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How do radiologists evaluate osteonecrosis?

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Abstract

Objectives

Management of patients with osteonecrosis of the hip remains controversial and challenging. Because the prognosis and treatment are determined in large part by the stage and extent of the disease, it is important to use a reliable and efficient method for evaluation and staging. The objective of this study was to determine how musculoskeletal (MSK) radiologists evaluate osteonecrosis and whether this evaluation is adequate.

Materials and methods

A 12-part questionnaire was designed to determine how MSK radiologists evaluate patients with osteonecrosis of the femoral head (ONFH). This was sent to 888 members of the Society of Skeletal Radiology.

Results

One hundred and twenty-one members responded to essentially all questions. Patients were evaluated using plain radiographs and MRI. All agreed that it is clinically important to determine the extent of necrosis and joint involvement, and 115 (95 %) stated that this should be part of the radiologists’ evaluation. However, only 55 (46 %) said that in practice they used a specific system of classification, and most of these used the Ficat and Arlet classification, which does not indicate the extent of involvement. One hundred and seven (88 %) respondents included a simple visual estimate of the extent of involvement, and a small number added a specific measurement of lesion size. The majority indicated that they were infrequently consulted about which imaging studies should be obtained.

Conclusions

Although radiologists recognize the clinical importance of determining the extent of necrosis and joint involvement in patients with ONFH, in practice the methods used to evaluate these patients often do not accomplish this satisfactorily. The use of an effective classification, which includes both stage and extent of involvement, should be stressed, as it will lead to improved treatment of patients with ON. Physicians who order imaging studies for patients with ON should be encouraged to consult routinely with their radiology colleagues regarding which studies to request, as well as on the interpretation of these studies.

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References

  1. Steinberg ME. Diagnostic imaging and the role of stage and lesion size in determining outcome in osteonecrosis of the femoral head. Tech Orthop. 2001;16(1):6–15.

    Article  Google Scholar 

  2. Mont MD, Jones LC, Hungerford DS. Nontraumatic osteonecrosis of the femoral head: ten years later. J Bone Joint Surg (Am). 2006;88:1117–32.

    Article  Google Scholar 

  3. Steinberg ME, Bands RE, Parry S, Hoffman E, Chan T, Hartman KM. Does lesion size affect the outcome in avascular necrosis? Clin Orthop. 1999;367:262–71.

    Article  PubMed  Google Scholar 

  4. Steinberg ME, Larcom PG, Strafford B, Hosick WB, Corces A, Bands RE, et al. Core decompression with bone grafting for osteonecrosis of the femoral head. Clin Orthop Relat Res. 2001;386:71–8.

    Article  PubMed  Google Scholar 

  5. Koo K-H, Kim R. Quantifying the extent of osteonecrosis of the femoral head: a new method using MRI. J Bone Joint Surg (Br). 1995;77:875–80.

    CAS  Google Scholar 

  6. Cherian SF, Laorr A, Saleh KJ, et al. Quantifying the extent of femoral head involvement is osteonecrosis. J Bone Joint Surg (Am). 2003;85:309–15.

    Google Scholar 

  7. Hernigou P, Lambotte SC. Volumetric analysis of osteonecrosis of the femur: anatomical correlation using MRI. J Bone Joint Surg (Br). 2001;83-B:672–5.

    Article  Google Scholar 

  8. Ha Y-C, Jung WH, Kim J-R, Seong NH, Kim S-Y, Koo K-H. Prediction of collapse in femoral head osteonecrosis: a modified Kerboul method with use of magnetic resonance images. J Bone Joint Surg (Am). 2006;88(Supp 3):35–40.

    Article  Google Scholar 

  9. Mont MA, Jones LC, Pacheo I, Hungerford DS. Radiographic predictors of outcome of core decompression for osteonecrosis stage III. Clin Orthop. 1998;354:159–68.

    Article  PubMed  Google Scholar 

  10. Lee GC, Steinberg ME. Are we evaluating osteonecrosis adequately? Int Orthop . 2012;36:2433–9.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Ficat RP, Arlet J. Necrosis of the femoral head. In: Hungerford DS, editor. Ischemia and necrosis of bone. Baltimore: Williams and Wilkins; 1980. p. 53–74.

    Google Scholar 

  12. Steinberg ME, Steinberg DR. Classification systems for osteonecrosis: an overview. Orthop Clin North Am. 2004;35:273–83.

    Article  PubMed  Google Scholar 

  13. Steinberg DR, Steinberg ME, Garino JP, Dalinka M, Udupa JK. Determining lesion size in osteonecrosis of the femoral head. J Bone Joint Surg. 2006;88-A(Suppl 3):27–34.

    Article  Google Scholar 

  14. Theodorou DJ, Malizos KN, Beris AE, Theodorou SF, Soucacos PN. Multi Modal imaging quantitation of the lesion size in osteonecrosis of the femoral head. Clin Orthop. 2001;386:54–63.

    Article  PubMed  Google Scholar 

  15. Arlet J, Ficat RP. Forage-biopsie de la tete femorale dans l’osteonecrose primitive. Observations histopathologiques portant sur huit foranes. Rev Rhum. 1964;31:257–64.

    Google Scholar 

  16. Ficat RP. Idiopathic bone necrosis of the femoral head: early diagnosis and treatment. J Bone Joint Surg (Br). 1985;67:3–9.

    CAS  Google Scholar 

  17. ARCO Committee on Terminology and Staging. The ARCO perspective for reaching one uniform staging system of osteonecrosis. In: Schoutens A, Arlet J, Gardeniers JWM, Huges SPF, editors. Bone circulation and vascularization in normal and pathological conditions. Plenum Press, New York. 1993. p. 375–80.

    Google Scholar 

  18. Sugano N, Takaoka K, Ohzono K, Matsui M, Masuhara K, Ono K. Prognostication of non-traumatic avascular necrosis of the femoral head: significance of location and size of the necrotic lesion. Clin Orthop. 1994;303:155–64.

    PubMed  Google Scholar 

  19. Mont MA, Marulanda GA, Jones LC, Saleh KJ, Gordon N, Hungerford DS, et al. Systematic analysis of classification systems for osteonecrosis of the femoral head. J Bone Joint Surg. 2006;88-A(Suppl 3):16–26.

    Article  Google Scholar 

  20. Steinberg ME, Hayken GD, Steinberg DR. A new method for evaluation and staging of avascular necrosis of the femoral head. In: Arlet J, Ficat RP, Hungerford DS, editors. Bone circulation. Baltimore: Williams and Wilkins; 1984. p. 398–403.

    Google Scholar 

  21. Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg (Br). 1995;77:34–41.

    CAS  Google Scholar 

  22. Gardeniers J, ARCO Committee on Terminology and Staging. A new proposition of terminology and an international classification of osteonecrosis. ARCO Newsl. 1991;3:153–9.

    Google Scholar 

  23. Gardeniers J. A New international classification of osteonecrosis of the ARCO Committee on Terminology and Classification. ARCO Newsl. 1992;4:41–6.

    Google Scholar 

  24. Gardeniers J. ARCO Committee on Terminology and Staging. Report on the Committee Meeting at Santiago de Compostela. ARCO Newsl. 1993;5:79–82.

    Google Scholar 

  25. Kerboul M, Thomine J, Postel M, Merle D’Aubigne R. The conservative surgical treatment of idiopathic aseptic necrosis of the femoral head. J Bone Joint Surg (Br). 1974;56:291–6.

    CAS  Google Scholar 

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Acknowledgements

The authors thank Annamarie D. Horan, PhD, Director of Clinical Research, Department of Orthopedic Surgery, for her technical assistance with this project.

Conflict of interest

No conflict of interest.

Disclosure

No outside funding was received for this study. None of the authors received payments or services from a third party in support of this work.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Pereleman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA

    G.-C. Lee, D. Steinberg & M. Steinberg

  2. Department of Radiology, Pereleman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA

    V. Khoury, W. Kim & M. Dalinka

  3. Penn Presbyterian Medical Center, 3900 Market Street, One Cupp Pavilion, Philadelphia, PA, 19104, USA

    G.-C. Lee & D. Steinberg

  4. Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    V. Khoury, W. Kim & M. Dalinka

  5. Hospital of the University of Pennsylvania, Silverstein 2, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    M. Steinberg

Authors
  1. G.-C. Lee
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  2. V. Khoury
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  3. D. Steinberg
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  4. W. Kim
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  5. M. Dalinka
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  6. M. Steinberg
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Corresponding author

Correspondence to M. Steinberg.

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Lee, GC., Khoury, V., Steinberg, D. et al. How do radiologists evaluate osteonecrosis?. Skeletal Radiol 43, 607–614 (2014). https://doi.org/10.1007/s00256-013-1803-4

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  • DOI: https://doi.org/10.1007/s00256-013-1803-4

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