Evaluating the Blood Supply of the Femoral Head During Different Stages of Necrosis Using Digital Subtraction Angiography.

Abstract

The authors investigated changes in the blood supply of necrotic femoral heads using digital subtraction angiography (DSA). Digital subtraction angiography was used to evaluate the blood perfusion of osteonecrosis of the femoral head of 81 patients (81 hips). Necrotic hips were grouped according to the Association Research Circulation Osseous staging classification. Five parameters were assessed to evaluate the intraosseous blood supply of the necrotic femoral heads. The authors chose the most effective images retrospectively and measured the following parameters: the blood vessel diameter ratio between the medial circumflex femoral artery (MCFA) and the deep femoral artery (DFA) (MCFA/DFA); the blood vessel diameter ratio between the lateral circumflex femoral artery (LCFA) and the DFA (LCFA/DFA); the ratio between the MCFA extending length and the width of the femoral neck (A); the number of vessels that reach or exceed line I (a, horizontal line through the junction of the upper femoral head and neck); and the number of vessels that reach or exceed line II (b, the boundary between the femoral head and neck). Significantly negative correlation with Association Research Circulation Osseous stage II to IV necrosis was found for A, a, and b. These parameters were significant (P<.05). Compared with the length and distribution of the vessels, differences in width (MCFA/DFA and LCFA/DFA) were not statistically significant in patients with Association Research Circulation Osseous stage II to IV necrosis. The relative length of the MCFA and the number of vessels above line I and line II are related to the severity of osteonecrosis of the femoral head, as revealed by DSA. Evaluation of blood supply by DSA can be used as one element to predict the fate of precollapsed femoral head. [Orthopedics. 2019; 42(2):e210-e215.].