Predictors of cartilage degeneration in patients with subchondral insufficiency fracture of the femoral head: a retrospective study

Abstract

Background There is evidence that the cause of primary osteoarthritis (OA) is related to the changes in subchondral bone; however, it is not fully understood if subchondral insufficiency fracture (SIF) of the femoral head would affect degeneration of the hip joint and what the prognostic factors related to joint degeneration are. The objectives of this study were 1) to investigate the longitudinal joint space narrowing and 2) to investigate the associations between joint space narrowing and bone metabolic markers as well as magnetic resonance imaging (MRI) among the patients with SIF. Methods Between January 2010 and December 2019, 238 patients in whom band pattern of the femoral head were observed on MRI visited our hospital. Among these patients, 44 hips in 41 patients were diagnosed with SIF and eligible for this retrospective study. We evaluated the joint space width (JSW) of the hip on the radiograph obtained at the first and last visits, length of the band lesion on MRI, bone mineral density by dual-energy x-ray absorptiometry, and bone metabolism markers. We investigated the factors associated with the necessity of surgery and the progression of the narrowing of the joint space. Results Fifteen of the 44 hips required total hip arthroplasty (THA). The JSW showed a significant decrease from the first visit to the final follow-up. Changes in the JSW were associated with the length of band patterns, serum type 1 procollagen-N-propeptide (P1NP), and tartrate-resistant acid phosphatase 5b (TRACP-5b) at the date of diagnosis. Additionally, bone metabolic markers tended to be associated with the length of the band pattern. Conclusions SIF could cause joint space narrowing and hip OA. In addition to MRI findings as prognostic predictors of SIF, as previously described, bone metabolic markers were also associated with changes in JSW, suggesting that these parameters could be useful to predict the prognosis of SIF. Considering that bone metabolic markers trended to be associated with the length of band pattern, they might reflect the local severity.