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Osteonecrosis of the Femoral Head: Overview

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Hip Arthroscopy and Hip Joint Preservation Surgery

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Abstract

Osteonecrosis (ON) of the femoral head is a progressive disease, which commonly impacts younger patients. The disease is characterized by an insult to the blood supply of the femoral head leading to collapse of the femoral head and degenerative changes. Several risk factors for the development of ON have been found; however the exact pathophysiology underlying this condition has yet to be been determined. Patients are diagnosed with ON based on clinical and radiological findings, with MRI becoming the gold standard for diagnosis and assisting in staging patients. Most surgeons attempt to diagnose and treat ON in the early stages, prior to collapse of the femoral head. There are a number of nonoperative (medications) and operative treatments that have been investigated for early stage ON. Operative treatments include core decompression alone, core decompression with injection of bone marrow aspirate or placement of some form of bone substitute, osteochondral allograft transplantation, and osteotomies. Once collapse of the femoral head occurs, nonsurgical options are ineffective. Bone preserving techniques utilized for post-collapse ON include vascularized fibula grafts, osteotomies, and osteochondral allograft transplant but their results are unpredictable. The ultimate salvage options are a hip arthroplasty. While the reconstructive options offer predictable pain relief, there are many operative and clinical considerations given the young age of this patient population.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA

    Courtney E. Baker, Matthew T. Houdek & Rafael J. Sierra

  2. Vanderbilt University, Nashville, TN, USA

    John R. Martin

Authors
  1. Courtney E. Baker
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  2. Matthew T. Houdek
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  3. John R. Martin
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  4. Rafael J. Sierra
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Corresponding author

Correspondence to Rafael J. Sierra .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Shane J. Nho

  2. Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, USA

    Bedi Asheesh

  3. Department of Orthopedic Surgery, Case Western Reserve University, Cleveland, OH, USA

    Michael J. Salata

  4. Department of Orthopedic Surgery, Duke Medical Center, Durham, NC, USA

    Richard C. Mather III

  5. Department of Orthopedic Surgery, Weill Medical College of Cornell Univers, New York, NY, USA

    Bryan T. Kelly

Section Editor information

  1. Department of Orthopedic Surgery, Henry Ford Health System and School of Medicine, Wayne State University, Detroit, MI, USA

    Eric C. Makhni

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Baker, C.E., Houdek, M.T., Martin, J.R., Sierra, R.J. (2021). Osteonecrosis of the Femoral Head: Overview. In: Nho, S.J., Asheesh, B., Salata, M.J., Mather III, R.C., Kelly, B.T. (eds) Hip Arthroscopy and Hip Joint Preservation Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7321-3_92-2

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  • DOI: https://doi.org/10.1007/978-1-4614-7321-3_92-2

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Chapter history

  1. Latest

    Osteonecrosis of the Femoral Head: Overview
    Published:
    28 November 2021

    DOI: https://doi.org/10.1007/978-1-4614-7321-3_92-2

  2. Original

    Avascular Necrosis: Overview
    Published:
    02 June 2014

    DOI: https://doi.org/10.1007/978-1-4614-7321-3_92-1

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