Accurate and Reliable Diagnosis of Avascular Necrosis of the Femoral Head From Total Hip Arthroplasty Specimens Requires Pathologic Examination

Abstract Objectives To evaluate the necessity of pathologic examination for confirming the diagnosis of avascular necrosis (AVN). Methods We retrospectively reviewed consecutive nonfractured total hip arthroplasty cases (n = 1,722), comparing operative diagnoses and radiologic data with final histol...

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Bibliographic Details
Published in:American journal of clinical pathology 2021-04, Vol.155 (4), p.565-574
Main Authors: Dermawan, Josephine K, Goldblum, Andrew, Reith, John D, Kilpatrick, Scott E
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip
Avascular necrosis
Cohort Studies
Diagnosis
Female
Femur Head Necrosis - diagnosis
Femur Head Necrosis - surgery
Humans
Joint diseases
Joint replacement surgery
Joint surgery
Male
Medical diagnosis
Middle Aged
Necrosis
Osteoarthritis
Pathology, Clinical
Retrospective Studies
Risk factors
Total hip arthroplasty
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Summary:Abstract Objectives To evaluate the necessity of pathologic examination for confirming the diagnosis of avascular necrosis (AVN). Methods We retrospectively reviewed consecutive nonfractured total hip arthroplasty cases (n = 1,722), comparing operative diagnoses and radiologic data with final histologic diagnoses, focusing specifically on AVN. Results Among 199 histologically confirmed cases of AVN, 62 (31%) had a preoperative diagnosis of osteoarthritis/degenerative joint disease (OA/DJD); 58 of the latter patients had radiology reports, but only two (3%) documented AVN. Patients with AVN preoperatively diagnosed as OA/DJD were significantly older (mean, 65 years) than patients with AVN correctly diagnosed clinically (mean, 52 years; P < .00001). Among 163 cases with a preoperative diagnosis of AVN, 26 (16%) were confirmed as OA/DJD; the radiology report incorrectly diagnosed AVN in 17 (65%) patients. These latter patients also were significantly older (mean, 60 years) than patients with AVN correctly diagnosed clinically (P = .0008). Patients with a preoperative clinical and/or radiologic diagnosis of AVN were more likely to be younger and have known AVN risk factors. Conclusions Accurate and reliable diagnosis of AVN requires pathologic examination, especially among older patients without known risk factors. Prompt diagnosis may lead to behavioral changes in affected patients that reduce the risk of subsequent lesions.
ISSN:0002-9173
1943-7722
DOI:10.1093/ajcp/aqaa153