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Aspects of postoperative magnetic resonance imaging of patients with avascular necrosis of the femoral head, treated by advanced core decompression

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Abstract

Objective

To analyze remodeling processes after advanced core decompression (ACD) in patients with avascular femoral head necrosis by means of 3T MRI and to identify indicators for clinical outcome considering the defect size and characteristics of the bone graft and of the neighboring regeneration tissue.

Materials and methods

Thirty-four hips, with preexisting preoperative MRIs in 21 cases, were examined 1–34 months (mean 12.7) postoperatively by 3T MRI. The volume of necrosis was measured manually pre- and postoperatively to calculate absolute as well as percentage necrosis reduction. The signal intensity of the bone graft was quantified using a 4-point scale. Border phenomena between the bone graft and bone were described and classified into groups. Wilcoxon sign-rank test was used to identify correlations between the analyzed items and clinical signs of femoral head collapse after a mean follow-up time of 28.6 months (10.4–46.8).

Results

Mean percentage reduction of necrosis was significantly higher in asymptomatic patients (59.36 %) compared to patients with signs of femoral head collapse (28.78 %, p = 0.008). Signal intensity of the bone graft increased in T1w and T2w TIRM sequences over time after surgery and was significantly higher in asymptomatic patients. Five border phenomena between the bone graft and healthy bone were identified. Among them, the so-called “rail sign” representing three layers of remodeling tissue correlated with the histological observations.

Conclusion

A variety of border phenomena representing remodeling processes have been described using 3T MRI. Beneath the percentage amount of necrosis reduction, we identified the signal intensity of the bone graft as an indicator for clinical outcome.

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References

  1. Kramer J, Scheurecker G, Scheurecker A, Stoger A, Huber A, Hofmann S. Femoral head necrosis. Radiologe. 2009;49(5):410–8.

    Article  CAS  PubMed  Google Scholar 

  2. Kaushik AP, Das A, Cui Q. Osteonecrosis of the femoral head: An update in year 2012. World J Orthop. 2012;3(5):49–57.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Seamon J, Keller T, Saleh J, Cui Q. The pathogenesis of nontraumatic osteonecrosis. Arthritis. 2012;2012:601763.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Lieberman JR, Engstrom SM, Meneghini RM, SooHoo NF. Which factors influence preservation of the osteonecrotic femoral head? Clin Orthop Relat Res. 2012;470(2):525–34.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Petrigliano FA, Lieberman JR. Osteonecrosis of the hip: novel approaches to evaluation and treatment. Clin Orthop Relat Res. 2007;465:53–62.

    PubMed  Google Scholar 

  6. Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg Br. 1995;77(1):34–41.

    CAS  PubMed  Google Scholar 

  7. Zalavras CG, Lieberman JR. Osteonecrosis of the femoral head: evaluation and treatment. J Am Acad Orthop Surg. 2014;22(7):455–64.

    Article  PubMed  Google Scholar 

  8. Landgraeber S, Theysohn JM, Classen T, et al. Advanced core decompression, a new treatment option of avascular necrosis of the femoral head–a first follow-up. J Tissue Eng Regen Med. 2013;7(11):893–900.

    Article  CAS  PubMed  Google Scholar 

  9. Urban RM, Turner TM, Hall DJ, Inoue N, Gitelis S. Increased bone formation using calcium sulfate-calcium phosphate composite graft. Clin Orthop Relat Res. 2007;459:110–7.

    Article  PubMed  Google Scholar 

  10. Landgraeber S, Claßen T, Warwas S, Jäger M, Schmid KW, Grabellus F. The characteristic of a composite calcium sulphate (CaSO4)-calcium phosphate (CaPO4) bone graft substitute in treatment option of avascular necrosis of the femoral head. Under review. 2014.

  11. Civinini R, De Biase P, Carulli C, et al. The use of an injectable calcium sulphate/calcium phosphate bioceramic in the treatment of osteonecrosis of the femoral head. Int Orthop. 2012;36(8):1583–8.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Bednarek A, Atras A, Gagala J, Kozak L. Operative technique and results of core decompression and filling with bone grafts in the treatment of osteonecrosis of femoral head. Ortop Traumatol Rehabil. 2010;12(6):511–8.

    PubMed  Google Scholar 

  13. Larsson S, Hannink G. Injectable bone-graft substitutes: current products, their characteristics and indications, and new developments. Injury. 2011;42 Suppl 2:S30–4.

    Article  PubMed  Google Scholar 

  14. Kotnis NA, Parasu N, Finlay K, Jurriaans E, Ghert M. Chronology of the radiographic appearances of the calcium sulphate-calcium phosphate synthetic bone graft composite following resection of bone tumours–a preliminary study of the normal post-operative appearances. Skelet Radiol. 2011;40(5):563–70.

    Article  Google Scholar 

  15. Athanasiou VT, Papachristou DJ, Panagopoulos A, Saridis A, Scopa CD, Megas P. Histological comparison of autograft, allograft-DBM, xenograft, and synthetic grafts in a trabecular bone defect: an experimental study in rabbits. Med Sci Monit. 2010;16(1):BR24–31.

    PubMed  Google Scholar 

  16. Mitchell DG, Joseph PM, Fallon M, et al. Chemical-shift MR imaging of the femoral head: an in vitro study of normal hips and hips with avascular necrosis. AJR Am J Roentgenol. 1987;148(6):1159–64.

    Article  CAS  PubMed  Google Scholar 

  17. Sakai T, Sugano N, Nishii T, Haraguchi K, Ochi T, Ohzono K. MR findings of necrotic lesions and the extralesional area of osteonecrosis of the femoral head. Skelet Radiol. 2000;29(3):133–41.

    Article  CAS  Google Scholar 

  18. Plenk Jr H, Gstettner M, Grossschmidt K, Breitenseher M, Urban M, Hofmann S. Magnetic resonance imaging and histology of repair in femoral head osteonecrosis. Clin Orthop Relat Res. 2001;386:42–53.

    Article  PubMed  Google Scholar 

  19. Mazieres B, Marin F, Chiron P, et al. Influence of the volume of osteonecrosis on the outcome of core decompression of the femoral head. Ann Rheum Dis. 1997;56(12):747–50.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Wirtz C, Zilkens KW, Adam G, Niethard FU. MRI-controlled outcome after core decompression of the femur head in aseptic osteonecrosis and transient bone marrow edema. Z Orthop Ihre Grenzgeb. 1998;136(2):138–46.

    Article  CAS  PubMed  Google Scholar 

  21. Landgraeber S, Tran TN, Claßen T, et al. Geometric analysis of an expandable reamer for treatment of avascular necrosis of the femoral head. Under review. 2014.

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Acknowledgements

This study was supported by a research grant from the German Research Foundation (Deutsche Forschungsgesellschaft, DFG).

Conflicts of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany

    Andrea Lazik, Thomas C. Lauenstein & Jens M. Theysohn

  2. Department of Orthopedics, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany

    Stefan Landgraeber & Tim Claßen

  3. Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Kokereiallee 7, 45141, Essen, Germany

    Oliver Kraff

Authors
  1. Andrea Lazik
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  2. Stefan Landgraeber
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  3. Tim Claßen
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  4. Oliver Kraff
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  5. Thomas C. Lauenstein
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  6. Jens M. Theysohn
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Correspondence to Andrea Lazik.

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Lazik, A., Landgraeber, S., Claßen, T. et al. Aspects of postoperative magnetic resonance imaging of patients with avascular necrosis of the femoral head, treated by advanced core decompression. Skeletal Radiol 44, 1467–1475 (2015). https://doi.org/10.1007/s00256-015-2192-7

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  • DOI: https://doi.org/10.1007/s00256-015-2192-7

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