Concentric Circle Technique for Assessment of Femoral Head Deficiency in Osteonecrosis of Femoral Head

Introduction There is a lack of standardized objective tools to assess collapse for osteonecrosis of the femoral head (ONFH) patients’ follow-up. We describe a quantitative technique of collapse assessment using a superimposed concentric circular ring matching the intact part of the femoral head in anteroposterior (AP) radiographs. Methods We retrospectively analyzed 30 normal femoral heads and 30 ONFH (15 pre-collapse,15 post-collapse) in anteroposterior hip radiographs. A best-fitting circle was superimposed on articular margins of the femoral head and the maximum width of the deficient zone of the femoral head (not matching the circle) was measured. The width (pW) was measured as percentage-width in proportion to the circle’s diameter. The findings were compared among normal and ONFH radiographs. Intraclass correlation coefficients were calculated for intraobserver and interobserver reliability of the measurements. Results The mean femoral head deficiencies predicted by pW were 0.2±0.5% for normal hip, 2.8±1.1% for pre-collapse, and 8.9±3.8% for post-collapse radiographs. We observed significant differences in the measurements of pW among the control group, pre-collapse and post-collapse groups. Interobserver and intraobserver reliabilities for the measurements were high. Conclusion The described concentric circle technique is a simple and reliable method for objective assessment of subtle alterations in the sphericity of the femoral head and can be helpful for the radiographic follow-up of ONFH patients.