This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal My Folders Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Calder, J. D. Articles by Revell, P. A. Search for Related Content PubMed PubMed Citation Articles by Calder, J. D. Articles by Revell, P. A.

The relationship between osteonecrosis of the proximal femur identified by MRI and lesions proven by histological examination

¹ Imperial College London, Charing Cross Campus, Reynolds Building, St Dunstan’s Road, London W6 8RP, UK.
² Department of Radiology
³ Department of Orthopaedic Surgery, Central Middlesex Hospital, Acton Lane, London NW10 7NS, UK.
⁴ University College London, Eastman Dental Institute, 256 Grays Inn Road, London WC1X 8LD, UK.

Correspondence should be sent to Mr J. D. F. Calder at North Hampshire Hospital, Aldermaston Road, Hampshire RG24 9NA, UK; email: j.calder{at}ic.ac.uk.

Total hip replacement in patients with advanced osteonecrosis of the femoral head is often complicated by early loosening of the femoral component. Recent evidence has suggested that abnormal bone extending into the proximal femur may be responsible for the early failure of the femoral component. We aimed to identify which patients were at high risk of early failure by evaluating gadolinium-enhanced MR images of histologically-confirmed osteonecrotic lesions beyond the femoral head.

Although the MR signal intensity has been shown to correlate well with osteonecrosis in the femoral head, it was found to be relatively insensitive at identifying lesions below the head, with a sensitivity of only 51% and a predictive value of a negative result of only 48%. However, the specificity was 90%, with the predictive value of a positive MRI finding being 86%. Only those patients with osteonecrosis of the femoral head secondary to sickle-cell disease, who are known to be at high risk of early loosening, had changes in the MR signal in the greater trochanter and the femoral shaft. This observation suggests that changes in the MR signal beyond the femoral head may represent osteonecrotic lesions in areas essential for the fixation of the femoral component. Pre-operative identification of such lesions in the neck of the femur may be important when considering hip resurfacing for osteonecrosis of the femoral head, following which early loosening of the femoral component and fracture of the neck are possible complications.

This article has been cited by other articles:

				M. S. Lee, P.-H. Hsieh, Y.-H. Chang, Y.-S. Chan, S. Agrawal, and S. W. N. Ueng Elevated intraosseous pressure in the intertrochanteric region is associated with poorer results in osteonecrosis of the femoral head treated by multiple drilling J Bone Joint Surg Br, July 1, 2008; 90-B(7): 852 - 857. [Abstract] [Full Text] [PDF]