize the location, shape and size of the lesion

Hu¹,

Huang²,

Wei³

et al. 2015

BJR

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of the femoral head: using CT, MRI and gross specimen to characterize the location, shape and size of the lesion. Br J Radiol 2015;88:20140508. FULL PAPER Osteonecrosis of the femoral head: using CT, MRI and gross specimen to characterize the location, shape and size of the lesion The results were compared with findings from coronal sectional gross specimens. Two radiologists independently measured the volume of necrotic lesions from CT and MR images using computer software, and the results were averaged. The volume of specimens' necrotic lesion was measured using the water displacement method.Results: There was a high degree of consistency between CT, MRI and the coronal sectional gross specimen on the location, shape and spatial structure of lesions.Differences of the lesion volume measured from CT and MR images were not statistically significant between two radiologists. The necrotic lesion volumes measured from CT and MR images and gross specimens were 22.07 6 5. Osteonecrosis of the femoral head (ONFH) is a common disease of the hip joint. If untreated, 80% of patients with ONFH will suffer the collapse of femoral head articular surface in a few years of disease progression.1 Once the femoral head collapses, osteoarthritis becomes inevitable and function of the hip joint will be seriously affected, which eventually will lead to artificial joint replacement. 2,3Although hip replacement is an effective approach to relieve pain and improve hip function in the short term, its long-term performance remains unsatisfactory.4,5 Furthermore, non-traumatic ONFH typically occurs in young adults and involves both hips. On the other hand, not all ONFH will progress to femoral head collapse.6 Therefore, being able to accurately predict the risk of femoral head collapse according to the disease severity and to take appropriate therapeutic measures are critical to preserve the hip joint and improve the prognosis of ONFH. 7 Studies have shown that the size and location of necrotic lesions are major factors associated with femoral head collapse.6-9 Although various approaches have been reported to illustrate the lesion location and size, all were based on MRI and/or radiographs.6-11 As a main imaging modality for diagnosis of ONFH, CT can clearly display ONFH that is in Association Research Circulation Osseous (ARCO) stage II or above. Multislice CT can achieve isotropic resolution. Volume data acquired from axial scans can be used to reconstruct in any direction to observe lesions. But so far, there has been no study that reports the feasibility and accuracy of using CT to measure the size of ONFH lesions. We hypothesized that CT and MRI could achieve highly consistent results in illustrating the size, shape and location of ONFH lesions in ARCO stage II and above, and both methods can be used to assess the risk of necrotic femoral head collapse.The objectives of this study are (1) to investigate the accuracy of using CT to capture the size, location, shape and spatial structural relationship of the necrotic lesion by com...

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“…Despite a poorly understood pathophysiology, it is known that patients in their third decade of life are at highest risk and that there is an annual prevalence of 10,000 to 20,000 new cases per year in the United States [47]. Left untreated, the natural history of the disease will progress to end-stage degenerative joint disease in greater than 80% of symptomatic cases and nearly two-thirds of asymptomatic ones [46,47,51].…”

Section: Introductionmentioning

confidence: 99%