Associated Risk Factors, Pathogenesis, Diagnosis, and Treatment Options for Multifocal Osteonecrosis: A Systematic...

Area of Science:

• Orthopedics
• Rheumatology
• Radiology

Background:

• Multifocal osteonecrosis (MFON) is osteonecrosis in at least three distinct anatomic sites.
• Data on MFON characterization, diagnosis, and treatment is limited.
• Awareness and appropriate management are vital for arthroplasty surgeons.

Purpose of the Study:

• Systematically review literature on MFON.
• Identify clinical presentation and epidemiology.
• Characterize pathophysiology, diagnostic modalities, and treatment guidelines.

Main Methods:

• Conducted a systematic review following PRISMA guidelines.
• Searched three databases for relevant articles.
• Included 12 articles meeting criteria for MFON data.

Main Results:

• Autoimmune diseases (e.g., lupus) and corticosteroid use are common MFON causes.
• The femoral head is most frequently affected, followed by knee, shoulder, and ankle.
• Diagnosis uses radiography and whole-body MRI for screening; regional MRI for staging.
• Treatment involves joint preservation or arthroplasty post-collapse.

Conclusions:

• MFON is rare but requires surgeon awareness and meticulous screening.
• Defined by osteonecrosis in ≥3 distinct anatomic sites (concurrently or consecutively).
• Surgeons must screen patients with osteonecrosis for multifocal involvement.