Evolutionary course of the femoral head osteonecrosis: Histopathological - radiologic characteristics and clinical staging systems

Osteonecrosis of the femoral head (ONFH) is a recalcitrant ischemic disorder, which could be classified into two major categories: traumatic and nontraumatic. Regardless of different risk factors, it has been testified that ONFH results from primitive vascular problems, leading to temporary or perma...

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Autores principales:	Yiwei Chen, Yu Miao, Kexin Liu, Feng Xue, Bin Zhu, Changqing Zhang, Guangyi Li
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2022
Materias:	Osteonecrosis of the femoral head Pathogenesis Histopathology Microarchitecture Imaging Staging Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/4f4cfe8dd3b74ae28684cafe17cc65e0
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spelling	oai:doaj.org-article:4f4cfe8dd3b74ae28684cafe17cc65e02021-11-28T04:32:22ZEvolutionary course of the femoral head osteonecrosis: Histopathological - radiologic characteristics and clinical staging systems2214-031X10.1016/j.jot.2021.07.004https://doaj.org/article/4f4cfe8dd3b74ae28684cafe17cc65e02022-01-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2214031X21000589https://doaj.org/toc/2214-031XOsteonecrosis of the femoral head (ONFH) is a recalcitrant ischemic disorder, which could be classified into two major categories: traumatic and nontraumatic. Regardless of different risk factors, it has been testified that ONFH results from primitive vascular problems, leading to temporary or permanent loss of blood supply to bone tissue. Histopathological and microarchitectural alterations ensues, which is a gradual evolutionary process involving bone marrow and osteocyte necrosis, progressive destruction of subchondral bone, unsuccessful reparative process, and eventual articular collapse and degenerative arthritis. Based on the imaging features of ONFH, different classification systems have been developed to evaluate the severity and prognosis of the disease, which is pivotal for implementation of treatment strategy, especially the joint-preserving surgery. However, patients classified with the same severity stage, especially in the peri-collapse stage, sometimes responded differently after similar joint-preserving surgery. The unusual phenomenon may be attributed to the limitation of the current imaging classification systems, which might underestimate the disease severity, especially when referring to the early stages. In this review, we briefly summarize the etiology and pathogenesis of ONFH. The imaging features and staging classification systems of ONFH are also described. More importantly, we focus on histopathological and microstructural alterations of the femoral head, and provide an overview of their essential contribution to ONFH progression. Given the observation of discordance between imaging characteristics and histopathological alterations, a substantial amount of research on the relationship between imaging and histopathological features is required to further modify and revise the current wide-accepted classification systems.Yiwei ChenYu MiaoKexin LiuFeng XueBin ZhuChangqing ZhangGuangyi LiElsevierarticleOsteonecrosis of the femoral headPathogenesisHistopathologyMicroarchitectureImagingStagingDiseases of the musculoskeletal systemRC925-935ENJournal of Orthopaedic Translation, Vol 32, Iss , Pp 28-40 (2022)
institution	DOAJ
collection	DOAJ
language	EN
topic	Osteonecrosis of the femoral head Pathogenesis Histopathology Microarchitecture Imaging Staging Diseases of the musculoskeletal system RC925-935
spellingShingle	Osteonecrosis of the femoral head Pathogenesis Histopathology Microarchitecture Imaging Staging Diseases of the musculoskeletal system RC925-935 Yiwei Chen Yu Miao Kexin Liu Feng Xue Bin Zhu Changqing Zhang Guangyi Li Evolutionary course of the femoral head osteonecrosis: Histopathological - radiologic characteristics and clinical staging systems
description	Osteonecrosis of the femoral head (ONFH) is a recalcitrant ischemic disorder, which could be classified into two major categories: traumatic and nontraumatic. Regardless of different risk factors, it has been testified that ONFH results from primitive vascular problems, leading to temporary or permanent loss of blood supply to bone tissue. Histopathological and microarchitectural alterations ensues, which is a gradual evolutionary process involving bone marrow and osteocyte necrosis, progressive destruction of subchondral bone, unsuccessful reparative process, and eventual articular collapse and degenerative arthritis. Based on the imaging features of ONFH, different classification systems have been developed to evaluate the severity and prognosis of the disease, which is pivotal for implementation of treatment strategy, especially the joint-preserving surgery. However, patients classified with the same severity stage, especially in the peri-collapse stage, sometimes responded differently after similar joint-preserving surgery. The unusual phenomenon may be attributed to the limitation of the current imaging classification systems, which might underestimate the disease severity, especially when referring to the early stages. In this review, we briefly summarize the etiology and pathogenesis of ONFH. The imaging features and staging classification systems of ONFH are also described. More importantly, we focus on histopathological and microstructural alterations of the femoral head, and provide an overview of their essential contribution to ONFH progression. Given the observation of discordance between imaging characteristics and histopathological alterations, a substantial amount of research on the relationship between imaging and histopathological features is required to further modify and revise the current wide-accepted classification systems.
format	article
author	Yiwei Chen Yu Miao Kexin Liu Feng Xue Bin Zhu Changqing Zhang Guangyi Li
author_facet	Yiwei Chen Yu Miao Kexin Liu Feng Xue Bin Zhu Changqing Zhang Guangyi Li
author_sort	Yiwei Chen
title	Evolutionary course of the femoral head osteonecrosis: Histopathological - radiologic characteristics and clinical staging systems
title_short	Evolutionary course of the femoral head osteonecrosis: Histopathological - radiologic characteristics and clinical staging systems
title_full	Evolutionary course of the femoral head osteonecrosis: Histopathological - radiologic characteristics and clinical staging systems
title_fullStr	Evolutionary course of the femoral head osteonecrosis: Histopathological - radiologic characteristics and clinical staging systems
title_full_unstemmed	Evolutionary course of the femoral head osteonecrosis: Histopathological - radiologic characteristics and clinical staging systems
title_sort	evolutionary course of the femoral head osteonecrosis: histopathological - radiologic characteristics and clinical staging systems
publisher	Elsevier
publishDate	2022
url	https://doaj.org/article/4f4cfe8dd3b74ae28684cafe17cc65e0
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_version_	1718408315284750336

Evolutionary course of the femoral head osteonecrosis: Histopathological - radiologic characteristics and clinical staging systems

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