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Observational Study
. 2024 Mar 29;14(3):e082342.
doi: 10.1136/bmjopen-2023-082342.

Time elapsed from definitive diagnosis to surgery for osteonecrosis of the femoral head: a nationwide observational study in Japan

Junichi Nakamura  1 , Wakaba Fukushima  2 , Wataru Ando  3   4 , Shigeo Hagiwara  5 , Yuya Kawarai  5 , Yuki Shiko  6 , Yohei Kawasaki  6   7 , Takashi Sakai  3   8 , Kazuya Ito  2   9 , Yoshiya Arishima  10 , Etsuo Chosa  11 , Yusuke Fujimoto  10 , Kazuo Fujiwara  12 , Yukiharu Hasegawa  13 , Shinya Hayashi  14 , Takashi Imagama  8 , Yutaka Inaba  15 , Yasuyuki Ishibashi  16 , Yasuhiro Ishidou  10 , Hideya Ito  17 , Hiroshi Ito  18 , Juji Ito  19 , Tetsuya Jinno  20 , Tamon Kabata  21 , Nobuhiro Kaku  22 , Ayumi Kaneuji  23 , Shunji Kishida  5 , Seneki Kobayashi  24 , Setsuro Komiya  10 , Toshikazu Kubo  25 , Tokifumi Majima  26 , Naohiko Mashima  27 , Masaaki Mawatari  28 , Hidenobu Miki  29 , Kazumasa Miyatake  20 , Goro Motomura  30 , Satoshi Nagoya  31 , Hiroaki Nakamura  32 , Yoshihide Nakamura  16 , Ryosuke Nakanishi  33 , Yasuharu Nakashima  30 , Satoshi Nakasone  34 , Takashi Nishii  3 , Takayuki Nishiyama  14 , Yoichi Ohta  32 , Kenji Ohzono  4 , Makoto Osaki  35 , Kan Sasaki  19 , Taisuke Seki  13   36 , Takaaki Shishido  37 , Takeshi Shoji  38 , Akihiro Sudo  39 , Michiaki Takagi  19 , Daisuke Takahashi  26 , Masaki Takao  3   27 , Sakae Tanaka  17 , Takeyuki Tanaka  17 , Tomonori Tetsunaga  12 , Keiichiro Ueshima  25 , Kengo Yamamoto  37 , Takuaki Yamamoto  30   40 , Yuji Yamamoto  16 , Takuma Yamasaki  38 , Yuji Yasunaga  38 , Nobuhiko Sugano  3
Affiliations
Observational Study

Time elapsed from definitive diagnosis to surgery for osteonecrosis of the femoral head: a nationwide observational study in Japan

Junichi Nakamura et al. BMJ Open. .

Abstract

Objectives: This study documents the time elapsed from the diagnosis of osteonecrosis of the femoral head (ONFH) to surgery, exploring the factors that influence ONFH severity.

Design: Retrospective observational study of a nationwide database.

Setting: The Kaplan-Meier method with log-rank tests was applied to examine the period from definitive diagnosis of ONFH to surgery using any surgery as the end point. For bilateral cases, the date of the first surgery was the endpoint.

Participants: This study included 2074 ONFH cases registered in 34 university hospitals and highly specialised hospitals of the multicentre sentinel monitoring system of the Japanese Investigation Committee between 1997 and 2018.

Main outcome measure: The primary outcome was the time from diagnosis to surgery. The secondary outcome was the proportion of subjects remaining without surgery at 3, 6 and 9 months, and at 1, 2 and 5 years after diagnosis.

Results: The median time to surgery was 9 months (IQR 4-22 months) after diagnosis of ONFH. The time to surgery was significantly shorter in the alcohol alone group and the combined corticosteroid and alcohol group than in the corticosteroid alone group (p=0.018 and p<0.001, respectively), in early stage ONFH with no or mild joint destruction (stages II and III, p<0.001), and with joint preserving surgery (p<0.001). The proportion without surgery was 75.8% at 3 months, 59.6% at 6 months, 48.2% at 9 months, 40.5% at 1 year, 22.2% at 2 years and 8.3% at 5 years.

Conclusion: ONFH has been considered to be an intractable disease that often requires surgical treatment, but the fact that surgery was performed in more than half of the patients within 9 months from diagnosis suggests severe disease with a significant clinical impact.

Trial registration number: Chiba University ID1049.

Keywords: EPIDEMIOLOGY; Factor Analysis, Statistical; Hip; REGISTRIES; RHEUMATOLOGY.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
The proportion of subjects remaining without surgery from definitive ONFH diagnosis. (A) Associated factors; (B) old type classification; (C) old stage classification; (D) surgical procedures. ONFH, osteonecrosis of the femoral head.
Figure 2
Figure 2
The proportion of subjects remaining without surgery from definitive ONFH diagnosis (subanalysis 1). Associated factors for (A) joint preserving surgery and (B) joint replacement surgery. Old stage classification for (C) joint preserving surgery and (D) joint replacement surgery. ONFH, osteonecrosis of the femoral head.
Figure 3
Figure 3
The proportion of subjects remaining without surgery from definitive ONFH diagnosis (subanalysis 2). (A) Joint preserving surgery and old type classification; (B) joint replacement surgery and old type classification; (C) comparison of surgical procedures in type B ONFH; (D) comparison of surgical procedures in type C ONFH. ONFH, osteonecrosis of the femoral head.
Figure 4
Figure 4
The proportion of subjects remaining without surgery from definitive ONFH diagnosis (subanalysis 3). Comparison of surgical procedures in (A) stage II; (B) stage III; (C) stage IV. ONFH, osteonecrosis of the femoral head.
See this image and copyright information in PMC

References

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