Abstract
Introduction: Avascular necrosis (AVN) of femoral head can be defined as cellular death of bone due to loss of blood supply because of any reason. It affects the individuals at a relatively younger age and males are affected more commonly as compared to females. Though the exact pathophysiology is not known, but loss of blood supply causing death of osteocytes is the final component of AVN. Magnetic resonance imaging is reported to be highly sensitive and specific for the diagnosis of AVN and helps in early diagnosis. We conducted this study to analyze role of MRI in evaluation of avascular necrosis of femoral head.
Materials and Methods: This was a prospective study conducted in the department of radiology of a tertiary care medical institute situated in an urban area. 50 patients having avascular necrosis of femoral head were included in this study on the basis of inclusion and exclusion criteria. Institutional ethical committee approved the study and informed consent was obtained from the patients. Demographic details and detailed history was noted in all the cases. MRI of both hips was done in all patients. MRI findings were studied. Statistical analysis was done using SSPE 16.0 software. For statistical purposes p value less than 0.05 was taken as statistically significant.
Results: In this study of 50 patients with avascular necrosis of femoral head there 43 (86%) males and 7 (14%) females with M: F ratio of 1:0.16 most of the patients (56%) were between 20-40 years and the mean age of patients was found to be 38.48 ± 13.28 years. AVN of femoral head was present bilaterally in 31 patients (62 %) and unilateral in 19 patients (38%). The most common risk factor associated with avascular necrosis of femoral head was alcohol consumption (56%). Most common stage of AVN was found to be Stage II (39.50%). The most common MRI sign in studied cases was double line sign which was present in 73/81 (90.12%) femoral heads. Stage II and III AVN was more common in age group of 21-30 years whereas stage IV AVN was more common in age group of 41-50 years. Effusion was present in 57 hip joints. Bone marrow edema was seen in 68 femoral heads out of 81 affected in our study. On the basis of MRI most common compartment to be affected was found to be antero-superior compartment (51.85%). Finally the analysis of the cases on the basis of Steinberg Staging showed that the out of 81 femoral heads Stage IIIC was the most common stage seen in 25 femoral heads (30.86 %).
Conclusion: Magnetic resonance imaging is highly sensitive and specific imaging technique for the early diagnosis of avascular necrosis of femoral head. Early diagnosis and appropriate intervention in cases with AVN of femoral head is associated with better outcome. This study demonstrates the diagnostic benefits of MRI in early detection of lesion and its properstaging.
Keywords: Avascular necrosis, Femoral Head, Magnetic resonance Imaging, Staging.
References
- Hernigou P. Avascular necrosis of head of femur. Indian J Orthop. 2009;43(1):1-2.
- Moya-Angeler J, Gianakos AL, Villa JC, Ni A, Lane JM. Current concepts on osteonecrosis of the femoral head. World J Orthop. 2015;6(8):590-601. Published 2015 Sep 18.
- Stoica Z, Dumitrescu D, Popescu M, Gheonea I, Gabor M, Bogdan N. Imaging of avascular necrosis of femoral head: familiar methods and newer trends. Curr Health Sci J. 2009;35(1):23-8.
- Markisz JA, Knowles RJ, Altchek DW, Schneider R, Whalen JP, Cahill PT. Segmental patterns of avascular necrosis of the femoral heads: early detection with MR imaging. Radiology 1987; 162:717-720.
- Baig SA, Baig MN. Osteonecrosis of the Femoral Head: Etiology, Investigations, and Management. Cureus. 2018;10(8): e3171. Published 2018 Aug 21.
- Markisz JA, Knowles RJ, Altchek DW, Schneider R, Whalen JP, Cahill PT. Segmental patterns of avascular necrosis of the femoral heads: early detection with MR imaging. Radiology 1987; 162:717-720.
- Iida S, Harada Y, Shimizu K, et al. Correlation between bone marrow edema and collapse of the femoral head in steroid-induced osteonecrosis. AJR 2000;174:735–743
- Vardhan H, Tripathy SK, Sen RK, Aggarwal S, Goyal T. Epidemiological Profile of Femoral Head Osteonecrosis in the North IndianPopulation. Indian J Orthop. 2018;52(2):140-146.
- Zhao DW, Yu M, Hu K, et al. Prevalence of Nontraumatic Osteonecrosis of the Femoral Head and its Associated Risk Factors in the Chinese Population: Results from a Nationally Representative Survey. Chin Med J (Engl). 2015; 128 (21):2843-50.
- Jacobs B. Epidemiology of traumatic and nontraumatic osteonecrosis. Clinical Orthopaedics and Related Research. 1978. 130; 51-67.
- Diana Kamal, RodicaTraistaru, D.O. Alexandru, D.C.Greecu, L.Mogoanta. Epidemiologic Study of Avascular Necrosis of the Femoral Head. Current Health Sciences Journal. Vol.39, No.3, 2013.
- Nam KW, Kim YL, Yoo JJ, Koo KH, Yoon KS, Kim HJ. Fate of untreated asymptomatic osteonecrosis of the femoral head. J Bone Joint Surg Am, 2008. 90(3): p. 477-84
- Beltran J, Burk JM, Herman LJ, Clark RN, Zuelzer WA, Freedy MR, Simon S. Avascular necrosis of the femoral head: early MRI detection and radiological correlation. MagnReson Imaging. 1987;5(6):431-42.
- Helena Gabriel. MD, Steven WFitzgerald. MD, Melissa T Myers, MD, James S Donaldson, MD. Andrew K Poznanskl, MD. MR Imaging of Hip Disorders, Radiographics 1994; /14.763-781.
- Takashi Nishii Nobuhiko Sugano Kenji Ohzono Takashi Sakai Yoshinobu Sato Hideki Yoshikawa Significance of lesion size and location in the prediction of collapse of osteonecrosis of the femoral head: a new three‐dimensional quantific-ation using magnetic resonance imaging J Orthop Res. 2002 Jan;20(1):130-6.
- Saurabh goyal , Purvi desai , Devyani ambadekar , Simranjeet singh correlation between ficat-arlet and mitchell’s Staging for avascular necrosis of femur head NJMR, volume 6, issue 4, oct – dec 2016 page 301.
- Beverly C. Coleman, MD, Herbert Y. Kressel, MD, Murray K. Dalinka, MD, Mark L. Scheibler, MD, D. Lawrence Burk, MD, Eve K. Cohen, MD, FRCPC. Radiographically Negative Avascular Necrosis: Detection with MR Imaging, Radiology 1988; 168:525-528.
- Kim YM, Oh HC, Kim HJ. The pattern of bone marrow oedema on MRI in osteonecrosis of the femoralhead. J Bone Joint Surg Br 2000;82:837– 841
- DG Mitchell, V Rao, M Dalinka, CE Spritzer, WB Gefter, L Axel, M Steinberg, and HY Kressel MRI of joint fluid in the normal and ischemic hip American Journal of Roentgenology 1986 146:6, 1215-1218.
- Guo-Shu Huang. Wing P. Chan, Yue-Cune Chang, Cheng• Yen Chang. Cheng-Yu Chen, Joseph S. Yu. MR Imaging of Bone Marrow Edema and Joint Effusion in Patients with Osteonecrosis of the Femoral Head: Relationship to Pain, AIR 2003, 181: 545-549.
Corresponding Author
Dr Mohammed Zeeshan Saleem
Junior Resident, Department of Radiology, MGM Medical College and Hospital
DOI: https://dx.doi.org/10.18535/jmscr/v7i4.82
