Subchondral involvement in osteonecrosis of the femoral head: insight on local composition, microstructure and vascularization

T Pascart; G Falgayrac; B Cortet; J Paccou; M Bleuse; R Coursier; S Putman; J-F Quinchon; N Bertheaume; J Delattre; P Marchandise; A Cultot; L Norberciak; G Kerckhofs; J-F Budzik

doi:10.1016/j.joca.2022.05.003

Subchondral involvement in osteonecrosis of the femoral head: insight on local composition, microstructure and vascularization

Osteoarthritis Cartilage. 2022 Aug;30(8):1103-1115. doi: 10.1016/j.joca.2022.05.003. Epub 2022 May 12.

Authors

T Pascart¹, G Falgayrac², B Cortet³, J Paccou³, M Bleuse², R Coursier⁴, S Putman⁵, J-F Quinchon⁶, N Bertheaume², J Delattre², P Marchandise², A Cultot⁷, L Norberciak⁸, G Kerckhofs⁹, J-F Budzik¹⁰

Affiliations

¹ Department of Rheumatology, Lille Catholic Hospitals and Lille Catholic University, Lille, France; Univ. Lille, CHU Lille, Univ. Littoral Côte D'Opale, ULR 4490 - MABLab- Adiposité Médullaire et Os, F-59000 Lille, France. Electronic address: pascart.tristan@ghicl.net.
² Univ. Lille, CHU Lille, Univ. Littoral Côte D'Opale, ULR 4490 - MABLab- Adiposité Médullaire et Os, F-59000 Lille, France.
³ Univ. Lille, CHU Lille, Univ. Littoral Côte D'Opale, ULR 4490 - MABLab- Adiposité Médullaire et Os, F-59000 Lille, France; Univ. Lille, CHU Lille, ULR 4490, Department of Rheumatology, 59000 Lille, France.
⁴ Department of Orthopaedic Surgery, Lille Catholic Hospitals and Lille Catholic University, Lille, France.
⁵ Department of Orthopaedic Surgery, CHU Lille, Lille University, Lille, France.
⁶ Department of Anatomopathology, Lille Catholic Hospitals and Lille Catholic University, Lille, France.
⁷ Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France.
⁸ Department of Research, Biostatistics, Lille Catholic Hospitals and Lille Catholic University, Lille, France.
⁹ Biomechanics Lab - Institute of Mechanics, Materials, and Civil Engineering, Louvain-la-Neuve, UCLouvain, Belgium; IREC - Institute of Experimental and Clinical Research, UCLouvain, Woluwe, Belgium; Department Materials Engineering, Leuven, KU Leuven, Belgium; Prometheus, Division for Skeletal Tissue Engineering, Leuven, KU Leuven, Belgium.
¹⁰ Univ. Lille, CHU Lille, Univ. Littoral Côte D'Opale, ULR 4490 - MABLab- Adiposité Médullaire et Os, F-59000 Lille, France; Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France.

PMID: 35568111
DOI: 10.1016/j.joca.2022.05.003

Abstract

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 K_trans. Volume fraction of subchondral bone, trabecular number, and K_ep 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.

Keywords: Avascular necrosis; Bone marrow adiposity; Contrast-enhanced computed microtomography; Dynamic-contrast enhanced MRI; Osteonecrosis femoral head; Raman spectroscopy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Arthroplasty, Replacement, Hip*
Femur / pathology
Femur Head / diagnostic imaging
Femur Head / pathology
Femur Head Necrosis* / diagnostic imaging
Humans
Male
Osteoarthritis* / pathology
X-Ray Microtomography / methods