{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T17:48:33Z","timestamp":1788371313606,"version":"build-2803163510"},"reference-count":35,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,7,16]],"date-time":"2022-07-16T00:00:00Z","timestamp":1657929600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Instituto de Investigaci\u00f3n Marqu\u00e9s de Valdecilla-IDIVAL","award":["PREVAL19\/02"],"award-info":[{"award-number":["PREVAL19\/02"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Osteonecrosis of the Femoral Head (ONFH) is a disabling disease affecting up to 30,000 people yearly in the United States alone. Diagnosis and staging of this pathology are both technically and logistically challenging, usually relying on imaging studies. Even anatomopathological studies, considered the gold standard for identifying ONFH, are not exempt from problems. In addition, the diagnosis is often made by different healthcare specialists, including orthopedic surgeons and radiologists, using different imaging modes, macroscopic features, and stages. Therefore, it is not infrequent to find disagreements between different specialists. The aim of this paper is to clarify the association and accuracy of ONFH diagnosis between healthcare professionals. To this end, femoral head specimens from patients with a diagnosis of ONFH were collected from patients undergoing hip replacement surgery. These samples were later histologically analyzed to establish an ONFH diagnosis. We found that clinico-radiological diagnosis of ONFH evidences a high degree of histological confirmation, thus showing an acceptable diagnostic accuracy. However, when the diagnoses of radiologists and orthopedic surgeons are compared with each other, there is only a moderate agreement. Our results underscore the need to develop an effective diagnosis based on a multidisciplinary approach to enhance currently limited accuracy and reliability.<\/jats:p>","DOI":"10.3390\/diagnostics12071731","type":"journal-article","created":{"date-parts":[[2022,7,17]],"date-time":"2022-07-17T21:00:28Z","timestamp":1658091628000},"page":"1731","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Osteonecrosis of the Femoral Head: A Multidisciplinary Approach in Diagnostic Accuracy"],"prefix":"10.3390","volume":"12","author":[{"given":"Adri\u00e1n","family":"Card\u00edn-Pereda","sequence":"first","affiliation":[{"name":"Departamento de Bioqu\u00edmica y Biolog\u00eda Molecular, Facultad de Medicina, Universidad de Cantabria-IDIVAL, 39012 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Garc\u00eda-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Departamento de Bioqu\u00edmica y Biolog\u00eda Molecular, Facultad de Medicina, Universidad de Cantabria-IDIVAL, 39012 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuria","family":"Ter\u00e1n-Villagr\u00e1","sequence":"additional","affiliation":[{"name":"Servicio de Anatom\u00eda Patol\u00f3gica, Hospital UM Valdecilla, Universidad de Cantabria, 39008 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Alfonso-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Servicio de Traumatolog\u00eda y Ortopedia, Hospital Universitario Marqu\u00e9s de Valdecilla-IDIVAL, Universidad de Cantabria, 39008 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Fakkas","sequence":"additional","affiliation":[{"name":"Servicio de Traumatolog\u00eda y Ortopedia, Hospital Universitario Marqu\u00e9s de Valdecilla-IDIVAL, Universidad de Cantabria, 39008 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Garc\u00e9s-Zarzalejo","sequence":"additional","affiliation":[{"name":"Servicio de Traumatolog\u00eda y Ortopedia, Hospital Universitario Marqu\u00e9s de Valdecilla-IDIVAL, Universidad de Cantabria, 39008 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9872-7990","authenticated-orcid":false,"given":"Flor Mar\u00eda","family":"P\u00e9rez-Campo","sequence":"additional","affiliation":[{"name":"Departamento de Bioqu\u00edmica y Biolog\u00eda Molecular, Facultad de Medicina, Universidad de Cantabria-IDIVAL, 39012 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.2106\/JBJS.19.01271","article-title":"Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today?: A 5-Year Update","volume":"102","author":"Mont","year":"2020","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1007\/s12178-015-9290-y","article-title":"Total hip arthroplasty in the treatment of osteonecrosis of the femoral head: Then and now","volume":"8","author":"Lavernia","year":"2015","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_3","unstructured":"Urbaniak, J.R., and Jones, J.R. (1997). The incidence of osteonecrosis. Osteonecrosis: Etiology, Diagnosis, Treatment, American Academy of Orthopedic Surgeons."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1309\/AJCPDMFQK6QZK9NN","article-title":"Comparison of clinical and histologic diagnoses in 16,587 total joint arthroplasties: Implications for orthopedic and pathologic practices","volume":"141","author":"DiCarlo","year":"2014","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"590","DOI":"10.5312\/wjo.v6.i8.590","article-title":"Current concepts on osteonecrosis of the femoral head","volume":"6","author":"Gianakos","year":"2015","journal-title":"World J. Orthop."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"341","DOI":"10.2147\/JPR.S347961","article-title":"Comparisons of Ultrasound-Guided Platelet-Rich Plasma Intra-Articular Injection and Extracorporeal Shock Wave Therapy in Treating ARCO I-III Symptomatic Non-Traumatic Femoral Head Necrosis: A Randomized Controlled Clinical Trial","volume":"15","author":"Luan","year":"2022","journal-title":"J. Pain Res."},{"key":"ref_7","first-page":"2050313X211067617","article-title":"Multimodal conservative treatment of migrating bone marrow edema associated with early osteonecrosis of the hip","volume":"10","author":"Sconza","year":"2022","journal-title":"SAGE Open Med. Case Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"456","DOI":"10.5312\/wjo.v12.i7.456","article-title":"Optimization of transdisciplinary management of elderly with femur proximal extremity fracture: A patient-tailored plan from orthopaedics to rehabilitation","volume":"12","author":"Invernizzi","year":"2021","journal-title":"World J. Orthop."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1517\/17530059.2013.757592","article-title":"Accuracy and limitations of diagnostic methods for avascular necrosis of the hip","volume":"7","author":"Karantanas","year":"2013","journal-title":"Expert. Opin. Med. Diagn."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.ocl.2004.02.006","article-title":"Pathologic conditions mimicking osteonecrosis","volume":"35","author":"Jackson","year":"2004","journal-title":"Orthop. Clin. N. Am."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1007\/s00264-018-3917-8","article-title":"Early-stage osteonecrosis of the femoral head: Where are we and where are we going in year 2018?","volume":"42","author":"Larson","year":"2018","journal-title":"Int. Orthop."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"72","DOI":"10.3109\/17453674.2015.1077418","article-title":"The role of \u201ccell therapy\u201d in osteonecrosis of the femoral head. A systematic review of the literature and meta-analysis of 7 studies","volume":"87","author":"Papakostidis","year":"2016","journal-title":"Acta Orthop."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s00256-015-2269-3","article-title":"Problems with the pathological diagnosis of osteonecrosis","volume":"45","author":"Parajuli","year":"2016","journal-title":"Skelet. Radiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1007\/s00264-018-4018-4","article-title":"Classification systems of hip osteonecrosis: An updated review","volume":"43","author":"Sultan","year":"2019","journal-title":"Int. Orthop."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1302\/0301-620X.71B2.2647752","article-title":"The femoral head in osteonecrosis. A quantitative study of osteocyte population","volume":"71","author":"Humphreys","year":"1989","journal-title":"J. Bone Joint. Surg. Br."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2471","DOI":"10.2106\/00004623-200411000-00017","article-title":"Histologic analysis of acetabular and proximal femoral bone in patients with osteonecrosis of the femoral head","volume":"86","author":"Kim","year":"2004","journal-title":"J. Bone Joint. Surg. Am."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1148\/radiology.169.2.3175001","article-title":"Avascular necrosis of the femoral head: High-field-strength MR imaging with histologic correlation","volume":"169","author":"Lang","year":"1988","journal-title":"Radiology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1007\/s00264-010-1121-6","article-title":"Histopathology of aseptic necrosis of the femoral head in sickle cell disease","volume":"35","author":"Donkerwolcke","year":"2011","journal-title":"Int. Orthop."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1097\/00003086-200105000-00006","article-title":"Magnetic resonance imaging and histology of repair in femoral head osteonecrosis","volume":"386","author":"Plenk","year":"2001","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/S0883-5403(89)80047-6","article-title":"Correlation of MRI images with histology in avascular necrosis in the hip. A preliminary study","volume":"4","author":"Simmons","year":"1989","journal-title":"J. Arthroplast."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1007\/s00256-009-0659-0","article-title":"Diagnostic performance of MR imaging in the assessment of subchondral fractures in avascular necrosis of the femoral head","volume":"38","author":"Yeh","year":"2009","journal-title":"Skelet. Radiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3655","DOI":"10.12659\/MSM.913393","article-title":"A Retrospective Study to Compare the Efficacy and Postoperative Outcome of Total Hip Arthroplasty with Internal Screw Fixation in Patients with Avascular Necrosis of the Femoral Head","volume":"25","author":"Pang","year":"2019","journal-title":"Med. Sci. Monit."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/S0883-5403(06)80036-7","article-title":"The natural history of the silent hip in bilateral atraumatic osteonecrosis","volume":"8","author":"Bradway","year":"1993","journal-title":"J. Arthroplast."},{"key":"ref_24","unstructured":"Bone, M.R. (1994). Laboratory Histopathology, Woods AE and Ellis RC."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1007\/s11832-016-0723-y","article-title":"Inter-observer and intra-observer reliability in the radiographic diagnosis of avascular necrosis of the femoral head following reconstructive hip surgery in children with cerebral palsy","volume":"10","author":"Hesketh","year":"2016","journal-title":"J. Child. Orthop."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1792","DOI":"10.1111\/os.12821","article-title":"Exploring the Risk Factors for the Misdiagnosis of Osteonecrosis of Femoral Head: A Case-Control Study","volume":"12","author":"Li","year":"2020","journal-title":"Orthop. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1093\/ajcp\/aqaa153","article-title":"Accurate and Reliable Diagnosis of Avascular Necrosis of the Femoral Head From Total Hip Arthroplasty Specimens Requires Pathologic Examination","volume":"155","author":"Dermawan","year":"2021","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"10721","DOI":"10.1038\/s41598-017-10817-w","article-title":"Avascular Necrosis of Femoral Head: A Metabolomic, Biophysical, Biochemical, Electron Microscopic and Histopathological Characterization","volume":"7","author":"Narayanan","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1097\/00003086-200105000-00005","article-title":"Classification of osteonecrosis of the femoral head. Reliability, reproducibility, and prognostic value","volume":"386","author":"Plakseychuk","year":"2001","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_30","first-page":"21","article-title":"Definition of bone necrosis by the pathologist","volume":"4","author":"Fondi","year":"2007","journal-title":"Clin. Cases Miner. Bone Metab."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.2214\/AJR.20.22930","article-title":"Comparison of Radiographic and Pathologic Diagnosis of Osteonecrosis of the Femoral Head","volume":"216","author":"Crim","year":"2021","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"580","DOI":"10.5858\/arpa.2019-0128-OA","article-title":"Pathology Assessment of Femoral Head Resection Specimens: An Important Quality Assurance Procedure","volume":"144","author":"Layfield","year":"2020","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1053\/joca.1999.0305","article-title":"A clinicopathologic study of osteonecrosis in the osteoarthritic hip","volume":"8","author":"Yamamoto","year":"2000","journal-title":"Osteoarthr. Cartil."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1007\/s00264-007-0320-2","article-title":"Avascular necrosis of the femoral head: Inter- and intraobserver variations of Ficat and ARCO classifications","volume":"32","author":"Kirchhoff","year":"2008","journal-title":"Int. Orthop."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1702","DOI":"10.2106\/00004623-199611000-00010","article-title":"Interobserver reliability and intraobserver reproducibility of the modified Ficat classification system of osteonecrosis of the femoral head","volume":"78","author":"Smith","year":"1996","journal-title":"J. Bone Joint. Surg. Am."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/7\/1731\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:52:13Z","timestamp":1760140333000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/7\/1731"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,16]]},"references-count":35,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,7]]}},"alternative-id":["diagnostics12071731"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics12071731","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,16]]}}}