Vol. 11, No. 3, December, 1999 Abstract Core Decompression in Nontraumatic Osteonecrosis of the Femoral Head - A comparison Study of Results between R

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1 Vol. 11, No. 3, December, 1999 Abstract Core Decompression in Nontraumatic Osteonecrosis of the Femoral Head - A comparison Study of Results between Radiographic Classification and Magnetic Resonance Imaging - Myung Chul Yoo, M.D., Yoon Je Cho, M.D., Kang Il Kim, M.D., Byung Joo Park, M.D., Dae Woo Hwang, M.D., Chan Teak Lim, M.D. Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea The purposes of this study were to compare the results of core decompression in the treatment of nontraumatic osteonecrosis of the femoral head according to radiographic classification and findings on magnetic resonance image, and to clarify the factors which influence the results of core decompression. Forty-four patients (forty-seven hips) who had been studied with preoperative magnetic resonance image were evaluated. The results of core decompression were analyzed on the basis of the extent, location and signal difference of the necrotic lesion on preoperative magnetic resonance image as well as preoperative modified Ficat and Arlet radiographic classification. The results were assessed according to the criteria of clinical progression (less than 80 points of Harris hip score), radiographic progression (more than 2mm collapse of the femoral head compared with that on preoperative radiograph) and clinical failure (conversion to THR). The survival rate of radiographic classification and findings (the extent, location and signal difference) on magnetic resonance image was plotted and analyzed by log rank test. There was no statistically significant difference among the radiological stages on the survival curve according to the results of all criteria. The extent on magnetic resonance image was significant according to all criteria (p=0.0038, 0006, 0077). The location on magnetic resonance image was significant according to one criterion of the radiographic progression results (p=0.0456). The signal difference on magnetic resonance image was insignificant according to all criteria (p>0.1). This study revealed that the extent and location of the necrotic lesion on magnetic resonance image are major predictors of the end results of core decompression in osteonecrosis of the femoral head. Key Words : Femoral head, Osteonecrosis, Magnetic resonance image, Core decompression

Fig. 1. Mid-sagittal section of femoral head on MRI. The necrotic extent was calculated on the latticed paper by ratio of necrotic area to whole femoral head. Fig.

The four sites was obtained by interval of 25 degree from the vertical line penetrating femoral head.

3 Fig. 1. Mid-sagittal section of femoral head on MRI. The necrotic extent was calculated on the latticed paper by ratio of necrotic area to whole femoral head. Fig. 2. Mid-coronal section of femoral head on MRI. The necrotic location was divided as 4 sites. The four sites was obtained by interval of 25 degree from the vertical line penetrating femoral head. Far-medial is medially degree from the vertical line, medial is medially 0-25 degree from the vertical line, lateral is laterally 0-25 degree from the vertical line, far-lateral is laterally degree from the vertical line. In this image, the location of necrotic lesion is far-lateral.

4 Table 1. Results according to the classification of modified Ficat and Arlet. Ficat stage Cases Clinical progression(%) Radiographic progression(%) Clinical failure(%) /4(25) 2/4(50) 1/4(25) 10 2/10(20) 3/10(30) 1/10(10) -a 31 12/31(39) 18/31(58) 10/31(32) -b 41 1/1(100) 1/1(100) 0/1(0) 41 1/1(100) 1/1(100) 1/1(100) Total 47 17/47(36) 25/47(53) 13/47(28)

5 A B C Fig. 3. A. Kaplan-Meier survival curve of core decompression for pain(clinical progression) according to the radiographic classification(stage). The survival difference among stages is statistically insignificant(logrank test: p=0.4807). B. Kaplan-Meier survival curve of core decompression for radiographic progression according to the radiographic classification(stage). The survival difference among stages is statistically insignificant(log-rank test: p=0.4410). C. Kaplan-Meier survival curve of core decompression for THR(clinical failure) according to the radiographic classification(stage). The survival difference among stages is statistically insignificant(logrank test: p=0.3925).

6 A B C Fig. 4. A. Kaplan-Meier survival curve of core decompression for pain(clinical progression) according to the extent of necrotic area on MRI(group A, B, C, D). The survival difference among groups is statistically significant(logrank test: p=0.0038). B. Kaplan-Meier survival curve of core decompression for radiographic progression according to the extent of necrotic area on MRI(group A, B, C, D). The survival difference among groups is statistically significant(log-rank test: p=0.0006). C. Kaplan-Meier survival curve of core decompression for THR(clinical failure) according to the extent of necrotic area on MRI(group A, B, C, D). The survival difference among groups is statistically significant(log-rank test: p=0.0077).

7 Table 2. Results according to the extent of necrotic lesion on MRI. Cases Clinical progression(%) Radiographic progression(%) Clinical failure(%) Group A 13 3/13(23) 4/13(31) 2/13(15) Group B 26 8/26(31) 13/26(50) 6/26(23) Group C 27 5/7(71) 7/7(100) 4/7(57) Group D 21 1/1(100) 1/1(100) 1/1(100) Total 47 17/47(36) 25/47(53) 13/47(28) Table 3. Results according to the location of necrotic lesion on MRI. Cases Clinical progression(%) Radiographic progression(%) Clinical failure(%) far-medial 24 0/4(0) 0/4(0) 0/4(0) medial 26 1/6(17) 1/6(17) 1/6(17) lateral 11 5/11(45) 8/11(73) 3/11(27) far-lateral 26 11/26(42) 16/26(62) 9/26(35) Total 47 17/47(36) 25/47(53) 13/47(28) Table 4. Results according to the signal intensity of necrotic lesion on MRI. Cases Clinical progression(%) Radiographic progression(%) Clinical failure(%) Signal H 20 8/20(40) 14/20(70) 7/20(35) Signal h 13 6/13(46) 6/13(46) 4/13(31) Signal L 27 2/7(29) 3/7(43) 1/7(14) Signal l 27 1/7(14) 2/7(29) 1/7(14) Total 47 17/47(36) 25/47(53) 13/47(28) Fig. 5. Kaplan-Meier survival curve of core decompression for radiographic progression according to the location of necrotic area on MRI(far-medial, medial, lateral, far-lateral). The survival difference among locations is statistically significant (log-rank test: p = ).

8 Table 5. The distribution of extent on MRI in the same stage. MRI group Ficat stage* Cases A B C D a * Stage -b and are excluded. Table 6. The distribution of location on MRI in the same stage. Ficat stage* Cases MRI location far-medial medial lateral far-lateral a * Stage -b and are excluded.

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Lumbar spine CT 32 111 DOI : 10.3831/KPI.2010.13.2.111 Lumbar Spine CT 32 Received : 10. 05. 23 Revised : 10. 06. 04 Accepted : 10. 06. 11 Key Words: Disc herniation, CT scan, Clinical analysis The Clinical