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Osteonecrosis of Hip
Cheryl A. Petersilge, MD, MBA; B.J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Ischemic necrosis, osteonecrosis (ON), aseptic necrosis, avascular necrosis
            • Definitions

              • Necrosis of cellular elements of bone 2° to ischemia

            IMAGING

            • General Features

              • Imaging Recommendations

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Nuclear Medicine Findings

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Reporting Tips

                                              Selected References

                                              1. Koren L et al: Hyperbaric oxygen for stage I and II femoral head osteonecrosis. Orthopedics. 38(3):e200-5, 2015
                                              2. Lee GC et al: How do radiologists evaluate osteonecrosis? Skeletal Radiol. 43(5):607-14, 2014
                                              3. Theysohn JM et al: Hip imaging of avascular necrosis at 7 Tesla compared with 3 Tesla. Skeletal Radiol. 43(5):623-32, 2014
                                              4. Vahid Farahmandi M et al: Midterm results of treating femoral head osteonecrosis with autogenous corticocancellous bone grafting. Trauma Mon. 19(4):e17092, 2014
                                              5. Viana SL et al: MRI of subchondral fractures: a review. Skeletal Radiol. 43(11):1515-27, 2014
                                              6. Sakamoto Y et al: Osteonecrosis of the femoral head extending into the femoral neck. Skeletal Radiol. 42(3):433-6, 2013
                                              7. Min BW et al: Untreated asymptomatic hips in patients with osteonecrosis of the femoral head. Clin Orthop Relat Res. 466(5):1087-92, 2008
                                              8. Ito H et al: Relationship between bone marrow edema and development of symptoms in patients with osteonecrosis of the femoral head. AJR Am J Roentgenol. 186(6):1761-70, 2006
                                              9. Huang GS et al: MR imaging of bone marrow edema and joint effusion in patients with osteonecrosis of the femoral head: relationship to pain. AJR Am J Roentgenol. 181(2):545-9, 2003
                                              10. Stevens K et al: Subchondral fractures in osteonecrosis of the femoral head: comparison of radiography, CT, and MR imaging. AJR Am J Roentgenol. 180(2):363-8, 2003
                                              11. Zurlo JV: The double-line sign. Radiology. 212(2):541-2, 1999
                                              12. Poggi JJ et al: Changes on magnetic resonance images after traumatic hip dislocation. Clin Orthop Relat Res. (319):249-59, 1995
                                              13. Steinberg ME et al: A quantitative system for staging avascular necrosis. J Bone Joint Surg Br. 77(1):34-41, 1995
                                              14. Vande Berg BE et al: MR imaging of avascular necrosis and transient marrow edema of the femoral head. Radiographics. 13(3):501-20, 1993
                                              15. Mitchell DG et al: Femoral head avascular necrosis: correlation of MR imaging, radiographic staging, radionuclide imaging, and clinical findings. Radiology. 162(3):709-15, 1987
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        TERMINOLOGY

                                                        • Synonyms

                                                          • Ischemic necrosis, osteonecrosis (ON), aseptic necrosis, avascular necrosis
                                                        • Definitions

                                                          • Necrosis of cellular elements of bone 2° to ischemia

                                                        IMAGING

                                                        • General Features

                                                          • Imaging Recommendations

                                                            • Radiographic Findings

                                                              • CT Findings

                                                                • MR Findings

                                                                  • Nuclear Medicine Findings

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Staging, Grading, & Classification

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Reporting Tips

                                                                                          Selected References

                                                                                          1. Koren L et al: Hyperbaric oxygen for stage I and II femoral head osteonecrosis. Orthopedics. 38(3):e200-5, 2015
                                                                                          2. Lee GC et al: How do radiologists evaluate osteonecrosis? Skeletal Radiol. 43(5):607-14, 2014
                                                                                          3. Theysohn JM et al: Hip imaging of avascular necrosis at 7 Tesla compared with 3 Tesla. Skeletal Radiol. 43(5):623-32, 2014
                                                                                          4. Vahid Farahmandi M et al: Midterm results of treating femoral head osteonecrosis with autogenous corticocancellous bone grafting. Trauma Mon. 19(4):e17092, 2014
                                                                                          5. Viana SL et al: MRI of subchondral fractures: a review. Skeletal Radiol. 43(11):1515-27, 2014
                                                                                          6. Sakamoto Y et al: Osteonecrosis of the femoral head extending into the femoral neck. Skeletal Radiol. 42(3):433-6, 2013
                                                                                          7. Min BW et al: Untreated asymptomatic hips in patients with osteonecrosis of the femoral head. Clin Orthop Relat Res. 466(5):1087-92, 2008
                                                                                          8. Ito H et al: Relationship between bone marrow edema and development of symptoms in patients with osteonecrosis of the femoral head. AJR Am J Roentgenol. 186(6):1761-70, 2006
                                                                                          9. Huang GS et al: MR imaging of bone marrow edema and joint effusion in patients with osteonecrosis of the femoral head: relationship to pain. AJR Am J Roentgenol. 181(2):545-9, 2003
                                                                                          10. Stevens K et al: Subchondral fractures in osteonecrosis of the femoral head: comparison of radiography, CT, and MR imaging. AJR Am J Roentgenol. 180(2):363-8, 2003
                                                                                          11. Zurlo JV: The double-line sign. Radiology. 212(2):541-2, 1999
                                                                                          12. Poggi JJ et al: Changes on magnetic resonance images after traumatic hip dislocation. Clin Orthop Relat Res. (319):249-59, 1995
                                                                                          13. Steinberg ME et al: A quantitative system for staging avascular necrosis. J Bone Joint Surg Br. 77(1):34-41, 1995
                                                                                          14. Vande Berg BE et al: MR imaging of avascular necrosis and transient marrow edema of the femoral head. Radiographics. 13(3):501-20, 1993
                                                                                          15. Mitchell DG et al: Femoral head avascular necrosis: correlation of MR imaging, radiographic staging, radionuclide imaging, and clinical findings. Radiology. 162(3):709-15, 1987