Prediction of posttraumatic femoral head osteonecrosis by quantitative intraosseous aspirate and core biopsy analysis: A prospective study


Published online: Aug 27 2010

Ramesh Kumar Sen, Sujit Kumar Tripathy, Shivinder Singh Gill, Neelam Verma, Paramjeet Singh, Bishan Dass Radotra

From the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

Abstract

Twenty-two patients with unreduced hip dislocation or fracture dislocation were prospectively evaluated. Intraosseous aspiration, marrow fluid analysis and core biopsy histological analysis was performed from the supero-lateral (test group) and central part (control group) of the femoral head. After appropriate surgical treatment and postoperative management, they were followed up for 2 years by clinical, radiological and magnetic resonance imaging evaluation. Eight patients eventually developed avascular necrosis (AVN) of the femoral head. The analysis of test samples revealed that 9 patients had an aspirate volume of <1cc ; marrow morphology of 11 hips showed necrotic cells ; 12 patients had a core biopsy histology suggestive of dead osseous fragments and necrotic osteocytes. In contrast, all the control samples had an aspirate volume of >1cc and showed viable cells on histology. Intra-operative assessment of marrow-aspirate volume (<1cc), marrow morphology and core biopsy histology from the superolateral part of femur head can fairly predict the development of subsequent ONFH after trauma ; the correlation is statistically significant (p<0.05).