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Review
. 2019 Mar 15;4(3):85-97.
doi: 10.1302/2058-5241.4.180036. eCollection 2019 Mar.

Osteonecrosis of the femoral head: pathophysiology and current concepts of treatment

Daniel Petek  1 , Didier Hannouche  2 , Domizio Suva  2
Affiliations
Review

Osteonecrosis of the femoral head: pathophysiology and current concepts of treatment

Daniel Petek et al. EFORT Open Rev. .

Abstract

Osteonecrosis of the femoral head is a disabling pathology affecting a young population (average age at treatment, 33 to 38 years) and is the most important cause of total hip arthroplasty in this population. It reflects the endpoint of various disease processes that result in a decrease of the femoral head blood flow.The physiopathology reflects an alteration of the vascularization of the fine blood vessels irrigating the anterior and superior part of the femoral head. This zone of necrosis is the source of the loss of joint congruence that leads to premature wear of the hip.Several different types of medication have been developed to reverse the process of ischemia and/or restore the vascularization of the femoral head. There is no consensus yet on a particular treatment.The surgical treatments aim to preserve the joint as far as the diagnosis could be made before the appearance of a zone of necrosis and the loss of joint congruence. They consist of bone marrow decompressions, osteotomies around the hip, vascular or non-vascular grafts.Future therapies include the use of biologically active molecules as well as implants impregnated with biologically active tissue. Cite this article: EFORT Open Rev 2019;4:85-97. DOI: 10.1302/2058-5241.4.180036.

Keywords: avascular necrosis; femoral head; osteonecrosis.

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Conflict of interest statement

ICMJE Conflict of interest statement: None declared.

Figures

Fig. 1
Fig. 1
Different pathways participating in ONFH.
Fig. 2
Fig. 2
Radiological aspects according to modality.
Fig. 3
Fig. 3
Grade I ONFH on a) plain radiograph, b) T1 and c) T2.
Fig. 4
Fig. 4
Crescent sign on a) MRI T2, b) CT scan c) radiograph.
Fig. 5
Fig. 5
Involvement of the acetabulum.
Fig. 6
Fig. 6
Total hip replacement in advanced femoral head collapse after ONFH.
Fig. 7
Fig. 7
Conservative surgery consisting of hip dislocation and non-vascular bone grafting.
Fig. 8
Fig. 8
a) Necrotic head portion, b) osteochondral transfer, c) CT scanner at one-year follow-up.
Fig. 9
Fig. 9
a) Debridement of the femoral head and PMMA filling of the defect, b) radiograph at five-year follow-up, c) aspect of the femoral head at time of arthroplasty, at 12 years of follow-up.
See this image and copyright information in PMC

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