The pathogenesis of multifocal osteonecrosis

Abstract

Our objective was to study the incidence, etiology, and diagnosis of multifocal osteonecrosis (MFON) and its treatment options to facilitate an earlier diagnosis and to optimize treatment. A radiological investigation was performed in osteonecrosis patients with a high risk of MFON for a more accurate diagnosis between January 2010 and June 2015. For patients with osteonecrosis of both the hip and knee joints or for patients with a history of corticosteroid use or alcohol abuse who had osteonecrosis of one or more joints in the shoulder, ankle, wrist or elbow, magnetic resonance imaging (MRI) was also performed on other joints, regardless of whether these joints were symptomatic. Furthermore, we performed a radiological screening of 102 patients who had a negative diagnosis of MFON but were at a high risk; among them, another 31 MFON cases were successfully identified (30.4%). Thus, the incidence of MFON during the study period increased from 3.1% to 5.2%. Patients diagnosed with osteonecrosis and who are at a high risk of MFON should have their other joints radiologically examined when necessary. This will reduce missed diagnosis of MFON and facilitate an earlier diagnosis and treatment to achieve an optimal outcome.

Figure 1. Radiological images of a male patient (age = 22 years).

The patient had a history of corticosteroid therapy (equivalent dose of methylprednisolone = 7000 mg) for bone marrow transplantation due to acute lymphoblastic leukemia. He had pain in his hips but no symptoms in his other joints, and he was initially diagnosed with stage IIIc osteonecrosis of the bilateral femoral heads. The MRI examination of his other joints revealed osteonecrosis of the bilateral knees, shoulders, ankles and wrists.