Introduction ITOH also known as bone marrow edema syndrome regional migratory osteoporosis migratory osteolysis Epidemiology demographics men >women (3:1) 2 groups middle aged (40-55y) men women in 3rd trimester of pregnancy rare in Asians location usually unilateral may recur Pathogenesis local hyperemia and impaired venous return with marrow edema and increased intramedullary pressure Prognosis resolves spontaneously in 6-8mths Presentation Symptoms progressive, atraumatic hip and groin pain over several weeks may be unable to bear weight Physical exam local tenderness reduced ROM Labs Elevated ESR Imaging Radiographs recommended views AP lateral findings (xray findings in femoral head and neck lag behind clinical signs by 4-8wks) subchondral cortical loss diffuse osteopenia of femoral head and neck joint effusion joint space is always preserved MRI imaging modality of choice shows marrow edema of femoral head and neck T1 decreased signal, loss of fatty marrow T2 high signal of marrow edema joint effusion Bone scan increased uptake in femoral head preceeds Xray changes Differential ITOH is a diagnosis of exclusion. Exclude femoral neck stress fracture infection malignancy AVN ITOH Avascular Necrosis Gender Male (3:1) Equal sex distribution Age Women 3rd trimester of pregnancy, middle aged men 20-40yo Laterality Unilateral Bilateral >50% Risk Factors 3rd trimester of pregnancy ETOH, Steroids Symptoms Acute pain, improves with PWB Insidious pain, progessively worse Examination Preserved except at extremes of ROM Marked reduced ROM especially internall rotation Radiographs Diffuse osteopenia femoral head and neck at 4-6wk Localized sclerosis, crescent sign, collapse Bone scan Homogenous increased uptake femoral head and neck Localized uptake in femoral head and neck MRI Diffuse edema but NO focal defects or subchondral changes. Decreased T1, increased T2 signal. Focal defects/subchondral changes anterosuperior region of femoral head. Decreased T1 and T2 signal. Treatment Protected WB, symptomatic Early surgery recommended Prognosis Self limiting Progressive Treatment Nonoperative symptomatic with avoidance of weightbearing indications first line of treatment protected weightbearing to avoid stress fractures resolves spontaneously in 6-8mths
QUESTIONS 1 of 4 1 2 3 4 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07HK.65) A 42-year-old man reports the recent onset of right hip pain. A radiograph and MRI scan are shown in Figures 38a and 38b. A WBC count, erythrocyte sedimentation rate, and hip aspiration are within normal limits. Management should now consist of Tested Concept QID: 6025 FIGURES: A B Type & Select Correct Answer 1 core decompression. 30% (48/161) 2 biopsy of the femoral head. 4% (7/161) 3 protected weight bearing and observation. 57% (91/161) 4 total hip arthroplasty. 6% (9/161) 5 percutaneous cannulated pin fixation of the femoral neck. 2% (3/161) L 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07HK.33) A 58-year-old man reports a 2-month onset of groin pain with no history of trauma. Examination reveals that range of motion of the hip is mildly restricted, and he has pain with both weight bearing and at rest. An MRI scan is shown in Figure 20. Treatment should consist of Tested Concept QID: 5993 FIGURES: A Type & Select Correct Answer 1 protected weight bearing and anti-inflammatory drugs. 45% (146/323) 2 core decompression of the femoral head. 15% (49/323) 3 vascularized free fibular grafting to the femoral head. 2% (8/323) 4 bipolar hemiarthroplasty of the hip. 6% (19/323) 5 total hip arthroplasty. 31% (100/323) N/A Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept