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Assessing osteonecrosis of the femoral head after internal fixation of femoral neck fractures: MARS MRI versus conventional radiography and patient-reported outcomes

Acta orthopaedica, 2023, Vol.94, p.135-140 [Peer Reviewed Journal]

2023 The Author(s) 2023 ;ISSN: 1745-3674 ;EISSN: 1745-3682 ;DOI: 10.2340/17453674.2023.11658 ;PMID: 36999919

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  • Title:
    Assessing osteonecrosis of the femoral head after internal fixation of femoral neck fractures: MARS MRI versus conventional radiography and patient-reported outcomes
  • Author: KINDT, Mikael ; JÖNSSON, Maria L ; TORFING, Trine ; STRØM RÖNNQUIST, Sebastian ; VIBERG, Bjarke ; OVERGAARD, Søren ; ROGMARK, Cecilia
  • Subjects: Clinical Medicine ; Klinisk medicin ; Medical and Health Sciences ; Medicin och hälsovetenskap ; Radiologi och bildbehandling ; Radiology, Nuclear Medicine and Medical Imaging
  • Is Part Of: Acta orthopaedica, 2023, Vol.94, p.135-140
  • Description: Background and purpose — Little is known on the use of metal artifact reduction sequence (MARS) MRI to diagnose osteonecrosis of the femoral head (ONFH) after fixation of femoral neck fractures (FNF) with conventional metal implants present. We compared MARS MRI with radiography in diagnosing ONFH. Secondarily, we determined whether signs of ONFH on MARS MRI correlate with patient-reported outcomes (PROs) via Oxford Hip Score (OHS) and pain (VAS). Patients and methods — 30 adults under 60 years treated with internal fixation after FNF were prospectively included (2015–2018) at 2 hospitals. They were followed up with radiography and PROs at 4, 12, and 24 months and MARS MRI at 4 and 12 months. OHS < 34 or VAS pain > 20 was considered significant. Results — At 12 months, 14 patients had a pathological MRI. 3 of 14 had ONFH on radiographs at 12 months, increasing to 5 at 24 months, and 4 had unfavorable PROs. 2 of 5 patients with ONFH signs on both MRI and radiography had unfavorable PROs. 1 of 10 patients with normal MRI and radiography had unfavorable 2-year PROs. 4 patients had inconsistent MRI results, of which 1 developed ONFH. 1 patient dropped out. Conclusion — Information from a pathological MRI was not useful, as a majority remained free from symptoms and ONFH signs on radiographs. Furthermore, PROs did not correlate with imaging results. MARS MRI findings must be better understood before being taken into clinical practice. However, a normal MARS MRI seems to be a good prog-nostic finding.
  • Publisher: Medical Journals Sweden, on behalf of the Nordic Orthopedic Federation
  • Language: English
  • Identifier: ISSN: 1745-3674
    EISSN: 1745-3682
    DOI: 10.2340/17453674.2023.11658
    PMID: 36999919
  • Source: GFMER Free Medical Journals
    PubMed Central
    Alma/SFX Local Collection
    SWEPUB Freely available online
    DOAJ Directory of Open Access Journals
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