Abstract
To identify imaging criteria that determine the outcome of core decompression (CD) in femoral-head avascular necrosis (AVN). Radiographs and magnetic resonance imaging (MRI) of 65 hips with early stage AVN treated by core decompression between January 1990 and December 2000 for AVN were reviewed. All hips were categorized into two groups according to the result of CD using total hip arthroplasty (THA) as an end point. Hips that had no THA at follow-up were allocated to group I; those treated with a THA were allocated to group II. CD results were calculated for each group using THA as an end point. The parameters analyzed were the presence or absence of edema associated with the double-line sign on the preoperative MRI, the type of epiphyseal scar (ES) according to Jing, and the type of necrosis according to Mitchell. On follow-up, 45 hips had no THA (group I); 20 patients had a THA (group II). Patients with a radiographic crescent sign and those with edema associated with the double-line sign progressed to THA significantly more frequently. The extent of the necrosis had less discriminatory effect between the two groups. ES and necrotic tissue types had no prognostic value. In regard to the success of CD, it is important to differentiate on MRI between a double line sign plus bone marrow edema and a double-line sign only.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Hungerford DS. Role of core decompression as treatment method for ischemic femur head necrosis. Orthopäde 1990; 19:219–223.
Stulberg BN, Davis AW, Bauer TW, Levine M, Easley K. Osteonecrosis of the femoral head. A prospective randomized treatment protocol. Clin Orthop 1991; 140–151.
Phemister DB. Treatment of the necrotic head of the femur in adults. J Bone Joint Surg Am 1949; 31:55–66.
Iida S, Harada Y, Shimizu K et al. Correlation between bone marrow edema and collapse of the femoral head in steroid-induced osteonecrosis. Am J Roentgenol 2000; 174:735–743.
Sugano N, Takaoka K, Ohzono K, Matsui M, Masuhara K, Ono K. Prognostication of nontraumatic avascular necrosis of the femoral head. Significance of location and size of the necrotic lesion. Clin Orthop 1994; 155–164.
Ohzono K, Saito M, Takaoka K et al. Natural history of nontraumatic avascular necrosis of the femoral head. J Bone Joint Surg Br 1991; 73:68–72.
Jiang CC, Shih TT. Epiphyseal scar of the femoral head: risk factor of osteonecrosis. Radiology 1994; 191:409–412.
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. Am J Roentgenol 1987; 148:1159–1164.
Ficat RP. Treatment of avascular necrosis of the femoral head. Hip 1983; 279–295.
Aigner N, Schneider W, Eberl V, Knahr K. Core decompression in early stages of femoral head osteonecrosis—an MRI-controlled study. Int Orthop 2002; 26:31–35.
Lavernia CJ, Sierra RJ. Core decompression in atraumatic osteonecrosis of the hip. J Arthroplasty 2000; 15:171–178.
Maniwa S, Nishikori T, Furukawa S et al. Evaluation of core decompression for early osteonecrosis of the femoral head. Arch Orthop Trauma Surg 2000; 120:241–244.
Iorio R, Healy WL, Abramowitz AJ, Pfeifer BA. Clinical outcome and survivorship analysis of core decompression for early osteonecrosis of the femoral head. J Arthroplasty 1998; 13:34–41.
Ito H, Matsuno T, Kaneda K. Prognosis of early stage avascular necrosis of the femoral head. Clin Orthop 1999; 149–157.
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 1998; 136:138–146.
Gardeniers J. ARCO International Classification of Osteonecrosis. ARCO Newsletter 1993; 5:79–82.
Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg Br 1995; 77:34–41.
Lausten GS, Mathiesen B. Core decompression for femoral head necrosis. Prospective study of 28 patients. Acta Orthop Scand 1990; 61:507–511.
Learmonth ID, Maloon J, Dall G. Core decompression for early atraumatic osteonecrosis of the femoral head. J Bone Joint Surg Br 1990; 72:387–390.
Fairbank AC, Bhatia D, Jinnah RH, Hungerford DS. Long-term results of core decompression for ischaemic necrosis of the femoral head. J Bone Joint Surg Br 1995; 77:42–49.
Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg BR 1995; 77:34–41.
Scully SP, Aaron RK, Urbaniak JR. Survival analysis of hips treated with core decompression or vascularized fibular grafting because of avascular necrosis. J Bone Joint Surg Am 1998; 80:1270–1275.
Nishii T, Sugano N, Ohzono K, Sakai T, Sato Y, Yoshikawa H. Significance of lesion size and location in the prediction of collapse of osteonecrosis of the femoral head: a new three-dimensional quantification using magnetic resonance imaging. J Orghop Res 2002; 20:130–136.
Koo KH, Ahn IO, Kim R et al. Bone marrow edema and associated pain in early stage osteonecrosis of the femoral head: prospective study with serial MR images. Radiology 1999; 213:715–722.
Vande Berg BE, Malghem JJ, Labaisse MA, Noel HM, Maldague BE. MR imaging of avascular necrosis and transient marrow edema of the femoral head. Radiographics 1993; 13:501–520.
Koo KH, Jeong ST, Jones JPJ. Borderline necrosis of the femoral head. Clin Orthop 1999; 158–165.
Hofmann S, Schneider W, Breitenseher M, Urban M, Plenk HJ. “Transient osteoporosis” as a special reversible form of femur head necrosis. Orthopade 2000; 29:411–419.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Radke, S., Kirschner, S., Seipel, V. et al. Magnetic resonance imaging criteria of successful core decompression in avascular necrosis of the hip. Skeletal Radiol 33, 519–523 (2004). https://doi.org/10.1007/s00256-004-0811-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-004-0811-9