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. 2015 Sep;8(3):210-20.
doi: 10.1007/s12178-015-9278-7.

Osteonecrosis of the femoral head: diagnosis and classification systems

Ho-Rim Choi  1 , Marvin E Steinberg, Edward Y Cheng
Affiliations

Osteonecrosis of the femoral head: diagnosis and classification systems

Ho-Rim Choi et al. Curr Rev Musculoskelet Med. 2015 Sep.

Abstract

Osteonecrosis of femoral head is a rare but disabling condition that usually results in progressive femoral head collapse and secondary arthritis necessitating total hip arthroplasty if not treated appropriately in early stages. However, early diagnosis is challenging as the onset of disease is insidious and the symptoms and signs are usually minimal and nonspecific until it becomes advanced. Of several diagnostic modalities, magnetic resonance imaging (MRI) is considered the imaging method of choice with the highest sensitivity and specificity, while detection of potential risk factors is very important as well. Many investigators have developed several different classification systems; however, there still is controversy regarding the optimal classification system. Diagnostic methods and the evolution of different classification systems will be reviewed in this paper.

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Figures

Fig. 1
Fig. 1
Plain radiograph shows no significant abnormality (a); however, MRI exam shows typical band-like pattern of ON lesion in T1W (b) and T2W (c) images
Fig. 2
Fig. 2
MRI shows typical band-like pattern of ON in both femoral heads
Fig. 3
Fig. 3
Although subchondral fracture is not clearly seen in plain radiographs, it is readily demonstrated in both coronal (a) and sagittal (b) reconstruction of the CT (arrow)
Fig. 4
Fig. 4
Left hip lateral plain X-ray shows subchondral fracture line (“crescent sign,” arrow)
Fig. 5
Fig. 5
Pelvis X-ray shows radiolucency and surrounding sclerosis of both femoral heads suggesting stage 2 osteonecrosis lesion
Fig 6
Fig 6
Pelvis AP X-ray shows collapsed femoral head and advanced osteoarthritic change involving acetabulum of left hip
See this image and copyright information in PMC

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