Osteonecrosis of the Femoral Head: A Multidisciplinary Approach in Diagnostic Accuracy

Abstract

Osteonecrosis of the Femoral Head (ONFH) is a disabling disease affecting up to 30,000 people yearly in the United States alone. Diagnosis and staging of this pathology are both technically and logistically challenging, usually relying on imaging studies. Even anatomopathological studies, considered the gold standard for identifying ONFH, are not exempt from problems. In addition, the diagnosis is often made by different healthcare specialists, including orthopedic surgeons and radiologists, using different imaging modes, macroscopic features, and stages. Therefore, it is not infrequent to find disagreements between different specialists. The aim of this paper is to clarify the association and accuracy of ONFH diagnosis between healthcare professionals. To this end, femoral head specimens from patients with a diagnosis of ONFH were collected from patients undergoing hip replacement surgery. These samples were later histologically analyzed to establish an ONFH diagnosis. We found that clinico-radiological diagnosis of ONFH evidences a high degree of histological confirmation, thus showing an acceptable diagnostic accuracy. However, when the diagnoses of radiologists and orthopedic surgeons are compared with each other, there is only a moderate agreement. Our results underscore the need to develop an effective diagnosis based on a multidisciplinary approach to enhance currently limited accuracy and reliability.

A Pilot Experiment to Measure the Initial Mechanical Stability of the Femoral Head Implant in a Cadaveric Model of Osteonecrosis of Femoral Head Involving up to 50% of the Remaining Femoral Head

“…Osteonecrosis of the femoral head (ONFH), also referred to as avascular necrosis, is defined as a pathologic condition arising from an ischemic injury that is characterized by both a crucial disruption of blood supply to the bone and an increase in the intraosseous pressure. Subsequently, this results in the degradation of the organic elements of the bone and the marrow, thus commonly leading to a collapse of subchondral bone in the femoral head [ 1 , 2 , 3 , 4 ]. As such, ONFH is a debilitating, progressive joint disease of idiopathic origin; it is an interesting topic from both clinical and economic perspectives [ 5 , 6 , 7 ].…”

“…Still, however, little is known about the risk factors associated with its pathogenesis and pathophysiology, although they include the long-term use of chronic steroids, smoking, alcoholism, hip trauma and prior hip surgery [ 11 , 12 ]. This makes it difficult to define surgical methods and curative effects [ 1 , 13 ]. It is, therefore, crucial to obtain a better understanding of the pathogenesis of and make therapeutic approaches to ONFH [ 8 ].…”

“…Despite recent advancements in diagnostic modalities, effective treatments have been elusive and a majority of cases of ONFH eventually result in a collapse of the femoral head. Most of the surgical modalities for patients with ONFH aim to prevent the collapse of the subchondral bone, although their clinical outcomes have been reported to be inconsistent [ 1 , 13 ]. Core decompression may be effective for the treatment of early-stage ONFH, although femoral osteotomy, vascularized or non-vascularized bone grafting and total hip arthroplasty (THA) may also be attempted for that of advanced ONFH [ 14 ].…”

“…Patients with ONFH account for 5–12% of those undergoing THA in the US [ 1 ]. If treated conservatively, >80% of affected hips would progress to femoral collapse and the destruction of the hip joint within four years of initial diagnosis; this often requires THA [ 15 ].…”

The Antagonism of Neuropeptide Y Type I Receptor (Y1R) Reserves the Viability of Bone Marrow Stromal Cells in the Milieu of Osteonecrosis of Femoral Head (ONFH)

“…Osteonecrosis of the femoral head (ONFH) is a major musculoskeletal disorder manifested by hip pain and disability and is one of the leading causes of total hip arthroplasties (THAs) [ 1 , 2 ]. ONFH mainly affects the young and middle-aged population and harbors an unignorable disability rate, jeopardizing the quality of life of the victims.…”