Prediction of collapse with magnetic resonance imaging of avascular necrosis of the femoral head.

Shimizu, Koh; Moriya, Hideshige; Akita, Tohru; Sakamoto, Masaaki; Suguro, Toru

doi:10.2106/00004623-199402000-00007

Cited by 186 publications

(93 citation statements)

References 10 publications

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“…However, we observed no extension of necrotic lesions for Stages I and II lesions, regardless of continued steroid administration. This finding is consistent with those from prospective studies using MRI showing the area of femoral head ON does not enlarge on serial MRIs [14,15]. The same has been observed for the knee [17].…”

Section: Discussionsupporting

confidence: 91%

“…The progression of the disease to humeral head collapse was observed in 71 (54%) of the 132 asymptomatic shoulders and in 68 (82%) of the 83 symptomatic shoulders. In particular, we found, as for the hip [14,15], an association between the size and location of the ON and the risk of quick radiographic or clinical failure. This also was confirmed for the shoulder by Sakai et al [13].…”

Section: Discussionmentioning

confidence: 63%

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The Natural Progression of Shoulder Osteonecrosis Related to Corticosteroid Treatment

Hernigou

Flouzat-Lachaniette

Roussignol

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Little is known about the rate and factors of progression of shoulder osteonecrosis (ON) related to corticosteroids. Purpose We retrospectively evaluated 125 patients (215 shoulders) with humeral head ON diagnosed by MRI to determine the delay between corticosteroid treatment and the different stages and factors influencing the progression of the disease. Methods Seventy-four of the shoulders had asymptomatic Stage I ON, 58 had asymptomatic Stage II ON, 46 had symptomatic Stage I ON, and 37 had symptomatic Stage II ON. The minimum followup was 10 years (average, 14 years; range, 10-20 years). The delay between the beginning of the corticosteroid treatment and the diagnosis of ON of the humeral head averaged 15 months (range, 6-24 months). Results We observed partial or total regression on MRI only in patients with asymptomatic Stage I ON. At last followup, pain had developed in 98 (74%) and collapse had occurred in 71 (54%) of the 132 previously asymptomatic shoulders. Of the 83 symptomatic shoulders, 68 (82%) had collapsed at the final followup. The time between diagnosis and collapse averaged 10 years for patients with symptomatic Stage I ON and 3 years for patients with symptomatic Stage II ON. Conclusions Stage at initial visit, occurrence of pain, and continuation of peak doses of corticosteroids predicted progression of disease in asymptomatic shoulders, whereas in the symptomatic shoulders, extent and location of the lesion were the main risk factors for progression.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 63%

The Natural Progression of Shoulder Osteonecrosis Related to Corticosteroid Treatment

Hernigou

Flouzat-Lachaniette

Roussignol

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…For the above-stated reasons, the differences observed among species may result in the difference in the location of ON. Moreover, in humans, ON is known to occur in multifocal regions in various part of bone tissue (5-7), and even the ON occurring in the femoral head sometimes remains silent and does not collapse if the region is small or is located in the central portion (8)(9)(10). We therefore should not exclude ON occurring in the metaphysis or diaphysis, just because these regions are not located in the area of the epiphysis or do not undergo collapse.…”

Section: Discussionmentioning

confidence: 99%

Effects of pulse methylprednisolone on bone and marrow tissues. Corticosteroid‐induced osteonecrosis in rabbits

Yamamoto

Irisa

Sugioka

et al. 1997

Arthritis & Rheumatism

226

181

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Objective. To investigate the effects of pulse methylprednisolone acetate on bone and bone marrow tissues and to clarify the causal factors of corticosteroidinduced osteonecrosis (ON) by using an experimental animal model.Methods. Male adult Japanese white rabbits were injected once with 20 mg/kg of methylprednisolone into the right gluteus medius muscle. Seven rabbits were killed at 4 weeks, 4 at 6 weeks, 4 at 8 weeks, and 6 at 10 weeks. Both histopathologic and hematologic studies were performed every week.Results. By 4 weeks after the steroid injection, 43% of the rabbits studied had developed multifocal ON lesions in the femur and/or humerus. In 1 rabbit, a thrombus was detected in an arteriole adjacent to the necrotic area at 4 weeks. After 6 weeks, there was also progressive histologic evidence of revascularization, with granulation tissue, and osteoblastic repair, with appositional bone formation. Hyperlipemia, fatty liver, and intraosseous fat embolism were observed in conjunction with thrombocytopenia and hypofibrinogenemia.Conclusion. A single injection of high-dose corticosteroids was found to be capable of inducing thrombocytopenia, hypofibrinogenemia, and hyperlipemia with multifocal ON in several bones.

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“…All showed nontraumatic ONFH on radiographs and MRI; 40 had Stage II and 20 had Stage III involvement per the Ficat-Arlet classification [11]. We used the classification of Shimizu et al [36] to define the extent and location of the lesion on the MR images. According to this classification, the extent of the lesion is defined as Grade A when the maximal radial distance of necrosis is less than 1 . 4 of the diameter of the head.…”

Section: Methodsmentioning

confidence: 99%

“…Nontraumatic ONFH usually affects young adults during the third to fourth decades of life, and most of the radiographically larger lesions progress to collapse, resulting in osteoarthritis without treatment [24,27,28,30,43]. The risk of collapse of the femoral head depends on the extent and location of the lesion [1,24,36]. Despite improvements in techniques and materials in total hip arthroplasty (THA), survivorship in young patients is still suboptimal owing to the high rate of complications [7,18,20,33].…”

Section: Introductionmentioning

confidence: 99%

Transtrochanteric Rotational Osteotomy for Nontraumatic Osteonecrosis of the Femoral Head in Young Adults

Biswal

Hazra

Yun

et al. 2009

Clin Orthop Relat Res

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Transtrochanteric rotational osteotomy (TRO) is a controversial procedure with reported inconsistent results. We reviewed 50 patients (60 hips) who underwent this procedure for extensive osteonecrosis of the femoral head, focusing on varization to determine its effectiveness as a head-preserving procedure in young adults. The mean age of the patients was 28 years (range, 18-46 years). Using the Ficat-Arlet classification, 40 hips had Stage II and 20 hips had Stage III involvement. According to the classification system of Shimizu et al., the extent of the lesions were Grade C in 54 hips and Grade B in six hips; the location of the lesions were Grade c in 56 hips and Grade b in four hips. Minimum followup was 18 months (mean, 84 months; range, 18-156 months). The mean preoperative Harris hip score was 44.7 points (range, 32-62 points) which improved to an average postoperative score of 80.1 points (range, 44-100 points) at the latest followup. Forty-four hips showed no radiographic evidence of progression of collapse. Ten hips showed progressive collapse, seven hips showed progressive varus deformity, three hips had stress fractures of the femoral neck, and one hip had infection. We believe TRO with varization is worth attempting for extensive osteonecrosis of the femoral head in young adults, although failures and complications are not uncommon.

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Prediction of collapse with magnetic resonance imaging of avascular necrosis of the femoral head.

Cited by 186 publications

References 10 publications

The Natural Progression of Shoulder Osteonecrosis Related to Corticosteroid Treatment

The Natural Progression of Shoulder Osteonecrosis Related to Corticosteroid Treatment

Effects of pulse methylprednisolone on bone and marrow tissues. Corticosteroid‐induced osteonecrosis in rabbits

Transtrochanteric Rotational Osteotomy for Nontraumatic Osteonecrosis of the Femoral Head in Young Adults

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