Nontraumatic osteonecrosis of the femoral head: Where dowe stand today? A ten-year update

Michael A. Mont, Jeffrey J. Cherian, Rafael J. Sierra, Lynne C. Jones, Jay R. Lieberman

Research output: Contribution to journalReview article

175 Scopus citations

Abstract

Although multiple theories have been proposed, no one pathophysiologic mechanism has been identified as the etiology for the development of osteonecrosis of the femoral head. However, the basic mechanism involves impaired circulation to a specific area that ultimately becomes necrotic. A variety of nonoperative treatment regimens have been evaluated for the treatment of precollapse disease, with varying success. Prospective, multicenter, randomized trials are needed to evaluate the efficacy of these regimens in altering the natural history of the disease. Joint-preserving procedures are indicated in the treatment of precollapse disease, with several studies showing successful outcomes at mid-term and long-term follow-up. Studies of total joint arthroplasty, once femoral head collapse is present, have described excellent outcomes at greater than ten years of follow-up, which is a major advance and has led to a paradigm shift in treating these patients. The results of hemiresurfacing and total resurfacing arthroplasty have been suboptimal, and these procedures have restricted indications in patients with osteonecrosis of the femoral head.

Original languageEnglish (US)
Pages (from-to)1604-1627
Number of pages24
JournalJournal of Bone and Joint Surgery - American Volume
Volume97
Issue number19
DOIs
StatePublished - Sep 2 2014

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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