Osteonecrosis of the femoral head: An update in year 2012

Abstract

Osteonecrosis is a phenomenon involving disruption to the vascular supply to the femoral head, resulting in articular surface collapse and eventual osteoarthritis. Although alcoholism, steroid use, and hip trauma remain the most common causes, several other etiologies for osteonecrosis have been identified. Basic science research utilizing animal models and stem cell applications continue to further elucidate the pathophysiology of osteonecrosis and promise novel treatment options in the future. Clinical studies evaluating modern joint-sparing procedures have demonstrated significant improvements in outcomes, but hip arthroplasty is still the most common procedure performed in these affected younger adults. Further advances in joint-preserving procedures are required and will be widely studied in the coming decade.

Keywords: Avascular necrosis; Core decompression; Femoral head; Hip; Osteonecrosis; Total hip arthroplasty.

Figure 1

Forty-one year old male with pre-collapse osteonecrosis of left femoral head as evidenced by (A) plain radiograph and (B) magnetic resonance imaging of pelvis. Patient underwent core decompression: (C) Kirschner wire to localize to affected subchondral bone; D: Drilling of lesion; E: Aspiration of bone marrow from cancellous bone in greater trochanter; F: Insertion of bone graft mixed with bone marrow aspirate.

Figure 2

Forty-eight year old female with osteonecrotic left femoral head, with evidence of left hip osteoarthritis (A). Patient underwent left uncemented total hip arthroplasty (B).