Abstract
Pathological examination of the resected femoral heads from approximately 2000 total hip replacement operations carried out at the Hospital for Joint Diseases from 1984 to 1989 identified the presence of osteonecrosis in 345 patients (377 femoral heads). In 232 patients the osteonecrosis, referred to as “idiopathic,” had occurred in the absence of a subcapital fracture. The present paper describes the pathology of the necrotic lesions in these 232 patients. The use of undecalcified sections and microradiography provides evidence of bone marrow calcification which, at the margin of the lesion, is sufficient to influence the radiographic features of the lesion significantly. Although a subchondral fracture is an almost constant feature of osteonecrosis when it occurs in a femoral head with a normal articular cartilage, no such fracture was found in cases in which osteonecrosis had occurred in an osteoarthritic joint
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Bassett LW, Mirra JM, Cracchiolo A, Gold RH (1987) Ischemic necrosis of the femoral head. Correlation of magnetic resonance imaging and histologic sections. Clin Orthop 223:181
Beltran J, Herman LJ, Burk JM, Zuelzer WA, Clark RN, Lucas JG, Weiss LD, Yang A (1988) Femoral head avascular necrosis: MR imaging with clinical-pathologic and radionuclide correlation. Radiology 166:215
Bullough PG, Kambolis CP, Marcove RC, Jaffe HL (1965) Bone infarctions not associated with caisson disease. J Bone Joint Surg [Am] 47:477
Catto M (1965) A histological study of avascular necrosis of the femoral head after transcervical fracture. J Bone Joint Surg [Br] 47:749
Catto M (1976) Pathology of aseptic bone necrosis. In: Davidson JK (ed) Aseptic necrosis of bone. Excerpta Medica, Amsterdam
Catto M (1983) Pathology of aseptic bone necrosis. In: Harris NH (ed) Postgraduate textbook of clinical orthopaedics. Wright, Bristol
Catto M (1965) The histological appearance of late segmental collapse of the femoral head after transcervical fracture. J Bone Joint Surg [Br] 47:777
Fisher DE, Bickel WH (1971) Corticosteroid-induced avascular necrosis. A clinical study of seventy-seven patients. J Bone Joint Surg [Am] 53:859
Glimcher MJ, Kenzora JE (1979) The biology of osteonecrosis of the human femoral head and its clinical implications. Clin Orthop 138:184; 139:283; 140:173
Ilardi CF, Sokoloff L (1984) Secondary osteonecrosis in osteoarthritis of the femoral head. Hum Pathol 15:79–83
Lang P, Jergensen HE, Moseley ME, Block JE, Chafetz NI, Genant HK (1988) Avascular necrosis of the femoral head: head-strength MR imaging with histologic correlation. Radiology 169:517–524
Meachim G, Whitehouse GH, Fedley RB, Nichol FE, Owen R (1980) An investigation of radiological, clinical and pathological correlations in osteoarthritis of the hip. Clin Radiol 31:565
Mitchell DG, Rao VM, Dalinka MK, Spritzer CE, Alavi A, Steinberg ME, Fallon M, Kressel HY (1987) Femoral head avascular necrosis: correlation of MR imaging, radiographic staging, radionuclide imaging, and clinical findings. Radiology 162:709–715
Mitchell DG, Joseph PM, Fallon M, Hickey W, Kressel HY, Rao VM, Steinberg ME, Dalinka MK (1987) Chemical-shift MR imaging of the femoral head: an in vitro study of normal hips and hips with avascular necrosis. Am J Roentgenol 148:1159
Mitchell DG, Steinberg ME, Dalinka MK, Rao JM, Fallon M, Kressel HY (1989) Magnetic resonance imaging of the ischemic hip. Alterations within the osteonecrotic viable and reactive zones. Clin Orthop 244:60
Norman A, Bullough P (1963) The radiolucent crescent linean early diagnostic sign of avascular necrosis of the femoral head. Bull Hosp J Dis 24:99
Patterson RJ, Bickel WH, Dahlin DC (1964) Idiopathic avascular necrosis of the head of the femur. A study of fifty-two cases. J Bone Joint Surg [Am] 46:267
Phemister DB (1939) The pathology of ununited fractures of the neck of the femur with special reference to the head. J Bone Joint Surg 21:681–693
Resnick D, Niwayama G (1988) Osteonecrosis: diagnostic techniques, specific situations, and complications. In: Resnick D, Niwayama G (eds) Diagnosis of bone and joint disorders, 2nd edn. WB Saunders, Philadelphia
Sherman MS, Phemister DB (1947) The pathology of ununited fractures of the neck of the femur. J Bone Joint Surg 29:3–24
Springfield DS, Enneking WF (1976) Idiopathic aseptic necrosis. In: Ackerman LV, Spjut HJ, Abell MR (eds) Bones and joints. Williams and Wilkins, Baltimore
Sweet DE, Madewell JE (1988) Pathogenesis of osteonecrosis. In: Resnick D, Niwayama G (eds) Diagnosis of bone and joint disorders. WB Saunders, Philadelphia, 2nd Edn
Takatori Y, Kamogawa M, Kobubo T, Nakamura T, Ninomiya S, Yoshikawa K, Kawahara H (1987) Magnetic resonance imaging and histopathology in femoral head necrosis. Acta Orthop Scand 58:499
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Sissons, H.A., Nuovo, M.A. & Steiner, G.C. Pathology of osteonecrosis of the femoral head. Skeletal Radiol. 21, 229–238 (1992). https://doi.org/10.1007/BF00243063
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DOI: https://doi.org/10.1007/BF00243063