Abstract
Background
The location of the lateral boundary of the necrotic lesion to the weight-bearing
portion of the acetabulum (Type classification) is an important factor for collapse
in osteonecrosis of the femoral head (ONFH). Recent studies also reported the significance
of the location of the anterior boundary of the necrotic lesion on the occurrence
of collapse. We aimed to assess the effects of the location of both anterior and lateral
boundaries of the necrotic lesion on collapse progression in ONFH.
Methods
We recruited 55 hips with post-collapse ONFH from 48 consecutive patients, who were
conservatively followed for more than one year. Using a plain lateral radiograph (Sugioka's
lateral view), the location of the anterior boundary of the necrotic lesion to the
weight-bearing portion of the acetabulum was classified as follows: Anterior-area
I (two hips) occupying the medial one-third or less; Anterior-area II (17 hips) occupying
the medial two-thirds or less; and Anterior-area III (36 hips) occupying greater than
the medial two-thirds. The amount of femoral head collapse was measured by biplane
radiographs at the onset of hip pain and each follow-up period, and Kaplan–Meier survival
curves with collapse progression (≥1 mm) as the endpoint were produced. The probability
of collapse progression was also assessed by the combination of Anterior-area and
Type classifications.
Results
Collapse progression was observed in 38 of the 55 hips (69.0%). The survival rate
of hips with Anterior-area III/Type C2 was significantly lower. Among hips with Type
B/C1, collapse progression occurred more frequently in hips with Anterior-area III
(21 of 24 hips) than in hips with Anterior-area I/II (3 of 17 hips, P < 0.0001).
Conclusions
Adding the location of the anterior boundary of the necrotic lesion to Type classification
was useful to predict collapse progression especially in hips with Type B/C1.
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Article info
Publication history
Published online: February 14, 2023
Accepted:
January 30,
2023
Received in revised form:
January 13,
2023
Received:
July 19,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.
