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Updated: Jun 16, 2025
Augmented Reality Navigation-Guided Core Decompression for Osteonecrosis of Femoral Head
Published on: April 12, 2022
Predicting Progression of Traumatic Osteonecrosis of the Femoral Head Based on Magnetic Resonance Imaging
Shihua Gao1, Changyu Huang2, Tiantian Xia2
1Department of Orthopaedics, Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, China; Department of Orthopaedics, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; Traumatology & Orthopedics Institute of Guangzhou, University of Chinese Medicine, Guangzhou, China.
Background:
The purpose of our study was to develop a novel magnetic resonance imaging classification system to predict the progression of traumatic osteonecrosis of the femoral head (TONFH) in young adults and assess its clinical implications.
Methods:
A retrospective cohort study was conducted from January 2007 to December 2022, including 134 hips (134 patients, mean age 41 years (range, 21 to 43), 65.7% men) diagnosed with TONFH at Association Research Circulation Osseous Stage I. The bone repair band (BRB) classification system categorized lesions into Superficial (Type S), Uncertain (Type U), and Extensive (Type E) based on magnetic resonance imaging coronal views. Patients were followed with observational treatment and x-ray assessments. Radiographic signs and femoral head collapse were evaluated during follow-up. Survival analysis and Cox proportional hazards regression assessed the association between BRB classification and disease progression.
Results:
The 134 hips were categorized into Type S (n = 54), Type U (n = 21), and Type E (n = 59). Over a mean follow-up of 39.6 months, radiographic signs were most prevalent in Type E (94.9%) and least in Type S (9.3%), with median times to radiographic signs of 18 months for Type U and 16 months for Type E. Femoral head collapse occurred in 50.8% of Type E, 23.8% of Type U, and none in Type S, with a median time to collapse of 34 months for Type E. Both univariate and multivariate analyses identified BRB classification as an independent predictor of disease progression, with Type E showing the highest risk for adverse outcomes.
Conclusions:
The newly proposed BRB classification provides a systematic approach to assessing necrotic lesion severity in TONFH and demonstrates significant correlation with femoral head collapse risk. Future studies are needed to further validate its clinical significance and explore the anatomical basis underlying this classification.
