Bone marrow edema resulting from nontraumatic femoral head necrosis: Association Research Circulation Osseous staging and pain grading

doi:10.3969/j.issn.2095-4344.2015.46.027

Abstract

Abstract:

BACKGROUND: The relationship between the occurrence time and clinical symptoms of bone marrow edema in nontraumatic femoral head necrosis is still controversial.

OBJECTIVE: To evaluate the relationship of bone marrow edema in nontraumatic femoral head necrosis with Association Research Circulation Osseous (ARCO) staging and pain grading.

METHODS: Forty-eight patients with nontraumatic femoral head necrosis (58 hips) were confirmed to have bone marrow edema on MRI T1 weighted images and T2 fat suppression images. Then, the patients were graded according to the MRI Classification Method reported by Zhao Pei-rong, the ARCO Staging System and Harris hip score for pain grading. We analyzed the correlation of bone marrow edema with ARCO staging and pain grading.

RESULTS AND CONCLUSION: The incidence rate of bone marrow edema in ARCO I-III was increased in sequence, and the difference was statistically significant (χ²=27.69, P=0.001); the average rank of bone marrow edema in ARCO I-III was increased significantly (χ²=19.947, P=0.000). The incidence rate of bone marrow edema also increased among different pain grading, and the difference was statistically significant (χ²=57.0, P=0.000); the average rank of bone marrow edema among different pain grading was increased significantly

(χ²=174.0, P=0.000). The presence and aggravation of bone marrow edema indicate the enlargement of necrosis area and the aggravation of symptoms in patients with nontraumatic femoral head necrosis, which can be used as an auxiliary index for the appraisal of disease progression.
中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: Bone Marrow, Edema, Femur Head Necrosis, Magnetic Resonance Imaging

Figures/Tables 6

References

[1] Kaushik AP, Das A,Cui Q. Osteonecrosis of the femoral head: An update in year 2012.World J Orthop.2012; 3: 49-57.

[2] Mont MA, Zywiel MG, Marker DR,et al. The natural history of untreated asymptomatic osteonecrosis of the femoral head: a systematic literature review. J Bone Joint Surg Am. 2010;92: 2165-2170.

[3] Lieberman JR, Berry DJ, Mont MA, et al. Osteonecrosis of the hip: management in the 21st century. Instr Course Lect. 2003; 52:337-355.

[4] Lavernia CJ, Sierra RJ, Grieco FR. Osteonecrosis of the femoral head. J Am Acad Orthop Surg.1999;7:250-261.

[5] Watson RM, Roach NA, Dalinka MK Avascular necrosis and bone marrow edema syndrome. Radiol Clin North Am.2004; 42:207-219.

[6] Solomon L.Mechanisms of idiopathic osteonecrosis. Orthop Clin North Am.1985;16:655-667.

[7] Jacobs B (1978) Epidemiology of traumatic and nontraumatic osteonecrosis. Clin Orthop Relat Res 130:51-67.

[8] Lee MS, Chang YH, Chao EK,et al. Conditions before collapse of the contralateral hip in osteonecrosis of the femoral head. Chang Gung Med J.2002;25(4):228-237.

[9] Assouline-Dayan Y, Chang C, Greenspan A, et al. Pathogenesis and natural history of steonecrosis.Semin Arthritis Rheum. 2002; 32:94e124.

[10] Meier R. Bone marrow oedema on MR imaging indicates ARCO stage 3 disease in patients with AVN of the femoral head. Eur Radiol.2014;24(9): 2271-2278.

[11] 赵培荣,庄奇新,乔瑞华,等.股骨头缺血坏死骨髓水肿的MRI研究[J].实用放射学杂志,2006,22(7):835-837,853.

[12] Totty WG,Murphy WA, Ganz WI,et al. Magnetic resonance imaging of the normal and ischemic femoral head. AJR Am J Roentgenol.1984;143:1273-1280.

[13] Harris WH.Traumatic Arthritis of the Hip After Dislocation and Acetabular Fractures: Treatment by Mold Arthroplasty: an End-result Study Using a New Method of Result Evaluation. J Bone Joint Surg.1969;51(4):737-755.

[14] ARCO (Association ResearchCirculation Osseous) Committee on terminology and classification. ARCO News.1992; 4:41-46

[15] Ito H, Matsuno T, Minami A.Relationship between bone marrow edema and development of symptoms in patients with osteonecrosis of the femoral head. AJR Am J Roentgenol. 2006; 186:1761-1770.

[16] Koo KH, Ahn IO, Kim R, et al Bone marrow edema and associated pain in early stage osteonecrosis of the femoral head: prospective study with serial MR images. Radiology.1999; 213: 715-722.

[17] Iida S, Harada Y, Shimizu K, et al Correlation between bone marrow edema and collapse of the femoral head in steroid-induced osteonecrosis. AJR Am J Roentgenol. 2000; 174:735-743.

[18] Huang GS, Chan WP, Chang YC,et al. MR imaging of bone marrow edema and joint effusion in patients with osteonecrosis of the moral head: relationship to pain. AJR Am J Roentgenol. 2003;181:545-549.

[19] Kim YM, Oh HC, Kim HJ (2000) The pattern of bone marrow oedema on MRI in osteonecrosis of the femoral head. J Bone Joint Surg (Br) 82:837-841.

[20] Fujioka M, Kubo T, Nakamura F, Shibatani M, Ueshima K,Hamaguchi H et al (2001) Initial changes of non-traumatic osteonecrosis of femoral head in fat suppression images: bone marrow edema was not found before the appearance of band patterns.Magn Reson Imaging 19:985-991.

[21] Turner DA, Templeton AC, Selzer PM,et al. Femoral capital osteonecrosis: MR finding of diffuse marrow abnormalities without focal lesions. Radiology.1989; 171:135-140.

[22] Sakai T,Sugano N,Nishii T,et al．MR findings of necrotic lesions and the extralesional area of osteonecrosis of the femoral head．Skeletal Radiol.2000;29:133-141.

[23] Kubo T,Yamamoto T,Inoue S,et al．Histological findings of bone marrow edema pattern on MRI in osteonecrosis of the femoral head．J Orthop Sei.2000;5:520-523．

[24] Froberg PK, Braunstein EM.Buckwalter KAOsteonecrosis, transient osteoporosis, and transient bone marrow edema: current concepts. Radiol Clin North Am. 1996;34:273-291.

[25] Plenk H Jr, Hofmann S, Eschberger J,et al.Histomorphology and bone morphometry of the bone marrow edema syndrome of the hip. Clin Orthop Relat Res.1997;334:73-84.

[26] Li KC, Hiette P.Contrast-enhanced fat saturation magnetic resonance imaging for studying the pathophysiology of osteonecrosis of the hips. Skeletal Radiol.1992;21:375-379.

[27] Velez R, Soldado F, Hernandez A, et al. A new preclinical femoral head osteonecrosis model in sheep. Arch Orthop Trauma Surg.2011;131:5-9.

[28] Shapiro F, Connolly S, Zurakowski D,et al. Femoral head deformation and repair following induction of ischemic necrosis: a histologic and magnetic resonance imaging study in the piglet. J Bone Joint Surg Am.2009;91:2903-2914.

[29] Sowers MF,Hayes C,Jamadar D,et al．Magnetic resonance-detected subchondral bone marrow and cartilage defect characteristics associated with pain and X-ray-defined knee osteoarthritis．Osteoarthritis Cartilage. 2003;1l(6):387-393．

[30] 耿晓鹏,陈百成,王霞,等.软骨下骨髓水肿与膝骨关节炎疼痛相关性的影像学研究[J].中华骨科杂志,2005,25(11):682.686．

[31] Castro FP Jr,Barrack RL. Core decompression and conservative treatment for avascular necrosis of the femoral head:a meta-analysis. Am J Orthop.2000;29:187-194．