| Affiliation: | (1) Department of Orthopaedic Surgery, Kyungpook National University College of Medicine, 50 Samduk-2 ga, Daegu 700-721, South Korea;(2) Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do 463-707, South Korea;(3) Department of Orthopaedic Surgery, Pusan National University College of Medicine, 10 Ami-dong, Pusan 602-739, South Korea;(4) Department of Orthopaedic Surgery, The Catholic University of Korea College of Medicine, 505 Banpo-dong, Seoul 137-040, South Korea;(5) Department of Orthopaedic Surgery, Kyung-Hee University College of Medicine, 1 Hoigi-dong, Seoul 130-702, South Korea;(6) Department of Orthopaedic Surgery, Keimyung University College of Medicine, 194 Dongsan-dong, Taegu 700-712, South Korea;(7) Department of Orthopaedic Surgery, Gyeong-Sang National University College of Medicine, 90 Chilam-dong, Chinju 660-702, South Korea;(8) Department of Diagnostic Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do 463-707, South Korea |
| Abstract: | Introduction In the proximal femoral metaphysis, hematopoietic marrow is predominant during the adult stage of life. The conversion of hematopoietic marrow to fatty marrow in the proximal femoral metaphysis has been suggested as an etiologic factor of ischemia in the pathogenesis of femoral head osteonecrosis. To determine whether the chronology of fatty marrow conversion of the proximal femoral metaphysis is related to transient bone marrow edema syndrome of the hip, a case control study was conducted on 10 patients with the disease.Materials and methods There were 8 men and 2 women with a mean age of 33 years (range 19–45 years). The 10 patients were matched with 20 controls for gender and age (5-year range). T1-weighted MRI scans of their hips were reviewed. Marrow of the greater trochanter becomes fatty before puberty, and thus, the greater trochanter can be used as a built-in control. The signal intensity of the proximal femoral metaphysis was compared to that of the greater trochanter.Results In all patients, the signal intensity of the proximal femoral metaphysis was isointense (fatty marrow) relative to that of the greater trochanter. In control subjects, the signal intensity was isointense in 8 (40%) and hypointense (hematopoietic marrow) in 12 (60%) (p<0.05).Conclusion The current study shows that the proximal femoral metaphysis is predominantly fatty in transient bone marrow edema syndrome. The conversion of hematopoietic to fatty marrow is known to correlate with decreases in intramedullary blood flow. Thus, the current study suggests that an ischemia of the proximal femur secondary to fatty marrow conversion of the proximal femoral metaphysis might be a cause of transient bone marrow edema syndrome of the hip. |
