Each author certifies that he has no commercial associations (eg consultancies, stock ownership, equity interest, patent/licencing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. a subchondral collapse requiring operative treatment [4]. Predictors of cartilage degeneration in patients with subchondral insufficiency fracture of the femoral head: a retrospective study. -, Fukui K, Kaneuji A, Fukushima M, Matsumoto T. Inversion of the acetabular labrum triggers rapidly destructive osteoarthritis of the hip: representative case report and proposed etiology. Statistical analysis was utilized to calculate mean age, mean BMI, prevalence of bone marrow edema (BME) on magnetic resonance imaging (MRI), prevalence of treatment, etiology, mean follow-up and prevalence of outcome of SIFFH on diagnosis. More recently, SIFFH has been shown to be histopathologically different from osteonecrosis, another cause of femoral head collapse [2, 3]. Treatment decisions were: 256 (55%) non-operative, 157 (34%) THA, 24 (5%) TARO, 9 (2%) hip arthroscopy, 7 (2%) hip resurfacing, 3 (1%) bone grafting, 3 (1%) hemiarthroplasty and 1 (1%) tantalum rod insertion. Because of the diversity of etiologies of SIFFH, it is difficult to highlight reasons for worsening and even among similar etiological cohorts there exists variation of recovery or worsening. ADL, activities of daily living; BMI, body mass index; F, female; HHS, Harris Hip score; M, male; m, statistical median used; mHHS, modified Harris Hip score; SD, standard deviation; TARO, transtrochanteric anterior rotational osteotomy. Accessibility Ikemura S, Yamamoto T, Nakashima Y et al. MRI was the most commonly used imaging modality to diagnose SIFFH, and there has been extensive research on the diagnostic signs of SIFFH. Usefulness of arthroscopic surgery in hip trauma cases. We found SIFFH to be shown in a wide variety of adult patients. Bone fragility has been purported as an important cause of SIFFH and the typical patient described is an elderly female [4–7]. Mean age was 53.6 ± 17.5 years and mean BMI was 23.4 ± 4.0 kg/m2. 2005 Sep;21(9):1120-5. doi: 10.1016/j.arthro.2005.05.021. Informed consent has been obtained from all study patients. She had a limited range of motion of 90° of flexion and 15° of internal rotation. There is a reported 23-34% increase in mortality over eight years 1.The vertebral fracture may only be one of many active medical issues and the treatment plan should be patient-specific. See this image and copyright information in PMC. Overall, 35% of SIFFH hips were converted to THA at latest follow-up. case of subchondral insufficiency fracture in both the femoral head and acetabulum has been reported to undergo rapid dis-appearance of the joint space13. Clin Orthop Relat Res. Values were compared against the patient acceptable symptomatic state (PASS) reported by Chahal et al. MRI was the dominant mode of diagnosis. Chosa E, Tajima N. Anterior acetabular head index of the hip on false-profile views. Following the two independent authors (MAG, LTS) search of the previously stated databases, a total of 120 citations were identified. Methods: Keywords: For full access to this pdf, sign in to an existing account, or purchase an annual subscription. These similarities often lead to missed or delayed diagnosis which can often delay or change management. A systematic approach to the plain radiographic evaluation of the young adult hip. 6. Because of this variability, there is little consensus as to the appropriate treatment option for a patient with SIFFH. Data collected from the studies was level of evidence, number of patients with SIFFH, mean age, mean body mass index (BMI), primary diagnosis imaging modality, treatment, purposed etiology, mean follow-up and outcome of SIFFH post-diagnosis. [18]. With stress/insufficiency fractures, pain is meant to be a protective response. J Bone Joint Surg Am. Our inclusion criteria consisted of English language or articles with English translations, studies with patients’ gender and age with SIFFH and reporting of treatment of SIFFH. Clinical and Radiographic Predictors for Worsened Clinical Outcomes After Hip Arthroscopic Labral Preservation and Capsular Closure in Developmental Dysplasia of the Hip. A conservative treatment modality to control symptoms during rehabilitation has not previously been described. Nine patients (median age 49.0 years, range 43-65, five female and four male patients) with SIFFH who underwent arthroscopic treatment with labral repair, capsular closure and internal fixation of SIFFH using HA/PLLA pins were retrospectively reviewed. Acetabular labral tears were found in all patients, and a mix of femoroacetabular impingement and dysplasia morphology was found. Iwasaki K, Yamamoto T, Nakashima Y et al. Two incisions are for the arthroscopic “scope” portion … When provided, these values were calculated using an unpaired Student’s t-test. SIFFH is associated with bony deformities and labral tears. [18]. BME is fluid exudation caused by the chronic inflammation and proliferating fibroblasts [15]. A consensus for any uncertainties was reached with the help of a third author (BM). The outcome of subchondral in-sufficiency fracture is thus unclear. According to various suggestions, conservative treatment is mainly based on restricting the load to the affected limb combined with use of anti-inflammatory and analgesic agents for 3 to 8 months according to the progression of symptoms and … Inclusion criteria were adult patients with precollapse SIFFH with minimum 1-year follow-up (median follow-up 30.0 months, range 12-56). Utsunomiya T, Yamamoto T, Motomura G et al. Often your doctor can determine that you have a hip fracture based on your symptoms and the abnormal position of your hip and leg. Yamamoto and Bullough [2, 13, 19] described SIFFH patients to be an elderly female with a high BMI, and, due to the prevalence of osteoporosis, this characterization has continued throughout the literature, even in recently published studies. A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and checklist [17]. Knee Surg Sports Traumatol Arthrosc. CONCLUSIONS: Hip fractures and SIF are highly prevalent in TIO patients. 2010 Jun;18(2):100-7. doi: 10.1097/JSA.0b013e3181dc652e. doi: 10.1302/0301-620X.85B6.14146. Pain is better managed by immobilization or modifying activity. Insufficiency fractures of the spine are often a sign of frailty. On imaging, there is a similar BME pattern and increased signal intensity on T2 MRI [27]. Studies involving subchondral insufficiency fractures of the femoral head (SIFFH) managed with hip preservation surgery. Sonoda et al. Recovery can be a period of weeks or months depending on the severity and location. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. The mean follow-up was 23.4 ± 15.9 months. The role of subchondral insufficiency fracture in rapid destruction of the hip joint: a preliminary report Arthritis Rheum , 43 ( 11 ) ( 2000 ) , pp. Osteonecrosis has a smooth low intensity band due to circumscription of necrotic segments [22]. Oxford University Press is a department of the University of Oxford. doi: 10.1177/0363546513499154. These studies used the crescent sign, a less radiolucent linear defect, with a slight sclerotic rim which is typically associated with osteonecrosis [2, 8]. A.F.K. Subchondral insufficiency fractures of the knee are commonly misdiagnosed fractures that are both very painful and difficult to treat. Also, the etiology and diagnostic standards for SIFFH has evolved over the past decades; therefore, it is always possible that patients captured in earlier studies might have different outcomes impacting overall results. Honda E, Utsunomiya H, Hatakeyama A, Nakashima H, Suzuki H, Matsuda DK, Sakai A, Uchida S. Knee Surg Sports Traumatol Arthrosc. More research is needed to determine which diagnostic features affect prognosis of SIFFH. All statistical analyses were performed using Microsoft Excel software (Version 16.16.17, Microsoft, Redmond, WA, USA). Each search included the following terms: subchondral AND insufficiency AND fracture AND femoral AND head. An alternative were observed in all patients, we reported the ages of cases separately arthritis or fracture should considered... 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On the severity and location two-year clinical outcomes of a joint is less clear in the differential is transient.
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