Bone marrow edema and synovitis as a predictors of ineffective core decompression in the early stages of femoral head osteonecrosis

Background. Core decompression is the standard joint-preserving procedure for early-stage osteonecrosis of the femoral head; however, a proportion of patients experience treatment failure and subsequently require total hip arthroplasty. Identifying preoperative predictors of decompression failure remains an important clinical challenge. Bone marrow edema and synovitis, detectable on MRI, are potentially informative markers, but their prognostic value has not been systematically evaluated.
Objective. To assess the value of MRI-detected bone marrow edema and synovitis as predictors of core decompression failure in early-stage osteonecrosis of the femoral head.
Materials and Methods. One hundred patients with ARCO stage II osteonecrosis of the femoral head who underwent joint-preserving surgical treatment (core decompression) were enrolled in a prospective study. Preoperative MRI of the hip joint was performed in all patients, with assessment of synovitis and bone marrow edema of the proximal femur. Treatment efficacy was defined by the need for subsequent total hip arthroplasty.
Results. In the absence of MRI signs of synovitis and bone marrow edema, core decompression failed in only 5.9% of patients. The rate of subsequent total hip arthroplasty was 21.1% in patients with isolated synovitis, 20.0% in those with isolated bone marrow edema, and 54.5% in patients presenting with both findings simultaneously.
Conclusion. MRI signs of synovitis and bone marrow edema — particularly in combination — are significant predictors of core decompression failure in ARCO stage II osteonecrosis of the femoral head. Their preoperative identification should be incorporated into surgical planning and patient counseling regarding the likelihood of future total hip arthroplasty. Contrast-enhanced MRI is recommended to accurately assess the extent of synovial inflammation.

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