Prediction of posttraumatic femoral head osteonecrosis by quantitative intraosseous aspirate and core biopsy analysis: a prospective study.
Twenty-two patients with unreduced hip dislocation or fracture dislocation were prospectively evaluated. Intraosseous aspiration, marrow fluid analysis and core biopsy histological analysis was performed from the supero-lateral (test group) and central part (control group) of the femoral head. After appropriate surgical treatment and postoperative management, they were followed up for 2 years by clinical, radiological and magnetic resonance imaging evaluation. Eight patients eventually developed avascular necrosis (AVN) of the femoral head. The analysis of test samples revealed that 9 patients had an aspirate volume of < 1 cc ; marrow morphology of 11 hips showed necrotic cells; 12 patients had a core biopsy histology suggestive of dead osseous fragments and necrotic osteocytes. In contrast, all the control samples had an aspirate volume of > 1cc and showed viable cells on histology. Intra-operative assessment of marrow-aspirate volume (< 1cc), marrow morphology and core biopsy histology from the superolateral part of femur head can fairly predict the development of subsequent ONFH after trauma; the correlation is statistically significant (p < 0.05).
Department of Orthopaedics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. senrameshpgi@yahoo.in
Ramesh Kumar
RK
Sen
Sujit Kumar
SK
Tripathy
Shivinder Singh
SS
Gill
Neelam
N
Verma
Paramjeet
P
Singh
Bishan Dass
BD
Radotra
D000328:Adult; D001707:Biopsy, Needle; D001856:Bone Marrow Examination; D005260:Female; D005270:Femur Head / Q000473:pathology; D005271:Femur Head Necrosis / Q000175:diagnosis / Q000209:etiology*; D006617:Hip Dislocation / Q000150:complications* / Q000628:therapy; D006620:Hip Fractures / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult