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Review
. 2018 Aug 21;10(8):e3171.
doi: 10.7759/cureus.3171.

Osteonecrosis of the Femoral Head: Etiology, Investigations, and Management

Shakoor A Baig  1 , M N Baig  2
Affiliations
Review

Osteonecrosis of the Femoral Head: Etiology, Investigations, and Management

Shakoor A Baig et al. Cureus. .

Abstract

Femoral head osteonecrosis is a condition caused by a compromise of the blood supply of the femoral head. The precarious blood supply of the head and its role as a major weight-bearing joint makes it one of the most common bones to be affected by osteonecrosis. We describe the etiology, clinical presentation, investigations and common management options used nowadays to treat it.

Keywords: bisphosphonates; core decompression; hyperbaric oxygen; osteonecrosis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Femoral head blood supply
Femoral head and neck blood supply (Courtesy ALPF Medical Research)
Figure 2
Figure 2. X-ray hip
Crescent sign. Arrows showing the hypointense crescent. (Courtesy http://onradiology.blogspot.com)
Figure 3
Figure 3. X-ray right hip
Advanced osteonecrosis shown in the circle.
Figure 4
Figure 4. CT pelvis - coronal view
Osteonecrosis left hip encircled.
Figure 5
Figure 5. MRI left hip T1
T1 MRI image encircled, showing osteonecrosis in the femoral headband-like lesion. MRI: Magnetic resonance imaging
Figure 6
Figure 6. ONFH and decompression
MRI with ONFH (left-sided image; star showing the osteonecrosis); X-ray left hip; arrow showing osteonecrosis and decompression. MRI: Magnetic resonance imaging; ONFH: Osteonecrosis of the femoral head
Figure 7
Figure 7. Illustration showing decompression and grafting
Post-decompression bone strut using a vascular fibular graft (shown in the circle). (Courtesy: Penn Medicine)
Figure 8
Figure 8. Post-op grafting X-ray
X-ray showing bone grafting after decompression with the help of k-wires (Kirschner wires).
Figure 9
Figure 9. Tantalum rod
Tantalum rod in vitro.
Figure 10
Figure 10. X-ray left hip with Tantalum rod
Tantalum rod in vivo highlighted by an arrow.
Figure 11
Figure 11. Illustration showing rotation osteotomy
The osteotomy is to rotate the damaged weight-bearing surface, so the undamaged area becomes the weight-bearing part of the femoral head. (Courtesy: Nakashima Y, Kubota H, Yamamoto T, Mawatari T, Motomura G, Iwamoto Y: Transtrochanteric rotational osteotomy for late-onset Legg-Calve-Perthes disease. J Pediatr Orthop. 2011, 31:223-228)
See this image and copyright information in PMC

References

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