title: Subchondral insufficiency fracture of the femoral head in elderly people.
abstract: We evaluated the clinical course of subchondral insufficiency fracture of the femoral head (SIFFH) and its characteristic findings with special regard to joint space narrowing (JSN). Thirty-one cases of SIFFH of mean age 68.9 yr initially underwent limited weight-bearing conservative treatment. During the follow-up period, the patients with intractable pain underwent total hip arthroplasty (THA). For radiographic evaluation, lateral center-edge angle, JSN and femoral head collapse (FHC) were documented, and the extent of FHC was classified as mild (<2 mm), moderate (2-4 mm), and severe (>4 mm). The progression or new development of FHC more than 2 mm was evaluated on sequential plain radiographs. The relationship between radiographic parameters and clinical outcomes were evaluated. THAs were performed in 15 cases (48.4%). There was no significant correlation between clinical outcomes and the extent of initial FHC. However, a significantly larger proportion of patients that underwent THA showed JSN and FHC progression compared to the symptom improvement group. The risk factor significantly associated with failed conservative treatment was JSN (P=0.038; OR, 11.8; 95% CI, 1.15-122.26). Clinical results of conservative treatment for SIFFH in elderly patients are relatively poor. The patients with JSN are at higher risk of failed conservative treatment.
authors.affiliation: Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Pil Whan
authors.identifier: 0000-0001-7354-0989
authors.initials: PW
authors.lastname: Yoon
authors.affiliation: Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hong Suk
authors.identifier: 0000-0001-5204-6201
authors.initials: HS
authors.lastname: Kwak
authors.affiliation: Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jeong Joon
authors.identifier: 0000-0002-6304-0101
authors.initials: JJ
authors.lastname: Yoo
authors.affiliation: Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Kang Sup
authors.identifier: 0000-0001-5917-1881
authors.initials: KS
authors.lastname: Yoon
authors.affiliation: Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hee Joong
authors.identifier: 0000-0002-3994-5672
authors.initials: HJ
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D015992:Body Mass Index; D018450:Disease Progression; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging* / Q000473:pathology; D006620:Hip Fractures / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011859:Radiography; D012307:Risk Factors
keywords: Bone; Fractures; Hip; Outcome Assessment (Health Care); Risk Factors
references.citation: AJR Am J Roentgenol. 2008 Oct;191(4):995-1001
references.pmid: 18806133
references.citation: Eur Radiol. 2004 Feb;14(2):201-7
references.pmid: 12851782
references.citation: J Orthop Surg (Hong Kong). 2010 Dec;18(3):271-5
references.pmid: 21187533
references.citation: Skeletal Radiol. 2009 Sep;38(9):925-8
references.pmid: 19418050
references.citation: J Bone Joint Surg Am. 2011 Feb 2;93(3):303-10
references.pmid: 21266644
references.citation: Clin Orthop Relat Res. 2007 Nov;464:196-204
references.pmid: 17975377
references.citation: Arch Orthop Trauma Surg. 2005 Jul;125(6):410-3
references.pmid: 15940505
references.citation: J Comput Assist Tomogr. 2003 Mar-Apr;27(2):189-93
references.pmid: 12703011
references.citation: Ann Rheum Dis. 2006 Jun;65(6):837-8
references.pmid: 16699059
references.citation: J Bone Joint Surg Am. 2004 Sep;86(9):1917-24
references.pmid: 15342753
references.citation: J Arthroplasty. 2003 Apr;18(3):377-82
references.pmid: 12728434
references.citation: Arthritis Rheum. 2005 Apr;52(4):1293-6
references.pmid: 15818681
references.citation: Orthop Clin North Am. 2009 Apr;40(2):259-65
references.pmid: 19358911
references.citation: Clin Orthop Surg. 2012 Sep;4(3):173-80
references.pmid: 22949947
references.citation: Arthritis Rheum. 1999 Dec;42(12):2719-23
references.pmid: 10616023
references.citation: Arch Orthop Trauma Surg. 2009 May;129(5):583-9
references.pmid: 18542974
references.citation: Mod Rheumatol. 2008;18(6):619-22
references.pmid: 18584289
references.citation: Ann Rheum Dis. 2008 Feb;67(2):150-3
references.pmid: 17526549
references.citation: AJR Am J Roentgenol. 2002 Feb;178(2):435-7
references.pmid: 11804912