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Chen M, Wang X, Takahashi E, Kaneuji A, Zhou Y, Kawahara N. Current Research on Subchondral Insufficiency Fracture of the Femoral Head. Clin Orthop Surg 2022; 14:477-485. [PMID: 36518923 PMCID: PMC9715932 DOI: 10.4055/cios22175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 09/06/2023] Open
Abstract
Subchondral insufficiency fracture (SIF) of the femoral head is one of the predominant etiologies of rapidly progressive osteoarthritis of the hip (RPOH). SIF is a rare disease that causes acute pain in the hip joint. It is most frequently found in elderly women with osteoporosis. It is often underdiagnosed or misdiagnosed as osteonecrosis of the femoral head. SIF is currently a well-established cause of RPOH; however, the deeper etiology of SIF is not clear. Good clinical outcomes have been reported for hip preservation therapy and hip replacement. SIF is not obvious radiologically in the early stage, and a T1-weighted magnetic resonance imaging shows a discontinuous low-intensity band under the articular cartilage convex to the articular surface as its characteristic manifestation. Some patients will lose the opportunity to preserve the hip joint due to symptoms such as progressive joint space narrowing and subchondral collapse within a very short period. Patients with progressive hip space narrowing and subchondral collapse on X-ray should be converted to total hip arthroplasty. Based on the characteristics of the disease, surgeons need to master the clinical and radiological characteristics of SIF and strive for early diagnosis and treatment.
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Affiliation(s)
- Mingliang Chen
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada-machi, Japan
- Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Yichang, China
| | - Xipeng Wang
- Department of Orthopaedic Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Eiji Takahashi
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada-machi, Japan
| | - Ayumi Kaneuji
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada-machi, Japan
| | - You Zhou
- Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Yichang, China
| | - Norio Kawahara
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada-machi, Japan
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Xu M, Motomura G, Utsunomiya T, Ikemura S, Yamaguchi R, Hatanaka H, Baba S, Kawano K, Nakashima Y. Traumatic subchondral fracture of the femoral head occurring concurrently with contralateral acetabular fracture. J Orthop Sci 2022; 27:495-499. [PMID: 31208823 DOI: 10.1016/j.jos.2019.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/09/2019] [Accepted: 05/26/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Mingjian Xu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Takeshi Utsunomiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Ryosuke Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hiroyuki Hatanaka
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shoji Baba
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Koichiro Kawano
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Gaudiani MA, Samuel LT, Mahmood B, Sultan AA, Kamath AF. Subchondral insufficiency fractures of the femoral head: systematic review of diagnosis, treatment and outcomes. J Hip Preserv Surg 2019; 7:85-94. [PMID: 32382434 PMCID: PMC7195931 DOI: 10.1093/jhps/hnz054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/16/2019] [Accepted: 10/03/2019] [Indexed: 12/31/2022] Open
Abstract
Subchondral insufficiency fractures of the femoral head (SIFFH) are a cause of femoral head collapse leading to degenerative hip disease. SIFFH is often mistaken for osteonecrosis given similar clinical and radiographic features. These similarities often lead to missed or delayed diagnosis which can often delay or change management. The purpose of this article is to systematically review the spectrum of demographics, diagnostic and treatment options, including hip preservation in young patient populations. A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. All related peer-reviewed publications from January 1999 to January 2019 were reviewed using the following databases: Medline, EMBASE, Scopus and Web of Science. The systematic review identified 54 articles, encompassing 482 patients (504 hips) diagnosed with SIFFH. One hundred and seventy-six (35%) males and 306 (63%) females were included, with a mean age of 53.6 ± 17.5 years and mean body mass index of 23.4 ± 4.0 kg/m2. Mean follow-up was 23.4 ± 15.9 months. Treatment decisions were 256 (55%) non-operative, 157 (34%) total hip arthroplasty (THA), 24 (5%) transtrochanteric anterior rotational osteotomy, 9 (2%) hip arthroscopy, 7 (2%) hip resurfacing, 3 (1%) bone grafting, 3 (1%) hemiarthroplasty and 1 (1%) tantalum rod insertion. Overall, 35% of SIFFH hips were converted to THA at latest follow-up. A majority of SIFFH patients had symptom resolution with non-operative management. Failure most often resulted in THA. In younger patients, hip preservation techniques have shown promising early results and should be considered as an alternative.
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Affiliation(s)
- Michael A Gaudiani
- School of Medicine, Case Western Reserve University, 2109 Adelbert Rd, Cleveland, OH 44106, USA
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue A41, Cleveland, OH 44123, USA
| | - Bilal Mahmood
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue A41, Cleveland, OH 44123, USA
| | - Assem A Sultan
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue A41, Cleveland, OH 44123, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue A41, Cleveland, OH 44123, USA
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