Significance of lesion size and location in the prediction of collapse of osteonecrosis of the femoral head: a new three-dimensional quantification using magnetic resonance imaging

Size and location of a necrotic lesion are considered important factors predicting collapse of the femoral head in the early stages of osteonecrosis. However, few analytical studies have performed a three-dimensional quantification of lesions to clarify how these two morphological factors are related to the occurrence of collapse. We evaluated the relevance of lesion size and location for prediction of collapse quantitatively using new three-dimensional indexes. Magnetic resonance (MR) imaging was performed in 65 hips in a consecutive series of 47 patients with osteonecrosis without radiological evidence of collapse. Lesion volume as well as latitude and longitude of the center of gravity of the lesion within the femoral head were calculated. Thirty-three hips developed radiological collapse, while in the remaining 32 hips collapse did not occur over 2 years. Multiple logistic regression analysis showed a significant relationship between lesion volume and radiological collapse. In 35 hips in which the lesion volume was less than 30% of the femoral head, only 9 collapsed. In comparison with non-collapsed hips, collapsed hips had a significantly higher combined value for latitude and longitude of the lesion, corresponding to the anterosuperior portion of the femoral head. Quantitative analysis of lesion morphology demonstrated that lesion volume is strongly correlated with risk of collapse, and that lesion location is an important prognostic indicator of collapse in small necrotic lesions.