Intra-articular pathology affects outcomes after joint preserving surgery for osteonecrosis of the femoral head

Abstract

Purpose

Currently, knowledge regarding the intra-articular pathology and its relationship to outcomes after joint-preserving surgery in patients with osteonecrosis of the femoral head (ONFH) is lacking. The purposes were to evaluate the intra-articular pathology and its relationship with outcomes of joint-preserving surgery in ONFH.

Methods

We reviewed 41 hips with ONFH in 41 patients (27 women; mean age, 34.9 years old) who underwent intertrochanteric curved varus osteotomy. Radiographic evaluations were based on pre-operative imaging studies, including radiographs, computed tomography (CT), and magnetic resonance imaging (MRI). Intra-articular pathology was evaluated by arthroscopic inspection of the femoral head, labrum, and acetabular cartilage during surgery. In addition, we performed radiographic measurements of the hip, including the collapse of the femoral head and minimal joint space width at three  years post-operatively and at final follow-up.

Results

Arthroscopy revealed damage to the acetabular cartilage and labrum in 22 (54%) and 13 patients (32%), respectively. However, these lesions could be detected on imaging in only 13 (32%) and ten patients (24%), respectively. The change in joint space width after surgery was significantly higher in patients with cartilage degeneration and labral injury (P = 0.02, P = 0.02). Logistic regression analysis for subsequent progression of osteoarthritis showed an association with degenerative changes of articular cartilage and the labral tear as independent predictors (P = 0.001, P = 0.03).

Conclusions

Our data demonstrate the presence of labral and acetabular cartilage lesions in ONFH patients, while images do not reveal the full extent of the tissue damage. These intra-articular pathologies can be associated with the outcomes after joint-preserving surgery.

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Correspondence to Takeshi Shoji.

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Ethics approval was granted by the Institutional Review Board (# E-677, 7/Feb/2017), and informed consent was obtained from all individual participants included in the study.

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Shoji, T., Yamasaki, T., Ota, Y. et al. Intra-articular pathology affects outcomes after joint preserving surgery for osteonecrosis of the femoral head. International Orthopaedics (SICOT) 44, 1295–1303 (2020). https://doi.org/10.1007/s00264-020-04550-9

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Keywords

  • Osteonecrosis of the femoral head
  • Intra-articular pathology
  • Arthroscopy
  • Hip preservation surgery
  • Articular cartilage
  • Labral tear