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Osteonecrosis of the femoral head: current concepts and controversies
1University of Iowa Hospitals and Clinics, Dept. of Orthopaedic Surgery, Iowa City 52242.
Abstract:
Despite many investigations into ON of the femoral head, many issues remain unresolved. The pathogenesis in most cases is only speculative and may involve intravascular factors such as microemboli or extravascular factors such as increased interosseous pressure. MRI has emerged as the diagnostic test of choice for suspected early lesions, and radiographs should be used to diagnose and follow advanced lesions. Bone scanning can be useful for early diagnosis and CT scanning or tomography may help plan surgical procedures. The role of the functional exploration of bone is controversial. The natural history of early lesions is unknown; this makes it difficult to evaluate results of treatment. Radiographic ON will usually progress to collapse and arthrosis if treated nonoperatively. The role of core decompression or other joint preserving operations to prevent collapse is controversial, since the reports of success and complication rates have been extremely variable. These procedures are ineffective if used after radiographic collapse. Total hip replacement is the only satisfactory treatment for advanced symptomatic stages, but is relatively contraindicated in young active patients. Further research is needed to assess the natural history of early ON and evaluate the role of surgery in preventing progression.
Insights
Osteonecrosis (ON) of the femoral head has unclear causes and unknown natural history. Treatment effectiveness for ON remains controversial, necessitating further research.
Area of Science:
- Orthopedics
- Radiology
- Bone Diseases
Background:
- Osteonecrosis (ON) of the femoral head presents unresolved diagnostic and etiological challenges.
- Pathogenesis is speculative, potentially involving intravascular (e.g., microemboli) or extravascular (e.g., increased interosseous pressure) factors.
Purpose of the Study:
- To review current diagnostic modalities and treatment controversies for femoral head osteonecrosis.
- To highlight the need for further research into the natural history and surgical interventions for ON.
Main Methods:
- Review of diagnostic imaging techniques including MRI, radiography, bone scanning, and CT.
- Discussion of treatment options such as core decompression and total hip replacement.
Main Results:
- MRI is preferred for early ON diagnosis; radiography is used for advanced lesions.
- Nonoperative treatment of radiographic ON typically leads to collapse and arthrosis.
- Core decompression efficacy is debated and ineffective post-collapse; total hip replacement is standard for advanced stages.
Conclusions:
- The natural history of early osteonecrosis remains largely unknown, complicating treatment evaluation.
- The role of joint-preserving surgeries like core decompression is controversial due to variable outcomes.
- Further research is crucial for understanding ON progression and optimizing surgical interventions.