Systematic Analysis of Classification Systems for Osteonecrosis of the Femoral Head

Mont, Michael A.; Marulanda, German A.; Jones, Lynne C.; Saleh, Khaled J.; Gordon, Noah; Hungerford, David S.; Steinberg, Marvin E.

doi:10.2106/jbjs.f.00457

Cited by 125 publications

(73 citation statements)

References 115 publications

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“…As the region of ON was larger in specimens from hips with postnecrotic fractures than in hips with biomechanically caused fractures and those revised for reasons other than fractures, we suggest the extent of the lesion might relate to its outcome. An association of lesion size of ON with its outcome would be similar to that proposed in most classification systems for conventional ON of the femoral head [11]. We found larger lesions were associated with periprosthetic fractures and larger lesions collapsed more frequently than smaller ones.…”

Section: Discussionsupporting

confidence: 83%

See 1 more Smart Citation

Association of Osteonecrosis and Failure of Hip Resurfacing Arthroplasty

Zustin

Sauter

Morlock

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Osteonecrosis (ON) has been reported in femoral remnants removed after failure of hip resurfacing arthroplasty. Experimental and clinical studies have further described thermal effects of the cementation technique, damage of extraosseous blood vessels, and intraoperative hypoxemia as possible causative factors. We analyzed histologically a series of 123 retrieved specimens with a preoperative diagnosis other than ON to investigate the incidence and extent of advanced ON. ON was found in 88% of cases and associated with 60% (51 of a total of 85) of periprosthetic fractures. The fracture incidence correlated with the extent of ON. Collapse of necrotic tissue in three (2%) cases resulted in disconnection of the bone stock-femoral component. We observed smaller regions of superficial ON in the majority of the remaining femoral remnants with periprosthetic fractures and in hips that failed for reasons other than fracture.

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Section: Discussionsupporting

confidence: 83%

“…This disease, which often leads to destruction of the hip, most commonly affects the femoral head [11].…”

Section: Introductionmentioning

confidence: 99%

Association of Osteonecrosis and Failure of Hip Resurfacing Arthroplasty

Zustin

Sauter

Morlock

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…In a systematic review of the literature, Mont et al [57] identified 16 major classification systems used to classify and describe ON. Of these, four classification systems accounted for greater than 85.4 % of the reported studies: the Ficat Classification [58] was the most frequently used system (63 %), followed by the University of Pennsylvania system (20 %) [47,26], the Association Research Circulation Osseous (ARCO) system (12 %) [59], and the Japanese Orthopaedic Association system (5 %) [60,61] (Table 2).…”

Section: Classificationmentioning

confidence: 99%

Osteonecrosis of the femoral head: diagnosis and classification systems

Choi

Steinberg

Cheng

2015

Curr Rev Musculoskelet Med

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Osteonecrosis of femoral head is a rare but disabling condition that usually results in progressive femoral head collapse and secondary arthritis necessitating total hip arthroplasty if not treated appropriately in early stages. However, early diagnosis is challenging as the onset of disease is insidious and the symptoms and signs are usually minimal and nonspecific until it becomes advanced. Of several diagnostic modalities, magnetic resonance imaging (MRI) is considered the imaging method of choice with the highest sensitivity and specificity, while detection of potential risk factors is very important as well. Many investigators have developed several different classification systems; however, there still is controversy regarding the optimal classification system. Diagnostic methods and the evolution of different classification systems will be reviewed in this paper.

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“…ONFH tends to affect younger patients; therefore, various head-preserving procedures have been used to delay the progression of the disease and provide pain relief to avert or delay total hip arthroplasty (THA) [8][9][10][11][12][13]. Femoral head sparing procedures (FHSP) include core decompression (CD), different bone grafting procedures, and/or biologic agents and rotational osteotomies.…”

Section: Introductionmentioning

confidence: 99%