Non-traumatic Osteonecrosis of the femoral head: an overview
Osteonecrosis of femoral head is a debilitating condition that frequently affects the young. Risk factors primarily include corticosteroid use, alcohol consumption, trauma, blood dyscrasias and coagulation abnormalities. Despite multiple theories, no single mechanism has been successful in fully explaining the pathophysiology, except for one common factor that impairment of circulation to the femoral head leading to subsequent development of necrotic patches. The natural history of the disease is eventual collapse of the hip joint and arthritis; therefore, early diagnosis and intervention are essential. Size and location of the lesion are prognostic factors of progression of the disease process and are best evaluated on magnetic resonance imaging. Management of non-traumatic osteonecrosis remains evolving with better knowledge of the disease process and advances in treatment options. In an early stage, joint-preservation is the primary objective, which offers options of core decompression alone or with adjunctive vascularized bone grafts, avascular grafts, bone morphogenetic proteins, stem cells, or combinations of the above or by transtrochanteric osteotomies. Once collapse has set in, total hip replacement has been the preferred treatment of choice. Nevertheless, careful patient selection and understanding the etiology plays a pivotal role in deciding course of management and choice of implants.
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