Risk Factors Leading to Total Hip Arthroplasty in Patients with Subchondral Insufficiency Fractures of the Femoral Head

Abstract

Purpose. To retrospectively evaluate factors leading to total hip arthroplasty (THA) in patients with subchondral insufficiency fractures (SIF) of the femoral head. Methods. 5 men and 22 women aged 51 to 85 (mean, 72) years with SIF of the femoral head initially underwent conservative treatment. THA was later performed for 13 patients, as the hip pain became worse secondary to joint space narrowing and/ or femoral head collapse. Patient demographics and radiological variables were retrieved. Risk factors leading to THA in patients with SIF of the femoral head were identified. Receiver operating characteristic curves were used to determine optimal cut-off values for the significant risk factors. Results. 2 men and 11 women aged 62 to 85 (mean, 74.9) years underwent THA and were followed up for 0.2 to 62 (mean, 13) months. The remaining 3 men and Risk factors leading to total hip arthroplasty in patients with subchondral insufficiency fractures of the femoral head Keita Miyanishi, Kohei Ishihara, Seiya Jingushi, Takehiko Torisu Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Kitakyushu, Japan Address correspondence and reprint requests to: Dr Keita Miyanishi, Department of Orthopaedic Surgery, Kyushu Rosai Hospital, 1-3-1, Kuzuharatakamatsu, Kokuraminami-ku, Kitakyushu, 800-0296, Japan. E-mail: keitam@major.ocn.ne.jp 2010;18(3):271-5 11 women aged 51 to 81 (mean, 68) years underwent conservative treatment and were followed up for 9 to 93 (mean, 28) months. Patient age was the only risk factor for THA (p=0.047, odds ratio=1.13), the cutoff value being 71 years (sensitivity, 77%; specificity, 64%). The survival rate was significantly lower in patients aged ≥71 years than in those aged <71 years (p<0.05). Conclusion. Elderly patients with SIF of the femoral head are at higher risk of undergoing THA. Journal of Orthopaedic Surgery

Clinical outcomes in relation to locations of bone marrow edema lesions in patients with a subchondral insufficiency fracture of the hip: a review of fifteen cases

“…Clinically, it has been reported that more elderly patients (.71 years) and female patients with subchondral insufficiency fracture of the femoral head are at higher risk of undergoing surgical treatment. 12,13 Radiologically, the acetabular head index and the length of T 1 low-intensity band (subchondral fracture line) of MR images to the weight-bearing portion ratio (band length ratio) have been shown to be important prognostic factors in patients with a subchondral insufficiency fracture of the femoral head. 14 The authors concluded that the adequacy of acetabular coverage (acetabular head index , 76.8) and a band length ratio of .57.9 were associated with a higher risk of the progression of collapse of the femoral head and the need for surgery, 14 which were consistent with the majority of our cases ( Table 2).…”

Subchondral insufficiency fractures of the femoral head: associated imaging findings and predictors of clinical progression

“…However, the use of this definition of progression has the benefit of being easily defined and confirmed, and it is generally quite indicative of disease severity; this definition has been used in previous literature in large multi-centre trials as a marker for degenerative joint disease progression [4,20,[29][30][31]. To further validate the use of this definition of progression, we compared our results of this analysis with those using radiographic definitions of progression, and these have confirmed our significant findings regarding the imaging characteristics associated with worse prognosis.…”

“…Despite this discrepancy in prognosis among those with SIF, little information exists to date that establishes firm criteria linked to progression of these fractures to advanced collapse, though this information would be critical for treatment decisions. Characteristics such as fracture length and band length ratio (defined as the ratio of the fracture line diameter to the entire weight-bearing portion of the femoral head) have been shown in previous studies to be associated with radiographic progression, as has patient age at the time of diagnosis [19,20]. But to date studies focusing on SIF have been limited by small sample sizes.…”

Subchondral Insufficiency Fracture of the Femoral Head in Elderly People

“…All cases showed progressive femoral head collapse and three of them were treated with THA after 4-12 months of conservative treatment. Recently, Miyanishi et al (18) reported the largest case series of 27 patients with SIFFH. Thirteen cases (48%) underwent THA.…”