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Lee YK, Won SH, Park JW, Im JW, Ha YC, Koo KH. Cementless Hip Arthroplasty in Patients with Subchondral Insufficiency Fracture of the Femoral Head. J Bone Joint Surg Am 2022; 104:84-89. [PMID: 34788256 DOI: 10.2106/jbjs.20.00410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Subchondral insufficiency fracture of the femoral head (SIFFH) occurs in elderly patients and might be confused with osteonecrosis of the femoral head (ONFH). Subchondral insufficiency fracture of the femoral head is an insufficiency fracture at the dome of the femoral head and has been known to be associated with osteoporosis, hip dysplasia, and posterior pelvic tilt. This study's aims were to evaluate (1) surgical complications, (2) radiological changes, (3) clinical results, and (4) survivorship of THA in patients with SIFFH. METHODS From November 2010 to June 2017, 21 patients (23 hips); 5 men (5 hips) and 16 women (18 hips) underwent cementless THA due to SIFFH at our institution. Their mean age was 71.9 years (range, 57 to 86) at the time of surgery, and mean T-score was -2.2 (range, -4.2 to 0.2). The mean lateral center-edge angle, abduction, and anteversion of the acetabulum were 29.9° (range, 14.8° to 47.5°), 38.5° (range, 31° to 45°), and 20.0° (range, 12° to 25°), respectively. The mean pelvic incidence, lumbar kyphotic angle and posterior pelvic tilt were 56.4° (range, 39° to 79°), 14.7° (range, -34° to 43°), and 13.0° (range, 3° to 34°), respectively. RESULTS An intraoperative calcar crack occurred in 1 hip. The mean anteversion and abduction of cup were 29.0° (range, 17° to 43°) and 43.3° (range, 37° to 50°), respectively. One patient sustained a traumatic posterior hip dislocation 2 weeks after the procedure, and was treated with open reduction. At a mean follow-up of 35.4 months (range, 24 to 79 months), no hip had prosthetic loosening or focal osteolysis. At the latest follow-up, the mean modified Harris hip score was 79.1 (range, 60 to 100) points, and mean UCLA activity score was 4.2 (range, 2 to 7) points. The survivorship was 95.7% (95% CI, 94.9% to 100%) at 6 years. CONCLUSIONS Cementless THA is a favorable treatment option for SIFFH in elderly patients. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Seok-Hyung Won
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jin Woo Im
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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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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Lee S, Kim HJ, Yoo JJ. Factors Affecting the Clinical Course of Subchondral Fatigue Fracture of the Femoral Head. Clin Orthop Surg 2022; 15:203-210. [PMID: 37008972 PMCID: PMC10060783 DOI: 10.4055/cios22044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/10/2022] [Accepted: 06/17/2022] [Indexed: 11/06/2022] Open
Abstract
Background Subchondral fatigue fracture of the femoral head (SFFFH) is a rare disease, and its disease entity is established in recent decades. Although there are a few studies on SFFFH, most of them are case series involving around 10 cases, and the clinical course of SFFFH is still not well known. This study analyzed the factors affecting the clinical course of SFFFH. Methods Patients who visited our institution from October 2000 to January 2019 were retrospectively evaluated. Of eligible cases, 89 hips (80 patients) were diagnosed with SFFFH and non-surgical treatment outcomes were analyzed. Radiographs and medical charts were reviewed for following factors: the degree of femoral head collapse, the interval between the onset of hip pain and the first hospital visit, hip dysplasia, osteoarthritic changes, sex, and age. Results Hip pain decreased in 82 cases (92.1%) through non-surgical treatment, and 7 cases (7.9%) underwent surgery. Patients with good results of non-surgical treatment had improvement 2.9 months on average after the treatment. All cases without a collapsed femoral head (55 cases) had hip pain alleviation through non-surgical treatment. Cases with femoral head collapse of 4 mm or less and non-surgical treatment within 6 months from the onset of hip pain (22 cases) all had hip pain alleviation. Among 8 cases with femoral head collapse of 4 mm or less and non-surgical treatment after 6 months or more from the onset of hip pain, 3 underwent surgery and 1 had persistent hip pain. Those with femoral head collapse of over 4 mm (3 cases) all underwent surgery. The osteoarthritic changes, dysplastic hip, sex, and age were not statistically related to the success of non-surgical treatment. Conclusions The success of non-surgical treatment for SFFFH can be affected by the degree of femoral head collapse and the timing of non-surgical treatment.
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Affiliation(s)
- Sunhyung Lee
- Department of Orthopaedic Surgery, Asan Medical Center, Seoul, Korea
| | - Hee Joong Kim
- Department of Orthopaedic Surgery, Yeson Hospital, Bucheon, Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
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Chen Y, Miao Y, Liu K, Xue F, Zhu B, Zhang C, Li G. Evolutionary course of the femoral head osteonecrosis: Histopathological - radiologic characteristics and clinical staging systems. J Orthop Translat 2022; 32:28-40. [PMID: 35591937 PMCID: PMC9072800 DOI: 10.1016/j.jot.2021.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023] Open
Abstract
Osteonecrosis of the femoral head (ONFH) is a recalcitrant ischemic disorder, which could be classified into two major categories: traumatic and nontraumatic. Regardless of different risk factors, it has been testified that ONFH results from primitive vascular problems, leading to temporary or permanent loss of blood supply to bone tissue. Histopathological and microarchitectural alterations ensues, which is a gradual evolutionary process involving bone marrow and osteocyte necrosis, progressive destruction of subchondral bone, unsuccessful reparative process, and eventual articular collapse and degenerative arthritis. Based on the imaging features of ONFH, different classification systems have been developed to evaluate the severity and prognosis of the disease, which is pivotal for implementation of treatment strategy, especially the joint-preserving surgery. However, patients classified with the same severity stage, especially in the peri-collapse stage, sometimes responded differently after similar joint-preserving surgery. The unusual phenomenon may be attributed to the limitation of the current imaging classification systems, which might underestimate the disease severity, especially when referring to the early stages. In this review, we briefly summarize the etiology and pathogenesis of ONFH. The imaging features and staging classification systems of ONFH are also described. More importantly, we focus on histopathological and microstructural alterations of the femoral head, and provide an overview of their essential contribution to ONFH progression. Given the observation of discordance between imaging characteristics and histopathological alterations, a substantial amount of research on the relationship between imaging and histopathological features is required to further modify and revise the current wide-accepted classification systems.
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Zhao D, Zhang F, Wang B, Liu B, Li L, Kim SY, Goodman SB, Hernigou P, Cui Q, Lineaweaver WC, Xu J, Drescher WR, Qin L. Guidelines for clinical diagnosis and treatment of osteonecrosis of the femoral head in adults (2019 version). J Orthop Translat 2020; 21:100-110. [PMID: 32309135 PMCID: PMC7152793 DOI: 10.1016/j.jot.2019.12.004] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/29/2019] [Accepted: 12/05/2019] [Indexed: 12/26/2022] Open
Abstract
Osteonecrosis of the femoral head (ONFH) is a common and refractory disease in orthopaedic clinics. The number of patients with ONFH is increasing worldwide every year. There are an estimated 8.12 million patients with nontraumatic osteonecrosis in China alone. Treatment of nontraumatic osteonecrosis has always been a clinical challenge for orthopaedic surgeons. To further standardize diagnosis and treatment of ONFH, these guidelines provide not only basic diagnosis, treatment, and evaluation systems for ONFH but also expert advice and standards in many aspects, including epidemiology, aetiology, diagnostic criteria, pathological staging, prevention and treatment options, and postoperative rehabilitation. The aetiological factors of ONFH can currently be divided into two major categories: traumatic and nontraumatic; however, the specific pathological mechanism of ONFH is not completely clear. Currently, the staging system of ONFH formulated by the Association Research Circulation Osseous is widely used in clinical practice. Based on the changes in the intraosseous blood supply at different stages, the corresponding nonsurgical and surgical treatments are recommended, and when there are risk factors for possible ONFH, certain preventive measures to avoid the occurrence of osteonecrosis are recommended. These guidelines provide brief classification criteria and treatment regimen for osteonecrosis. Specification of the aetiology, treatment plan based on comprehensive consideration of the different stages of osteonecrosis, hip function, age, and occupation of the patients are important steps in diagnosis and developing treatment strategies. TRANSLATIONAL POTENTIAL OF THIS ARTICLE New advances in the epidemiology, etiology, pathophysiology, imaging, diagnosis and treatment of ONFH have been renewed in this revision. This guideline can be used for reference by orthopedic professionals and researchers, and for standardized diagnosis and treatment management under the clinical guidance, which is conducive to the prevention, treatment and further research of ONFH, improving the diagnosis and treatment level, making patients' symptoms under good control, and improving their quality of life.
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Key Words
- ARCO, Association Research Circulation Osseous
- BMES, Bone marrow oedema syndrome
- CT, Computed tomography
- DSA, Digital subtraction angiography
- Diagnosis
- Guideline
- MRI, Magnetic resonance imaging
- ONFH, Osteonecrosis of the femoral head
- Osteonecrosis of the femoral head (ONFH)
- PET, Positron emission tomography
- RHS, Reconstruction Hip Scores
- SPECT, Single-photon emission computed tomography
- T1WI, T1-weighted images
- Treatment
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Affiliation(s)
- Dewei Zhao
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, PR China
| | - Feng Zhang
- JMS Burn and Reconstructive Center, Jackson, MS, USA
| | - Benjie Wang
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, PR China
| | - Baoyi Liu
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, PR China
| | - Lu Li
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, PR China
| | - Shin-Yoon Kim
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, South Korea
| | - Stuart B. Goodman
- Department of Orthopaedic Surgery and (by Courtesy) Bioengineering, Stanford University Medical Center Outpatient Center, Redwood City, CA, 94063, USA
| | - Philippe Hernigou
- Department of Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France
| | - Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Virginia, 22903, USA
| | | | - Jiake Xu
- School of Pathology and Laboratory Medicine, The University of Western Australia, Perth, Western Australia, 6009, Australia
| | - Wolf R. Drescher
- Department of Orthopaedic Surgery of the Lower Limb and Arthroplasty, Rummelsberg Hospital, D-90592, Schwarzenbruck, Germany
| | - Ling Qin
- Musculoskeletal Research Laboratory, Department of Orthopedics & Traumatology, The Chinese University of Hong Kong, PR China
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Kim CH, Moon JK, Yoon JY, Yoon PW. Arthroscopic Treatment of Collapsed Subchondral Fatigue Fracture in the Femoral Head of a Young Military Recruit at a 5-Year Follow-Up: A Case Report. JBJS Case Connect 2019; 9:e0138. [PMID: 31850957 DOI: 10.2106/jbjs.cc.19.00138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 20-year-old military recruit presented with pain in his left hip. He was referred by the military hospital for osteonecrosis of the femoral head in both hip joints. Plain radiographs and magnetic resonance imaging showed a marked collapse in the left femoral head; however, the patient was diagnosed as having subchondral fatigue fractures of the femoral head (SFFFH) after a thorough review of previous sequential images. Arthroscopic debridement and labral repair were performed. At 3 years after surgery, the patient was symptom-free and second-look hip arthroscopy revealed the articular defect filling with fibrocartilage on the femoral head. CONCLUSION In a young patient, hip arthroscopy can be a successful joint preserving treatment option even for collapsed SFFFH.
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Affiliation(s)
- Chul-Ho Kim
- Department of Orthopedic Surgery, Armed Forces Daejeon Hospital, Daejeon, South Korea
| | - Jun-Ki Moon
- Department of Orthopedic Surgery, Asan Medical Center, Seoul, South Korea
| | - Jae Youn Yoon
- Department of Orthopedic Surgery, Asan Medical Center, Seoul, South Korea
| | - Pil Whan Yoon
- Department of Orthopedic Surgery, Asan Medical Center, Seoul, South Korea
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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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ACR Appropriateness Criteria Osteonecrosis of the Hip. J Am Coll Radiol 2016; 13:147-55. [PMID: 26846390 DOI: 10.1016/j.jacr.2015.10.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 10/30/2015] [Indexed: 12/16/2022]
Abstract
Osteonecrosis of the hip (Legg-Calvé-Perthes) is a common disease, with 10,000-20,000 symptomatic cases annually in the United States. The disorder affects both adults and children and is most frequently associated with trauma and corticosteroid usage. The initial imaging evaluation of suspected hip osteonecrosis is done using radiography. MRI is the most sensitive and specific imaging modality for diagnosis of osteonecrosis of the hip. The clinical significance of hip osteonecrosis is dependent on its potential for articular collapse. The likelihood of articular collapse is significantly increased with involvement of greater than 30%-50% of the femoral head area, which is optimally evaluated by MRI, often in the sagittal plane. Contrast-enhanced MRI may be needed to detect early osteonecrosis of the hip in pediatric patients, revealing hypoperfusion. In patients with a contraindication for MRI, use of either CT or bone scintigraphy with SPECT (single-photon emission CT) are alternative radiologic methods of assessment. Imaging helps guide treatment, which may include core decompression, osteotomy, and ultimately, need for joint replacement. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Kim SM, Oh SM, Cho CH, Lim SJ, Moon YW, Choi SH, Park YS. Fate of subchondral fatigue fractures of femoral head in young adults differs from general outcome of fracture healing. Injury 2016; 47:2789-2794. [PMID: 27771040 DOI: 10.1016/j.injury.2016.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 10/16/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study is to report the clinical course of fatigue-type subchondral fractures of the femoral head in young healthy adults. MATERIALS/METHODS We retrospectively reviewed 28 consecutive patients (34 hips) who had a clear history of a sudden increase in physical activity without trauma on the hip and pelvis, and were diagnosed as having a fatigue-type subchondral fracture of the femoral head. The diagnosis was made primarily on the basis of sequential plain radiographs and magnetic resonance images. RESULTS Of the 34 hips, 19 hips with no bony collapse experienced gradual disappearance of subjective pain a few months after onset, and there were no recurrences. Other 2 hips that showed bony collapse, but preserved the articular margin, also experienced no definite deterioration of collapse or arthritic change and did not need surgical intervention. In the remaining13 hips with bony collapse and destroyed articular margin or arthritic change, hip pain gradually worsened necessitating surgery. CONCLUSIONS The current findings suggest that a subchondral fatigue fracture of the femoral head could show a different severity of subchondral injury over time. In the collapsed subchondral fatigue fractures, especially when combined with head incongruency, the hip pain was aggravated enough to require surgical intervention.
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Affiliation(s)
- Sang-Min Kim
- Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, South Korea
| | - Seung-Min Oh
- Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, South Korea
| | - Chang-Ho Cho
- Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, South Korea
| | - Seung-Jae Lim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Wan Moon
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang-Hee Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Youn-Soo Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Yu T, Zhang Z, Xie L, Ke X, Liu Y. The influence of traditional Chinese medicine constitutions on the potential repair capacity after osteonecrosis of the femoral head. Complement Ther Med 2016; 29:89-93. [PMID: 27912962 DOI: 10.1016/j.ctim.2016.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 02/17/2016] [Accepted: 09/11/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To explore the effects of traditional Chinese medicine (TCM) constitutions on repair capacity after osteonecrosis of the femoral head (ONFH). DESIGN AND SETTING Ninety-six patients with TCM constitutions of yang-deficiency, dampness-heat and/or blood-stasis were recruited from the orthopedic outpatient clinic of the Guang'anmen Hospital of the China Academy of Chinese Medical Science. Each patient underwent computed tomography (CT) examination of the hips, and CAD software was used to estimate proximal sclerosis ratios based on the CT images. MAIN OUTCOME MEASURES The proximal sclerosis ratios of subjects with different TCM constitutions were found to be significantly different (P=0.046): the ratios of subjects with the yang-deficiency, dampness-heat, blood-stasis, yang-deficiency plus dampness-heat, yang-deficiency plus blood-stasis, and dampness-heat plus blood-stasis constitutions were, respectively, 0.20±0.25, 0.24±0.25, 0.39±0.29, 0.29±0.37, 0.35±0.29, and 0.42±0.28. Differences among the three types of single, uneven constitutions were also observed (P=0.042). RESULTS For each pairwise comparison, the yang-deficiency constitution was different from the blood-stasis constitution (P=0.02) and dampness-heat plus blood-stasis constitution (p=0.02). The proximal sclerosis ratio was lower in the yang-deficiency constitution group but higher in the blood-stasis constitution group. CONCLUSIONS TCM constitutions influence the capacity for ONFH repair. The blood-stasis constitution has a strong repair ability, but the yang-deficiency constitution has a poor repair ability and tends to collapse and require positive treatment. Furthermore, important therapeutic principles should reinforce the kidney and strengthen the spleen.
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Affiliation(s)
- Tong Yu
- Department of Orthopedics, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Zhennan Zhang
- Department of Orthopedics, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Limin Xie
- Department of Orthopedics, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China.
| | - Xun Ke
- Department of Orthopedics, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Yang Liu
- Department of Orthopedics, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
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Murphey MD, Foreman KL, Klassen-Fischer MK, Fox MG, Chung EM, Kransdorf MJ. From the radiologic pathology archives imaging of osteonecrosis: radiologic-pathologic correlation. Radiographics 2015; 34:1003-28. [PMID: 25019438 DOI: 10.1148/rg.344140019] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Osteonecrosis is common and represents loss of blood supply to a region of bone. Common sites affected include the femoral head, humeral head, knee, femoral/tibial metadiaphysis, scaphoid, lunate, and talus. Symptomatic femoral head osteonecrosis accounts for 10,000-20,000 new cases annually in the United States. In contradistinction, metadiaphyseal osteonecrosis is often occult and asymptomatic. There are numerous causes of osteonecrosis most commonly related to trauma, corticosteroids, and idiopathic. Imaging of osteonecrosis is frequently diagnostic with a serpentine rim of sclerosis on radiographs, photopenia in early disease at bone scintigraphy, and maintained yellow marrow at MR imaging with a serpentine rim of high signal intensity (double-line sign) on images obtained with long repetition time sequences. These radiologic features correspond to the underlying pathology of osseous response to wall off the osteonecrotic process and attempts at repair with vascularized granulation tissue at the reactive interface. The long-term clinical importance of epiphyseal osteonecrosis is almost exclusively based on the likelihood of overlying articular collapse. MR imaging is generally considered the most sensitive and specific imaging modality both for early diagnosis and identifying features that increase the possibility of this complication. Treatment subsequent to articular collapse and development of secondary osteoarthritis typically requires reconstructive surgery. Malignant transformation of osteonecrosis is rare and almost exclusively associated with metadiaphyseal lesions. Imaging features of this dire sequela include aggressive bone destruction about the lesion margin, cortical involvement, and an associated soft-tissue mass. Recognizing the appearance of osteonecrosis, which reflects the underlying pathology, improves radiologic assessment and is important to guide optimal patient management.
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Affiliation(s)
- Mark D Murphey
- From the Departments of Musculoskeletal Imaging (M.D.M., K.L.F., E.M.C.) and Pediatric Imaging (E.M.C.), American Institute for Radiologic Pathology, 1010 Wayne Ave, Suite 320, Silver Spring, MD 20910; Uniformed Services University of the Health Sciences, Bethesda, Md (M.D.M., E.M.C.); Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (M.D.M., K.L.F., E.M.C.); Joint Pathology Center, Silver Spring, Md (M.K.K.F.); Department of Radiology, University of Virginia, Charlottesville, Va (M.G.F.); and Mayo Clinic Hospital, Phoenix, Ariz (M.J.K.)
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Yoon PW, Kwak HS, Yoo JJ, Yoon KS, Kim HJ. Subchondral insufficiency fracture of the femoral head in elderly people. J Korean Med Sci 2014; 29:593-8. [PMID: 24753710 PMCID: PMC3991806 DOI: 10.3346/jkms.2014.29.4.593] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 02/07/2014] [Indexed: 11/20/2022] Open
Abstract
We evaluated the clinical course of subchondral insufficiency fracture of the femoral head (SIFFH) and its characteristic findings with special regard to joint space narrowing (JSN). Thirty-one cases of SIFFH of mean age 68.9 yr initially underwent limited weight-bearing conservative treatment. During the follow-up period, the patients with intractable pain underwent total hip arthroplasty (THA). For radiographic evaluation, lateral center-edge angle, JSN and femoral head collapse (FHC) were documented, and the extent of FHC was classified as mild (<2 mm), moderate (2-4 mm), and severe (>4 mm). The progression or new development of FHC more than 2 mm was evaluated on sequential plain radiographs. The relationship between radiographic parameters and clinical outcomes were evaluated. THAs were performed in 15 cases (48.4%). There was no significant correlation between clinical outcomes and the extent of initial FHC. However, a significantly larger proportion of patients that underwent THA showed JSN and FHC progression compared to the symptom improvement group. The risk factor significantly associated with failed conservative treatment was JSN (P=0.038; OR, 11.8; 95% CI, 1.15-122.26). Clinical results of conservative treatment for SIFFH in elderly patients are relatively poor. The patients with JSN are at higher risk of failed conservative treatment.
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Affiliation(s)
- Pil Whan Yoon
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Suk Kwak
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kang Sup Yoon
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Joong Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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