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Bone marrow lesion on magnetic resonance imaging indicates the last chance for hip osteonecrosis treated with vascularized fibular grafting before collapse

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Abstract

Purpose

Timing of surgery is the most critical prognostic factor for hip osteonecrosis treated with free vascularized fibular grafting (FVFG). Bone marrow lesion (BML) on MRI usually occurs immediately before femoral head collapse. We conducted a retrospective cohort study to evaluate whether the noncollapsed hips with BML can benefit from FVFG.

Methods

Consecutive patients undergoing modified FVFG were identified from our clinical repository between January 2014 and December 2014. Based on whether BML was pre-operatively detected, the four year radiographic and clinical outcomes were compared.

Results

In the BML cohort, 22 of 53 hips (42%) showed radiographic signs of osteonecrosis progression, which was significantly higher than that in the control cohort (8 of 49, 16%; P = 0.005). The BML hips showed a significantly lower pre-operative Harris Hip Score (HHS) than those without BML (77.8 vs. 85.5, P = 0.046), whereas no such difference was observed in the final HHS or its post-operative improvement (HHS 90 vs. 94, P = 0.397; HHS improvement 12 vs. 8, P = 0.067). In the subgroup of patients with a pre-operative HHS lower than 80, BML hips were associated with a slightly lower final HHS than hips without BML. Four of 5 (80%) failed hips with BML had a poor pre-operative hip function.

Conclusion

BML indicates the last chance for a reproducible improvement in the treatment of hip osteonecrosis with FVFG before collapse. However, the concomitant lower pre-operative HHS (< 80) is a poor prognostic factor for BML-positive hips.

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Author notes

  1. Yi-Gang Huang and Wee Kai Chia contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, China

    Yi-Gang Huang, Wee Kai Chia, Dongxu Jin, Youshui Gao, Jiagen Sheng & Changqing Zhang

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  1. Yi-Gang Huang
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  2. Wee Kai Chia
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  3. Dongxu Jin
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  4. Youshui Gao
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  6. Changqing Zhang
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Correspondence to Changqing Zhang.

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The study protocol was approved by the ethics committees of Jiao Tong University Affiliated Sixth People’s Hospital.

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All the authors declared that they have no conflicts of interest to this work.

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Huang, YG., Chia, W.K., Jin, D. et al. Bone marrow lesion on magnetic resonance imaging indicates the last chance for hip osteonecrosis treated with vascularized fibular grafting before collapse. International Orthopaedics (SICOT) 44, 2529–2536 (2020). https://doi.org/10.1007/s00264-020-04697-5

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  • DOI: https://doi.org/10.1007/s00264-020-04697-5

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