University of Oulu

Väänänen M, Tervonen O, Nevalainen MT. Magnetic resonance imaging of avascular necrosis of the femoral head: predictive findings of total hip arthroplasty. Acta Radiologica Open. April 2021. doi:10.1177/20584601211008379

Magnetic resonance imaging of avascular necrosis of the femoral head : predictive findings of total hip arthroplasty

Saved in:
Author: Väänänen, Matti1,2; Tervonen, Osmo1,2,3; Nevalainen, Mika T.1,2,3,4
Organizations: 1Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
2Medical Research Center, Oulu University of Oulu, Oulu, Finland
3Research Unit of Medical Imaging, Physics and Technology Faculty of Medicine, University of Oulu, Oulu, Finland
4Department of Radiology, Central Finland Central Hospital, Jyväskylä ,Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
Persistent link:
Language: English
Published: SAGE Publications, 2021
Publish Date: 2021-06-14


Background: Avascular osteonecrosis of the femoral head (AVNFH) is an ischemic condition which despite different treatments often leads to collapse of the femoral head and to total hip arthroplasty. However, the magnetic resonance imaging findings predisposing to disease progression and total hip arthroplasty are somewhat elusive.

Purpose: To evaluate the magnetic resonance imaging findings of AVNFH and to assess the patterns of findings which may predict total hip arthroplasty.

Materials and methods: A retrospective study was conducted with a total of 18 diagnosed AVNFH treated with core decompression combined with intraosseous stem cell treatment. After treatment, magnetic resonance imaging follow-ups were done at three-month and one-year follow-up or until total hip arthroplasty. Association Research Circulation Osseous classification and magnetic resonance imaging findings such as the size and the location of the AVNFH, bone marrow edema in femoral neck, effusion and subchondral fracture were evaluated.

Results: Hips advancing to total hip arthroplasty have more often bone marrow edema in femoral neck (90% vs. 0%), adjacent to necrotic lesion (100% vs. 43%) and in acetabulum (90% vs. 14%), but also subchondral fractures (70% vs. 0%), effusion (80% vs. 29%), and synovitis (80% vs. 14,3%). The greater size and the lateral weight-bearing location of the necrotic lesion also predicted future total hip arthroplasty.

Conclusion: Hips advancing to total hip arthroplasty have often a combination of pathognomonic AVNFH imaging findings compared to hips not advancing to total hip arthroplasty.

see all

Series: Acta radiologica open
ISSN: 2058-4601
ISSN-E: 2058-4601
ISSN-L: 2058-4601
Volume: 10
Issue: 4
Article number: 20584601211008379
DOI: 10.1177/20584601211008379
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Copyright information: © The Foundation Acta Radiologica 2021. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (