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.