Three-dimensional mapping of necrotic lesions for early-stage osteonecrosis of the femoral head

Wen An ^1,2,3,4, Yanjiang Yang ^1,2,3, Wei He ^1,2,3,5

¹Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.
²Orthopaedic Research Institute of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
³Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
⁴Department of Orthopaedics, Qinhuangdao First Hospital, Hebei Medical University, Qinhuangdao, 066000, Hebei, People's Republic of China.
⁵Department of Orthopaedics, Hebei Chest Hospital, Shijiazhuang, 050041, People's Republic of China.
⁶Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China. 809776478@qq.com.
⁷Orthopaedic Research Institute of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. 809776478@qq.com.
⁸Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. 809776478@qq.com.
⁹Department of Orthopaedics, the 3rd Hospital, Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China. 809776478@qq.com.
¹⁰Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China. yzzhang@hebmu.edu.cn.
¹¹Orthopaedic Research Institute of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. yzzhang@hebmu.edu.cn.
¹²Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. yzzhang@hebmu.edu.cn.
¹³NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, 050051, Hebei, People's Republic of China. yzzhang@hebmu.edu.cn.
¹⁴Hebei Orthopaedic Clinical Research Center, Shijiazhuang, 050051, Hebei, People's Republic of China. yzzhang@hebmu.edu.cn.
¹⁵Department of Orthopaedics, the 3rd Hospital, Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China. yzzhang@hebmu.edu.cn.

⁰Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.

Journal of Orthopaedic Surgery and Research +

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September 18, 2024

View abstract on PubMed

Summary

Necrotic lesion location in early osteonecrosis of the femoral head (ONFH) depends on size. Smaller lesions concentrate anteromedially, while larger ones spread laterally and inferiorly, guiding joint-preserving surgery.

Area Of Science

Orthopedics
Radiology
Medical Imaging

Background

Limited evidence exists on necrotic lesion size and location in early osteonecrosis of the femoral head (ONFH).
Understanding these patterns is crucial for effective joint-preserving treatments.
This study aimed to map lesion distribution in early ONFH.

Purpose Of The Study

To characterize the distribution patterns of necrotic lesions in early-stage ONFH.
To correlate lesion size with specific locations within the femoral head.
To utilize 3D mapping for detailed spatial analysis of ONFH lesions.

Main Methods

Retrospective analysis of CT images from patients with stage I and II ONFH (2018-2022).
Reconstruction of 3D femoral head structures, dividing them into eight regions.
Superimposition of lesion images onto a standard template for 3D mapping and concentration analysis.

Main Results

Analysis of 150 hips from 143 patients with stage I/II ONFH.
Lesions <15% femoral head volume concentrated in regions I, III, V (I most concentrated).
Lesions 15-30% spread to regions I, II, III, IV, V, VII (concentrated in I, III, V).
Lesions >30% extensively involved the femoral head with expanded concentrated areas.

Conclusions

Necrotic lesion distribution in ONFH is size-dependent.
Smaller lesions are anterior/medial (anterosuperior focus); larger lesions extend laterally/inferiorly.
Findings improve ONFH classification and inform hip-preserving surgical planning.

Keywords:

Computed tomography Osteonecrosis of femoral head Three-dimensional distribution Three-dimensional mapping