Stages Of Osteonecrosis Of The Femoral Head Research Articles

Treatment of Early Stage Osteonecrosis of the Femoral Head

Osteonecrosis is a devastating disease that primarily affects weight-bearing joints. The hip is the most commonly affected joint. Although hip osteonecrosis can affect patients of any age group, it typically presents in young patients between the ages of twenty and forty years1. The factors that affect the progression of this disease are still not fully understood, but radiographic lesion size, femoral head collapse (if present), and, occasionally, clinical presentation at the time of diagnosis have been shown to be predictive of the eventual clinical outcome2,3. After collapse, most patients will require a standard total hip arthroplasty4,5. However, because of the young age of many of these patients, a hip replacement cannot be expected to last the patient's lifetime and therefore, when feasible, attempts should be made to save the femoral head prior to collapse with use of less invasive treatment modalities. The efficacy of these procedures has been variable, with reported success rates ranging between 60% and 80% at the time of short-term and midterm follow-up6-8. Current treatments range from pharmacotherapies to surgical interventions that include core decompression, vascularized or nonvascularized bone-grafting, and osteotomy. Recently there have been attempts to enhance these surgical techniques with use of various growth and differentiation factors. The primary purpose of this report is threefold: (1) to discuss the importance of early diagnosis and the standards for identifying and staging osteonecrosis; (2) to assess the efficacy of various treatment modalities and techniques by conducting an extensive literature review and comparing reported outcomes with those of patients treated at our institution; and (3) to provide a recommended treatment algorithm based on the assessment of these treatment options. All patients who were treated at our institution for early stage osteonecrosis of the hip …

Survivorship Analysis and Radiographic Outcome Following Tantalum Rod Insertion for Osteonecrosis of the Femoral Head

For early stages of osteonecrosis, preservation of the femoral head is the primary objective; however, there has not been a consensus on how best to achieve this goal. Core decompression alone is associated with a lack of structural support with inconsistent outcomes, whereas vascularized fibular grafting requires an extensive surgical procedure with high donor-site morbidity and prolonged rehabilitation. The adjunctive use of a porous tantalum implant offers the advantages of core decompression, structural support, minimally invasive surgery, and no donor-site morbidity. The purpose of this study was to assess the survivorship and to evaluate the clinical results and radiographic outcomes of hips in which osteonecrosis of the femoral head was treated with core decompression and a porous tantalum implant. We evaluated fifty-four patients (sixty consecutive hips) in whom osteonecrosis of the femoral head was treated with core decompression and insertion of a porous tantalum implant. Fifty-two patients (fifty-eight hips) were available for follow-up at a mean of twenty-four months. All patients were sixty-five years of age or younger (mean age, thirty-five years). According to the classification system of Steinberg et al., one hip (2%) had stage-I disease, forty-nine hips (84%) had stage-II disease, and eight hips (14%) had stage-III disease. Outcome measures that were used included a limb-specific score (Harris hip score), radiographic outcome measures, and survivorship analysis with revision to total hip arthroplasty as the end point. Overall, nine hips (15.5%) were converted to total hip arthroplasty, including six with stage-II disease and three with stage-III disease. The overall survival rates were 91.8% (95% confidence interval, 87.8% to 95.8%) at twelve months, 81.7% (95% confidence interval, 75.8% to 87.6%) at twenty-four months, and 68.1% (95% confidence interval, 54.7% to 81.5%) at forty-eight months. The absence of chronic systemic diseases resulted in a survival rate of 92% at forty-eight months (95% confidence interval, 87.4% to 96.4%). Treatment of early stage osteonecrosis of the femoral head with core decompression and a porous tantalum implant can be accomplished with a minimally invasive technique and no donor-site morbidity. The early clinical results show encouraging survival rates in patients who do not have chronic systemic disease, especially in association with early stage disease. Therapeutic Level IV. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.

Osteonecrosis: What to do, what to do!

Despite extensive literature on the subject, the treatment approaches for osteonecrosis of the femoral head (ONFH) remain controversial. The literature presently available to the orthopaedist suggests that i) ONFH can be identified early; ii) there are reasonable treatments for early stages of ONFH; iii) no single treatment is sufficient for all hips; and iv) there is as yet no predictable permanent treatment for early ONFH. The author's recommended approach for the practicing orthopaedist includes the following: i) develop a high degree of clinical suspicion that the disease is present and understand the role of magnetic resonance imaging in making an accurate diagnosis; ii) understand and use an appropriate staging system for each hip diagnosed; iii) be comfortable with several treatment options for early ONFH or choose to refer to appropriate centers; and iv) become comfortable with the use of uncemented THA for end-stage ONFH. The field continues to need and should support better treatment studies, including randomized clinical trials. © 2003 Elsevier Inc. All rights reserved.

A new animal model of femoral head necrosis induced by intraosseous injection of ethanol.

There is no reliable animal model of the early stages of osteonecrosis of the femoral head (ONFH) for the evaluation of new therapeutic approaches. In this study, we propose a new animal model of femoral head osteonecrosis. Pure ethanol was injected into the centre of the femoral head in adult Merino sheep under fluoroscopic control. After 3, 6 and 12 weeks the animals were killed and the femoral heads were harvested. Microradiographic and histological changes were analysed and recorded. Partial necrosis was documented over a period of 12 weeks in all animals. The appearance of necrosis in combination with intact macrotexture, macrocirculation and joint cartilage is similar to the features described in early ONFH in humans. Due to its efficacy and its similarity to the early stages of ONFH in humans, this model may be suitable to evaluate new therapeutic techniques in the treatment of ONFH.

Occurrence of Marrow Edema in Early Stage Osteonecrosis of the Femoral Head: a Prospective Study with Repeated MR Imagings

Occurrence of Marrow Edema in Early Stage Osteonecrosis of the Femoral Head: a Prospective Study with Repeated MR Imagings