Quantitative evaluation of bone-resorptive lesion volume in osteonecrosis of the femoral head using micro-computed tomography

Abstract

Objectives To quantify the volume of bone-resorptive lesions in post-collapse osteonecrosis of the femoral head (ONFH) using micro-computed tomography (micro-CT) and assess their characteristics in postcollapse ONFH.Methods We investigated 35 femoral heads resected from 35 patients with ONFH (20 men and 15 women; mean age, 47.2 years). On each of seven coronal high-resolution micro-CT slices of the femoral head, the bone-resorptive areas were extracted using bone microstructure measurement software. Next, the total bone-resorptive volume ratio, defined as the ratio of all bone-resorptive cross-sectional areas to all femoral head cross-sectional areas in all seven slices, was calculated. Associations between total boneresorptive volume ratio and sex, age, ONFH-associated factors, patient workload levels, ONFH stage, ONFH type, necrotic volume on magnetic resonance imaging, and duration from the onset of pain to surgery were analyzed. Lesion location and the association between bone-resorptive lesion and collapse were also evaluated.Results The mean total bone-resorptive volume ratio was 7.0 ± 6.0%, which varied significantly by ONFH stage (ARCO collapse quantitation 3A, 3.5 ± 2.1%; 3B, 6.8 ± 3.0%; and 3 C, 13.6 ± 8.8%). ONFH stage was independently associated with total bone-resorptive volume ratio (P < 0.05). Furthermore, high boneresorptive volume ratios were found in the anterior femoral head and were associated with collapse.Conclusions This study demonstrated that bone-resorptive volume in post-collapse ONFH was significantly associated with the disease stage, which was more widespread in the anterior portion of the femoral head than in the posterior portion.

Is bone mineral density lower in the necrotic lesion in pre‐collapse osteonecrosis of the femoral head?

“…Therefore, apart from the eccentrically located necrotic lesions, the HU values in the current study may well reflect those of extended necrotic lesions that have a high possibility of collapse. We focused on the anterosuperior portion of the femoral head because this is where collapse usually occurs, and thus examining this region should provide the most information about the decrease in HU values in pre‐collapse ONFH 15,30 . Finally, we did not actually demonstrate that the HU values of the necrotic lesion decreased after collapse in ONFH.…”

“…We focused on the anterosuperior portion of the femoral head because this is where collapse usually occurs, and thus examining this region should provide the most information about the decrease in HU values in pre-collapse ONFH. 15,30 F I G U R E 6 Differences in Hounsfield unit (HU) values of the lateral boundary between osteonecrosis of the femoral head (ONFH) patients with and without subsequent collapse after CT. The mean HU value of the lateral boundary in 12 ONFH patients with subsequent collapse within one year after CT is 350.1 ± 139.1 (153.6-591.3), while that in 15 patients without collapse after CT is 240.3 ± 84.9 (94.5-393.7).…”

Three‐Dimensional Distribution of Bone‐Resorption Lesions in Osteonecrosis of the Femoral Head Based on the Three‐Pillar Classification

“…The pathologic characteristics of bone-resorptive lesions, in which trabecular structure was no longer present, are noncavitary and contain loose fibrous elements 10,11 . By using micro-CT imaging of the femoral head in ARCO stage III from total hip arthroplasty, Hamada et al 6 and Baba et al 7 found that the bone resorption area can lead to the initiation of subchondral fracture and accelerate the progress of collapse. In addition, Gao et al 8 also demonstrated that the femoral head with osteonecrosis complicating by cystic bone-resorptive area is more likely to accompany microfracture and crescent sign, which could hint that the femoral head loses its stability and proceeds to collapse more quickly.…”

“…Moreover, others studies demonstrated that when the necrotic lesions involved more anterolateral femoral head, collapse will almost be inevitable 4 , 5 . Besides the size and location of the necrotic lesion, previous studies have demonstrated that subchondral fracture and collapse are closely related to bone‐resorptive lesions, suggesting the importance of bone‐resorptive lesions on the collapse progression 6 , 7 , 8 .…”

Differences in the Microarchitectural and Histomorphologic Characteristics Between Glucocorticoid-induced Osteonecrosis of Femoral Head and Alcohol-induced Osteonecrosis of Femoral Head

“…Our results revealed that the reactive interface and normal region displayed a less sclerotic microarchitecture in GIONFH as compared with AIONFH, exhibiting a lower bone volume fraction, less trabecular number, and wider trabecular space, especially in the Cen-Cen region. The deteriorated microarchitecture has been reported to play a pivotal role in the failure of mechanical stabilization in the femoral head, and eventually leads to the progression of collapse 52 . The alterations of microstructure may be due to the distinct bone remodeling status 53 , which could be in uenced by different reagents that affect bone metabolism such as glucocorticoid and alcohol.…”