13 June 2023: Review Articles
Review of the Pathogenesis, Diagnosis, and Management of Osteoradionecrosis of the Femoral Head
Yang Li 12EF , Zhongsheng Zhou 12BC , Shenghao Xu 1B , Jinlan Jiang 2A , Jianlin Xiao 1AE*DOI: 10.12659/MSM.940264
Med Sci Monit 2023; 29:e940264
Table 1 Differential diagnosis of diseases analogous to osteoradionecrosis of the femoral head.
| Diseases | Age predilection | Sex predilection | Etiology | Unilateral or bilateral | Acetabulum involved or not | Diagnosis elements |
|---|---|---|---|---|---|---|
| Osteoradionecrosis of hip | Adults and the elderly | No sex differences | Radiation | Bilateral | Yes | History of radiation therapy;MRI: cetabula, pubis, femoral head and upper femur demonstrated long T1 and T2 signals |
| Osteoarthritis | Middle-aged and older | No sex differences | Degeneration | Bilateral | Yes | CT: sclerotic bone and cystic change;MRI: crescent sign |
| Acetabular dysplasia secondary | Children and youth | Female | Genetic factors | Bilateral | Yes | X-rays: hip joint dislocation, hip joint space narrowing and features of secondary osteoarthritis |
| Ankylosing spondylitis involving the hip | Teenagers | Male | Genetic factors and environment | Bilateral | Yes | HLA-B27(+), sacroiliac joint erosions and iliac side subchondral sclerosis |
| Idiopathic transient osteoporosis of the hip (ITOH) | Middle-aged and youth | No sex differences | None | Unilateral | No | MRI: low signal intensity on T1WI, high signal intensity on T2WI, extending from the femoral head to the intertrochanteric region |
| Chondroblastoma in femoral head | Children and teenager | Male | Unclear | Unilateral | No | CT: irregular dissolved bone;MRI: high signal intensity on T2WI |
| Subchondral insufficiency fracture | Elderly | Female | Osteoporosis | Unilateral | No | X-rays: femoral head becomes flat;MRI: subchondral low signal intensity on T1WI and T2WI, with bone marrow edema pattern |
| Pigmented villonodular synovitis | Young adults | No sex differences | None | Unilateral | Yes | X-rays and CT: hip joint space narrowing;MRI: extensive thickening of the joint lining or an extensive mass, possibly with destructive bone changes |
| Bone Infarction | Unclear | Unclear | Unclear | Bilateral | No | MRI: high signal intensity on T2WI, characteristic double-line sign, which consists of a hyperintense inner ring and a hypointensity outer ring |
| CT – computed tomography; MRI – magnetic resonance imaging. | ||||||