Rapid destructive osteoarthritis of the hip: Vanishing femoral head with MRI findings mimicking septic arthritis

Purpose: In osteoarthritis of the hip, the pain may be strong even if the deformity is mild, but the pain may be mild even if the deformity is severe. If the factors related to the pain can be identified on imaging, reducing such factors can alleviate the pain, and effective measures can be taken for cases where surgery cannot be performed. In addition, imaging findings related to the pain are also important information for determining the procedures and the timing of surgery. Thus, the purpose of this study was to identify the differences in features of osteoarthritis seen on imaging between painless and painful osteoarthritis of the hip. Methods: The subjects were the patients with hip osteoarthritis who visited our department in 2015 and who underwent x-ray, computed tomography (CT), and magnetic resonance imaging (MRI), a total of 29 patients (54 hip joints; mean age 63 years; 8 males and 21 females). The degree of osteoarthritis was determined using the Tönnis grade from the x-ray image. The cartilage morphology, intensity changes of bone marrow on MRI (subchondral bone marrow lesions [BMLs]), osteophytes, joint effusions, and paralabral cysts were scored based on the Hip Osteoarthritis MRI Scoring System (HOAMS). The cross-sectional area of the psoas major muscle at the level of the iliac crest was measured on CT, and the psoas index (PI; the cross-sectional area ratio of the psoas major muscle to the lumbar 4/5 intervertebral disc) was calculated to correct for the difference in physique. Then, the relationships between these and visual analog scale (VAS) scores of pains were evaluated. Results: The average VAS was 55.4 ± 39 mm. The PI and all items of HOAMS correlated with the VAS. The average VAS of Tönnis grade 3 osteoarthritis was 75.8 ± 26 mm. When investigating only Tönnis grade 3 osteoarthritis, the differences between cases with less than average pain and those with above average pain were the BML score in the central-inferior femoral head ( P = .0213), the osteophyte score of the inferomedial femoral head ( P = .0325), and the PI ( P = .0292). Conclusion: Investigation of the differences between painless and painful osteoarthritis of the hip showed that the cases with more pain have BMLs of the femoral head on MRI that extend not only to the loading area, but also to the central-inferior area. Even with the same x-ray findings, the pain was stronger in patients with severe psoas atrophy. Thus, the instability due to muscle atrophy may also play a role in the pain of hip osteoarthritis.

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Osteonecrosis of the patella in patients with nontraumatic osteonecrosis of the femoral head: MRI findings in 60 patients

Acta Orthopaedica Scandinavica ◽

10.1080/000164700317381108 ◽

2000 ◽

Vol 71 (5) ◽

pp. 447-451 ◽

Cited By ~ 1

Author(s):

Takashi Sakai ◽

Nobuhiko Sugano ◽

Takashi Nishii ◽

Keiji Haraguchi ◽

Hideki Yoshikawa ◽

...

Keyword(s):

Femoral Head ◽

Mri Findings

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The role of the subchondral layer in osteonecrosis of the femoral head: analysis based on HR-QCT in comparison to MRI findings

Acta Radiologica ◽

10.1177/0284185118786070 ◽

2018 ◽

Vol 60 (4) ◽

pp. 501-508 ◽

Cited By ~ 3

Author(s):

Alexander R Kolb ◽

Janina M Patsch ◽

Wolf-Dieter Vogl ◽

Emir Benca ◽

David Stelzeneder ◽

...

Keyword(s):

Femoral Head ◽

Trabecular Bone ◽

Severe Disease ◽

Quantitative Computed Tomography ◽

Young Patients ◽

High Signal ◽

Homogeneity Test ◽

Special Focus ◽

Mri Findings ◽

Bone Parameters

Background Non-traumatic avascular osteonecrosis of the femoral head (ONFH) is a severe disease causing destruction of the hip joint, often necessitating total hip arthroplasty (THA) even in young patients. Magnetic resonance imaging (MRI) is commonly used for diagnosis of ONFH, but provides limited insight into the subchondral bone microstructure. Purpose To analyze routine MRI findings in comparison to high-resolution quantitative computed tomography (HR-QCT) with a special focus on the subchondral layer and to estimate the importance of differences determining the indication for THA. Material and Methods Twelve patients with ONFH were included before THA. Preoperative MRI and HR-QCT of the retrieved femoral heads were aligned using a registration algorithm. Pathological findings and trabecular bone parameters in matched areas were analyzed by two readers. McNemar, marginal homogeneity test, and Pearson’s correlation coefficient were used for comparison. Results Subchondral delamination was found in nine cases on HR-QCT, but missed or underestimated in all but one case on MRI ( P = 0.016). Chondral discontinuity was found in all cases on HR-QCT and in two cases on MRI ( P = 0.016). Areas of complete bone resorption on HR-QCT were linked to high signal intensity on 3D gradient-echo MRI sequences with water-selective excitation, while there was no correlation between trabecular bone parameters and MRI signal intensities in other areas ( P = 0.304). Conclusion Subchondral delamination, subchondral resorption, and chondral discontinuity are found frequently in advanced stages of ONFH. These lesions tend to be underestimated on conventional MRI. Our results support the importance of CT imaging in the evaluation of ONFH.

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Accumulation of microdamage in subchondral bone at the femoral head in patients with end-stage osteoarthritis of the hip

Journal of Bone and Mineral Metabolism ◽

10.1007/s00774-019-00988-z ◽

2019 ◽

Vol 37 (5) ◽

pp. 880-885 ◽

Cited By ~ 2

Author(s):

Masashi Shimamura ◽

Ken Iwata ◽

Tasuku Mashiba ◽

Takanori Miki ◽

Tetsuji Yamamoto

Keyword(s):

Femoral Head ◽

Subchondral Bone ◽

Osteoarthritis Of The Hip ◽

End Stage

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Is This Rapid Destructive Hip Osteoarthritis ?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00078 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0007

Author(s):

Tung HO Sheung ◽

Yip Kan Yeung ◽

Ming Yu Chiu ◽

Yeung IP Hoi

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Septic Arthritis ◽

Hip Arthroplasty ◽

Frozen Section ◽

Hip Osteoarthritis ◽

Rapid Progression ◽

Total Hip ◽

Diagnosis By Exclusion ◽

Rapid Destruction

Rapid destructive hip osteoarthritis is a diagnosis by exclusion. It should be differentiated from septic arthritis, osteonecrosis, neuropathic arthritis and other aetiologies causing rapid bone resorption or destruction around the hip. The present study aims to review the incidence of rapid destructive hip osteoarthritis among those patients who request total hip arthroplasty for end stage arthrosis. A retrospective review of radiographs of all patients who scheduled for total hip arthroplasty from January 2010 to March 2019 were analysed by 3 orthopaedic fellows. Of 174 hips of 146 patients, 35 hips of 29 patients were considered by at least 2 orthopaedic fellows to have rapid destructive hip osteoarthritis based on radiographic criteria of rapid joint space narrowing or rapid destruction of femoral head with or without acetabular involvement. Clinical history and physical finding, blood biochemistry, cultures and pathology with or without frozen section are reviewed. Early total hip arthroplasty, rather than routine operation in the long waiting list, is recommended for rapid destructive hip osteoarthritis to prevent technical difficulty in dealing with the bone loss or defect associated with rapid destructive hip osteoarthritis. However, one must exclude septic arthritis before proceeding to total hip arthroplasty. In clinically highly suspected cases, staged total hip arthroplasty was done despite of normal initial blood investigationsand negative hip aspiration with equivocal frozen section on table. In one such patient, the culture was initially negative, but became positive only after extended period of culture. On the other hand, rapid destruction of acetabulum requiring impaction bone grafting and acetabular augmentation for total hip arthroplasty was needed in one patient. Malignancy was suspected in another patient, but there was no evidence of malignancy or infection in the femoral head and tissue obtained by excisional arthroplasty of hip. One patient with hip pain and bilateral hip involvement was found to have Charcot joint. Rapid destruction hip osteoarthritis represents an uncommon subset of arthrosis with rapid progression. A delicate balance between correct diagnosis and timely early operation should be exercised to prevent rapid loss of bone stock making delayed total hip arthroplasty become technical difficult with possible compromised outcomes.

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The Role of Acetabulum Geometry and Femoral Head-Neck Ratio in the Development of Osteoarthritis in Young Men

Hip International ◽

10.1177/112070000701700302 ◽

2007 ◽

Vol 17 (3) ◽

pp. 131-136 ◽

Cited By ~ 2

Author(s):

B. Halle ◽

D.M. Halle ◽

T. Torfing ◽

S. Overgaard

Keyword(s):

Femoral Head ◽

Young Men ◽

Control Group ◽

Case Group ◽

Trauma Patients ◽

X Rays ◽

Osteoarthritis Of The Hip ◽

Total Coverage ◽

Head Neck

We studied the role of acetabulum geometry and head neck ratio in the development of osteoarthritis of the hip in young men. Contrary to previous studies we evaluated the significance of the anterior, posterior and total coverage of the femoral head, the influence of the femoral neck and the consequence of acetabular retroversion on standardized x-rays. Men aged 26–55 years who earlier had a total hip arthroplasty were included in the case group. This group was compared to a control-group of men treated as trauma patients. The study indicates that acetabular dysplasia and retroversion and a relative decreased head neck ratio are associated with osteoarthritis of the hip in young men.

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MRI-based static and functional assessment of complex hip deformities in comparison with CT: a validation study

Magnetic Resonance Materials in Physics Biology and Medicine ◽

10.1007/s10334-020-00845-5 ◽

2020 ◽

Vol 33 (6) ◽

pp. 829-838

Author(s):

Sophia Blum ◽

Lea Franken ◽

Albrecht Hartmann ◽

Falk Thielemann ◽

Verena Plodeck ◽

...

Keyword(s):

Femoral Head ◽

Linear Regression Analysis ◽

Intraclass Correlation ◽

Alpha Angle ◽

Acetabular Coverage ◽

Mri Findings ◽

Perfect Agreement ◽

Femoral Torsion ◽

Center Edge ◽

Hip Morphology

Abstract Objective This study aimed at investigating the agreement between predefined quantitative parameters of hip morphology derived from magnetic resonance imaging (MRI) and virtual range of motion (ROM) analysis using computed tomography (CT) as standard of reference. Methods Twenty patients (13 females, 7 males, 16–59 years) with hip deformities underwent MRI prior to surgery. Clockwise alpha angle, femoral head and neck diameter, collum caput diaphysis angle, femoral torsion, center-edge angles, acetabular coverage of the femoral head, sourcil angle, and acetabular anteversion were measured. Additionally, tern single and combined movements were simulated using a motion analysis program. The MRI findings were compared with the corresponding results obtained by CT. Correlation of MRI with CT was assessed using different statistical methods (intraclass correlation coefficient, Bland–Altmann plot, two one-sided t test), and linear regression analysis was performed. Results The results showed near-perfect intraclass correlation coefficients (ICCs) for anteversion (0.95), acetabular sector angles (0.98–0.99), sourcil angle (0.95), and acetabular coverage (anterior 0.96, posterior 0.99). Intermethod correlation for femoral parameters showed almost perfect agreement except for the alpha angle (0.73–0.97). No significant proportional bias was detected for traditional acetabular and femoral parameters. ROM analysis was performed for 370 movements in 37 hips. For 78.4% (290/370) of the movements analysed, neither CT nor MRI detected impingement across the physiological ROM. For 18.6% (69/370) of the movements, impingement was detected by both CT and MRI, while 2.2% (8/370) of the movements with impingement in CT showed no impingement in MRI, and 0.8% (3/370) of the movements with impingement in MRI had no corresponding result in CT. Conclusion Finally, it was concluded that MRI-based assessment of hip morphology and virtual ROM analysis is feasible and can be performed with good intermethod agreement in comparison to the gold standard (CT). Therefore, MRI appears to be substantially equivalent to CT for use in virtual ROM analysis and so may reasonably be used in place of CT for this purpose.

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