The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head

Sugano, Nobuhiko; Atsumi, Takashi; Ohzono, Kenji; Kubo, Toshikazu; Hotokebuchi, Takao; Takaoka, Kunio

doi:10.1007/s007760200108

Cited by 371 publications

(319 citation statements)

References 14 publications

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“…The eligibility criteria were age between 20 and 80 years and presence of ONFH at precollapse stage 1 or 2 according to the classification system for ONFH staging developed by the Japanese Investigation Committee of Health and Welfare (JICHW) [10]. Factors underlying ONFH were determined as associated with steroid use, associated with alcohol intake, or idiopathic.…”

Section: Patientsmentioning

confidence: 99%

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A pilot study of regenerative therapy using controlled release of recombinant human fibroblast growth factor for patients with pre-collapse osteonecrosis of the femoral head

Kuroda

Asada

et al. 2015

International Orthopaedics (SICOT)

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Purpose We evaluated the safety and clinical outcomes of a single local administration of gelatin hydrogel impregnated with recombinant human fibroblast growth factor (rhFGF)-2 for the treatment of the precollapse stage of osteonecrosis of the femoral head (ONFH). Methods Patients with ONFH (precollapse stage ≤2) received a single local administration of 800 μg of rhFGF-2-impregnated gelatin hydrogel and were followed up for one year. The surgery was performed using a minimally invasive technique involving a 1-cm skin incision, and walking was allowed from day one postoperatively. The primary outcomes included occurrence of adverse events and complications. The secondary outcomes included changes in the Harris hip scores, visual analog scale for pain scores, University of California, Los Angeles (UCLA) activity scores, and radiological images. Results We included ten patients, of which five experienced 14 adverse events, including one complication from spinal anesthesia. However, patients completely recovered from all adverse events. The mean clinical scores significantly improved by one year postoperatively compared with the pre-operative scores (before vs. after: visual analog score for pain, 21.2 vs. 5.3 mm; UCLA activity score, 5.5 vs. 6.6; Harris hip score, 81.0 vs. 96.9 points). There was only one case of femoral head collapse; however, this occurred in a hip with extensive necrosis. Stage progression and collapse did not occur in the other nine cases. Computed tomography confirmed bone regeneration in the femoral heads. Conclusions Clinical application of rhFGF-2-impregnated gelatin hydrogel for patients with precollapse ONFH was feasible and safe.

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Section: Patientsmentioning

confidence: 99%

“…The JICHW stage and type classifications were used to describe ONFH and localization of the necrotic lesion [10]. During preoperative planning, the drilling route to the necrotic lesion was planned using navigation software (Orthomap 3D, Stryker, Kalamazoo, MI, USA; Fig.…”

Section: Radiographic Assessmentmentioning

confidence: 99%

A pilot study of regenerative therapy using controlled release of recombinant human fibroblast growth factor for patients with pre-collapse osteonecrosis of the femoral head

Kuroda

Asada

et al. 2015

International Orthopaedics (SICOT)

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“…The lesions with Grade c locations were further subdivided into Types c1 and c2 as described by Sugano et al [37,38]. Both types occupy greater than the medial 2 .…”

Section: Methodsmentioning

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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“…3 The patients were examined using 3D SPGR MRI 13 between April 1998 and May 2005. Twenty hip joints (19 patients) had type C2 and 20 (17 patients) had type C1.…”

Section: Patients and Imagesmentioning

confidence: 99%

MRI‐based surgical simulation of transtrochanteric rotational osteotomy for femoral head osteonecrosis

Koyama

Sugano

Nishii

et al. 2009

Journal Orthopaedic Research

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Transtrochanteric rotational osteotomy (TRO) is one of the joint-preserving surgical treatments for osteonecrosis of the femoral head (ONFH). It can prevent collapse of the femoral head as necrotic lesions in the weight-bearing portion can be moved sufficiently to a less weight-bearing portion by anterior rotation, posterior rotation, or varus angulation. Patient selection and preoperative planning are important to determine indications for TRO. It has been reported that successful TRO requires at least 34% of the weight-bearing area supported by the intact part of the femoral head. However, this ratio is difficult to preoperatively quantify according to the rotation angle using conventional two-dimensional MR images or X-rays. Therefore, we developed a method of simulating TRO using three-dimensional (3D) models reconstructed from 3D MR images and applied it to serial patients with types C1 and C2 osteonecrosis at stage 1 or 2. The simulation visualized positional changes of the necrotic lesion in the weight-bearing area and enabled quantitation of the postoperative intact ratio. Our surgical simulation is useful for evaluating the postoperative intact ratio and for determining indications for TRO as well as the optimal angle of femoral head rotation and varus angulation. Osteonecrosis of the femoral head (ONFH) predominantly occurs in young and middle-aged adults. 1 If a necrotic lesion in the weight-bearing portion is large, the femoral head will progressively collapse in the natural course, resulting in osteoarthrosis of the hip that requires total hip arthroplasty even in young patients. The ratio to which the necrotic lesion of the ONFH occupies the weight-bearing portion of the acetabulum on anteroposterior (AP) radiographs or magnetic resonance (MR) images has been reported to be closely associated with the prognosis of idiopathic ONFH. 2 The type classification of idiopathic ONFH by the working group of the Japanese Ministry of Health, Labor and Welfare 3 is based on this ratio and consists of types A, B, C1, and C2 (Fig. 1). Patients with type C1 and C2 lesions that exceed the medial two-thirds of the weight-bearing portion have a poor prognosis of progressive collapse in the absence of surgical intervention, 2 so joint-preserving strategies such as osteotomy are important for such patients.Transtrochanteric rotational osteotomy (TRO) 4-6 is one of the joint-preserving surgical treatments for ONFH (Fig. 2), that can prevent collapse of the femoral head and consequent osteoarthrosis of the hip. To achieve this, the necrotic lesion of the femoral head in the weight-bearing portion must be moved sufficiently to less weight-bearing portion after transtrochanteric osteotomy by rotating the femoral head and neck anteriorly or posteriorly along the femoral neck axis with or without varus angulation. To accurately determine indications for TRO, and for TRO to be successful, patient selection and preoperative planning are critical. It has been reported that the ratio of the transposed intact articular...

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The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head

Cited by 371 publications

References 14 publications

A pilot study of regenerative therapy using controlled release of recombinant human fibroblast growth factor for patients with pre-collapse osteonecrosis of the femoral head

A pilot study of regenerative therapy using controlled release of recombinant human fibroblast growth factor for patients with pre-collapse osteonecrosis of the femoral head

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

MRI‐based surgical simulation of transtrochanteric rotational osteotomy for femoral head osteonecrosis

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