Malignant causes of fever of unknown origin. What is fatigue or weakness?.įoggo V, Cavenagh J. Signs and symptoms of osteosarcoma.Īmerican Academy of Orthopaedic Surgeons. Bone cancer (sarcoma of bone): Symptoms and signs.Īmerican Cancer Society. Self-care of chronic musculoskeletal pain - experiences and attitudes of patients and health care providers. Kovačević I, Kogler VM, Turković TM, Dunkić LF, Ivanec Ž, Petek D. Causes of chronic hip pain undiagnosed or misdiagnosed by primary physicians in young adult patients: A retrospective descriptive study. Lee YJ, Kim SH, Chung SW, Lee YK, Koo KH. Bone pain in cancer patients: Mechanisms and current treatment. Zajączkowska R, Kocot-Kępska M, Leppert W, Wordliczek J. Skeletal complications in cancer patients with bone metastases. Tsuzuki S, Park SH, Eber MR, Peters CM, Shiozawa Y. Osteonecrosis of the Femoral Head: An Updated Review of ARCO on Pathogenesis, Staging and Treatment. The 2019 Revised Version of Association Research Circulation Osseous Staging System of Osteonecrosis of the Femoral Head. (1975) The American journal of physiology. Effect of pH on ionic exchange and function in rat and rabbit myocardium. Subchondral insufficiency fractures of the femoral head. Subchondral fractures in osteonecrosis of the femoral head: comparison of radiography, CT, and MR imaging. Stevens K, Tao C, Lee SU, Salem N, Vandevenne J, Cheng C, Neumann G, Valentin-Opran A, Lang P. Femoral head avascular necrosis: a frequently missed incidental finding on multidetector CT. Femoral head avascular necrosis: CT assessment with multiplanar reconstruction. Magid D, Fishman EK, Scott WW, Brooker AF, Arnold WP, Lennox DW, Siegelman SS.

Avascular necrosis of the hip: comparison of MR, CT, and scintigraphy. Mitchell MD, Kundel HL, Steinberg ME, Kressel HY, Alavi A, Axel L. Chemical shift and the double-line sign in MRI of early femoral avascular necrosis. The ARCO classification is the most recent, developed in 2019 10. The Mitchell classification is commonly utilized for MRI images.

The Steinberg classification is similar but quantifies the involvement of the femoral head. The earliest and most commonly used is the Ficat and Arlet classification which includes x-ray, MRI and bone scan appearances. Several staging systems for osteonecrosis of the hip exist. T2: may show a second hyperintense inner line between normal marrow and ischemic marrow this appearance is highly specific for osteonecrosis of the hip and is known as the ' double-line sign' T1: usually the initial specific findings are areas of low signal intensity representing edema, which can be bordered by a hyperintense line that represents blood products As there is a high rate of bilateral involvement, both hips should be included in the field of view of at least some sequences. MRI is the most sensitive modality, with a sensitivity of 71-100% and specificity of 94-100% 1. Presence of a potentially unstable osteochondral fragment: rim signĬT is often more sensitive than plain film in showing subchondral fractures. Other than describing the general appearance of the affected region, the following are necessary to include in the report as they have a bearing on prognosis and treatment:Įstimating percentage volume of the head involved (axial) and percentage weight-bearing surface involved (coronal)Ĭoexisting osteoarthritis or secondary degenerative change In non-traumatic cases, it is mostly bilateral in 70-80% 10. Traumatic osteonecrosis is usually unilateral 10.

It can be thought of as traumatic (secondary to the neck of femur fractures) or non-traumatic. Typically it affects the superior articular surface (between 10-2 o'clock) and begins in the most anterior part of the hip. However, few patients may remain asymptomatic until the late stages. The most common presenting symptom is pain in the region of the affected hip, thigh, groin, and buttock. Typically affects adults under 50 years of age 12.

Xray of a normal right hip