Ischemic osteonecrosis in the proximal femur tissue of patients with osteonecrosis of femoral head

Changsuo XIA; Bo LI; Shujuan LI; Changfeng LI

ABSTRACT

BACKGROUND:

Ischemic osteonecrosis of femoral head can cause dysfunction of the patients and the most frequently advocated treatment for advanced osteonecrosis of femoral head is total hip arthroplasty. But the reason is unknown. A potential cause in patients with osteonecrosis of femoral head is abnormal cancellous bone in the proximal femur which is short of further investigation.

OBJECTIVE:

To probe into proximal femoral change of patients with ischemic osteonecrosis of the femoral head.

DESIGN:

A non-randomized concurrent controlled study based on the patients.

SETTING:

Department of Traumatic Surgery, Affiliated Hospital of Medical College of Qingdao University

PARTICIPANTS:

This study was done at the Department of Traumatic Surgery, Affiliated Hospital of Medical College of Qingdao University from September 1999 to May 2003. Eighteen patients with osteonecrosis of the femoral head including 12 males and 6 females with the average age of (50 ± 5) years and eighteen patients with osteoarthritis of the hip attended including 10 males and 8 female with the average age of(62 ±3)years were involved in this study.

METHODS:

Histological examination of the femoral heads and cancellous bone biopsies from four regions of the proximal femur in 18 patients with osteonecrosis of the femoral head following total hip arthroplasty was perforned. Eighteen patients with osteoarthritis were set as control group. All histological specimens were examined in a double-blinded fashion.MAIN OUTCOME

MEASURES:

The femoral neck, the greater trochanter, the lesser trochanter, the necrosis scoring and necrosis positive rate of shaft of femur of the patients in the two groups.

RESULTS:

Extensive osteonecrosis was found in the proximal femur up to 4 cm below the lesser trochanter in the group with osteonecrosis. The osteonecrosis scoring was 82 and 16 in the osteonecrosis group and control group respectively and the osteonecrotic positive rate was 63.89% and 19.44% respectively, There was an overall statistically significant difference in the extent of osteonecrosis death in the proximal femur between the two groups ( P ＜ 0. 001 ).

CONCLUSION:

Bone change of proximal femur might be one of the reasons for the early failure of total hip replacement reported in patients with osteonecrosis of the femoral head.