Skip to main content
Erschienen in: European Radiology 6/2016

03.09.2015 | Musculoskeletal

Subchondral insufficiency fractures of the femoral head: associated imaging findings and predictors of clinical progression

verfasst von: Lauren A. Hackney, Min Hee Lee, Gabby B. Joseph, Thomas P. Vail, Thomas M. Link

Erschienen in: European Radiology | Ausgabe 6/2016

Einloggen, um Zugang zu erhalten

Abstract

Objectives

To characterize the morphology and imaging findings of femoral head subchondral insufficiency fractures (SIF), and to investigate clinical outcomes in relation to imaging findings.

Methods

Fifty-one patients with hip/pelvis magnetic resonance (MR) images and typical SIF characteristics were identified and reviewed by two radiologists. Thirty-five patients had follow-up documentation allowing assessment of clinical outcome. Subgroup comparisons were performed using regression models adjusted for age and body mass index.

Results

SIF were frequently associated with cartilage loss (35/47, 74.5 %), effusion (33/42, 78.6 %), synovitis (29/44, 66 %), and bone marrow oedema pattern (BMEP) (average cross-sectional area 885.7 ± 730.2 mm2). Total hip arthroplasty (THA) was required in 16/35 patients, at an average of 6 months post-MRI. Compared to the THA cohort, the non-THA group had significantly (p < 0.05) smaller overlying cartilage defect size (10 mm vs. 29 mm), smaller band length ratio and fracture diameters, and greater incidence of parallel fracture morphology (p < 0.05). Male gender and increased age were significantly associated with progression, p < 0.05.

Conclusions

SIF were associated with synovitis, cartilage loss, effusion, and BMEP. Male gender and increased age had a significant association with progression to THA, as did band length ratio, fracture diameter, cartilage defect size, and fracture deformity/morphology.

Key points

Femoral head subchondral insufficiency fractures (SIF) frequently require total hip arthroplasty (THA).
SIF frequently coexist with synovitis, cartilage loss, and bone marrow oedema pattern.
SIF cartilage defect size, band length ratio, and fracture diameter/morphology can predict progression risk.
Literatur
1.
Zurück zum Zitat Bangil M, Soubrier M, Dubost JJ et al (1996) Subchondral insufficiency fracture of the femoral head. Rev Rhum Engl Ed 63:859–861PubMed Bangil M, Soubrier M, Dubost JJ et al (1996) Subchondral insufficiency fracture of the femoral head. Rev Rhum Engl Ed 63:859–861PubMed
2.
Zurück zum Zitat Iwasaki K, Yamamoto T, Motomura G, Mawatari T, Nakashima Y, Iwamoto Y (2011) Subchondral insufficiency fracture of the femoral head in young adults. Clin Imaging 35:208–213CrossRefPubMed Iwasaki K, Yamamoto T, Motomura G, Mawatari T, Nakashima Y, Iwamoto Y (2011) Subchondral insufficiency fracture of the femoral head in young adults. Clin Imaging 35:208–213CrossRefPubMed
3.
Zurück zum Zitat Yamamoto T, Nakashima Y, Shuto T, Jingushi S, Iwamoto Y (2007) Subchondral insufficiency fracture of the femoral head in younger adults. Skelet Radiol 36:S38–S42CrossRef Yamamoto T, Nakashima Y, Shuto T, Jingushi S, Iwamoto Y (2007) Subchondral insufficiency fracture of the femoral head in younger adults. Skelet Radiol 36:S38–S42CrossRef
4.
Zurück zum Zitat Yoon PW, Kwak HS, Yoo JJ, Yoon KS, Kim HJ (2014) Subchondral insufficiency fracture of the femoral head in elderly people. J Korean Med Sci 29:593–598CrossRefPubMedPubMedCentral Yoon PW, Kwak HS, Yoo JJ, Yoon KS, Kim HJ (2014) Subchondral insufficiency fracture of the femoral head in elderly people. J Korean Med Sci 29:593–598CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Uetani M, Hashmi R, Ito M et al (2003) Subchondral insufficiency fracture of the femoral head: magnetic resonance imaging findings correlated with micro-computed tomography and histopathology. J Comput Assist Tomogr 27:189–193CrossRefPubMed Uetani M, Hashmi R, Ito M et al (2003) Subchondral insufficiency fracture of the femoral head: magnetic resonance imaging findings correlated with micro-computed tomography and histopathology. J Comput Assist Tomogr 27:189–193CrossRefPubMed
6.
Zurück zum Zitat Zhao G, Yamamoto T, Ikemura S et al (2010) A histopathological evaluation of a concave-shaped low-intensity band on T1-weighted MR images in a subchondral insufficiency fracture of the femoral head. Skelet Radiol 39:185–188CrossRef Zhao G, Yamamoto T, Ikemura S et al (2010) A histopathological evaluation of a concave-shaped low-intensity band on T1-weighted MR images in a subchondral insufficiency fracture of the femoral head. Skelet Radiol 39:185–188CrossRef
7.
Zurück zum Zitat Yamamoto T, Iwamoto Y, Schneider R, Bullough PG (2008) Histopathological prevalence of subchondral insufficiency fracture of the femoral head. Ann Rheum Dis 67:150–153CrossRefPubMed Yamamoto T, Iwamoto Y, Schneider R, Bullough PG (2008) Histopathological prevalence of subchondral insufficiency fracture of the femoral head. Ann Rheum Dis 67:150–153CrossRefPubMed
8.
Zurück zum Zitat Yamamoto T, Bullough PG (1999) Subchondral insufficiency fracture of the femoral head: a differential diagnosis in acute onset of coxarthrosis in the elderly. Arthritis Rheum 42:2719–2723CrossRefPubMed Yamamoto T, Bullough PG (1999) Subchondral insufficiency fracture of the femoral head: a differential diagnosis in acute onset of coxarthrosis in the elderly. Arthritis Rheum 42:2719–2723CrossRefPubMed
9.
Zurück zum Zitat Yamamoto T, Schneider R, Bullough PG (2001) Subchondral insufficiency fracture of the femoral head: histopathologic correlation with MRI. Skelet Radiol 30:247–254CrossRef Yamamoto T, Schneider R, Bullough PG (2001) Subchondral insufficiency fracture of the femoral head: histopathologic correlation with MRI. Skelet Radiol 30:247–254CrossRef
10.
Zurück zum Zitat Davies M, Cassar-Pullicino VN, Darby AJ (2004) Subchondral insufficiency fractures of the femoral head. Eur Radiol 14:201–207CrossRefPubMed Davies M, Cassar-Pullicino VN, Darby AJ (2004) Subchondral insufficiency fractures of the femoral head. Eur Radiol 14:201–207CrossRefPubMed
11.
Zurück zum Zitat Miyanishi K, Hara T, Kaminomachi S, Maeda H, Watanabe H, Torisu T (2009) Contrast-enhanced MR imaging of subchondral insufficiency fracture of the femoral head: a preliminary comparison with that of osteonecrosis of the femoral head. Arch Orthop Trauma Surg 129:583–589CrossRefPubMed Miyanishi K, Hara T, Kaminomachi S, Maeda H, Watanabe H, Torisu T (2009) Contrast-enhanced MR imaging of subchondral insufficiency fracture of the femoral head: a preliminary comparison with that of osteonecrosis of the femoral head. Arch Orthop Trauma Surg 129:583–589CrossRefPubMed
12.
Zurück zum Zitat Ikemura S, Yamamoto T, Motomura G, Nakashima Y, Mawatari T, Iwamoto Y (2010) MRI evaluation of collapsed femoral heads in patients 60 years or older: differentiation of subchondral insufficiency fracture from osteonecrosis of the femoral head. AJR Am J Roentgenol 195:63–68CrossRef Ikemura S, Yamamoto T, Motomura G, Nakashima Y, Mawatari T, Iwamoto Y (2010) MRI evaluation of collapsed femoral heads in patients 60 years or older: differentiation of subchondral insufficiency fracture from osteonecrosis of the femoral head. AJR Am J Roentgenol 195:63–68CrossRef
13.
Zurück zum Zitat Ikemura S, Yamamoto T, Motomura G, Nakashima Y, Mawatari T, Iwamoto Y (2013) The utility of clinical features for distinguishing subchondral insufficiency fracture from osteonecrosis of the femoral head. Arch Orthop Trauma Surg 133:1623–1627CrossRefPubMed Ikemura S, Yamamoto T, Motomura G, Nakashima Y, Mawatari T, Iwamoto Y (2013) The utility of clinical features for distinguishing subchondral insufficiency fracture from osteonecrosis of the femoral head. Arch Orthop Trauma Surg 133:1623–1627CrossRefPubMed
14.
Zurück zum Zitat Rafii M, Mitnick H, Klug J, Firooznia H (1997) Insufficiency fracture of the femoral head: MR imaging in three patients. AJR Am J Roentgenol 168:159–163CrossRefPubMed Rafii M, Mitnick H, Klug J, Firooznia H (1997) Insufficiency fracture of the femoral head: MR imaging in three patients. AJR Am J Roentgenol 168:159–163CrossRefPubMed
15.
Zurück zum Zitat Hagino H, Okano T, Teshima R, Nishi T, Yamamoto K (1999) Insufficiency fracture of the femoral head in patients with severe osteoporosis: report of 2 cases. Acta Orthop Scand 70:87–89CrossRefPubMed Hagino H, Okano T, Teshima R, Nishi T, Yamamoto K (1999) Insufficiency fracture of the femoral head in patients with severe osteoporosis: report of 2 cases. Acta Orthop Scand 70:87–89CrossRefPubMed
16.
Zurück zum Zitat Yamamoto T, Bullough PG (2000) The role of subchondral insufficiency fracture in rapid destruction of the hip joint: a preliminary report. Arthritis Rheum 43:2423–2427CrossRefPubMed Yamamoto T, Bullough PG (2000) The role of subchondral insufficiency fracture in rapid destruction of the hip joint: a preliminary report. Arthritis Rheum 43:2423–2427CrossRefPubMed
17.
Zurück zum Zitat Fukui K, Kaneuji A, Fukushima M, Matsumoto T (2015) Early MRI and intraoperative findings in rapidly destructive osteoarthritis of the hip: a case report. Int J Surg Case Rep 8:13–17CrossRefPubMedCentral Fukui K, Kaneuji A, Fukushima M, Matsumoto T (2015) Early MRI and intraoperative findings in rapidly destructive osteoarthritis of the hip: a case report. Int J Surg Case Rep 8:13–17CrossRefPubMedCentral
18.
Zurück zum Zitat Yamamoto T, Takabatake K, Iwamoto Y (2002) Subchondral insufficiency fracture of the femoral head resulting in rapid destruction of the hip joint: a sequential radiographic study. AJR Am J Roentgenol 178:435–437CrossRefPubMed Yamamoto T, Takabatake K, Iwamoto Y (2002) Subchondral insufficiency fracture of the femoral head resulting in rapid destruction of the hip joint: a sequential radiographic study. AJR Am J Roentgenol 178:435–437CrossRefPubMed
19.
Zurück zum Zitat Iwasaki K, Yamamoto T, Motomura G et al (2012) Prognostic factors associated with a subchondral insufficiency fracture of the femoral head. Br J Radiol 85:214–218CrossRefPubMedPubMedCentral Iwasaki K, Yamamoto T, Motomura G et al (2012) Prognostic factors associated with a subchondral insufficiency fracture of the femoral head. Br J Radiol 85:214–218CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat Miyanishi K, Ishihara K, Jingushi S, Torisu T (2010) Risk factors leading to total hip arthroplasty in patients with subchondral insufficiency fractures of the femoral head. J Orthop Surg (Hong Kong) 18:271–275 Miyanishi K, Ishihara K, Jingushi S, Torisu T (2010) Risk factors leading to total hip arthroplasty in patients with subchondral insufficiency fractures of the femoral head. J Orthop Surg (Hong Kong) 18:271–275
22.
Zurück zum Zitat Altman RD, Gold GE (2007) Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthr Cartil 15:A1–A56CrossRefPubMed Altman RD, Gold GE (2007) Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthr Cartil 15:A1–A56CrossRefPubMed
23.
Zurück zum Zitat Gossec L, Jordan JM, Lam M et al (2009) Comparative evaluation of three semi-quantitative radiographic grading techniques for hip osteoarthritis in terms of validity and reproducibility in 1404 radiographs: report of the OARSI-OMERACT task force. Osteoarthr Cartil 17:182–187CrossRefPubMed Gossec L, Jordan JM, Lam M et al (2009) Comparative evaluation of three semi-quantitative radiographic grading techniques for hip osteoarthritis in terms of validity and reproducibility in 1404 radiographs: report of the OARSI-OMERACT task force. Osteoarthr Cartil 17:182–187CrossRefPubMed
24.
Zurück zum Zitat Lee S, Nardo L, Kumar D et al (2014) Scoring hip osteoarthritis with MRI (SHOMRI): a whole joint osteoarthritis evaluation system. J Magn Reson Imaging 41:1549–1557CrossRefPubMed Lee S, Nardo L, Kumar D et al (2014) Scoring hip osteoarthritis with MRI (SHOMRI): a whole joint osteoarthritis evaluation system. J Magn Reson Imaging 41:1549–1557CrossRefPubMed
25.
Zurück zum Zitat Lippe J, Spang JT, Leger RR, Arciero RA, Mazzocca AD, Shea KP (2012) Inter-rater agreement of the Goutallier, Patte, and Warner classification scores using preoperative magnetic resonance imaging in patients with rotator cuff tears. Arthroscopy 28:154–159CrossRefPubMed Lippe J, Spang JT, Leger RR, Arciero RA, Mazzocca AD, Shea KP (2012) Inter-rater agreement of the Goutallier, Patte, and Warner classification scores using preoperative magnetic resonance imaging in patients with rotator cuff tears. Arthroscopy 28:154–159CrossRefPubMed
26.
Zurück zum Zitat Niimi R, Hasegawa M, Sudo A, Uchida A (2005) Rapidly destructive coxopathy after subchondral insufficiency fracture of the femoral head. Arch Orthop Trauma Surg 125:410–413CrossRefPubMed Niimi R, Hasegawa M, Sudo A, Uchida A (2005) Rapidly destructive coxopathy after subchondral insufficiency fracture of the femoral head. Arch Orthop Trauma Surg 125:410–413CrossRefPubMed
27.
Zurück zum Zitat Kubo T, Yamazoe S, Sugano N (1997) Initial MRI findings of non-traumatic osteonecrosis of the femoral head in renal allograft recipients. Magn Reson Imaging 15:1017–1023CrossRefPubMed Kubo T, Yamazoe S, Sugano N (1997) Initial MRI findings of non-traumatic osteonecrosis of the femoral head in renal allograft recipients. Magn Reson Imaging 15:1017–1023CrossRefPubMed
28.
Zurück zum Zitat Vande Berg BC, Malghem JJ, Lecouvet FE, Jamart J, Maldague BE (1999) Idiopathic bone marrow edema lesions of the femoral head: predictive value of MR imaging findings. Radiology 212:527–535CrossRefPubMed Vande Berg BC, Malghem JJ, Lecouvet FE, Jamart J, Maldague BE (1999) Idiopathic bone marrow edema lesions of the femoral head: predictive value of MR imaging findings. Radiology 212:527–535CrossRefPubMed
29.
Zurück zum Zitat Yamamoto T, Karasuyama K, Iwasaki K, Doi T, Iwamoto Y (2014) Subchondral insufficiency fracture of the femoral head in males. Arch Orthop Trauma Surg 134:1199–1203CrossRefPubMed Yamamoto T, Karasuyama K, Iwasaki K, Doi T, Iwamoto Y (2014) Subchondral insufficiency fracture of the femoral head in males. Arch Orthop Trauma Surg 134:1199–1203CrossRefPubMed
30.
Zurück zum Zitat Iwasaki K, Yamamoto T, Motomura G, Ikemura S, Yamaguchi R, Iwamoto Y (2013) Radiologic measurements associated with the prognosis and need for surgery in patients with subchondral insufficiency fractures of the femoral head. AJR Am J Roentgenol 201:W97–W103CrossRefPubMed Iwasaki K, Yamamoto T, Motomura G, Ikemura S, Yamaguchi R, Iwamoto Y (2013) Radiologic measurements associated with the prognosis and need for surgery in patients with subchondral insufficiency fractures of the femoral head. AJR Am J Roentgenol 201:W97–W103CrossRefPubMed
31.
Zurück zum Zitat Bruyere O, Pavelka K, Rovati LC et al (2008) Total joint replacement after glucosamine sulphate treatment in knee osteoarthritis: results of a mean 8-year observation of patients from two previous 3-year, randomised, placebo-controlled trials. Osteoarthr Cartil 16:254–260CrossRefPubMed Bruyere O, Pavelka K, Rovati LC et al (2008) Total joint replacement after glucosamine sulphate treatment in knee osteoarthritis: results of a mean 8-year observation of patients from two previous 3-year, randomised, placebo-controlled trials. Osteoarthr Cartil 16:254–260CrossRefPubMed
Metadaten
Titel
Subchondral insufficiency fractures of the femoral head: associated imaging findings and predictors of clinical progression
verfasst von
Lauren A. Hackney
Min Hee Lee
Gabby B. Joseph
Thomas P. Vail
Thomas M. Link
Publikationsdatum
03.09.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
European Radiology / Ausgabe 6/2016
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-3967-x

Weitere Artikel der Ausgabe 6/2016

European Radiology 6/2016 Zur Ausgabe

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.