J Korean Med Sci.  2016 Oct;31(10):1650-1655. 10.3346/jkms.2016.31.10.1650.

Decreased Lumbar Lordosis and Deficient Acetabular Coverage Are Risk Factors for Subchondral Insufficiency Fracture

• Jo WL
• Lee WS
• Chae DS
• Yang IH
• Lee KM
• Koo KH

• KMID: 2468258
• DOI: http://doi.org/10.3346/jkms.2016.31.10.1650

Abstract

Subchondral insufficiency fracture (SIF) of the femoral head occurs in the elderly and recipients of organ transplantation. Osteoporosis and deficient lateral coverage of the acetabulum are known risk factors for SIF. There has been no study about relation between spinopelvic alignment and anterior acetabular coverage with SIF. We therefore asked whether a decrease of lumbar lordosis and a deficiency in the anterior acetabular coverage are risk factors. We investigated 37 patients with SIF. There were 33 women and 4 men, and their mean age was 71.5 years (59-85 years). These 37 patients were matched with 37 controls for gender, age, height, weight, body mass index and bone mineral density. We compared the lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope, acetabular index, acetabular roof angle, acetabular head index, anterior center-edge angle and lateral center-edge angle. Lumbar lordosis, pelvic tilt, sacral slope, lateral center edge angle, anterior center edge angle, acetabular index and acetabular head index were significantly different between SIF group and control group. Lumbar lordosis (OR = 1.11), lateral center edge angle (OR = 1.30) and anterior center edge angle (OR = 1.27) had significant associations in multivariate analysis. Decreased lumbar lordosis and deficient anterior coverage of the acetabulum are risk factors for SIF as well as decreased lateral coverage of the acetabulum.

Keyword

Subchondral Insufficiency Fracture; Lumbar Lordosis; Deficient Acetabular Coverage

MeSH Terms

Absorptiometry, Photon
Acetabulum/diagnostic imaging/*physiopathology
Aged
Aged, 80 and over
Body Mass Index
Bone Density
Case-Control Studies
Female
Femur Head/diagnostic imaging
Fractures, Stress/*diagnosis/diagnostic imaging/etiology
Humans
Lordosis/diagnostic imaging/*physiopathology
Magnetic Resonance Imaging
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Risk Factors

Figure

• 

  Fig. 1 A 59-year-old woman had a pain on the right hip. (A) Radiograph shows a focal depression in the subchondral portion of the right femoral head. (B) Lateral radiograph of the lumbar spine shows a decrease of lumbar lordosis (7.8°). (C) T2-weighted coronal MRI shows subchondral collapse, which appears as a low signal band lesion, and surrounding edema, which appears as high signal intensity. (D) T2-weighted mid-sagittal MRI shows a decrease of anterior center-edge angle (31.4°).

• 

  Fig. 2 A 77-year-old woman with a subchondral insufficiency fracture of the right femoral head. (A) Radiograph after sudden onset of right hip pain shows subchondral collapse in the superolateral portion of the femoral head. (B) Lateral radiograph of the lumbar spine shows decreased lumbar lordosis (24.7°). (C) On the mid-coronal T2-weighted MRI, a diffuse bone marrow edema pattern with linear low signal intensity line at epiphysis of femoral head is seen. (D) On the mid-sagittal T2-weighted MRI, anterior center-edge angle was decreased to 29.2°. (E) Radiograph at 2 months follow-up shows rapidly progressive collapse of the femoral head.

• 

  Fig. 3 Images of the lumbar spine, pelvis, and the hip. (A) The angle of lumbar lordosis (LL) was measured as an angle between line passing through the superior endplates of L1 and S1 by lateral radiograph of the lumber spine. (B) The pelvic incidence (PI) is defined as the angle between the line perpendicular to the sacral slope at its midpoint and the line connecting this point to the axis of the center of the right and left femoral heads by lateral radiograph of the pelvis. (C) On the mid-sagittal MRI, anterior center-edge (ACE) angle which is made by the intersection plane through the center of the femoral head. PT, pelvic tilt; SS, sacral slope; GL, ground line.

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