The effect of the anterior boundary of necrotic lesion on the occurrence of collapse in osteonecrosis of the femoral head

• Published in: International orthopaedics 2018-07, Vol.42 (7), p.1449-1455
• Main Authors: Kubo, Yusuke, Motomura, Goro, Ikemura, Satoshi, Sonoda, Kazuhiko, Hatanaka, Hiroyuki, Utsunomiya, Takeshi, Baba, Shoji, Nakashima, Yasuharu
• Format: Article
• Language: English
• Subjects: Adult; Aged; Female; Femur Head - diagnostic imaging; Femur Head - pathology; Femur Head Necrosis - complications; Follow-Up Studies; Hip Joint - diagnostic imaging; Hip Joint - pathology; Humans; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Original Paper; Orthopedics; Retrospective Studies; Risk Factors; Survival Analysis
• ISSN: 0341-2695; 1432-5195
• DOI: 10.1007/s00264-018-3836-8

Purpose The location of the necrotic lesion is one of the important factors for collapse in osteonecrosis of the femoral head (ONFH). The significance of anterior localization has been little studied. This study evaluated the effects of anterior boundary of a necrotic lesion on collapse. Methods We reviewed the outcomes of 113 consecutive non-collapsed asymptomatic hips in 98 ONFH patients with mean follow-up of 4.7 years (2.0–11.8) after the initial magnetic resonance (MR) imaging. The presence or absence of collapse was investigated using follow-up radiographs. The location of the anterior boundary of a necrotic lesion was assessed using the anterior necrotic angle between the midline of the femoral neck shaft and the line passing from the femoral head centre to the anterior boundary on mid-oblique MR imaging. Multivariate analysis was performed to identify risk factors for collapse, and further analyses were executed according to the lateral boundary of the necrotic lesion. Results During the follow-up period, collapse was confirmed in 61 hips (54.0%). Multivariate analysis revealed that the anterior necrotic angle was independently associated with collapse as well as the lateral boundary of the necrotic lesion. When the lateral boundary was located at the middle third of weight-bearing portion (32 hips), that was generally categorized as a low risk of collapse, all five cases with anterior necrotic angle ≥ 79° developed collapse, whereas only one of 27 cases (3.7%) with an anterior necrotic angle