Subchondral involvement in osteonecrosis of the femoral head: insight on local composition, microstructure and vascularization.
(2022) Osteoarthritis and Cartilage — Vol. 30, n° 8, p. 1103-1115 (2022)
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- (en) OBJECTIVE: To determine changes of subchondral bone composition, micro-structure, bone marrow adiposity and micro-vascular perfusion in end-stage osteonecrosis of the femoral head (ONFH) compared to osteoarthritis (OA) using a combined in vivo and ex vivo approach. DESIGN: Male patients up to 70 years old referred for total hip replacement surgery for end-stage ONFH were included (n = 14). Fifteen patients with OA were controls. Pre-operative MRI was used to assess bone perfusion (dynamic contrast-enhanced (DCE) sequences) and marrow fat content (chemical shift imaging). Three distinct zones of femoral head subchondral bone - necrotic, sclerotic, distant - were compared between groups. After surgery, plugs were sampled in these zones and Raman spectroscopy was applied to characterize bone mineral and organic components (old and newly-formed), and contrast-enhanced micro-computed tomography (CE-μCT) to determine bone micro-structural parameters and volume of bone marrow adipocytes, using conventional 2D histology as a reference. RESULTS: In the necrotic zone of ONFH patients compared to OA patients: 1) the subchondral plate did not exhibit significant changes in composition nor structure; 2) the volume fraction of subchondral trabecular bone was significantly lower; 3) type-B carbonate substitution was less pronounced, 4) collagen maturity was more pronounced; and 5) bone marrow adipocytes were significantly depleted. The sclerotic zone from the ONFH group showed greater trabecular thickness, and higher DCE-MRI AUC and Ktrans. Volume fraction of subchondral bone, trabecular number, and Kep were significantly lower in the distant zone of the ONFH group. CONCLUSIONS: This study demonstrated alterations of subchondral bone microstructure, composition, perfusion and/or adipose content in all zones of the femoral head.
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Pascart, T., Falgayrac, G., Cortet, B., Paccou, J., Bleuse, M., Coursier, R., Putman, S., Quinchon, J.-F., Bertheaume, N., Delattre, J., Marchandise, P., Cultot, A., Norberciak, L., Kerckhofs, G., & Budzik, J.-F. (2022). Subchondral involvement in osteonecrosis of the femoral head: insight on local composition, microstructure and vascularization. Osteoarthritis and Cartilage, 30(8), 1103-1115. https://doi.org/10.1016/j.joca.2022.05.003 (Original work published 2022)