Prediction of collapse in femoral head osteonecrosis: role of volumetric assessment

2020 ◽  
pp. 112070002097858
Author(s):  
Sajid Ansari ◽  
Tarun Goyal ◽  
Roop B Kalia ◽  
Souvik Paul ◽  
Sanny Singh
Keyword(s):  
Survival Analysis ◽  
Femoral Head ◽  
Lesion Size ◽  
Necrotic Lesion ◽  
Rank Test ◽  
Lesion Volume ◽  
Femoral Head Osteonecrosis ◽  
Volumetric Assessment ◽  
Angular Measurements ◽  
Stage 1

Purpose: The purpose of this study was to evaluate and compare the accuracy of three different techniques of measuring the extent of osteonecrosis involvement of the femoral head on MRI to determine the best predictor of collapse and to identify the size of the lesion volume which best predicts collapse. Methods: We prospectively enrolled 48 hips of osteonecrosis femoral head (ONFH) with stage 1 or 2 osteonecrosis and the enrolled patients were followed up for 1 year. Angular measurements (modified Kerboul Angle and modified index of necrotic extent) were compared with the 3D volumetric measurement of necrotic lesion based on MRI in predicting the collapse of the head. ROC analysis was done to evaluate the diagnostic performance of the 3 indices in predicting collapse. Survival analysis of all the hips in the collapsed and non-collapsed group were interpreted using Kaplan Meir survival analysis. Results: In lesion sizes larger than 25% of femoral head volume - 90.6% (29/32) of hips collapsed within 1 year as compared to 31.3% (5/16) hips collapsed in lesion volume <25% of femoral head (Log-rank test p = 0.001). There was good inter-observer (ICC, 0.94; 95% CI, 0.89–0.97) and intra-observer reliability (ICC, 0.93; 95% CI, 0.88–0.96). Conclusions: The Volumetric method assessed the severity of lesion size with the future collapse better and more predictably than angular measurements. Necrotic lesion volume of 25% is a potential cut off beyond which future collapse of early ONFH can be predicted and aid in the further management. This study can help in solving the mystery behind prediction of collapse in ONFH.

scholarly journals Efficacy of tantalum rod insertion for preventing femoral head collapse in osteonecrosis in a paediatric population: a pilot study

2021 ◽  
Author(s):  
Muqtasid Hussaini ◽  
Jitendra Balakumar ◽  
David Slattery
Keyword(s):  
Femoral Head ◽  
Group Analysis ◽  
Paediatric Population ◽  
Porous Tantalum ◽  
Femoral Head Collapse ◽  
Femoral Head Osteonecrosis ◽  
Plain Films ◽  
Stage 1 ◽  
Tönnis Grade

ABSTRACT Femoral head osteonecrosis in the paediatric population is difficult to treat, with the primary goals of management being prevention of subchondral collapse and the avoidance of early total hip replacement. This study aims to describe the use of a porous tantalum rod implant to provide mechanical support in preventing femoral head collapse in a paediatric population. A retrospective chart-based analysis of patients with osteonecrosis of the hip was performed at our institution to identify those who had undergone tantalum rod insertion. A total of 10 patients (fives males and five females, median age 12.5 years, 9–18) had tantalum rods implanted between December 2013 and February 2018. One patient was excluded due to follow-up at a different institution. The radiographic degree of osteonecrosis was characterized according to the Ficat classification and the Kerboul angle. Radiographic assessment of pre- and post-operative plain films was performed. The outcome measures were Tonnis grade and percentage collapse of the femoral head. Nine patients with a mean follow-up time of 18.4 months were included in the analysis. There was no significant increase in the femoral head collapse percentage post tantalum rod insertion compared to pre-operatively (P = 0.63). There was a significant increase in the Tonnis grade post-operatively (P &lt; 0.05), with sub-group analysis showing minimal increase in Ficat Stage 1 patients. This study is the first to examine the role of tantalum rod insertion in preventing femoral head collapse in a paediatric population, with results suggesting potential benefit in a subset of patients.

Femoral Head Osteonecrosis in Pediatric and Young Adult Patients With Leukemia or Lymphoma

2007 ◽  
Vol 25 (12) ◽  
pp. 1525-1531 ◽  
Author(s):  
Evguenia J. Karimova ◽  
Shesh N. Rai ◽  
Scott C. Howard ◽  
Michael Neel ◽  
Lunetha Britton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Head ◽  
Childhood Leukemia ◽  
Hematologic Malignancy ◽  
Late Toxicity ◽  
Lesion Size ◽  
Primary Diagnosis ◽  
Joint Surface ◽  
Femoral Head Osteonecrosis ◽  
Surface Collapse

Purpose Osteonecrosis of the capital femoral epiphysis is a significant late toxicity of treatment for childhood leukemia and lymphoma. We determined clinical and imaging risk factors predicting clinical joint outcomes of femoral head osteonecrosis in pediatric patients with leukemia or lymphoma. Patients and Methods We reviewed retrospectively medical records and magnetic resonance imaging scans of 80 patients with osteonecrosis of the capital femoral epiphysis. Logistic regression was used to examine relationships between risk factors and outcomes of joint surface collapse and arthroplasty. We used Kaplan-Meier survival curves to display the time to joint surface collapse and arthroplasty based on selected predictors. Results Median time between primary diagnosis and diagnosis of osteonecrosis of the hip was 1.7 years (range, 0.1 to 17.5 years). Twenty-three patients (29%) underwent arthroplasty in 36 hips at a mean of 1.3 years (range, 0.5 to 8.6 years) after diagnosis of osteonecrosis. Median age at time of first arthroplasty was 20.1 years (range, 15.1 to 35.4 years). Joint outcome of osteonecrosis was predicted solely by lesion size at diagnosis of osteonecrosis. The worst prognosis was associated with lesions occupying more than 30% of the femoral head volume; 80% of hips with these lesions collapsed within 2 years of diagnosis and 50% required arthroplasty. Conclusion Lesion size of osteonecrosis is the best predictor of clinical joint outcome of hip osteonecrosis in survivors of pediatric hematologic malignancy. Lesions occupying more than 30% of the femoral head have high likelihood of joint deterioration necessitating arthroplasty at a young age.

Diagnostic value of necrotic lesion boundary in bone collapse of femoral head osteonecrosis

2021 ◽  
Author(s):  
Yinuo Fan ◽  
Jiahao Zhang ◽  
Minghai Chen ◽  
Fengxiang Pang ◽  
Haicheng Chen ◽  
...  
Keyword(s):  
Femoral Head ◽  
Diagnostic Value ◽  
Necrotic Lesion ◽  
Femoral Head Osteonecrosis

The effect of corticosteroids on development of femoral head osteonecrosis in patients after kidney transplantation

2017 ◽  
Author(s):  
Enis Gursel ◽  
Omer Faruk Bilgen ◽  
Sadik Bilgen ◽  
Basak Erdemli Gursel ◽  
Canan Ersoy ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Femoral Head ◽  
Femoral Head Osteonecrosis

Epidemiological Study of Femoral Head Osteonecrosis

2017 ◽  
Vol 68 (5) ◽  
pp. 974-976
Author(s):  
Alexandru Patrascu ◽  
Liliana Savin ◽  
Dan Mihailescu ◽  
Victor Grigorescu ◽  
carmen Grierosu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Young Patients ◽  
Head Group ◽  
Bipolar Hemiarthroplasty ◽  
Aseptic Necrosis ◽  
Total Hip ◽  
Femoral Head Osteonecrosis

In recent years, there has been an increase in the number of studies on the etiology of femoral head necrosis. We retrospectively reviewed all patients diagnosed with aseptic necrosis of the femoral in the period of 2010-2015. We recorded a total of 230 cases diagnosed with aseptic necrosis of the femoral head, group was composed of 65.7% men and 34.3% women, risk factors identified was 19.13% (post-traumatic), 13.91% (glucocorticoids), 26.52% (alcohol), 3.47% (another cause) and in 36 95% of the cases no risk factors were found. The results of the study based on the type of surgery performed on the basis of stages of disease progression, 8 patients (3.48%) benefited from osteotomy, 28 patients (12.17%) benefited of bipolar hemiarthroplasty prosthesis and 188 patients (81.74%) benefited of total hip arthroplasty. Osteonecrosis of the femoral head is characteristic to young patients between the age of 30-50 years old. Predisposing factors, alcohol and corticosteroid therapy remains an important cause of the disease. Total hip arthroplasty remains the best option for the patients with osteonecrosis of the femoral head.

scholarly journals Outcome after a new porous tantalum rod implantation for treatment of early-stage femoral head osteonecrosis

2019 ◽  
Vol 7 (18) ◽  
pp. 441-441 ◽  
Author(s):  
Wei Huang ◽  
Xuan Gong ◽  
Steve Sandiford ◽  
Xiaoqiang He ◽  
Feilong Li ◽  
...  
Keyword(s):  
Femoral Head ◽  
Early Stage ◽  
Porous Tantalum ◽  
Femoral Head Osteonecrosis
Sign in / Sign up

Export Citation Format

Share Document