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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

Kindt, Mikael LU ; Jönsson, Maria L. ; Torfing, Trine ; Strøm Rönnquist, Sebastian LU orcid ; Viberg, Bjarke ; Overgaard, Søren and Rogmark, Cecilia LU (2023) In Acta Orthopaedica 94. p.135-140
Abstract

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... (More)

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.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Orthopaedica
volume
94
pages
6 pages
publisher
Taylor & Francis
external identifiers
  • pmid:36999919
  • scopus:85153229702
ISSN
1745-3674
DOI
10.2340/17453674.2023.11658
language
English
LU publication?
yes
id
bab4eed3-db24-4e48-ac17-fba83efce9b7
date added to LUP
2023-07-14 11:40:03
date last changed
2024-04-19 23:29:38
@article{bab4eed3-db24-4e48-ac17-fba83efce9b7,
  abstract     = {{<p>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 &lt; 34 or VAS pain &gt; 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.</p>}},
  author       = {{Kindt, Mikael and Jönsson, Maria L. and Torfing, Trine and Strøm Rönnquist, Sebastian and Viberg, Bjarke and Overgaard, Søren and Rogmark, Cecilia}},
  issn         = {{1745-3674}},
  language     = {{eng}},
  pages        = {{135--140}},
  publisher    = {{Taylor & Francis}},
  series       = {{Acta Orthopaedica}},
  title        = {{Assessing osteonecrosis of the femoral head after internal fixation of femoral neck fractures : MARS MRI versus conventional radiography and patient-reported outcomes}},
  url          = {{http://dx.doi.org/10.2340/17453674.2023.11658}},
  doi          = {{10.2340/17453674.2023.11658}},
  volume       = {{94}},
  year         = {{2023}},
}