Subchondral Insufficiency Fracture of the Femoral Head may be Associated with Hip Dysplasia: A Pilot Study

Abstract

Background Subchondral insufficiency fracture of the femoral head occurs mainly in elderly patients with osteoporosis. Spontaneous resolution is observed after nonoperative treatment in some patients whereas other show progressive joint destruction requiring THA. Several studies report the occurrence of subchondral insufficiency fracture of the femoral head in dysplastic hips. Questions/purposes We asked whether the extent of hip dysplasia or osteoporosis was greater in patients with subchondral insufficiency fracture of the femoral head than in normal control subjects. Patients and Methods We compared the clinical and imaging findings of 13 patients with subchondral insufficiency fractures of the femoral head and 12 patients scheduled for TKA with asymptomatic hips. Age, gender, and body mass index were comparable in the two groups. Results Higher mean Sharp angles, lower acetabular head indices, lower center-edge angles, and higher acetabular roof angles in patients with subchondral insufficiency fracture of the femoral head than in those with asymptomatic hips suggested a greater degree of hip dysplasia.Bone mineral density and serum levels of Type I collagen cross-linked N-telopeptide and bone alkaline phosphatase were similar in the two groups. Conclusions We speculate an excessive amount of stress on the acetabular edge from dysplasia may be associated with the occurrence of subchondral insufficiency fracture of the femoral head.

Rapidly destructive arthrosis of the hip joint in a young adult with systemic lupus erythematosus

“…2b) shows a poorly marginated high-intensity lesion from the superior to inferior portion of the right femoral head as well as long-term corticosteroid treatment over 25 years [14]. Furthermore, SIF was suggested to be associated with acetabular dysplasia [15], the presence of which was confirmed in the current case. Although acetabular dysplasia was possibly a coincidence, we think that stress concentration by acetabular dysplasia on the femoral head might play a role on the rapid destruction of the hip joint in our case as important as bone fragility.…”

Common site of subchondral insufficiency fractures of the femoral head based on three-dimensional magnetic resonance imaging

“…First, the mechanism of SIF is not clear. Ishihara et al reported that the occurrence of SIF is associated with insufficient acetabular coverage [11]. However, in our experience, many patients who have no findings of insufficient acetabular coverage develop SIF.…”

“…Such cases accounted for 11 of the 33 SIF cases in the present study. Ishihara et al reported that the occurrence of SIF is associated with insufficient acetabular coverage [11]. In patients with insufficient acetabular coverage, an excessive amount of stress is placed between the acetabular edge and superolateral portion of the femoral head, causing SIF.…”

Hip arthroscopy enables classification and treatment of precollapse subchondral insufficiency fracture of the femoral head associated intra-articular pathology

“…A pilot study by Ishihara demonstrated that SIFFH is associated with DDH [8]. A recent case report has shown that SIFFH occurred in patients with overcoverage of acetabular rim that can be implicated with pincer type of impingement [10].…”