Background Avascular necrosis of the femoral head (AVNH) is a condition that causes ischemic necrosis of a portion of the femoral head in the absence of infection or trauma and progresses to destruction of the femoral head and to secondary osteoarthritis.
AVNH affects adults (25-50 years) and has a profound impact on their quality of life. Pathology changes affect both fat bone marrow and hematogenic bone marrow.
Objectives The purpose of this research was to find the correlation between imaging studies (particularly MRI and scintigraphy) and biopsy changes in the early stages of AVNH.
Methods We studied 50 patients with AVNH, male, aged 25-45 years. The study is retrospective and based on data from patient’s files. The 50 patients were divided in 2 groups: 25 patients with one hip stage III-IV AVNH and contralateral hip to be studied; 25 patients with stage I-II AVNH.
Results The results showed that in the early stages of development, radiography is less sensitive in detecting avascular necrosis and its sensitivity increases if other imaging technique, scan or MRI, is associated. The latter, especially MRI, show a good correlation with pathology (whose sensitivity and specificity is 100%) It is also true that the combination of two criteria obtained by different diagnostic methods significantly increases the probability of correct diagnosis in early stages of disease.
Conclusions The examination of the contralateral hip, even when it is asymptomatic, is required because the disease may develop bilateral in 30-50% of cases, and early identification allows choosing appropriate therapeutic method.
For a better correlation with the staging the MEF study of the femoral head may be necessary, in order to choose the appropriate surgical technique.
ARCO Committee on Terminology and Classification, ARCO News, 4:41-46, 1992.
Ficat, P, Arlet, J L’exploration fonctionnelle de la circulation intra-osseuse et ses applicationsMasson, Paris,1977.
Ficat P, Arlet J Ischemie et necrose osseuse- l’exploration fonctionelle de la circulation intra-osseuse et ses applications. Paris, Masson, 1977.
Ficat P, Résultats du forage-biopsie dans les osteonecroses de la hanche. J. Belge Rhum. Med. Phys. 1972, 27, 204.
Ficat R.P. – Idiopathic bone necrosis of the femoral head- early diagnosis and treatment, J. Bone Joint Surg. (Br.), 1985, 67B, 3-9.
Rizzo PF, Gould ES, Lyden JP et al. Diagnosis of occult fractures about the hip. Magnetic resonance imaging compared with bone-scanning. J Bone Joint Surg Am. 1993, Vol. 75, 395-401.
Sugano N., Atsumi T., Ohzono K., Kubo T., Hotokebuchi T., Takaoka K. The 2001 revised criteria for diagnosis, classification and staging of idiopathic osteonecrosis of the femoral head. J Orthop Sci. 2002, Vol. 7, 601-605.
Steinberg ME, Hayken GD, Steinberg DR- A quantitative system for staging avascular necrosisJBJS, 77B: 34-41, 1995.
Disclosure of Interest None Declared