Insufficient blood supply of fovea capitis femoris, a risk factor of femoral head osteonecrosis

Abstract

Background A defective nutrient foramen in the fovea capitis femoris was hypothesized to reflect the blood circulation pattern of the femoral head, leading to insufficient blood supply and causing osteonecrosis of the femoral head. Methods Normal and necrotic femoral head specimens were collected. The necrotic femoral head group was divided into a non-traumatic and traumatic subgroup. 3D scanning was applied to read the number, the diameter, and the total cross-sectional area of the nutrient foramina in the fovea capitis femoris. Chi-squared tests and independent t-tests were used to detect any differences in the categorical and continuous demographic variables. Logistic regression models were used to estimate the odds ratio (OR) for non-traumatic and traumatic osteonecrosis in different characteristic comparisons. Results A total of 249 femoral head specimens were collected, including 100 normal femoral heads and 149 necrotic femoral heads. The necrotic femoral head group revealed a significantly higher percentage of no nutrient foramen (p < 0.001), a smaller total area of nutrient foramina (p < 0.001), a smaller mean area of nutrient foramina (p = 0.014), a lower maximum diameter of the nutrient foramen (p < 0.001), and a lower minimum diameter of the nutrient foramen (p < 0.001) than the normal femoral head group. The logistic regression model demonstrated an increasing number of nutrient foramina (crude OR, 0.51; p < 0.001), a larger total area of nutrient foramina (crude OR, 0.58; p < 0.001), a larger mean area of nutrient foramina (crude OR, 0.52; p = 0.023), a greater maximum diameter of the nutrient foramen (crude OR, 0.26; p < 0.001), and greater minimum diameter of the nutrient foramen (crude OR, 0.20; p < 0.001) significantly associated with reduced odds of osteonecrosis of the femoral head (ONFH). The necrotic femoral head group was further divided into 118 non-traumatic and 31 traumatic necrotic subgroups, and no significant difference was observed in any characteristics between them. Conclusions Characteristics of the nutrient foramen in the fovea capitis femoris showed a significant defect of necrotic than normal femoral heads, and significantly reduced odds were associated with the higher abundance of the nutrient foramen in ONFH. Therefore, the condition of the nutrient foramen might be the indicator of ONFH.

A comprehensive morphometric and morphological analysis of fovea capitis femoris and femoral head parameters according to gender

“…However, our study found no difference in the number of foramina between the sexes. It was found that the risk of avascular necrosis decreased as the number of foramina increased in a study by gender independently [10]. Another study found that male are more likely than female to develop avascular necrosis [33].…”

“…In addition, an excess of nutrient foramina reduces the likelihood of developing osteonecrosis [6]. Hip dysplasia and osteoarthrosis have been related to modi cations in the morphometric structure and location of the FCF in the hip joint [10][11][12]. As the femoral head is supplied by vessels that travel through the FCF, the features of the anatomical structures on the head of the femur are considered potential factors in avascular necrosis.…”

Three-dimensional computed tomography mapping and clinical predictive factors for morphologic characterization of displaced femoral neck fractures

“…The fracture maps generated in this study could also aid in the evaluation of vascular damage to the femoral head of patients with DFNFs. The absence of nutrient foramina in the fovea capitis femoris has been shown to be associated with a high likelihood of femoral head osteonecrosis ( 25 ). Thus, a residual blood supply around the femoral head and neck junction is crucial for patients with DFNFs, especially when nutrient foramina are absent from the fovea capitis femoris.…”

Emerging roles of growth factors in osteonecrosis of the femoral head

“…Insufficient blood supply to the femoral head has been suggested as a pathogenic mechanism of ONFH ( Zhao K. et al, 2021 ). Several studies have investigated the relationship between polymorphisms in the VEGF gene and the risk of ONFH; however, the results are inconsistent and contradictory.…”