Accurate and Reliable Diagnosis of Avascular Necrosis of the Femoral Head From Total Hip Arthroplasty Specimens Requires Pathologic Examination
| Autor: | John D. Reith, Scott E. Kilpatrick, Andrew Goldblum, Josephine K Dermawan |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Arthroplasty Replacement Hip medicine.medical_treatment Avascular necrosis Osteoarthritis Preoperative care Cohort Studies 03 medical and health sciences Femoral head 0302 clinical medicine Femur Head Necrosis medicine Humans Medical diagnosis Aged Retrospective Studies Aged 80 and over 030222 orthopedics Pathology Clinical business.industry General Medicine Middle Aged medicine.disease Osteochondritis dissecans Arthroplasty medicine.anatomical_structure 030220 oncology & carcinogenesis Female Radiology business Total hip arthroplasty |
| Zdroj: | American Journal of Clinical Pathology. 155:565-574 |
| ISSN: | 1943-7722 0002-9173 |
| DOI: | 10.1093/ajcp/aqaa153 |
| Popis: | ObjectivesTo evaluate the necessity of pathologic examination for confirming the diagnosis of avascular necrosis (AVN).MethodsWe retrospectively reviewed consecutive nonfractured total hip arthroplasty cases (n = 1,722), comparing operative diagnoses and radiologic data with final histologic diagnoses, focusing specifically on AVN.ResultsAmong 199 histologically confirmed cases of AVN, 62 (31%) had a preoperative diagnosis of osteoarthritis/degenerative joint disease (OA/DJD); 58 of the latter patients had radiology reports, but only two (3%) documented AVN. Patients with AVN preoperatively diagnosed as OA/DJD were significantly older (mean, 65 years) than patients with AVN correctly diagnosed clinically (mean, 52 years; P < .00001). Among 163 cases with a preoperative diagnosis of AVN, 26 (16%) were confirmed as OA/DJD; the radiology report incorrectly diagnosed AVN in 17 (65%) patients. These latter patients also were significantly older (mean, 60 years) than patients with AVN correctly diagnosed clinically (P = .0008). Patients with a preoperative clinical and/or radiologic diagnosis of AVN were more likely to be younger and have known AVN risk factors.ConclusionsAccurate and reliable diagnosis of AVN requires pathologic examination, especially among older patients without known risk factors. Prompt diagnosis may lead to behavioral changes in affected patients that reduce the risk of subsequent lesions. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|