Osteonecrosis or vascular necrosis refers to the final result of a number of different pathways leading to bone death and ultimately to joint destruction. The femoral head is the most common site of osteonecrosis.
Osteonecrosis develops bilaterally in more than 80% of cases. Besides the hip, the most common sites for necrosis are knees, shoulders, ankles, and elbows. ■ The most common risk factors for osteonecrosis are glucocorticoid use, excessive alcohol consumption, and cigarette smoking.
The fi rst symptom associated with the disease is typically a deep, throbbing groin pain. This pain, usually intermittent and of gradual onset, occasionally appears abruptly.
A variety of non-operative treatment interventions are available at some centers, including vasodilators, lipid-lowering agents, prostacyclin analogues, various types of anticoagulants, bisphosphonates, hyperbaric oxygen therapy, and extracorpeal shock wave therapy. Rigorous data on the effi cacy of these approaches are currently not available.
There are currently four general categories of operative treatment options aimed toward preserving the femoral head and delaying (or preventing) total arthroplasty: (1) core decompression; (2) osteotomy; (3) nonvascularized bone grafting; and (4) vascularized bone grafting.
■ Many patients eventually undergo total joint arthroplasty or resurfacing arthroplasty.
KeywordsFemoral Head Total Joint Arthroplasty Extracorpeal Shock Wave Therapy Core Decompression Shock Wave Therapy
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