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Yoon HK, Choi MH, Lee H, Park J, Ahn J. Subchondral stress fracture of the femoral head (SSFFH) in young and healthy military recruits: clinical recommendations and fracture configurations on MRI. INTERNATIONAL ORTHOPAEDICS 2023; 47:1315-1321. [PMID: 36829086 DOI: 10.1007/s00264-023-05739-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/16/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE This study aimed to evaluate the clinical and radiologic characteristics of the fatigue-type of SSFFH in healthy military recruits. MATERIALS AND METHOD We retrospectively analyzed 39 hips from 32 patients who were treated for SSFFH between 2014 and 2018. Clinical variables were analyzed. We devised a categorization system that divided SSFFH into five types (A-E) according to the extent of the fracture line MRI axial view. The femoral head was divided into three parts for the categorization: the anterior third, middle third, and posterior third. RESULTS The included patients were 39 hips from 32 patients with the mean age 22.3 years. Almost all patients with SSFFH (96.9%) complained of hip pain with limping at the time of diagnosis. The mean time to the onset of the hip pain from the beginning of military training was 24.8 days. There were seven patients (21.9%) with concomitant stress fractures on whole-body bone scan. Six hips (15.4%) developed osteoarthritis and required surgery. Almost all the cases (94.9%) involved the anterior compartment of the femoral head. CONCLUSIONS Military recruits with the hip pain and limping within one month of military training should undergo detailed evaluation. A whole-body bone scan with SPECT is useful for identifying other concomitant stress fractures. Majority of SSFFH involved the anterior compartment of the femoral head.
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Affiliation(s)
- Hyung Ku Yoon
- Department of Orthopaedic Surgery, Armed Forces Capital Hospital, 81, Saemaeul-Ro 177Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, Republic of Korea
| | - Min-Ho Choi
- Department of Orthopaedic Surgery, Armed Forces Capital Hospital, 81, Saemaeul-Ro 177Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, Republic of Korea
| | - Ho Lee
- Department of Orthopaedic Surgery, Armed Forces Capital Hospital, 81, Saemaeul-Ro 177Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, Republic of Korea
| | - Jinyong Park
- Department of Orthopaedic Surgery, Armed Forces Capital Hospital, 81, Saemaeul-Ro 177Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, Republic of Korea
| | - Joosuk Ahn
- Department of Orthopaedic Surgery, Armed Forces Capital Hospital, 81, Saemaeul-Ro 177Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, Republic of Korea.
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Higuchi Y, Tomosugi T, Futamura K, Okada M, Kusano T, Sawada H, Kobayashi K, Narumi S, Watarai Y, Goto N, Ando T, Sato K. Risk factors for subchondral insufficiency fracture of the femoral head in renal transplant patients. J Bone Miner Metab 2022; 40:968-973. [PMID: 36001151 DOI: 10.1007/s00774-022-01360-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 07/11/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Risk factors associated with subchondral insufficiency fracture (SIF) of the femoral head have not been established. The aim of the present study was to determine the incidence and risk factors for SIF of the femoral head following renal transplantation (RT). MATERIALS AND METHODS We analyzed the cases of 681 RT patients (mean age at surgery: 49.5 ± 13.6 years, 249 women, 432 men) to determine the incidence of SIF. Hip magnetic resonance imaging (MRI) was performed 6 months post-RT. The following potential predictors of SIF were evaluated: (1) patient's condition at RT: bone mineral density (BMD), pre-RT laboratory values including calcium (Ca), phosphorus (P), calcium-phosphorus product (Ca × P), and intact parathyroid hormone; the patient and donor's blood relationship; and mismatching number of human leukocyte antigens (HLAs), and (2) post-RT dosage(s) of steroid(s), the immunosuppressive regimen, and the incidence of acute rejection. RESULTS SIF was observed in 15 hips (13 patients, 1.9%). We successfully matched 39 patients without SIF. A multivariate logistic regression analysis adjusted for cumulative dosages of steroids, revealed the following were risk factors for SIF: osteoporosis (OR: 11.4, p = 0.046), lumbar BMD (OR: 0.003, p = 0.038), pre-RT serum P (OR 2.68, p = 0.004), and pre-RT serum Ca × P (OR: 1.11, p = 0.005). CONCLUSION Since osteoporosis, the lumbar BMD, serum P, and serum Ca × P were identified as risk factors for a post-RT SIF, these factors should be evaluated before RT for the prediction of the SIF risk.
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Affiliation(s)
- Yoshitoshi Higuchi
- Department.of Orthopaedic.Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-cho, Showa-ku, Nagoya city, 466-8650, Japan.
| | - Toshihide Tomosugi
- Department.of Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya city, Japan
| | - Kenta Futamura
- Department.of Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya city, Japan
| | - Manabu Okada
- Department.of Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya city, Japan
| | - Taiki Kusano
- Department.of Orthopaedic.Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-cho, Showa-ku, Nagoya city, 466-8650, Japan
| | - Hideyoshi Sawada
- Department.of Orthopaedic.Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-cho, Showa-ku, Nagoya city, 466-8650, Japan
| | - Kazuyoshi Kobayashi
- Department.of Orthopaedic.Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-cho, Showa-ku, Nagoya city, 466-8650, Japan
| | - Shunji Narumi
- Department.of Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya city, Japan
| | - Yoshihiko Watarai
- Department.of Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya city, Japan
| | - Norihiko Goto
- Department.of Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya city, Japan
| | - Toshihiro Ando
- Department.of Orthopaedic.Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-cho, Showa-ku, Nagoya city, 466-8650, Japan
| | - Koji Sato
- Department.of Orthopaedic.Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-cho, Showa-ku, Nagoya city, 466-8650, Japan
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Ishizu H, Shimizu T, Kaibara T, Asano T, Terkawi MA, Takahashi D, Iwasaki N. Bilateral subchondral insufficiency fractures of the femoral head in a normally active adolescent patient: A case report. J Orthop Sci 2022; 27:492-494. [PMID: 31176516 DOI: 10.1016/j.jos.2019.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/21/2019] [Accepted: 05/14/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Hotaka Ishizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan.
| | - Takuma Kaibara
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Tsuyoshi Asano
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Mohamad Alaa Terkawi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Daisuke Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
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Xu M, Motomura G, Utsunomiya T, Ikemura S, Yamaguchi R, Hatanaka H, Baba S, Kawano K, Nakashima Y. Traumatic subchondral fracture of the femoral head occurring concurrently with contralateral acetabular fracture. J Orthop Sci 2022; 27:495-499. [PMID: 31208823 DOI: 10.1016/j.jos.2019.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/09/2019] [Accepted: 05/26/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Mingjian Xu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Takeshi Utsunomiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Ryosuke Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hiroyuki Hatanaka
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shoji Baba
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Koichiro Kawano
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Gaudiani MA, Samuel LT, Mahmood B, Sultan AA, Kamath AF. Subchondral insufficiency fractures of the femoral head: systematic review of diagnosis, treatment and outcomes. J Hip Preserv Surg 2019; 7:85-94. [PMID: 32382434 PMCID: PMC7195931 DOI: 10.1093/jhps/hnz054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/16/2019] [Accepted: 10/03/2019] [Indexed: 12/31/2022] Open
Abstract
Subchondral insufficiency fractures of the femoral head (SIFFH) are a cause of femoral head collapse leading to degenerative hip disease. SIFFH is often mistaken for osteonecrosis given similar clinical and radiographic features. These similarities often lead to missed or delayed diagnosis which can often delay or change management. The purpose of this article is to systematically review the spectrum of demographics, diagnostic and treatment options, including hip preservation in young patient populations. A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. All related peer-reviewed publications from January 1999 to January 2019 were reviewed using the following databases: Medline, EMBASE, Scopus and Web of Science. The systematic review identified 54 articles, encompassing 482 patients (504 hips) diagnosed with SIFFH. One hundred and seventy-six (35%) males and 306 (63%) females were included, with a mean age of 53.6 ± 17.5 years and mean body mass index of 23.4 ± 4.0 kg/m2. Mean follow-up was 23.4 ± 15.9 months. Treatment decisions were 256 (55%) non-operative, 157 (34%) total hip arthroplasty (THA), 24 (5%) transtrochanteric anterior rotational osteotomy, 9 (2%) hip arthroscopy, 7 (2%) hip resurfacing, 3 (1%) bone grafting, 3 (1%) hemiarthroplasty and 1 (1%) tantalum rod insertion. Overall, 35% of SIFFH hips were converted to THA at latest follow-up. A majority of SIFFH patients had symptom resolution with non-operative management. Failure most often resulted in THA. In younger patients, hip preservation techniques have shown promising early results and should be considered as an alternative.
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Affiliation(s)
- Michael A Gaudiani
- School of Medicine, Case Western Reserve University, 2109 Adelbert Rd, Cleveland, OH 44106, USA
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue A41, Cleveland, OH 44123, USA
| | - Bilal Mahmood
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue A41, Cleveland, OH 44123, USA
| | - Assem A Sultan
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue A41, Cleveland, OH 44123, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue A41, Cleveland, OH 44123, USA
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Ohtsuru T, Yamamoto T, Murata Y, Morita Y, Munakata Y, Kato Y, Okazaki K. Incidence of osteonecrosis and insufficiency fracture of the hip and knee joints based on MRI in 300 renal transplant patients. Hip Int 2019; 29:316-321. [PMID: 30547689 DOI: 10.1177/1120700018808693] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The purpose of this study was to investigate the incidence of necrosis and insufficiency fracture of the hip and knee using magnetic resonance imaging (MRI) in renal transplant patients. METHODS We examined 300 consecutive renal transplant patients using MRI of the hips and knees (T1-weighted coronal MRI) preoperatively and at 3 and 6 months postoperatively. Oblique axial-plane T1-weighted MRI and short-tau inversion-recovery T2-weighted MRI were performed parallel to the femoral neck when distinguishing the osteonecrosis of the femoral head (ONFH) from subchondral insufficiency fracture (SIF) of the femoral head was difficult. RESULTS ONFH was observed in 3 hips (3 cases, 1.0%). Osteonecrosis of the knee was observed in 2 knees (1 case, 0.3%). SIF of the femoral head was observed in 5 hips (3 cases, 1.0%). Bilateral simultaneous onset of SIF of the femoral head was observed in 2 cases (0.7%). Insufficiency fracture of the knee was observed in 2 knees (1 case, 0.3%). CONCLUSIONS When it was difficult to distinguish ONFH from SIF of the femoral head, oblique axial-plane T1-weighted MRI and the short-tau inversion-recovery T2-weighted MRI parallel to the femoral neck were useful to establish the correct diagnosis.
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Affiliation(s)
- Tadahiko Ohtsuru
- 1 Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takuaki Yamamoto
- 2 Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yasuaki Murata
- 3 Department of Orthopaedic Surgery, Teikyo University, Chiba, Japan
| | - Yuji Morita
- 1 Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yutaro Munakata
- 1 Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Ken Okazaki
- 1 Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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