Koo K-H, Ahn I-O, Kim R, et al (Gyeong-Sang Natl Univ, South Korea; Seoul Natl Univ, South Korea; Catholic Univ of Korea, Seoul )
Bone Marrow Edema and Associated Pain in Early Stage Osteonecrosis of the Femoral Head: Prospective Study With Serial MR Images
Radiology 213: 715-722, 1999
It has been well documented that the pain in the hip is disabling before radiographic evidence of collapse and joint incongruity.
Pain was related to marrow edema and bone infarct.
M.R. imaging can give us a guideline for the definitive treatment in 3 categories
a) Contralateral hip showing osteonecrosis.
b) Hip symptoms but no x ray changes.
c) X ray showed osteonecrosis of heads but no collapse.
Diagnosis of Osteonecrosis was established with x rays, M.R. imaging or both.
Conclusion – The study suggests that marrow edema of proximal femur and focal osteonecrosis of femoral head in combination are associated strongly with hip pain in early stages of osteonecrosis even before collapse.
As a result of this early diagnosis it is said that core decompression of the head of the femur helps to alleviate the pain.
Steinberg ME, Corces A, Fallon M (Univ of Pennsylvania, Philadelphia)
Acetabular Involvement in Osteonecrosis of the Femoral Head
J Bone Joint Surg Am 81-A: 60-65, 1999
In patients with osteonecrosis of the femoral head arthroplasty may be necessary before any radiographic evidence of acetabular abnormality becomes apparent. If no changes are seen in acetabulum – bipolar or replacement and /or resurfacing may be considered.
On gross examination the acetabular cartilage appeared to be abnormal in 40 out of 41 cases. Cartilage degeneration involved less than 20% of the acetabulum.
The likelihood of acetabular degeneration should be considered before deciding the type of arthroplasty.
Bozic KJ, Zurakowski D, Thornhill TS (Harvard Med School, Boston; Brigham and Women’s Hosp, Boston)
Survivorship Analysis of Hips Treated With Core Decompression for Nontraumatic Osteonecrosis of the Femoral Head
J Bone Joint Surg Am 81-A: 200-209, 1999
Introduction: Nontraumatic osteonecrosis of the femoral head is a diagnostically and therapeutically challenging condition that can lead to early destruction of the hip joint. There have been few long-term follow-up.
Analysis included 54 hips of 34 patients undergoing core decompression from 1981-1995. Apparent risk factors were corticosteroid, 37 cases; excessive alcohol use, 8 cases; and ACT II for multiple sclerosis for 2 cases.
Modified Ficat and Arlet classification combined with system of Steinberg et al prospective disease stage was I (x ray normal) in 24%. II A sclerotic 13%, II A cystic 30%, and III collapse 15%.
Conclusion- 48% showed clinical satisfaction and x ray revealed 37%. It is a safe procedure for selected patients with nontraumatic osteonecrosis of femoral head those with stage I or stage II A sclerotic disease