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Comparative Studies | Orthopedic | India | Volume 14 Issue 3, March 2025 | Popularity: 5.9 / 10
Osteonecrosis of the Femoral Head Extent Estimation using Koo & Kim Angle and Volumetric Necrosis Measurement, and Assessing their Correlation with Functional Status of the Harris Hip Score: A Comparative Observational Study
Dr. Amit Saraf, Dr. Aneesh Kiran Malhotra
Abstract: Background: Numerous studies have indicated that the location and extent of necrotic lesions are crucial in determining the prognosis and occurrence of collapse in patients with osteonecrosis of the femoral head (ONFH). Despite the multiple classification systems, physicians face difficulties regarding the most appropriate strategy for measuring and assessing the extent of ONFH. Aim: To determine the extent of ONFH measured by Koo and Kim and volumetric necrosis measurements and assess their correlation with the Harris Hip Score (HHS) functional status in ONFH patients. Materials and methods: This study evaluated 87 adult patients with nontraumatic hip pain at an Indian tertiary care center. Patients underwent clinical assessment and bilateral hip magnetic resonance imaging (MRI) scans. The primary outcome correlated the extent of ONFH, measured by the Koo and Kim angle and volumetric assessment, with HHS functional status. The secondary outcomes assessed the impact of risk factors, including alcohol/smoking habits, steroid use, comorbidities, COVID-19 history, and pain duration, on the extent of ONFH. Results: The mean age of the study cohort was 40.6 ? 14.3 years. There was a strong negative correlation between the HHS, Koo, and Kim angles and necrosis volume. A large necrotic volume (>30% necrotic region) and large Koo and Kim angles [66% necrotic arc angle (NAA)] were strongly associated with poor HHS (<70?). Conversely, a small necrotic volume (<15% necrotic region) was correlated with good or excellent HHS (80-100). However, small Koo and Kim angles were less consistently correlated with HHS than necrosis volume. Alcohol/smoking status, steroid use, and pain duration were significantly correlated with HHS. A similar correlation was observed between necrosis volume and the Koo and Kim angles. Conclusion: Volumetric necrosis assessment provided a more detailed three-dimensional perspective of the necrotic area and showed a stronger correlation with the functional HHS score. Therefore, this method is more reliable in assessing the extent of ONFH.
Keywords: Osteonecrosis, Femur head, Magnetic Resonance Imaging, Hip injuries, Necrosis
Edition: Volume 14 Issue 3, March 2025
Pages: 1018 - 1024
DOI: https://www.doi.org/10.21275/SR25321102440
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