Three-dimensional distribution of cystic lesions in osteonecrosis of the femoral head

Liu, Guang-Bo; Li, Rui; Lu, Qiang; Ma, Haiyang; Zhang, Yuxuan; Qi, Qi; Liang, Xue‐Zhen; Peng, Jiang; Lu, Shibi

doi:10.1016/j.jot.2019.10.010

Cited by 20 publications

(21 citation statements)

References 27 publications

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“…Furthermore, the results of the finite element study show that the bone-resorption lesions could lead to the formation of a stress concentration area around it and increase the stress in the necrotic area, which could increase the risk of collapse 22,23 . Previous reports have also shown that the bone-resorption lesions are mainly located near the sclerosis rim, destroying its protective effect on the necrotic area 8,13 . All of above elements might contribute to the occurrence of collapse in ONFH.…”

Section: Discussionmentioning

confidence: 95%

“…In addition, a bone chamber study in rats also confirmed that systemic alendronate could prevent resorption of necrotic bone, indicating the close connection between osteoclasts and bone-resorption lesions 25 . Based on previous studies, the bone-resorption lesions were mainly located at the junction of the necrotic zone and the normal zone 13 . Li et al 26 observed the distribution of tartrate resistant acid phosphatase (TRAP)-positive cells in 51 hips and found that TRAP-positive cells were detected in the early radiologic stage and were detected increasingly through the reparative interface zone in accordance with progression of the radiologic stage.…”

Section: Discussionmentioning

confidence: 99%

“…Three-Dimensional Reconstruction of the Femur, and Bone-Resorptive Lesions All patients underwent CT images, which the scans had a slice thickness of ≤1 mm, a slice increment of ≤0.6mm, and a pixel size of ≤0.8 mm. The three-dimensional structure of the femoral head and bone-resorption lesions were obtained based on the previous method 13 . Briefly, row hip CT data were obtained in the axial plane and imported to the Mimics software (version 21.0, Materialise, Leuven, Belgium).…”

Section: General Information Of Participantsmentioning

confidence: 99%

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

Liu

Meng

et al. 2021

Orthopaedic Surgery

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Objective: To investigate three-dimensional distribution of bone-resorptive lesions based on the three-pillar classification and its effect on the disease progression of osteonecrosis of the femoral head (ONFH).Methods: A total of 194 femoral head CT images from 117 patients diagnosed with ARCO stage II and III ONFH were retrospectively reviewed from April 2014 to February 2019. Three-dimensional structures of the femoral head and the bone-resorptive lesions were reconstructed. Using the three-pillar classification and coronal plane of the femoral head, we divided each femoral head into six regions to observe the location characteristics of bone-resorption lesions, and explore the destruction of different areas of the femoral head by the bone-resorptive lesions. Then the hips were divided into two groups based on whether they contained bone-resorption lesions and compared the difference of stage II and stage III between the two groups.Results: The regional distribution revealed 39 (27.27%), 55 (38.46%), six (4.20%), 23 (16.08%), 17 (11.89%) and three (2.10%) bone-resorptive lesions in regions I, II, III, IV, V and VI respectively. The lateral pillar, AL (I + IV), contained 44.76% of the lesions, central pillar, C (II + V), 48.95%, and medial pillar, M (III + VI), 6.29%. Moreover, there were 81.82% boneresorption lesions in anterolateral pillar, AL (I + II + IV), and 18.18% in posteromedial pillar, PM (III + V + VI). In all ONFH hips, the lateral pillar of 81(88.04%) femoral heads were affected, the central pillar of 84 (91.30%) femoral heads were affected, and the medical pillar of 29 (31.52%) femoral heads were affected. The ratio of ARCO stage III in the group with bone-resorption lesions was significantly higher than that of the group without bone-resorption lesions (76.09% vs 30.39%, P < 0.001).Conclusions: This study demonstrated that the bone-resorption lesions are mainly distributed in the lateral and central pillar of the femoral head, and the two pillars of the femoral head are usually involved by bone-resorption lesions. Furthermore, the ratio of ARCO stage III in the group with bone-resorption lesions was significantly higher than that of the group without bone-resorption lesions, suggesting that the bone-resorption lesions might accelerate the progression of ONFH.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: General Information Of Participantsmentioning

confidence: 99%

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

Liu

Meng

et al. 2021

Orthopaedic Surgery

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“…[ 33 , 34 ]) in Spain, three (Appendix Ref. [ 24 , 30 , 32 ]) in America and two (Appendix Ref. [31, 36]) in Italy.…”

Section: Resultsmentioning

confidence: 99%

General recommendation for assessment and management on the risk of glucocorticoid-induced osteonecrosis in patients with COVID-19

Huang

Tan

et al. 2021

Journal of Orthopaedic Translation

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“…Necrotic lesion located on the lateral and anterior femoral head had high collapse risk, as shown in using magnetic resonance imaging (MR), computed tomography (CT), or radiographs [10][11][12] . The anterior and lateral bone structure of the femoral head is a critical weight-bearing area and the load-bearing ability reduced as a result of impairment of necrotic bone [13][14][15][16][17] . Therefore, an ideal method for predicting the progression of ONFH should focus on evaluating the bone structure in the weight-bearing area.…”

Section: Introductionmentioning

confidence: 99%

Anterolateral Necrotic Lesion Serves as an Early Warning Sign of Developing Collapse in Osteonecrosis of the Femoral Head

Wei¹,

He²,

He³

et al. 2021

Preprint

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Objective: Load bearing capacity of the bone structure of anterolateral weight-bearing area plays an important role in the progressive collapse in osteonecrosis of the femoral head (ONFH). The purpose of this study is to assess the efficacy of combined evaluation of anteroposterior (AP) and frog-leg lateral (FLL) view to diagnose collapse.Methods: Between December 2016 to August 2018, a total of 478 hips from 372 patients with ONFH (268 men, 104 women; mean age 37.9±11.4 years) were retrospectively evaluated. All patients received standard AP and FLL views of hip joints. Japanese Investigation Committee (JIC) classification system was used to classified necrotic lesion in AP view. Anterior necrotic lesion was evaluated by FLL view. All patients with precollapse ONFH underwent non-operative hip preserving therapy. The collapse rate was calculated and compared with Kaplan–Meier survival analysis with radiological collapse as endpoints.Results: Forty-four (44/478, 9.2%) hips were classified as type A, 65 (65/478, 13.6%) as type B, 232 (232/478, 48.5%) as type C1, and 137 (137/478, 28.7%) as type C2. Three hundred cases (300/478, 62.5%) were collapsed at the initial time point. Two hundred and twenty six (226/300, 75.3%) hips and 298 (298/300, 99.3%) hips collapse were identified with AP view and FLL view, respectively. An average follow-up of 37.0±32.0 months was conducted to evaluate the occurence of collapse in 178 precollapse hips. During follow-up period, collapse occurred in 89 hips (50.0%). Seventy-seven (77/89, 86.5%) hips was determined with AP view alone and 85 (85/89, 95.5%) hips were determined with combination of AP and FLL views. The collapse rate at five years were reported as 0% and 0%, 16.2% and 24.3%, 58.3% and 68.1%, and 100% and 100% according to combination of AP and FLL views or AP view alone for types A, B, C1, and C2, respectively.Conclusion: The collapse can be diagnosed more accurately by combination of AP and FLL views. Besides, JIC type A and type B ONFH can be treated with conservative hip preservation, but precollapse type C2 ONFH should be treated with joint-preserving surgery. Type C1 needs further study to determine which subtype has potential risk of collapse.

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Three-dimensional distribution of cystic lesions in osteonecrosis of the femoral head

Cited by 20 publications

References 27 publications

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

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

General recommendation for assessment and management on the risk of glucocorticoid-induced osteonecrosis in patients with COVID-19

Anterolateral Necrotic Lesion Serves as an Early Warning Sign of Developing Collapse in Osteonecrosis of the Femoral Head

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