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[Osteonecrosis: natural course and conservative therapy].
1Orthopädische Abteilung, LKH Stolzalpe, Osterreich. hofmann@murau.at
Der Orthopade
|June 30, 2000
Summary
Early Osteonecrosis (ON) of the femoral head prognosis depends on lesion size and location. Most large, lateral lesions progress to collapse within two years, while small, medial lesions may fare better. Conservative treatments show limited success.
Area of Science:
- Orthopedics
- Radiology
- Pathology
Context:
- Osteonecrosis (ON) of the femoral head, particularly early stages (ARCO 0-II), lacks sufficient natural course evaluation.
- Advances in MR-imaging provide new insights into early, pre-collapse ON.
- Early ON findings can be reversible, but the "point of no return" is often in ARCO stage II.
Purpose:
- To evaluate the natural course of early Osteonecrosis (ON) of the femoral head.
- To assess the prognostic factors influencing ON progression.
- To review current and potential conservative and surgical treatment outcomes.
Summary:
- Prognosis for early ON is dictated by lesion size and location; small, medial lesions have a better outlook than large, lateral ones.
- Large, lateral lesions have an 80% chance of femoral head collapse within two years.
- Conservative therapies, including protected weight-bearing and pulsed electromagnetic fields, show limited efficacy compared to natural progression or core decompression.
Impact:
- Identifies key prognostic factors for early femoral head ON, aiding clinical decision-making.
- Highlights the limitations of current conservative treatments for ON.
- Emphasizes the need for prospective, MRI-controlled studies to validate new therapeutic strategies for ON.