Quantifying the Extent of Femoral Head Involvement in Osteonecrosis

Cherian, Sebastian F.; Laorr, Alan; Saleh, Khaled J.; Kuskowski, Michael A.; Bailey, Robert F.; Cheng, Edward Y.

doi:10.2106/00004623-200302000-00019

Cited by 84 publications

(71 citation statements)

References 14 publications

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“…The extent of the remaining cold defect on follow-up SPECT/CT might be associated with the occurrence and severity of AVN; however, statistical analysis could not be performed because of the small numbers. Although further studies with SPECT/CT will be needed to explore the association, this finding is consistent with a previous study by Cherian et al [11], which demonstrated that the necrotic extent of the femoral head on MRI was related to the severity of AVN. One patient developed Ficat stage II AVN despite completely normalized femoral head uptake on the followup bone SPECT/CT.…”

Section: Discussionsupporting

confidence: 91%

“…One patient developed Ficat stage II AVN despite completely normalized femoral head uptake on the followup bone SPECT/CT. This might have resulted from the limited spatial resolution of the SPECT scanner, although the small AVN that was obscured on SPECT is likely to have a good functional prognosis without subchondral collapse [11].…”

Section: Discussionmentioning

confidence: 99%

“…Both Bcomplete cold defect^and Bpartial cold defect^are considered as a cold defect of the femoral head. On the follow-up postoperative bone SPECT/ CT, femoral head uptake was compared with that of the immediate postoperative bone SPECT/CT and then classified as Bcompletely normalized uptake,^Bpartially normalized uptake,^or Bpersistent cold defect.^In the Bpartially normalized uptake^group, the extent of the remaining cold defect was visually estimated as the percentage of the femoral head compared with the area of the whole femoral head as ≤30 % and >30 % [11].…”

Section: Bone Spect/ct Acquisition and Image Analysismentioning

confidence: 99%

“…A significant proportion of those who develop AVN complain of disabling pain and require secondary arthroplasty because of secondary osteoarthritis [6,10]. Femoral head collapse is considered the most important functional prognostic factor in progression to secondary osteoarthritis [11]. Joint-preserving procedures, such as core decompression or vascularized fibular grafts, can be performed more successfully at an earlier stage of AVN to prevent progression in severity and joint destruction [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

“…Femoral head collapse is considered the most important functional prognostic factor in progression to secondary osteoarthritis [11]. Joint-preserving procedures, such as core decompression or vascularized fibular grafts, can be performed more successfully at an earlier stage of AVN to prevent progression in severity and joint destruction [11][12][13]. Hence, early prediction of developing AVN is critical for assessing the functional prognosis and planning further therapeutic approaches.…”

Section: Introductionmentioning

confidence: 99%

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Risk Stratification for Avascular Necrosis of the Femoral Head After Internal Fixation of Femoral Neck Fractures by Post-Operative Bone SPECT/CT

Han

Yoon

et al. 2016

Nucl Med Mol Imaging

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Purpose Avascular necrosis (AVN) of the femoral head is a major complication after internal fixation of a femoral neck fracture and determines the functional prognosis. We investigated postoperative bone single-photon emission computed tomography/computed tomography (SPECT/CT) for assessing the risk of femoral head AVN. Methods We retrospectively reviewed 53 consecutive patients who underwent bone SPECT/CT within 2 weeks of internal fixation of a femoral neck fracture and follow-up serial hip radiographs over at least 12 months. Results Nine patients developed femoral head AVN. In 15 patients who showed normal uptake on immediate postoperative SPECT/CT, no AVN occurred, whereas 9 of 38 patients who showed cold defects of the femoral head later developed AVN. The negative predictive value of immediate postoperative SPECT/CT for AVN was 100 %, whereas the positive predictive value was 24 %. Among 38 patients with cold defects, 1 developed AVN 3 months postoperatively. A follow-up bone SPECT/CT was performed in the other 37 patients at 2-10 months postoperatively. The follow-up bone SPECT/CT revealed completely normalized femoral head uptake in 27, partially normalized uptake in 8, and persistent cold defects in 2 patients. AVN developed in 3.7 % (1/27), 62.5 % (5/8), and 100 % (2/2) of each group, respectively. Conclusions According to the time point of imaging, radiotracer uptake patterns of the femoral head on postoperative bone SPECT/CT indicate the risk of AVN after internal fixation of femoral neck fractures differently. Postoperative bone SPECT/CT may help orthopedic surgeons determine the appropriate follow-up of these patients.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Bone Spect/ct Acquisition and Image Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk Stratification for Avascular Necrosis of the Femoral Head After Internal Fixation of Femoral Neck Fractures by Post-Operative Bone SPECT/CT

Han

Yoon

et al. 2016

Nucl Med Mol Imaging

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Frog leg lateral view is a reliable predictor of the prognosis in osteonecrosis of the femoral head

Cheng

Xian

Wang

et al. 2020

Journal Orthopaedic Research

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The location and size of necrotic lesions are primary factors that predict the prognosis in osteonecrosis of the femoral head (ONFH). The Japanese Investigation Committee (JIC) classification system, based on the location of the necrotic lesion, has been widely accepted and applied around the world. However, there is no report about whether the location of the necrotic area in lateral view may affect the prognosis predicted initially by the JIC classification. The purpose of this study was to investigate whether the location of the necrotic area in the frog leg lateral (FL) view would affect the prediction of prognosis for patients with ONFH. We retrospectively studied 90 hips in 76 patients with ONFH (Ficat stage I to II) after a mean follow-up of 35.3 months. All patients received standard radiographs including an anteroposterior (AP) and a FL view of the affected hip. The percentage of the necrotic area (necrotic area/whole femoral head area) was measured and compared between AP and FL view. Hips with ONFH were categorized using the JIC classification and the FL view type system, and inter-and intraobserver reliability was compared between them. All patients underwent personalized hip physiotherapy, and the cumulative survival rate with subsequent collapse and/or requirement for further hip surgery as the endpoints was evaluated for the two classification systems. The percentage of the necrotic area was found to be significantly greater in the FL views (47.0 ± 1.5%) than that in the AP views (37.7 ± 1.7%, P < .01).Intraobserver reliability in the JIC classification (mean: 0.91, range: 0.85-0.98) was higher than that in the FL view type (mean: 0.77, range: 0.63-0.89; P < .01), as well as the interobserver reliability in the JIC classification (mean: 0.74, range: 0.38-0.87) was higher than that in the FL view type (mean: 0.58, range: 0.31-0.76; P < .01).Comparisons of survival curves showed that type III in FL view type had the worst prognosis than other two divisions, following the type II. The type I was likely to gain optimal outcomes. These findings provide evidence that the location to which necrosis extended in the FL view is a reliable indicator in predicting the prognosis of ONFH.

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Osteonecrosis

Steinberg¹,

Steinberg²

2015

Diagnosis and Management of Hip Disease

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Quantifying the Extent of Femoral Head Involvement in Osteonecrosis

Cited by 84 publications

References 14 publications

Risk Stratification for Avascular Necrosis of the Femoral Head After Internal Fixation of Femoral Neck Fractures by Post-Operative Bone SPECT/CT

Risk Stratification for Avascular Necrosis of the Femoral Head After Internal Fixation of Femoral Neck Fractures by Post-Operative Bone SPECT/CT

Frog leg lateral view is a reliable predictor of the prognosis in osteonecrosis of the femoral head

Osteonecrosis

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