title: Clinical outcomes in relation to locations of bone marrow edema lesions in patients with a subchondral insufficiency fracture of the hip: a review of fifteen cases.
abstract: OBJECTIVE
  The prognosis of patients with a subchondral insufficiency fracture remains unclear. The purpose of this study was to investigate the correlation between locations of bone marrow edema (BME) lesions and clinical outcome in patients with a subchondral insufficiency fracture of the hip.
  
  
  METHODS
  We retrospectively reviewed 15 consecutive hips in 14 patients who were diagnosed with subchondral insufficiency fracture of the hip at our institution between April 2013 and September 2014. This study included five males (six hips) and nine females (nine hips), ranging from 36 to 83 years of age (mean age: 66 years). The mean duration from the onset of hip pain to MRI examination was 1.8 months (range 0.5-5 months). Both clinical and imaging findings were investigated.
  
  
  RESULTS
  Based on the findings of MR images, BME lesion in the femoral head alone was observed in six patients (six hips), BME lesion in the acetabulum alone was observed in one patient (two hips) and BME lesions in both the femoral head and acetabulum were observed in seven patients (seven hips). 3 of 15 hips resulted in rapidly destructive arthrosis and their BME lesions were observed in both the femoral head and acetabulum. 8 of 15 hips successfully healed by conservative treatment and BME lesions in 7 of these 8 hips were observed in only the femoral head or acetabulum.
  
  
  CONCLUSIONS
  The results of this study indicate that the locations of BME lesions (femoral side alone, acetabular side alone or both) may be related to the clinical outcome in patients with a subchondral insufficiency fracture of the hip.
  
  
  CONCLUSIONS
  Patients with subchondral insufficiency fracture of the hip in whom BME lesions were observed in both the femoral head and acetabulum may have a higher risk to need to undergo total hip arthroplasty.
authors.affiliation: Department of Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ikemura
authors.affiliation: Department of Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Mawatari
authors.affiliation: Department of Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka, Japan.
authors.forename: Gen
authors.initials: G
authors.lastname: Matsui
authors.affiliation: Department of Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Iguchi
authors.affiliation: Department of Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Mitsuyasu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D001853:Bone Marrow / Q000000981:diagnostic imaging* / Q000473:pathology*; D004487:Edema / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D005260:Female; D015775:Fractures, Stress / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D006620:Hip Fractures / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies