The predictive value of hemodynamic studies in preclinical ischemic necrosis of bone

This study evaluated the predictive value of bone marrow pressures and intraosseous venography in joints at risk for developing ischemic necrosis of bone. Forty-two patients with ischemic necrosis of bone had hemodynamic studies performed on their contralateral, asymptomatic joint. A followup evaluation of symptoms and radiographs was obtained to establish the prevalence of clinical ischemic necrosis in the index joints. Thirty-six of 48 joints had increased bone marrow pressure and of these, 15 (42%) developed histologically or radiographically confirmed ischemic necrosis of bone. In none of the 12 bones with normal bone marrow pressure did ischemic necrosis of bone occur (p = 0.005). Venography was also significantly predictive for ischemic necrosis of bone, both alone and in conjunction with bone marrow pressure. Our study reaffirms the risk of developing bilateral ischemic necrosis of bone (31% at a mean followup of 47 months) once the diagnosis has been made on one side. Bone pressure measurements are of predictive value in establishing those joints which require close clinical followup so that detection of disease may be in the precollapse stage of ischemic necrosis of bone.