Non-traumatic Osteonecrosis of the femoral head: an overview

  • Geevarughese NM Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal (M.P.)
  • Ipe J Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal (M.P.)
  • Chatterji G Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal (M.P.)
  • Vashistha D Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal (M.P.)
  • Haq RU Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal (M.P.)
Keywords: Non-traumatic, Osteonecrosis, Avascular necrosis, Femoral head, Total hip arthroplasty

Abstract

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.

Downloads

Download data is not yet available.

References

1. Lieberman JR, Berry DJ, Montv MA, Aaron RK, Callaghan JJ, Rayadhyaksha A, et al. Osteonecrosis of the Hip: Management in the Twenty-first Century. J Bone Joint Surg Am 2002;84(5):834-53.
2. Ohzono K, Saito M, Takaoka K, Ono K, Saito S, Nishina T, et al. Natural history of nontraumatic avascular necrosis of the femoral head. J Bone Joint Surg Br 1991;73(1):68-72.
3. Aldridge JM 3rd, Urbaniak JR. Avascular necrosis of the femoral head: etiology, pathophysiology, classification, and current treatment guidelines. Am J Orthop (Belle Mead NJ) 2004;33(7):327-32.
4. Wang GJ, Cui Q, Balian G. The Nicolas Andry award. The pathogenesis and prevention of steroid-induced osteonecrosis. Clin Orthop Relat Res 2000;(370):295-310.
5. Matsuo K, Hirohata T, Sugioka Y, Ikeda M, Fukuda A. Influence of alcohol intake, cigarette smoking, and occupational status on idiopathic osteonecrosis of the femoral head. Clin Orthop Relat Res 1988;(234):115-23.
6. Chao YC, Wang SJ, Chu HC, Chang WK, Hsieh TY. Investigation of alcohol metabolizing enzyme genes in Chinese alcoholics with avascular necrosis of hip joint, pancreatitis and cirrhosis of the liver. Alcohol 2003;38(5):431-36.
7. Hirota Y, Hirohata T, Fukuda K, Mori M, Yanagawa H, Ohno Y, et al. Association of alcohol intake, cigarette smoking, and occupational status with the risk of idiopathic osteonecrosis of the femoral head. Am J Epidemiol 1993;137(5):530-38.
8. Jones JP Jr. Intravascular coagulation and osteonecrosis. Clin Orthop Relat Res 1992;(277):41-53.
9. Akinyoola AL, Adediran IA, Asaleye CM, Bolarinwa AR. Risk factors for osteonecrosis of the femoral head in patients with sickle cell disease. Int Orthop 2009;33(4):923-26.
10. Björkman A, Svensson PJ, Hillarp A, Burtscher IM, Rünow A, Benoni G. Factor V leiden and prothrombin gene mutation: risk factors for osteonecrosis of the femoral head in adults. Clin Orthop Relat Res 2004;(425):168-72.
11. Zalavras CG, Vartholomatos G, Dokou E, Malizos KN. Genetic background of osteonecrosis: associated with thrombophilic mutations? Clin Orthop Relat Res 2004;(422):251-55.
12. Ries MD, Barcohana B, Davidson A, Jergesen HE, Paiement GD. Association between human immunodeficiency virus and osteonecrosis of the femoral head. J Arthroplasty 2002;17(2):135-39.
13. Choi HR, Steinberg ME, E YC. Osteonecrosis of the femoral head: diagnosis and classification systems. Curr Rev Musculoskelet Med 2015;8(3):210-20.
14. Hauzeur JP, Pasteels JL, Schoutens A, Hinsenkamp M, Appelboom T, Chochrad I, et al. The diagnostic value of magnetic resonance imaging in non-traumatic osteonecrosis of the femoral head. J Bone Joint Surg Am 1989;71(5):641-49.
15. Ha YC, Jung WH, Kim JR, Seong NH, Kim SY, Koo KH. Prediction of collapse in femoral head osteonecrosis: a modified Kerboul method with use of magnetic resonance images. J Bone Joint Surg Am 2006;88 Suppl 3:35-40.
16. Malizos KN, Karantanas AH, Varitimidis SE, Dailiana ZH, Bargiotas K, Maris T. Osteonecrosis of the femoral head: etiology, imaging and treatment. Eur J Radiol 2007;63(1):16-28.
17. Stevens K, Tao C, Lee SU, Salem N, Vandevenne J, Cheng C, et al. Subchondral fractures in osteonecrosis of the femoral head: comparison of radiography, CT, and MR imaging AJR. Am J Roentgenol 2003;180(2):363-68.
18. Mont MA, Jones LC, Hungerford DS. Nontraumatic osteonecrosis of the femoral head: ten years later. J Bone Joint Surg Am 2006;88(5):1117-32.
19. Stulberg BN. Osteonecrosis: what to do, what to do! J Arthroplasty 2003;18(3 Suppl 1):74-79.
20. Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br 1985;67(1):3-9.
21. Steinberg DR, Steinberg ME. The University of Pennsylvania Classification of Osteonecrosis. In: Koo K-H, Mont MA, Jones LC, editors. Osteonecrosis Berlin, Heidelberg: Springer Berlin Heidelberg; 2014. pp. 201-6.
22. Gardeniers J. A new international classification of osteonecrosis of the ARCO-committee on terminology and classification. ARCO Newsletter 1992;4(4):41-46.
23. Sugano N, Atsumi T, Ohzono K, Kubo T, Hotokebuchi T, Takaoka K. The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head. J Orthop Sci 2002;7(5):601-5.
24. Yoon BH, Mont MA, Koo KH, Chen CH, Cheng EY, Cui Q, et al. The 2019 Revised Version of Association Research Circulation Osseous Staging System of Osteonecrosis of the Femoral Head. J Arthroplasty 2020;35(4):933-40.
25. Mont MA, Cherian JJ, Sierra RJ, Jones LC, Lieberman JR. Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today? A Ten-Year Update J Bone Joint Surg Am 2015;97(19):1604-27.
26. Moya-Angeler J, Gianakos AL, Villa JC, Ni A, Lane JM. Current concepts on osteonecrosis of the femoral head. World J Orthop 2015;6(8):590-601.
27. Mont MA, Zywiel MG, Marker DR, McGrath MS, Delanois RE. The natural history of untreated asymptomatic osteonecrosis of the femoral head: a systematic literature review. J Bone Joint Surg Am 2010;92(12):2165-70.
28. Agarwala S, Shah SB. Ten-year follow-up of avascular necrosis of femoral head treated with alendronate for 3 years. J Arthroplasty 2011;26(7):1128-34.
29. Lai KA, Shen WJ, Yang CY, Shao CJ, Hsu JT, Lin RM. The use of alendronate to prevent early collapse of the femoral head in patients with nontraumatic osteonecrosis. A randomized clinical study. J Bone Joint Surg Am 2005;87(10):2155-59.
30. Yuan HF, Guo CA, Yan ZQ. The use of bisphosphonate in the treatment of osteonecrosis of the femoral head: a meta-analysis of randomized control trials. Osteoporos Int 2016;27(1):295-99.
31. Li D, Yang Z, Wei Z, Kang P. Efficacy of bisphosphonates in the treatment of femoral head osteonecrosis: A PRISMA-compliant meta-analysis of animal studies and clinical trials. Sci Rep 2018;8(1):1450.
32. Chen CH, Chang JK, Lai KA, Hou SM, Chang CH, Wang GJ. Alendronate in the prevention of collapse of the femoral head in nontraumatic osteonecrosis: a two-year multicenter, prospective, randomized, double-blind, placebo-controlled study. Arthritis Rheum 2012;64(5):1572-78.
33. Pritchett JW. Statin therapy decreases the risk of osteonecrosis in patients receiving steroids. Clin Orthop Relat Res 2001;(386):173-78.
34. Ajmal M, Matas AJ, Kuskowski M, Cheng EY. Does statin usage reduce the risk of corticosteroid-related osteonecrosis in renal transplant population? Orthop Clin North Am 2009;40(2):235-39.
35. Jäger M, Zilkens C, Bittersohl B, Matheney T, Kozina G, Blondin D, et al. Efficiency of iloprost treatment for osseous malperfusion. Int Orthop 2011;35(5):761-65.
36. Guo P, Gao F, Wang Y, Zhang Z, Sun W, Jiang B, et al. The use of anticoagulants for prevention and treatment of osteonecrosis of the femoral head: A systematic review. Medicine (Baltimore) 2017;96(16):e6646.
37. Massari L, Fini M, Cadossi R, Setti S, Traina GC. Biophysical stimulation with pulsed electromagnetic fields in osteonecrosis of the femoral head. J Bone Joint Surg Am 2006;88 Suppl 3:56-60.
38. Alves EM, Angrisani AT, Santiago MB. The use of extracorporeal shock waves in the treatment of osteonecrosis of the femoral head: a systematic review. Clin Rheumatol 2009;28(11):1247-51.
39. Paderno E, Zanon V, Vezzani G, Giacon TA, Bernasek TL, Camporesi EM, et al. Evidence-Supported HBO Therapy in Femoral Head Necrosis: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2021;18(6).
40. Li W, Ye Z, Wang W, Wang K, Li L, Zhao D. Clinical effect of hyperbaric oxygen therapy in the treatment of femoral head necrosis : A systematic review and meta-analysis. Orthopade 2017;46(5):440-46.
41. Moghamis I, Alhammoud AA, Kokash O, Alhaneedi GA. The outcome of hyperbaric oxygen therapy versus core decompression in the non-traumatic avascular necrosis of the femoral head: Retrospective Cohort Study. Ann Med Surg (Lond) 2021;62:450-54.
42. Mont MA, Salem HS, Piuzzi NS, Goodman SB, Jones LC. Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today?: A 5-Year Update. J Bone Joint Surg Am 2020;102(12):1084-99.
43. Pierce TP, Jauregui JJ, Elmallah RK, Lavernia CJ, Mont MA, Nace J. A current review of core decompression in the treatment of osteonecrosis of the femoral head. Curr Rev Musculoskelet Med 2015;8(3):228-32.
44. Hua KC, Yang XG, Feng JT, Wang F, Yang L, Zhang H, et al. The efficacy and safety of core decompression for the treatment of femoral head necrosis: a systematic review and meta-analysis. J Orthop Surg Res 2019;14(1):306.
45. Song WS, Yoo JJ, Kim YM, Kim HJ. Results of multiple drilling compared with those of conventional methods of core decompression. Clin Orthop Relat Res 2007;454:139-46.
46. Gupta AK, Frank RM, Harris JD, McCormick F, Mather RC, Nho SJ. Arthroscopic-assisted core decompression for osteonecrosis of the femoral head. Arthrosc Tech 2014;3(1):e7-11.
47. Wang Z, Sun QM, Zhang FQ, Zhang QL, Wang LG, Wang WJ. Core decompression combined with autologous bone marrow stem cells versus core decompression alone for patients with osteonecrosis of the femoral head: A meta-analysis. Int J Surg 2019;69:23-31.
48. Piuzzi NS, Chahla J, Schrock JB, LaPrade RF, Pascual-Garrido C, Mont MA, et al. Evidence for the Use of Cell-Based Therapy for the Treatment of Osteonecrosis of the Femoral Head: A Systematic Review of the Literature. J Arthroplasty 2017;32(5):1698-1708.
49. Wu CT, Yen SH, Lin PC, Wang JW. Long-term outcomes of Phemister bone grafting for patients with non-traumatic osteonecrosis of the femoral head. Int Orthop 2019;43(3):579-87.
50. Yildiz C, Erdem Y, Koca K. Lightbulb technique for the treatment of osteonecrosis of the femoral head. Hip Int 2018;28(3):272-77.
51. Ünal MB, Cansu E, Parmaksızoğlu F, Cift H, Gürcan S. Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting: Results of 7.6-year follow-up. Acta Orthop Traumatol Turc 2016;50(5):501-6.
52. Zhang L, Fan Y, Zhang Y, Chen X, Liu Y. Comparison of sartorius muscle-pedicle and circumflex iliac deep bone flap grafts in the treatment of early non-traumatic osteonecrosis of femoral head in young adults. Acta orthopaedica et traumatologica turcica 2019;53(4):255-59.
53. Zhao D, Xie H, Xu Y, Wang Y, Yu A, Liu Y, et al. Management of osteonecrosis of the femoral head with pedicled iliac bone flap transfer: A multicenter study of 2190 patients. Microsurgery 2017;37(8):896-901.
54. Lee YK, Park CH, Ha YC, Kim DY, Lyu SH, Koo KH. Comparison of Surgical Parameters and Results between Curved Varus Osteotomy and Rotational Osteotomy for Osteonecrosis of the Femoral Head. Clin Orthop Surg 2017;9(2):160-68.
55. Amstutz HC, Le Duff MJ. Current status of hemi-resurfacing arthroplasty for osteonecrosis of the hip: a 27-year experience. Orthop Clin North Am 2009;40(2):275-82.
56. Chan YS, Shih CH. Bipolar versus total hip arthroplasty for hip osteonecrosis in the same patient. Clin Orthop Relat Res 2000;(379):169-77.
57. Kim YH, Park JW. Ultra-Short Anatomic Uncemented Femoral Stem and Ceramic-on-Ceramic Bearing in Patients With Idiopathic or Ethanol-Induced Femoral Head Osteonecrosis. J Arthroplasty 2020;35(1):212-18.
Published
2021-06-30
How to Cite
1.
Geevarughese NM, Ipe J, Chatterji G, Vashistha D, Haq RU. Non-traumatic Osteonecrosis of the femoral head: an overview. ojmpc [Internet]. 2021Jun.30 [cited 2021Jun.25];27(2):53-. Available from: https://ojmpc.com/index.php/ojmpc/article/view/145
Section
Review Article