This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the exams for this article:
 CME 4: October, November, December 2004
Adult Hip Reconstruction Test 11: Topics of Interest in Adult Hip Reconstru...
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hernigou, P.
Right arrow Articles by Manicom, O.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hernigou, P.
Right arrow Articles by Manicom, O.
Related Collections
Right arrow Adult Hip
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?
The Journal of Bone and Joint Surgery (American). 2004;86:2589-2593
© 2004 The Journal of Bone and Joint Surgery, Inc.

Fate of Very Small Asymptomatic Stage-I Osteonecrotic Lesions of the Hip

P. Hernigou, MD1, A. Poignard, MD1, A. Nogier, MD1 and O. Manicom, MD1

1 Hôpital Henri Mondor, 94010 Creteil, France

Investigation performed at Hôpital Henri Mondor, Creteil, France

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The prognosis for a patient with osteonecrosis of the hip is generally considered to be worse if a large volume of the femoral head is involved, the patient is symptomatic, and the stage of the lesion is advanced. In 1990, we began a prospective study to detect collapse in asymptomatic hips with a very small stage-I osteonecrotic lesion in the femoral head. We hypothesized that such patients would have a favorable prognosis. These hips were followed for a minimum of ten years after the diagnosis.

Methods: A small asymptomatic stage-I osteonecrotic lesion (not seen on plain radiographs) was diagnosed with magnetic resonance imaging in forty patients (forty hips) contralateral to a hip with symptomatic osteonecrosis. The criterion for inclusion in the study was a lesion with a volume of <5 cm3 involving <10% of the volume of the femoral head. Plain radiographs were made annually in six different projections for all patients. At the most recent follow-up evaluation (average, eleven years), patients with a symptomatic hip but without evidence of collapse on plain radiographs underwent a computerized tomography scan.

Results: Thirty-five (88%) of the forty hips became symptomatic, and twenty-nine (73%) demonstrated collapse. The mean interval between the diagnosis and the first symptoms was eighty months. Symptoms always preceded collapse by at least six months. The mean interval between the diagnosis and the collapse was ninety-two months (range, seventy-two to 140 months). The diagnosis of collapse could be made on only one or two of the six radiographic views obtained for each patient at each evaluation. The diagnosis of collapse for two patients was made only on a computerized tomography scan at the most recent follow-up evaluation. At the time of final follow-up, the twenty-nine hips with collapse had symptoms of intractable pain and required surgery.

Conclusions: This study confirms that the diagnosis of collapse is difficult in hips with a very small stage-I osteonecrotic lesion. Multiple radiographic views and computerized tomography scans may be required to demonstrate small areas of collapse. Clinical and radiographic signs of progression of the disease in asymptomatic hips with a very small asymptomatic lesion progress more slowly than do those signs in hips with a large symptomatic stage-II lesion. Because hips with a small area of osteonecrosis do collapse in a large percentage of patients, such patients should be followed carefully over a long period of time.

Level of Evidence: Prognostic study, Level I-1 (prospective study). See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
K. W. Nam, Y. L. Kim, J. J. Yoo, K.-H. Koo, K. S. Yoon, and H. J. Kim
Fate of Untreated Asymptomatic Osteonecrosis of the Femoral Head
J. Bone Joint Surg. Am., March 1, 2008; 90(3): 477 - 484.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
B. J. McGrory, S. C. York, R. Iorio, W. Macaulay, R. R. Pelker, B. S. Parsley, and S. M. Teeny
Current Practices of AAHKS Members in the Treatment of Adult Osteonecrosis of the Femoral Head
J. Bone Joint Surg. Am., June 1, 2007; 89(6): 1194 - 1204.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
Ph. Hernigou, A. Habibi, D. Bachir, and F. Galacteros
The Natural History of Asymptomatic Osteonecrosis of the Femoral Head in Adults with Sickle Cell Disease
J. Bone Joint Surg. Am., December 1, 2006; 88(12): 2565 - 2572.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
M. A. Mont, L. C. Jones, and D. S. Hungerford
Nontraumatic Osteonecrosis of the Femoral Head: Ten Years Later
J. Bone Joint Surg. Am., May 1, 2006; 88(5): 1117 - 1132.
[Abstract] [Full Text] [PDF]