Osteonecrosis of the Femoral Head

Abstract

Avascular necrosis when occurring as osteonecrosis of the femoral head poses a challenge for hip surgeons due to the risk of collapse of the articular cartilage. The pathological process and its various stages have been classified using a number of systems to aid with diagnostic decision making and employing a variety of methods of operative intervention for appropriate indications. When there is such a plethora of manage-ment options, it highlights that there is no one “excellent” option for management of the condition. Having undertaken a scoping review, the authors conclude that surgical decision-making, based on the options available, should be tailored to patient factors (aetiology, age, collapse, etc.) and surgical skills set (microvascular surgery, pedicle grafting versus non-vascularised versus synthetic grafting). There are different hip preservation techniques in the literature with different success rates, however, from the current data available, it can be observed that vascularised techniques result in a lesser rate of conversion to arthroplasty but require greater time and technical abilities in microsurgery than non-vascularised techniques.