Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today?: A 5-Year Update

Abstract

1. ➢

   Clinicians should exercise a high level of suspicion in at-risk patients (those who use corticosteroids, consume excessive alcohol, have sickle cell disease, etc.) in order to diagnose osteonecrosis of the femoral head in its earliest stage.

2. ➢

   Nonoperative treatment modalities have generally been ineffective at halting progression. Thus, nonoperative treatment is not appropriate in early stages when one is attempting to preserve the native joint, except potentially on rare occasions for small-sized, medially located lesions, which may heal without surgery.

3. ➢

   Joint-preserving procedures should be attempted in early-stage lesions to save the femoral head.

4. ➢

   Cell-based augmentation of joint-preserving procedures continues to show promising results, and thus should be considered as an ancillary treatment method that may improve clinical outcomes.

5. ➢

   The outcomes of total hip arthroplasty in the setting of osteonecrosis are excellent, with results similar to those in patients who have an underlying diagnosis of osteoarthritis.

Fig. 1-A

Fig. 1-B

Fig. 2

Aspiration of bone marrow from the iliac crest for subsequent processing and implantation following femoral head CD.

Fig. 3

The lightbulb technique—creation of a cortical window at the femoral head-neck junction for evacuation of necrotic tissue and replacement with a bone graft.