Khaladkar m s, randhawa s, singh g, aditi g, rajesh k, rajeshwar s. Avascular necrosis or osteonecrosis is a condition affecting the upper part of the leg specifically the femoral head. Original article analysis of early imaging prediction. Diagnostic imaging pathways hip avascular necrosis. Mr imaging of avascular necrosis and transient marrow. Osteonecrosis is also called avascular necrosis avn or aseptic necrosis. Avascular necrosis of the hip, also known as osteonecrosis of the hip, is a condition that occurs when the blood supply to the femoral head is disrupted. The normal spherical contour of the head of the femur was lost. The femoral head is the ballshaped top of the thigh bone, or femur.
Most sites of involvement have an eponym associated with avascular necrosis of that area, and these sites are discussed individually as each site has unique clinical, etiologic and. Avascular necrosis of the femur head avnfh is a debilitating disease caused due to the use of alcohol, steroids, following trauma or unclear idiopathic etiology, affecting mostly the middle. Better prognoses when the diagnosis of avascular necrosis avn is made early in the course of the disease. Early imaging prediction signs of type 2 avascular necrosis 824 int j clin exp med 2020. The high incidence of bilaterality 60% and occult disease in cases of femoral head avn warrant imaging of the unaffected leg. The value of high spatial resolution and contrast materialenhanced magnetic resonance mr imaging was assessed in 69 patients with either femoral head avascular necrosis avn or transient bone marrow edema lesions.
Avascular necrosis most commonly affects the epiphyses ends of the femur thigh bone. Imaging of avascular necrosis of bone springerlink. Necrosis results if the vascular supply to the proximal femur is interrupted. It fits inside a socketshaped hollow in the hip bone, known as the acetabulum, and the two parts make up the hip joint. Clinical presentation usually nonspecific and depend on the cause and location. Avascular necrosis of the femoral head physioworks. The primary approach in treating avascular necrosis is to try to stop the progress of the disease and preserve the femoral head. Avn has a wide variety of causes and can affect nearly any bone in the body. Imaging tests can help pinpoint the source of pain. Screening for avascular necrosis of the hip with rapid mri. Both mri and conventional radiographs accurately detected avn in the remaining 75% of hips. Definition cellular death of bone components secondary to interruption of blood supply. Staging of avascular necrosis orthopaedicsone articles.
The highsignalintensity line seen on t2weighted mr images appears to represent fluid accumulating in the subchondral fracture, which may indicate a breach in the overlying articular cartilage. Learn more about the symptoms, causes, diagnosis, and treatment of. Transient bone marrow edema syndrome versus osteonecrosis. Image based fracture prediction diagnostic tool for. A broken bone or dislocated joint can interrupt blood flow to the bone, causing avascular necrosis osteonecrosis, the death of bone tissue.
Avascular necrosis of femoral head avnfh is a progressive, multifactorial and challenging clinical problem that is on the rise 1, 2, mostly affecting the middle aged male population in the most. Turner jh 1983 posttraumatic avascular necrosis of the femoral head predicted by preoperative technetium99m antimonycolloid scan. Avascular necrosis avn, or more correctly osteonecrosis, is a generic term referring to the ischemic death of the constituents of bone. In some cases, the condition is diagnosed during routine xray imaging, due to a. Avascular necrosis diagnosis and treatment mayo clinic. An imaging study in the form of an xray was obtained showed marked joint space obliteration. Predicting the collapse of the femoral head due to. Though most of patients are asymptomatic the prevalence is supposed to be markedly higher. Magnetic resonance imaging mri is the most sensitive and specific imaging technique for evaluating.
A retrospective evaluation of magnetic resonance mr imaging for the detection of avascular necrosis avn of the femoral head was performed in 49 patients 85 hips with clinical suspicion of avn. In the early stages localized subchondral edema is characteristic. Avascular necrosis avn of the femoral head is an increasingly common cause of musculoskeletal disability, and it poses a major diagnostic and therapeutic challenge. Positive findings at bone biopsy or evidence on plain radiographs was considered proof of avn. Mri detected avn in 25% of the hips during the preradiological stage of the disease. Osteonecrosis uw radiology university of washington. Avascular necrosis of the head of the femur bone is a common cause of musculoskeletal disability, cascading as a major diagnostic and therapeutic challenge. Prediction methods for osteonecrosis of the femoral head complications. Comparison of plain radiograph and mri in avascular. Magnetic resonance imaging mri and conventional radiographs were compared in 49 hips with avascular necrosis avn. The left hip had advanced avascular necrosis with a collapse. The aim of diagnostic imaging procedures in avascular femoral head necrosis is to provide the patient with a stageadapted therapy. Diagnostic performance of mr imaging in the assessment of subchondral fractures in avascular necrosis of the femoral head. Consequent collapse of bone components pain, loss of function of joints proximal epiphysis of femur most commonly affected.
Otherwise, the patient was placed in a viabletolow risk for avn category. Osteonecrosis of the hip is a painful condition that occurs when the blood supply to the head of the femur thighbone is disrupted. Subchondral fractures in osteonecrosis of the femoral head. Postdoctoral fellowships discoverys edge magazine search publications training grant programs. An excellent original article entitled f18 fluoride petct bone scan in the diagnosis of avascular necrosis of the femoral headcomparison with mri published in the current issue of indian journal of nuclear medicine highlights an attractive evidence based option in an otherwise grey area of imaging to diagnose avascular necrosis avn of bone. Avascular necrosis of the femoral head physiopedia. Mri is the most sensitive and specific imaging procedure for avn, of the hip with an overall sensitivity that exceeds 90%.
Imaging of postoperative avascular necrosis of the ankle. Mr imaging is the modality of choice for early diagnosis as well as followup of therapy of the bone marrow oedema syndrome or avascular necrosis and can be performed already during pregnancy. An avn lesion was typically a welldemarcated epiphyseal area of. The most commonly affected site is the femoral head and patients usually present with hip and referred knee pain. Effective early diagnosis using magnetic resonance imaging mri. Though patients are initially asymptomatic, avascular necrosis in majority of cases progresses to joint destruction, clinically manifesting before the 5th decade of life. The role of imaging in diagnosis and management of femoral. There were marked degenerative changes suggesting arthritis.
Avascular necrosis is most associated with longterm use of steroid medications and alcohol. Predicting the collapse of the femoral head due to osteonecrosis. Imaging evaluation of patients with osteonecrosis of the. In addition, nontraumatic bilateral avn usually occurs at different times. Avascular necrosis of the proximal femur in developmental dislocation of the hip. Rapid magnetic resonance imaging protocol for detecting. Essentially, the femoral head or ball of your hip joint receives less and less blood supply. Because bone cells need a steady supply of blood to stay healthy, osteonecrosis can ultimately lead to destruction of the hip joint and severe arthritis. Therefore, a differentiated diagnostic workup is needed. Independent of its etiology and localization it shows typical pathologies and radiological images. A diagnostic fracture prediction tool would aid clinical diagnosis, anticipate disease progression and help with the planning of subsequent interventions. Necrosis is a general term that means a cell has died. A case seriesits utility in the general population in developing countries. Although patients are initially asymptomatic, avascular necrosis avn of the femoral head usually progresses to joint destruction, requiring total hip replacement thr, usuall.
Mri evaluation of post core decompression changes in avascular. Trauma is the most common cause of avascular necrosis. Incidence, risk factors, sequelae and mr imaging for diagnosis and prognosis. Scaphoid viability or necrosis was diagnosed intraoperatively depending on whether punctate bleeding was present.
There are several possible ways to treat avascular necrosis of the hip. Femoral head avascular necrosis is a common disease of the hip joint with an incidence of 10,00020,000 new cases in the united states. Magnetic resonance imaging has recently emerged as the most sensitive, specific, and widely used diagnostic tool for avascular necrosis of. Prediction value of spectct in avascular necrosis of. Avascular necrosis of the femoral head avn is an increasingly common cause of musculoskeletal disability, and it poses a major diagnostic and therapeutic challenge. Though patients are initially asymptomatic, avascular necrosis in majority of. Diagnosis of acute or subacute avascular necrosis cadth. The use of crutches to reduce the weight borne by the hip joint may be considered, but if the condition persists, a. Ct reveals more subchondral fractures in osteonecrosis of the femoral head than unenhanced radiography or mr imaging. The bone cells in your body, specifically the ones in the femoral head, need a steady amount of blood to stay healthy. Avascular necrosis avn is also known as osteonecrosis, aseptic necrosis, and ischemic necrosis. Avascular necrosis of the femoral head is a common cause of musculoskeletal disability, cascading as a significant diagnostic and therapeutic challenge.
Synonyms include aseptic necrosis, bone necrosis, avascular necrosis, bone infarction and ischemic necrosis. Although it can occur in any bone, osteonecrosis most often affects the hip. Persistent pain is the most common symptom, and the patient may. Avascular necrosis of hip typically presents in young patients. Stage 1 and 2 osteonecrosis could benefit from a physical therapy program5. The etiology of avascular necrosis avn is multifactorial. Mri images of avascular necrosis demonstrating flattening and sclerosis of the superior articular surface of the left femur arrow. For this purpose we described and evaluated different radiological techniques, such as xray, computed tomography ct, magnetic resonance imaging mri, and nuclear medicine. Avascular necrosis is the death of bone tissue because of a lack of blood supply. Avascular necrosis of the femoral head is a condition in which the blood supply to the femoral head is lost, resulting in osteonecrosis, or death of bone cells. Although patients are initially asymptomatic, avn usually progresses to joint destruction, requiring total hip replacement, usually before the fifth decade. Rapid magnetic resonance imaging protocol for detecting femoral head avascular necrosis.
Avascular necrosis, death of bone tissue caused by a lack of blood supply to the affected area. It is the most sensitive means of diagnosing avascular necrosis avn. Current methods to diagnose bone diseases like avascular necrosis avn are subjective and a reliable assessment of the fracture risk is not available. Also called avascular bone necrosis, osteonecrosis common. Cortical fragmentation and marrow oedema are present within the femoral head. Osteonecrosis of the femoral head onfh is a progressive process due to multiple factors affecting the blood supply of the femoral head and the disruption of the synthesis of the bone component. Collapse of the femoral head is one of the most severe complications. The strength of bones, including the femur, can be calculated using structural mechanics. Avascular necrosis of femoral heads something about. Avascular necrosis incidence after intertrochanteric fracture is very rare with 0.
453 292 427 298 812 441 138 1162 547 824 1097 949 1351 162 943 1295 878 882 1426 1014 862 1651 6 1529 1421 855 1490 767 987 220 138 986 553 1362 62 357 338 1116