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. 2015 Jan-Feb;49(1):28-45.
doi: 10.4103/0019-5413.143911.

Management of femoral head osteonecrosis: Current concepts

Sujit Kumar Tripathy  1 , Tarun Goyal  2 , Ramesh Kumar Sen  3
Affiliations

Management of femoral head osteonecrosis: Current concepts

Sujit Kumar Tripathy et al. Indian J Orthop. 2015 Jan-Feb.

Abstract

Osteonecrosis of femoral head (ONFH) is a disabling condition of young individuals with ill-defined etiology and pathogenesis. Remains untreated, about 70-80% of the patients progress to secondary hip arthritis. Both operative and nonoperative treatments have been described with variable success rate. Early diagnosis and treatment is the key for success in preserving the hip joint. Once femoral head collapses (>2 mm) or if there is secondary degeneration, hip conservation procedures become ineffective and arthroplasty remains the only better option. We reviewed 157 studies that evaluate different treatment modalities of ONFH and then a final consensus on treatment was made.

Keywords: Avascular necrosis; Avascular necrosis of bone; femur head; hip; osteonecrosis; treatment; treatment protocols.

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Conflict of interest statement

Conflict of Interest: None.

Figures

Figure 1
Figure 1
Radiograph of pelvis with both hip joints anteroposterior view showing a bilateral idiopathic osteonecrosis of hip in early stage
Figure 2
Figure 2
Magnetic resonance imaging of the same patient demonstrates edema inside femoral head as well as effusion in the hip joint (a-preoperative) and, after 1-year of core decompression the lesion has diminished in size, the edema has subsided and hip joint effusion is resolved (b-postoperative 1-year)
Figure 3
Figure 3
(a) Plain x-ray anteroposterior view of left hip in a 32-year old young patient showing posttraumatic AVN in its early stage (b) MRI of both hips showing early avascular changes (c) Intraopartaive photographs demonstrating core decompression and (d) bone marrow concentrate instillation inside the core tract. (e) After 15 months, the necrotic lesion has completely healed
Figure 4
Figure 4
(a) X-ray (R) hip joint anteroposterior view showing advanced stage osteonecrosis of hip treated with vascularized fibular graft, (b) X-ray pelvis both hip joints anteroposterior view (b) after 11 years showing the lesion has healed and femoral head has maintained the sphericity
Figure 5
Figure 5
An algorithm of ONFH management
See this image and copyright information in PMC

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