Management of avascular necrosis of femoral head at pre-collapse stage

Abstract

In osteonecrosis the success of interventions that forestall or prevent femoral head collapse and maintain hip function would represent a substantial achievement in the treatment of this disease. A review of recent literature regarding bisphosphonate, anticoagulant, and vasodilators and biophysical modalities have demonstrated efficacy in reducing pain and delaying disease progression in early stage osteonecrosis. Though it has been considered still insufficient, to support their routine use in the treatment or prevention of osteonecrosis of the hip. Core decompression with modification of technique is still one of the safest and most commonly employed procedures with evidence based success in the pre-collapse stage of AVN of femoral head. The additional use of bone morphogenic protein, and bone marrow stem cells may provide the opportunity to enhance the results of core decompression. At present, the use of large vascularised cortical grafts, the other surgical procedure with high success rate is still not common due to technical difficulty in surgery. Likewise osteotomies are also not getting common as arthroplasty is getting more acceptable, so is awaited without any intermediate big surgical interventions.

Keywords: Avascular necrosis; core decompression; fibular grafting; osteonecrosis.

Figure 1A

Anteroposterior radiograph of pelvis. No lucency, sclerosis or subchondral collapse noted in the femoral head. Joint space is preserved.

Figure 1B

T2 weighted coronal section shows avascular necrosis involving bilateral femoral heads with reparative border appearing hypo/hyperintense (double rim sign) on right side indicating granulation and sclerosis respectively. Dark line bordering the AVN focus on left side represents sclerosis. The cartilage and acetabulum are normal.

Figure 1C

Axial T1 weighted image shows fatty high signal within the necrotic area and hypointense line around them due to reparative new bone.