Key pathway to prevent the collapse of femoral head in osteonecrosis

Osteonecrosis of the femoral head (ONFH) is a multifactorial disease, with unclear pathogenesis. The collapse of the femoral head is an important turning point in ONFH, especially for young patients. Many methods have been proposed, but the best treatment lacks consensus among orthopedic surgeons. Thus, understanding the collapse mechanism of the femoral head in ONFH is the key to a successful outcome of joint preservation. This review aims to provide an update of the collapse mechanism of the femoral head in ONFH and to focus on the most appropriate therapeutic strategies to adopt in clinical practice.

We reviewed the international literature to identify studies focusing on ONFH and therapeutic options. PubMed, Medline and Cochrane Library databases were searched for English language papers.

An imbalance between bone resorption and bone formation as well as stress distribution on insufficient trabecular bone may be the most important collapse mechanism in ONFH.

Treatment to avoid femoral head collapse should focus on local effective mechanical support with modification of bone remodeling in the femoral head.