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Prognostic analysis of different morphology of the necrotic-viable interface in osteonecrosis of the femoral head

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Abstract

Purpose

The purpose of this study was to investigate the collapse progression in different morphologies of the necrotic-viable interface in osteonecrosis of the femoral head (ONFH).

Methods

A total of 168 patients (202 hips) with Association Research Circulation Osseous (ARCO) stage II ONFH were included. Ending with the collapse of the femoral head, all patients received conservative treatment but without surgical intervention and were followed for three to 91 months. Bilateral hip-joint radiographs and magnetic resonance imaging (MRI) were examined, and the largest layer of necrosis within the coronal section of MRI images was selected together with its anteroposterior radiograph to observe the morphology of the necrotic-viable interface. The morphology was divided into four types: I, type transverse; II, type “V”; III, type zigzag; IV, type closed. The collapse rate and the time to collapse in different morphologies were assessed.

Results

A total of 120 hips collapsed in two years or less, 61 were type-I, 51 were type-II, and 8 were type-III. Non-collapse occurred in all 17 hips with type-IV ONFH during long-term follow-up. In 202 hips with ARCO stage-II ONFH, the collapse rate in type-I ONFH was significantly higher than that of type-II and type-III ONFH (P < 0.01 for both). The time to collapse was markedly shortened.

Conclusions

The risk of ONFH-induced collapse is influenced by the morphology of the necrotic-viable interface. Effective mechanical support for preventing the collapse of the femoral head is necessary when the morphology of the necrotic-viable interface is type transverse.

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Acknowledgments

This work was supported by grants from the project of the National Natural Science Foundation of China (No. 81473697). We thank all the colleagues for their invaluable assistance during the execution of the present study.

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Authors and Affiliations

  1. Department of Orthopaedics, Zhongshan Hospital of Guangzhou University of Traditional Chinese Medicine, Kangxin Road, Zhongshan, Guangdong, 528400, China

    Wei Wu & Da-Wei Gao

  2. Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Baiyun District, Guangzhou, Guangdong, 510405, China

    Wei He, Qiu-Shi Wei, Zhen-Qiu Chen, Peng Chen, Qing-Wen Zhang, Bin Fang & Lei-lei Chen

  3. Department of Endocrinology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Baiyun District, Guangzhou, Guangdong, 510405, China

    Bao-Ling Li

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  1. Wei Wu
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Corresponding author

Correspondence to Wei He.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was conducted in agreement with the Declaration of Helsinki and its later amendments or comparable ethical standards and had been approved by the ethics board of Guangzhou University of Traditional Chinese Medicine (No: 20140307).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Hospital A in the manuscript refers to Zhongshan Hospital of Guangzhou University of Traditional Chinese Medicine.

Hospital B in the manuscript refers to The First Affiliated Hospital of Guangzhou Medicine.

University C in the manuscript refers to Guangzhou University of Traditional Chinese Medicine.

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Wu, W., He, W., Wei, QS. et al. Prognostic analysis of different morphology of the necrotic-viable interface in osteonecrosis of the femoral head. International Orthopaedics (SICOT) 42, 133–139 (2018). https://doi.org/10.1007/s00264-017-3679-8

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  • DOI: https://doi.org/10.1007/s00264-017-3679-8

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