Natural Course and the JIC Classification of Osteonecrosis of the Femoral Head

Osteonecrosis ◽  
2014 ◽  
pp. 207-210 ◽  
Author(s):  
Nobuhiko Sugano ◽  
Kenji Ohzono
Keyword(s):  
Femoral Head ◽  
Natural Course

scholarly journals Reliability of the classification of cartilage and labral injuries during hip arthroscopy

2020 ◽  
Vol 7 (3) ◽  
pp. 448-457
Author(s):  
Stephanie W Mayer ◽  
Tobias R Fauser ◽  
Robert G Marx ◽  
Anil S Ranawat ◽  
Bryan T Kelly ◽  
...  
Keyword(s):  
Femoral Head ◽  
Transition Zone ◽  
Central Compartment ◽  
Classification Systems ◽  
Cartilage Injury ◽  
Intraobserver Agreement ◽  
Acetabular Cartilage ◽  
Femoral Head Cartilage ◽  
Labral Tears

Abstract To determine interobserver and intraobserver reliabilities of the combination of classification systems, including the Beck and acetabular labral articular disruption (ALAD) systems for transition zone cartilage, the Outerbridge system for acetabular and femoral head cartilage, and the Beck system for labral tears. Additionally, we sought to determine interobserver and intraobserver agreements in the location of injury to labrum and cartilage. Three fellowship trained surgeons reviewed 30 standardized videos of the central compartment with one surgeon re-evaluating the videos. Labral pathology, transition zone cartilage and acetabular cartilage were classified using the Beck, Beck and ALAD systems, and Outerbridge system, respectively. The location of labral tears and transition zone cartilage injury was assessed using a clock face system, and acetabular cartilage injury using a five-zone system. Intra- and interobserver reliabilities are reported as Gwet’s agreement coefficients. Interobserver and intraobserver agreement on the location of acetabular cartilage lesions was highest in superior and anterior zones (0.814–0.914). Outerbridge interobserver and intraobserver agreement was >0.90 in most zones of the acetabular cartilage. Interobserver and intraobserver agreement on location of transition zone lesions was 0.844–0.944. The Beck and ALAD classifications showed similar interobserver and intraobserver agreement for transition zone cartilage injury. The Beck classification of labral tears was 0.745 and 0.562 for interobserver and intraobserver agreements, respectively. The Outerbridge classification had almost perfect interobserver and intraobserver agreement in classifying chondral injury of the true acetabular cartilage and femoral head. The Beck and ALAD classifications both showed moderate to substantial interobserver and intraobserver reliabilities for transition zone cartilage injury. The Beck system for classification of labral tears showed substantial agreement among observers and moderate intraobserver agreement. Interobserver agreement on location of labral tears was highest in the region where most tears occur and became lower at the anterior and posterior extents of this region. The available classification systems can be used for documentation regarding intra-articular pathology. However, continued development of a concise and highly reproducible classification system would improve communication.

scholarly journals Effects of pelvis rotation on the projected radiographic position of the femoral head in relationship to the acetabulum

2017 ◽  
Vol 62 (No. 7) ◽  
pp. 377-385 ◽  
Author(s):  
J. Martins ◽  
B. Colaco ◽  
S. Alves-Pimenta ◽  
A. Ferreira ◽  
M. Ginja
Keyword(s):  
Femoral Head ◽  
Hip Dysplasia ◽  
Scoring Systems ◽  
Normal Position ◽  
Pelvis Rotation ◽  
Mean Differences ◽  
The Right ◽  
Extended View ◽  
Norberg Angle

The aim of this study was to describe the influence of pelvis rotation on the projected radiographic position of the femoral head in relationship to the acetabulum in the standard ventrodorsal hip extended view, i.e. Norberg angle, pelvic thickness at the level of the cranial effective acetabular rim, femoral head subluxation index, femoral head subluxation category and femoral head-acetabular distance. Twelve adult dogs of large and giant breeds were radiographed in standard hip extended view and with 2°, 4° and 6° of rotation on the right and left sides. Norberg angle, pelvic thickness, subluxation index, subluxation category and femoral head-acetabular distance were measured on radiographs and analysed comparing a normal position with positions of different degrees of rotation for the dependent and non-dependent side. All the studied parameters showed adequate repeatability. Norberg angle and femoral head-acetabular distance did not show significant mean differences in all degrees of rotated pelvis (P > 0.05). The pelvic thickness showed an increase with the degree of rotation on the dependent side (P < 0.05) and a slight decrease on the non-dependent side (P > 0.05). The subluxation index and subluxation category showed an increase with the degree of rotation on the dependent side and a decrease on the non-dependent side (P < 0.05). As the subluxation index and subluxation category are parameters used in the classification of the main international hip dysplasia scoring systems, pelvic rotation can impair the final hip score, especially in scoring systems that are based on the worst joint.

Pelvic Fractures

1994 ◽  
Vol 35 (5) ◽  
pp. 420-425 ◽  
Author(s):  
J. Albrechtsen ◽  
J. Hede ◽  
A. G. Jurik
Keyword(s):  
Femoral Head ◽  
Pelvic Ring ◽  
Posterior Part ◽  
Conventional Radiography ◽  
Pelvic Fractures ◽  
Acetabular Fractures ◽  
Pelvic Ring Fractures

Sixty-two patients with pelvic fractures were evaluated by conventional radiography and CT. A correct pathoanatomic classification of the fractures was most often obtained by conventional radiography, but CT added information regarding acetabular fractures and involvement of the posterior part of the pelvic ring. Besides, CT was essential in the detection of intraarticular fragments and lesions of the femoral head. Classification of pelvic ring fractures by the pattern of traumatic forces was easily obtainable by conventional radiography, but often difficult to achieve by CT.

scholarly journals Classification of osteonecrosis of the femoral head

2019 ◽  
Vol 8 (10) ◽  
pp. 451-458 ◽  
Author(s):  
Yutaka Kuroda ◽  
Takeyuki Tanaka ◽  
Takaki Miyagawa ◽  
Toshiyuki Kawai ◽  
Koji Goto ◽  
...  
Keyword(s):  
Femoral Head ◽  
Treatment Guidelines ◽  
Type A ◽  
Type B ◽  
Kaplan Meier ◽  
Joint Preserving Surgery ◽  
Asymptomatic Patients ◽  
Study Results ◽  
Collapse Rate

Objectives Using a simple classification method, we aimed to estimate the collapse rate due to osteonecrosis of the femoral head (ONFH) in order to develop treatment guidelines for joint-preserving surgeries. Methods We retrospectively analyzed 505 hips from 310 patients (141 men, 169 women; mean age 45.5 years (sd 14.9; 15 to 86)) diagnosed with ONFH and classified them using the Japanese Investigation Committee (JIC) classification. The JIC system includes four visualized types based on the location and size of osteonecrotic lesions on weightbearing surfaces (types A, B, C1, and C2) and the stage of ONFH. The collapse rate due to ONFH was calculated using Kaplan–Meier survival analysis, with radiological collapse/arthroplasty as endpoints. Results Bilateral cases accounted for 390 hips, while unilateral cases accounted for 115. According to the JIC types, 21 hips were type A, 34 were type B, 173 were type C1, and 277 were type C2. At initial diagnosis, 238/505 hips (47.0%) had already collapsed. Further, the cumulative survival rate was analyzed in 212 precollapsed hips, and the two-year and five-year collapse rates were found to be 0% and 0%, 7.9% and 7.9%, 23.2% and 36.6%, and 57.8% and 84.8% for types A, B, C1, and C2, respectively. Conclusion Type A ONFH needs no further treatment, but precollapse type C2 ONFH warrants immediate treatment with joint-preserving surgery. Considering the high collapse rate, our study results justify the importance of early diagnosis and intervention in asymptomatic patients with type C2 ONFH. Cite this article: Y. Kuroda, T. Tanaka, T. Miyagawa, T. Kawai, K. Goto, S. Tanaka, S. Matsuda, H. Akiyama. Classification of osteonecrosis of the femoral head: Who should have surgery?. Bone Joint Res 2019;8:451–458. DOI: 10.1302/2046-3758.810.BJR-2019-0022.R1.

Clinical Classification and Prognosis of Patients with Multiple Sclerosis in Northern China

2013 ◽  
Vol 680 ◽  
pp. 606-610
Author(s):  
Xue Mei Han ◽  
Ying Chang ◽  
Zhao Shi Zheng ◽  
Song Yan Liu
Keyword(s):  
Quality Of Life ◽  
Multiple Sclerosis ◽  
Nervous System ◽  
Natural History ◽  
Northern China ◽  
Natural Course ◽  
Neurological Deficits ◽  
Clinical Classification

Objective: To study the clinical classification of multiple sclerosis (MS) by analyzing the features of the magnetic resonance imaging (MRI) on brain and spinal cord and surveying the natural history. Methods: MRI examination was conducted on 132 clinically diagnosed multiple sclerosis patients and their quality of life and disability rate were graded. Results: The general distribution of lesions in the nervous system was obtained. In northern China, relapsing-remitting MS (RRMS) by natural course classification and simple brain MS by lesion distribution classification lead to fewer neurological deficits with a relatively top life quality. Meanwhile, there is a tendency for the correlation between the pathogenetic locations of MS and its natural course prognosis. Conclusion: To improve the understanding of the prognosis of MS and promote the diagnosis ability to guide MS treatment. Multiple sclerosis (MS) is a common immune-mediated chronic disease of the central nervous system with the demyelination of white matter as the main pathological feature. The incidence of MS has a significant regional difference and studies on the natural history classification and lesions distribution classification of MS patients in northern China are not sufficient. In this study, natural history and lesions distribution of MS patients were classified by MRI approach and the impacts of each MS classification on neurological deficits and quality of life were observed. In this thesis, features and prognosis of MS classifications in northern China are discussed for the purpose of improving the level of diagnosis and treatment.

Classification of Osteonecrosis of the Femoral Head

2001 ◽  
Vol 386 ◽  
pp. 34-41 ◽  
Author(s):  
Anton Y. Plakseychuk ◽  
Munir Shah ◽  
Sokratis E. Varitimidis ◽  
Harry E. Rubash ◽  
Dean Sotereanos
Keyword(s):  
Femoral Head

scholarly journals Multiple drilling is not effective in reducing the rate of conversion to Total hip Arthroplasty in early-stage nontraumatic osteonecrosis of the femoral head: a case-control comparative study with a natural course

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Zunhan Liu ◽  
Xuetao Yang ◽  
Yuhan Li ◽  
Wei-Nan Zeng ◽  
Enze Zhao ◽  
...  
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Confidence Interval ◽  
Hip Arthroplasty ◽  
Cox Regression ◽  
Early Stage ◽  
Case Control ◽  
Necrotic Lesion ◽  
Natural Course ◽  
Work Intensity

Abstract Background To determine whether multiple drilling is effective in postponing the need for total hip arthroplasty (THA) in early-stage nontraumatic osteonecrosis of the femoral head (ONFH). Methods We identified 514 patients who were diagnosed with early-stage ONFH between January 2008 and December 2018. One hundred ninety-six patients underwent multiple drilling, and 318 patients had a natural course of progression. One hundred fifty-nine patients were selected for each group after case-control matching for preoperative demographics and modified Ficat and Arlet stage. The rates of THA conversion were compared. We also performed Cox regression to identify risk factors associated with THA conversion in patients who underwent multiple drilling. Results Kaplan-Meier survivorship with an endpoint of THA for nontraumatic reasons were not significantly different between the multiple drilling group (75.6, 95% confidence interval 67.8–83.4%) and the natural course group (72.2, 95% confidence interval 64.8–79.6%) at 5 years (log-rank, P = .191). In the Cox regression model, a larger extent of necrotic lesion, bone marrow edema (BME), and higher postoperative work intensity significantly increased the risk of THA conversion (P < .05). Among patients treated with autogenous bone grafting, there was a lower risk of failure in patients with necrotic lesion less than 15% (P < .05). Conclusions Multiple drilling is not effective in reducing the rate of THA conversion in early-stage nontraumatic ONFH. The risk of conversion to THA after multiple drilling is increased by a larger extent of necrotic lesion, presence of BME, and higher postoperative work intensity in patients with early-stage ONFH. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR2000035180) dated 2 August 2020.

scholarly journals Avascular necrosis of the femoral head in the patients with posterior wall acetabular fractures associated with dislocations of the hip

2013 ◽  
Vol 60 (2) ◽  
pp. 65-69 ◽  
Author(s):  
Sasa Milenkovic ◽  
Milorad Mitkovic ◽  
Jordan Saveski ◽  
Ivan Micic ◽  
Predrag Stojiljkovic ◽  
...  
Keyword(s):  
Femoral Head ◽  
Young Patients ◽  
Hip Dislocation ◽  
Posterior Wall ◽  
Acetabular Fractures ◽  
Type I ◽  
Severe Injuries ◽  
Stable Osteosynthesis ◽  
Posterior Hip Dislocation

Introduction: Acetabular fractures are severe injuries, mostly occured in young patients after traffic accident or fall from heights. Of the all acetabular fractures, posterior wall acetabular fractures are the most often observed. Regarding to mechanism of the injury, about 30% of these fractures are associated with posterior hip dislocation. Material and methods: The incidence of AVN in 18 patients with posterior wall acetabular fractures associated with dislocations of the hip is presented. Thompson-Epstein Scale (type I-V) was used as the classification of the injury. Kocher-Langenbeck surgical approach was achieved in all patients. Results: Average following time after surgery was 22,66 months (8-36 months). After that period the incidence of femoral head AVN was observed in 33,3%6. Femoral head AVN was observed in 5,55%1 of patient who was treated by the reduction of hip dislocation in first 24 hours after injury, while in patients with later reduction, femoral head AVN were observed in 27,77%5. Conclusion: Posterior wall acetabular fractures associated with hip dislocation are severe injuries. Urgent, closed reduction of the hip, early definitive stable osteosynthesis of acetabulum and the experience of surgical team are factors that greatly decrease the possibility for AVN occurrence. Later reduction, comminution of posterior wall of the acetabulum (Thompson-Epstein III et IV), impaction, chondral lesion of the femoral head and associated fractures of femoral head, increase the possibility for AVN occurrence.

How to use antidepressive drugs more effectively

1980 ◽  
Vol 18 (19) ◽  
pp. 73-74
Keyword(s):  
Clinical Practice ◽  
Depressive Symptoms ◽  
Drug Treatment ◽  
Depressive Illness ◽  
Medical Advice ◽  
Natural Course ◽  
Double Blind ◽  
The Past ◽  
Antidepressive Drugs

Depressive symptoms are common and often lead the patient to seek medical advice. Forty proprietary antidepressive drugs are available in Britain. Although it is generally agreed that antidepressives can be helpful, it is not yet clear whom they may help, or how much. This is because of disagreement on the classification of depressive illness,1 and difficulty in predicting its natural course. Many patients get better without drug treatment. Although double-blind comparisons with placebo over the past 20 years have shown that these drugs reduce depressive symptoms in most patients, this is less convincing in clinical practice.2 3 Several factors influence the response to drug treatment and understanding them should improve the management of depression.

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