CT Hounsfield units in assessing bone and soft tissue quality in the proximal femur: A systematic review focusing on osteonecrosis and total hip arthroplasty

Tong-jie Yang, Peng-peng Wen, Xin Ye, Xiao-feng Wu, Cheng Zhang, Shi-yi Sun, Zi-xuan Wu, Guang-yi Zhang, Yi-fei Sun, Ren Ye, Cheng-kun Zhou, Hai-jun He

Abstract

Computed tomography (CT) Hounsfield Units (HU) offer valuable insights into the changes in bone and soft tissue densities, playing a crucial role in the diagnosis and management of various proximal femur conditions.

Introduction

Osteonecrosis of the femoral head (ONFH) poses a significant challenge in orthopedic practice, often leading to femoral head collapse and necessitating total hip arthroplasty (THA) in advanced stages [1,2]. The ability to accurately assess the quality of bone and soft tissue in the proximal femur is crucial for diagnosing ONFH, predicting femoral head collapse, and planning THA.

Materials and methods

The authors adhered to the criteria outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for this review [5].

Results

After several rounds of screening, 58 papers meeting the standard were eventually retained, involving 15,668 patients. The sample sizes ranged from 50 to 685, with the CT slice thickness varying from 0.5 mm to 10 mm.

Discussion

While DEXA is widely recognized as the “gold standard” for assessing bone quality [41], its application in ONFH patients presents challenges. Due to structural changes like trabecular loss, femoral head collapse, and increased density at certain regions, DEXA often struggles to accurately assess bone density in the proximal femur [8,42].

Conclusion

The systematic review demonstrates that Hounsfield Units (HU) can effectively assess the density of bone and soft tissue in the proximal femur, reflecting local stress changes. Additionally, bone density in the necrotic area of the femoral head of ONFH patients does not decrease before collapse.

Citation: Yang T-j, Wen P-p, Ye X, Wu X-f, Zhang C, Sun S-y, et al. (2025) CT Hounsfield units in assessing bone and soft tissue quality in the proximal femur: A systematic review focusing on osteonecrosis and total hip arthroplasty. PLoS ONE 20(3): e0319907. https://doi.org/10.1371/journal.pone.0319907

Editor: Giulia Pascoletti, University of Perugia: Universita degli Studi di Perugia, ITALY

Received: June 12, 2024; Accepted: February 10, 2025; Published: March 26, 2025

Copyright: © 2025 Yang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting information files.

Funding: This work was supported by the Scientific and Technological Innovation Project of China Academy of Chinese Medical Sciences [grant numbers CI2021A05406].

Competing interests: The authors have declared that no competing interests exist.