Seventy-seven (77/89, 86.5%) hips were determined with AP view alone and 85 (85/89, 95.5%) hips were determined with the combination of AP and FLL views. An average follow-up of 37.0 ± 32.0 months was conducted to evaluate the occurrence of collapse in 178 pre-collapse hips. Two hundred and twenty six (226/300, 75.3%) hips and 298 (298/300, 99.3%) hips collapse were identified with AP view and FLL view, respectively. Three hundred cases (300/478, 62.5%) were collapsed at the initial time point. The collapse rates were calculated and compared with Kaplan–Meier survival analysis with radiological collapse as endpoints. All patients with pre-collapse ONFH underwent non-operative hip-preserving therapy. Anterior necrotic lesion was evaluated by FLL view. Japanese Investigation Committee (JIC) classification system was used to classify necrotic lesion in AP view. All patients received standard AP and FLL views of hip joints. Between December 2016 and August 2018, a total of 478 hips from 372 patients with ONFH (268 male, 104 female mean age 37.9 ± 11.4 years) were retrospectively evaluated. The purpose of this study is to assess the efficacy of combined evaluation of anteroposterior (AP) and frog-leg lateral (FLL) view in diagnosing collapse. Load-bearing capacity of the bone structures of anterolateral weight-bearing area plays an important role in the progressive collapse in osteonecrosis of the femoral head (ONFH).
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