The effect of the anterior boundary of necrotic lesion on the occurrence of collapse in osteonecrosis of the femoral head

Kubo, Yusuke; Motomura, Goro; Ikemura, Satoshi; Sonoda, Kazuhiko; Hatanaka, Hiroyuki; Utsunomiya, Takeshi; Baba, Soumei; Nakashima, Yasuharu

doi:10.1007/s00264-018-3836-8

Cited by 37 publications

(57 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Karasuyama suggested that stress concentration along the lateral sclerotic boundary triggered the subchondral fracture and finally induced the femoral head collapse. Kubo reported different collapse rates of 0%, 23%, and 81%, respectively, corresponding to different locations of lateral sclerotic boundary at the medial one‐third, the middle third, and the lateral one‐third of the weight‐bearing portion of the acetabulum, and he found that the anterior sclerotic boundary could also have an impact on the risk of collapse. Utsunomya generated patient‐specific FEM from 51 patients with ONFH, and he reported that stress was equally distributed on the femoral head surface in all FEM of ARCO Stage I hips, but stress was concentrated at the lateral boundary of the femoral head surface in all FEM of both ARCO Stages II and III hips, which is in accordance with the low‐intensity band on T1‐weighted MRI images, sclerotic changes on CT images and subchondral fractures on micro‐CT images.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prediction of Collapse Using Patient‐Specific Finite Element Analysis of Osteonecrosis of the Femoral Head

Huang

et al. 2019

Orthopaedic Surgery

View full text Add to dashboard Cite

Objective To develop a prediction method for femoral head collapse by using patient‐specific finite element analysis of osteonecrosis of the femoral head (ONFH). Methods The retrospective study recruited 40 patients with ARCO stage‐II ONFH (40 pre‐collapse hips). Patients were divided into two groups according to the 1‐year follow‐up outcomes: patient group without femoral head collapse (noncollapse group, n = 20) and patient group with collapse (collapse group, n = 20). CT scans of the hip were performed for all patients once they joined the study. Patient‐specific finite element models were generated based on these original CT images following the same procedures: segmenting the necrotic lesion and viable proximal femur, meshing the computational models, assigning different material properties according to the Hounsfield unit distribution, simulating the stress loading of the slow walking gait, and measuring the distribution of the von Mises stress. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive performance of the maximum level of the von Mises stress. The optimal cut‐off value was selected based on the Youden index and the corresponding predictive accuracy was reported as well. Results The mean level of the maximum von Mises stress in the collapse group was 2.955 ± 0.539 MPa, whereas the mean stress level in the noncollapse group was 1.923 ± 0.793 MPa (P < 0.01). ROC analysis of the maximum von Mises stress found that the area under the ROC curve was 0.842 (95% CI: 0.717–0.968, P < 0.01). The maximum Youden index was 0.60, which corresponded to two optimal cut‐off values: 2.7801 MPa (sensitivity: 0.70; specificity: 0.90; predictive accuracy: 80.00%; LR+: 7), and 2.7027 MPa (sensitivity: 0.75; specificity: 0.85; predictive accuracy: 77.50%; LR+: 5). Conclusion Finite element analysis is a potential method for femoral head collapse prediction among pre‐collapse ONFH patients. The maximum level of the von Mises stress on the weight‐bearing surface of the femoral head could be a good biomechanical marker to classify the collapse risk. The collapse prediction method based on patient‐specific finite element analysis is, thus, suitable to apply to clinical practice, but further testing on a larger dataset is desirable.

show abstract

Section: Discussionmentioning

confidence: 99%

“…reported that only 59% of hips became collapsed during a follow‐up period of 5–15 years when left untreated. Kubo reported a collapse rate of 54.0% among 113 asymptomatic hips during a follow‐up period of 2.0–11.8 years. Zhao reported that only 42.73% of hips progressed to femoral head collapse during 7‐year follow‐up.…”

Section: Introductionmentioning

confidence: 99%

Prediction of Collapse Using Patient‐Specific Finite Element Analysis of Osteonecrosis of the Femoral Head

Huang

et al. 2019

Orthopaedic Surgery

View full text Add to dashboard Cite

show abstract

“…Occurrence of collapse remains difficult to predict. Radiologic [17][18][19][20] and biologic [21] markers, site of necrosis, volume of osteonecrosis, and etiology of osteonecrosis are discussed in this issue.…”

Section: Risk Of Collapse and Quality Of Lifementioning

confidence: 99%

Hip osteonecrosis: stem cells for life or behead and arthroplasty?

Hernigou¹,

Daltro

Hernigou

2018

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

“…The degree of collapse was also measured according to evaluated by concentric circles on both anteroposterior and lateral radiographs using ImageJ (1.52a, National Institutes of Health, USA), referring to previous literatures [16,17]. With the increasing progression of femoral head collapse, lateral subluxation was defined when Shenton's line was not continuous.…”

Section: Methodsmentioning

confidence: 99%

The natural history of traumatic femur head necrosis after femoral neck fracture in children and adolescent: a retrospective case series of 64 patients

Yang

Hong

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The natural history of traumatic femur head necrosis (TFHN) after femoral neck fracture (FNF) in children and adolescent is relatively unknown and has never been specifically characterized. As we speculated, the natural history in such population would be poor and characterized as the high risk of femoral head collapse, hip deformity and degeneration in a short term. Methods: This retrospective case series enrolled 64 children and adolescent with TFHN who treated with observational treatment from 2000.1 to 2018.1. The primary outcomes, such as the progression of femoral head collapse, hip deformity (Stulberg classification) and hip degeneration (Tönnis grade), and their prognostic factors were analysed. Results: 42 males and 22 females with a mean age of 13 years (6-16 years), were included. A total of 28 hips (44%) showed unsatisfactory outcome and Twenty-five (39%) hips collapsed progressively during a mean follow-up of 48 months (24-203 months). Finally, 38 hips (59%) experienced hip deformity, 20 of them were class IV/V. 34 hips (53%) generally progressed to osteoarthritis, 14 of them were classified as grades II/III. The location of the lesion and the presence of lateral subluxation were found to be independently related to progression of femoral head collapse; however, the presence of lateral subluxation was the only independent risk factor of severe hip deformity and degeneration. Conclusion: TFHN in children and adolescent is a rapidly progressing disease with a poor natural history characterized by a high risk of femoral head collapse progression. If the lateral subluxation emerged, collapsed cases showed increasingly tendency towards severe hip deformity and degeneration.

show abstract

The effect of the anterior boundary of necrotic lesion on the occurrence of collapse in osteonecrosis of the femoral head

Abstract: This study indicates that ONFH patients with anterior localization of a necrotic lesion can develop collapse even if the necrotic lesion is medially located.

Cited by 37 publications

References 23 publications

Prediction of Collapse Using Patient‐Specific Finite Element Analysis of Osteonecrosis of the Femoral Head

Prediction of Collapse Using Patient‐Specific Finite Element Analysis of Osteonecrosis of the Femoral Head

Hip osteonecrosis: stem cells for life or behead and arthroplasty?

The natural history of traumatic femur head necrosis after femoral neck fracture in children and adolescent: a retrospective case series of 64 patients

Contact Info

Product

Resources

About