SpringerLink
Log in

Factors related to collapse progression in Japanese Investigation Committee classification type B osteonecrosis of the femoral head

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to identify factors related to collapse progression in Japanese Investigation Committee classification type B osteonecrosis of the femoral head (ONFH) and to identify patients who would benefit from surgical treatment.

Methods

This study included 41 patients (56 hips) with type B ONFH with a minimum follow-up of three years. Based on a ≥ 3 mm collapse progression in ONFH, we categorised patients into two groups: collapse progression and no collapse progression. Sagittal and coronal computed tomography images were used to measure the necrotic region relative to the intact femoral head diameter. The ratios of the necrotic regions of transverse and vertical diameter in coronal and sagittal images are defined as mediolateral transverse and mediolateral vertical, anteroposterior transverse and anteroposterior vertical, respectively. Demographic data and these imaging findings were compared between the two groups. We established a cut-off value for predicting collapse progression through receiver operating characteristic analysis and determined survival rates.

Results

Type B ONFH had a 17.8% collapse progression rate. The mediolateral transverse, mediolateral vertical, anteroposterior transverse, and anteroposterior vertical were significantly higher in the collapse progression group (P < 0.01). Mediolateral transverse was an independent risk factor of collapse progression (hazard ratio, 1.27; 95% confidence interval, 1.03–1.57; P = 0.03), with an optimal cut-off of 45.6%. The 5-year survival rates with collapse progression as the endpoints were 57.0 and 94.9% in the mediolateral transverse of ≥ 45.6 and < 45.6%, respectively.

Conclusion

A mediolateral transverse of ≥ 45.6% predicts collapse progression in patients with type B ONFH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (United Kingdom)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

Data availability

The datasets during and/or analyzed during the current study available from the corresponding author on reasonable request.

References

  1. Mankin HJ (1992) Nontraumatic necrosis of bone (osteonecrosis). N Engl J Med 326:1473–1479

    Article  CAS  PubMed  Google Scholar 

  2. Arbab D, König DP (2016) Atraumatic femoral head necrosis in adults. Dtsch Arztebl Int 113:31–38

    PubMed  PubMed Central  Google Scholar 

  3. Osawa Y, Seki T, Takegami Y et al (2018) Do femoral head collapse and the contralateral condition affect patient-reported quality of life and referral pain in patients with osteonecrosis of the femoral head? Int Orthop 42(7):1463–1468

    Article  PubMed  Google Scholar 

  4. Osawa Y, Seki T, Takegami Y et al (2018) Cementless total hip arthroplasty for osteonecrosis and osteoarthritis produce similar results at ten years follow-up when matched for age and gender. Int Orthop 42:1683–1688

    Article  PubMed  Google Scholar 

  5. Kim HS, Park JW, Ha JH et al (2022) Third-generation ceramic-on-ceramic total hip arthroplasty in patients with osteonecrosis of the femoral head: a 10- to 16-year follow-up study. J Bone Joint Surg Am 104:68–75

    Article  PubMed  Google Scholar 

  6. Hartofilakidis G, Karachalios T, Karachalios G (2005) The 20-year outcome of the charnley arthroplasty in younger and older patients. Clin Orthop Relat Res 434:177–182

    Article  Google Scholar 

  7. Wang B-L, Sun W, Shi Z-C et al (2010) Treatment of nontraumatic osteonecrosis of the femoral head with the implantation of core decompression and concentrated autologous bone marrow containing mononuclear cells. Arch Orthop Trauma Surg 130:859–865

    Article  PubMed  Google Scholar 

  8. Ito H, Tanino H, Yamanaka Y et al (2012) Long-term results of conventional varus half-wedge proximal femoral osteotomy for the treatment of osteonecrosis of the femoral head. J Bone Joint Surg Br 94:308–314

    Article  CAS  PubMed  Google Scholar 

  9. Osawa Y, Seki T, Okura T et al (2021) Long-term outcomes of curved intertrochanteric varus osteotomy combined with bone impaction grafting for non-traumatic osteonecrosis of the femoral head. Bone Joint J 103-B:665–671

    Article  PubMed  PubMed Central  Google Scholar 

  10. Liang D, Pei J, Zhang X, Chen X (2023) Clinical outcomes of autologous platelet-rich plasma and bone marrow mononuclear cells grafting combined with core decompression for Association Research Circulation Osseous II-IIIA stage non-traumatic osteonecrosis of the femoral head. Int Orthop 47:2181–2188

    Article  PubMed  Google Scholar 

  11. Hernigou P, Verrier S, Homma Y et al (2023) Prognosis of hip osteonecrosis after cell therapy with a calculator and artificial intelligence: ten year collapse-free survival prediction on three thousand and twenty one hips. Int Orthop 47:1689–1705

    Article  PubMed  Google Scholar 

  12. Hernigou P, Lambotte JC (2000) Bilateral hip osteonecrosis: influence of hip size on outcome. Ann Rheum Dis 59:817–821

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Hernigou P, Habibi A, Bachir D, Galacteros F (2006) The natural history of asymptomatic osteonecrosis of the femoral head in adults with sickle cell disease. J Bone Joint Surg Am 88:2565–2572

    Article  PubMed  Google Scholar 

  14. Hernigou P (2023) Revisiting prediction of collapse in hip osteonecrosis with artificial intelligence and machine learning: a new approach for quantifying and ranking the contribution and association of factors for collapse. Int Orthop 47:677–689

    Article  PubMed  Google Scholar 

  15. Ando W, Sakai T, Fukushima W et al (2021) Japanese Orthopaedic Association 2019 Guidelines for osteonecrosis of the femoral head. J Orthop Sci 26:46–68

    Article  PubMed  Google Scholar 

  16. Sugano N, Atsumi T, Ohzono K et al (2002) The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head. J Orthop Sci 7:601–605

    Article  PubMed  Google Scholar 

  17. Nakamura J, Harada Y, Oinuma K et al (2010) Spontaneous repair of asymptomatic osteonecrosis associated with corticosteroid therapy in systemic lupus erythematosus: 10-year minimum follow-up with MRI. Lupus 19:1307–1314

    Article  CAS  PubMed  Google Scholar 

  18. Shimizu K, Moriya H, Akita T et al (1994) Prediction of collapse with magnetic resonance imaging of avascular necrosis of the femoral head. J Bone Joint Surg Am 76:215–223

    Article  CAS  PubMed  Google Scholar 

  19. Mont MA, Zywiel MG, Marker DR et al (2010) The natural history of untreated asymptomatic osteonecrosis of the femoral head: a systematic literature review. J Bone Joint Surg Am 92:2165–2170

    Article  PubMed  Google Scholar 

  20. Nam KW, Kim YL, Yoo JJ et al (2008) Fate of untreated asymptomatic osteonecrosis of the femoral head. J Bone Joint Surg Am 90:477–484

    Article  PubMed  Google Scholar 

  21. Utsunomiya T, Motomura G, Yamaguchi R et al (2023) Effects of the location of both anterior and lateral boundaries of the necrotic lesion on collapse progression in osteonecrosis of the femoral head. J Orthop Sci. https://doi.org/10.1016/j.jos.2023.01.011

    Article  PubMed  Google Scholar 

  22. Fan Y, Zhang J, Chen M et al (2022) Diagnostic value of necrotic lesion boundary in bone collapse of femoral head osteonecrosis. Int Orthop 46:423–431

    Article  PubMed  Google Scholar 

  23. Osawa Y, Takegami Y, Kato D et al (2023) Hip function in patients undergoing conservative treatment for osteonecrosis of the femoral head. Int Orthop 47:89–94

    Article  PubMed  Google Scholar 

  24. Kubo Y, Motomura G, Ikemura S et al (2018) The effect of the anterior boundary of necrotic lesion on the occurrence of collapse in osteonecrosis of the femoral head. Int Orthop 42:1449–1455

    Article  PubMed  Google Scholar 

  25. Kanda Y (2013) Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant 48:452–458

    Article  CAS  PubMed  Google Scholar 

  26. Sun W, Li Z-R, Wang B-L et al (2014) Relationship between preservation of the lateral pillar and collapse of the femoral head in patients with osteonecrosis. Orthopedics 37:e24–e28

    Article  PubMed  Google Scholar 

  27. Lavernia CJ, Sierra RJ (2000) Core decompression in atraumatic osteonecrosis of the hip. J Arthroplasty 15:171–178

    Article  CAS  PubMed  Google Scholar 

  28. Yoon TR, Song EK, Rowe SM, Park CH (2001) Failure after core decompression in osteonecrosis of the femoral head. Int Orthop 24:316–318

    Article  CAS  PubMed  Google Scholar 

  29. Zhao G, Yamamoto T, Ikemura S et al (2010) Radiological outcome analysis of transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head at a mean follow-up of 12.4 years. J Bone Joint Surg Br 92:781–786

    Article  CAS  PubMed  Google Scholar 

  30. Koo K-H, Mont MA, Cui Q et al (2022) The 2021 Association Research Circulation Osseous Classification for Early-Stage Osteonecrosis of the Femoral Head to Computed Tomography-Based Study. J Arthroplasty 37:1074–1082

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank the following people for their contributions: Takamune Asamoto, Shinya Tanaka and Keiji Otaka.

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, 466-8550, Japan

    Hiroaki Ido, Yusuke Osawa, Yasuhiko Takegami, Funahashi Hiroto, Yuto Ozawa & Shiro Imagama

Authors
  1. Hiroaki Ido
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yusuke Osawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yasuhiko Takegami
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Funahashi Hiroto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuto Ozawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shiro Imagama
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Hiroaki Ido [1] substantial contributions to research design, or the acquisition, analysis or interpretation of data; [2] drafting the paper or revising it critically; [3] approval of the submitted and final versions.

Yusuke Osawa: [1] substantial contributions to research design, or the acquisition, analysis or interpretation of data; [2] drafting the paper or revising it critically; [3] approval of the submitted and final versions.

Yasuhiko Takegami: [2] drafting the paper or revising it critically; [3] approval of the submitted and final versions.

Hiroto Funahashi: [2] drafting the paper or revising it critically; [3] approval of the submitted and final versions.

Yuto Ozawa: [1] the acquisition of data; [2] approval of the submitted and final versions.

Shiro Imagama: [1] drafting the paper or revising it critically; [2] approval of the submitted and final versions.

Corresponding author

Correspondence to Yusuke Osawa.

Ethics declarations

Ethics approval

The study was approved by the institutional review board, and it conforms to the provisions of the Declaration of Helsinki.

Consent to publish

Patients signed informed consent regarding publishing their data.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ido, H., Osawa, Y., Takegami, Y. et al. Factors related to collapse progression in Japanese Investigation Committee classification type B osteonecrosis of the femoral head. International Orthopaedics (SICOT) (2024). https://doi.org/10.1007/s00264-024-06221-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00264-024-06221-5

Keywords

Search

Navigation