Early-stage osteonecrosis of the femoral head: where are we and where are we going in year 2018?

  • Eric Larson
  • Lynne C. Jones
  • Stuart B. Goodman
  • Kyung-Hoi Koo
  • Quanjun Cui
Review Article

Abstract

Osteonecrosis of the femoral head (ONFH) is a devastating condition affecting relatively young patients whereby the femoral head is necrotic, resulting in significant pain, articular surface collapse, and eventual osteoarthritis. This condition has been highly associated with chronic steroid use, alcoholism, and hip trauma, as well as other less common conditions. Without intervention, this condition has a high likelihood of progressing and developing into end-stage osteoarthritis. Unfortunately, ONFH is difficult to diagnose on plain radiographs in the early stages of the disease, and often requires more advanced imaging modalities such as MRI in order to fully assess for early degeneration. Providers, therefore, must have a high index of suspicion when a younger patient presents with hip pain and negative X-rays. Unfortunately, in patients whose femoral heads have already collapsed, joint-preserving procedures are not effective, and total hip arthroplasty remains the most reliable long-term treatment. Multiple treatments have been pursued to address osteonecrosis in patients whose femoral head have not yet collapsed, but the results of these treatments are mixed. The most promising of these interventions to date is core decompression with the use of concentrated bone marrow aspirate to improve the healing potential of the femoral head. Further studies including randomized clinical trials are necessary in order to assess the effectiveness of this therapy, the best possible source of cells and the best method of implantation in order to further improve results in those with pre-collapse ONFH.

Keywords

Osteonecrosis Avascular necrosis Stem cells Mesenchymal stem cells Core decompression Femoral head Hip 

Notes

Compliance with ethical standards

Conflict of interest

Dr. Cui or an immediate family member serves as a paid consultant to Exactech has received research or institutional support from the National Institute of Health, Department of Defense and Exactech; serves as a board member, owner, officer, or committee member of the Virginia Orthopaedic Society, Journal of Arthroplasty, World Journal of Orthopaedics and Journal of Orthopaedic Research; and received royalties from Elsevier. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Larson, Dr. Goodman, Dr. Jones, and Dr. Koo.

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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryUniversity of Virginia School of MedicineCharlottesvilleUSA
  2. 2.Department of Orthopaedic SurgeryJohns Hopkins School of MedicineBaltimoreUSA
  3. 3.Department of Orthopaedic SurgeryStanford University Medical Center Outpatient CenterRedwood CityUSA
  4. 4.Department of Orthopedic SurgerySeoul National University, Bundang HospitalSeongnamSouth Korea

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