Assessing osteonecrosis of the femoral head after internal fixation of femoral neck fractures in young patients with fixation implants in situ: the value of MARS MRI in relation to conventional radiography and patient-reported outcomes
DOI:
https://doi.org/10.2340/17453674.2023.11658Abstract
Background and purpose: Little is known on the use of metal artifact reduction sequence (MARS) MRI to diagnose osteonecrosis of the femoral head (ONFH) after fixation of femoral neck fractures (FNF) with conventional metal implants present. We compared MARS MRI with radiography in diagnosing ONFH. Secondarily, we determined whether signs of ONFH on MARS MRI correlate with patient-reported outcomes (PROs) via Oxford Hip Score (OHS) and pain (VAS).
Patients and methods: 30 adults under 60 years treated with internal fixation after FNF were prospectively included (2015–2018) at 2 hospitals. They were followed up with radiography and PROs at 4, 12, and 24 months and MARS MRI at 4 and 12 months. OHS < 34 or VAS pain > 20 was considered significant.
Results: At 12 months, 14 patients had a pathological MRI. 3 of 14 had ONFH on radiographs at 12 months, increasing to 5 at 24 months, and 4 had unfavorable PROs. 2 of 5 patients with ONFH signs on both MRI and radiography had unfavorable PROs. 1 of 10 patients with normal MRI and radiography had unfavorable 2-year PROs. 4 patients had inconsistent MRI results, of which 1 developed ONFH. 1 patient dropped out.
Conclusion: Information from a pathological MRI was not useful, as a majority remained free from symptoms and ONFH signs on radiographs. Furthermore, PROs did not correlate with imaging results. MARS MRI findings must be better understood before being taken into clinical practice. However, a normal MARS MRI seems to be a good prognostic finding.
Downloads
References
Ehlinger M, Moser T, Adam P, Bierry G, Gangi A, de Mathelin M, et al. Early prediction of femoral head avascular necrosis following neck fracture. Orthop Traumatol Surg Res 2011; 97(1): 79-88. doi: 10.1016/j.otsr.2010.06.014. DOI: https://doi.org/10.1016/j.otsr.2010.06.014
Rönnquist S S, Lagergren J, Viberg B, Möller M, Rogmark C. Rate of conversion to secondary arthroplasty after femoral neck fractures in 796 younger patients treated with internal fixation: a Swedish national register-based study. Acta Orthop 2022; 93: 547-53. doi: 10.2340/17453674.2022.3038. DOI: https://doi.org/10.2340/17453674.2022.3038
Rogmark C, Kristensen M T, Viberg B, Rönnquist SS, Overgaard S, Palm H. Hip fractures in the non-elderly: who, why and whither? Injury 2018; 49(8): 1445-50. doi: 10.1016/j.injury.2018.06.028. DOI: https://doi.org/10.1016/j.injury.2018.06.028
Stockton D J, O’Hara L M, O’Hara N N, Lefaivre K A, O’Brien P J, Slobogean G P. High rate of reoperation and conversion to total hip arthroplasty after internal fixation of young femoral neck fractures: a population-based study of 796 patients. Acta Orthop 2019; 90(1): 21-5. doi: 10.1080/17453674.2018.1558380. DOI: https://doi.org/10.1080/17453674.2018.1558380
Kawasaki M, Hasegawa Y, Sakano S, Sugiyama H, Tajima T, Iwasada S, et al. Prediction of osteonecrosis by magnetic resonance imaging after femoral neck fractures. Clin Orthop Relat Res 2001; (385): 157-64. doi: 10.1097/00003086-200104000-00024. DOI: https://doi.org/10.1097/00003086-200104000-00024
Blum A, Raymond A, Teixeira P. Strategy and optimization of diagnostic imaging in painful hip in adults. Orthop Traumatol Surg Res 2015; 101(1 Suppl.): S85-99. doi: 10.1016/j.otsr.2014.11.002. DOI: https://doi.org/10.1016/j.otsr.2014.11.002
Choi H R, Steinberg M E, Y. Cheng E. Osteonecrosis of the femoral head: diagnosis and classification systems. Curr Rev Musculoskelet Med 2015; 8(3): 210-20. doi: 10.1007/s12178-015-9278-7. DOI: https://doi.org/10.1007/s12178-015-9278-7
Kuroda Y, Tanaka T, Miyagawa T, Kawai T, Goto K, Tanaka S, et al. Classification of osteonecrosis of the femoral head: who should have surgery? Bone Joint Res 2019; 8(10): 451-8. doi: 10.1302/2046-3758.810.BJR-2019-0022.R1. DOI: https://doi.org/10.1302/2046-3758.810.BJR-2019-0022.R1
Väänänen M, Tervonen O, Nevalainen M T. Magnetic resonance imaging of avascular necrosis of the femoral head: predictive findings of total hip arthroplasty. Acta Radiol Open 2021; 10(4): 2058460121100839. doi: 10.1177/20584601211008379. DOI: https://doi.org/10.1177/20584601211008379
Kim C H, Shin M, Lee D, Choi S J, Moon D H. Hidden osteonecrosis of the femoral head after healed femoral neck fractures: magnetic resonance imaging study of 58 consecutive patients. Arch Orthop Trauma Surg 2022; 142(7): 1443-50. doi: 10.1007/s00402-021-03802-6. DOI: https://doi.org/10.1007/s00402-021-03802-6
Larson E, Jones L C, Goodman S B, Koo K H, Cui Q. Early-stage osteonecrosis of the femoral head: where are we and where are we going in year 2018? Int Orthop 2018; 42(7): 1723-8. doi: 10.1007/s00264-018-3917-8. DOI: https://doi.org/10.1007/s00264-018-3917-8
Dawson J, Fitzpatrick R, Carr A, Murray D. Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg Br 1996; 78(2): 185-90. DOI: https://doi.org/10.1302/0301-620X.78B2.0780185
Strøm Rönnquist S, Viberg B, Kristensen M T, Palm H, Jensen J E B, Madsen C F, et al. Frailty and osteoporosis in patients with hip fractures under the age of 60: a prospective cohort of 218 individuals. Osteoporos Int 2022; 33(5): 1037-55. doi: 10.1007/s00198-021-06281-y. DOI: https://doi.org/10.1007/s00198-021-06281-y
Hutchings L, Fox R, Chesser T. Proximal femoral fractures in the elderly: how are we measuring outcome? Injury 2011; 42(11): 1205-13. doi: 10.1016/j.injury.2010.12.016. DOI: https://doi.org/10.1016/j.injury.2010.12.016
Kalairajah Y, Azurza K, Hulme C, Molloy S, Drabu K J. Health outcome measures in the evaluation of total hip arthroplasties: a comparison between the Harris Hip Score and the Oxford Hip Score. J Arthroplasty 2005; 20(8): 1037-41. doi: 10.1016/j.arth.2005.04.017. DOI: https://doi.org/10.1016/j.arth.2005.04.017
Duncan G H, Bushnell C M, Lavigne G J. Comparison of verbal and visual analogue scales for measuring the intensity and unpleasantness of experimental pain. Pain 1989; 37(3): 295-303. doi: 10.1016/0304-3959(89)90194-2. DOI: https://doi.org/10.1016/0304-3959(89)90194-2
Farshad-Amacker N A, Koff M F, Dyke J P, Lazaro L E, Shah P, Lorich D G, et al. Assessment of osteonecrosis in the presence of instrumentation for femoral neck fracture using contrast-enhanced MAVRIC sequence. HSS J 2016; 12(1): 51-8. doi: 10.1007/s11420-015-9475-3. DOI: https://doi.org/10.1007/s11420-015-9475-3
Takashima K, Sakai T, Hamada H, Takao M, Sugano N. Which classification system is most useful for classifying osteonecrosis of the femoral head? Clin Orthop Relat Res 2018; 476(6): 1240-9. doi: 10.1007/s11999.0000000000000245. DOI: https://doi.org/10.1007/s11999.0000000000000245
Additional Files
Published
How to Cite
License
Copyright (c) 2023 Mikael Kindt, Maria L Jönsson, Trine Torfing, Sebastian Strøm Rönnquist, Bjarke Viberg, Søren Overgaard, Cecilia Rogmark
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
