Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today? A Ten-Year Update.
Mont MA, Cherian JJ, Sierra RJ, et al. The Journal of bone and joint surgery. American volume 2015 · PMID 26446969 · doi:10.2106/jbjs.o.00071
- Question
- What is the current evidence for diagnosing, staging and treating non-traumatic osteonecrosis of the femoral head?
- Design
- Narrative evidence review (current concepts).
- Patients
- Adults with non-traumatic osteonecrosis of the femoral head (e.g. steroid- or alcohol-associated).
- Intervention
- Joint-preserving procedures (core decompression, bone grafting, osteotomy) and arthroplasty
- Comparison
- Non-operative management and between surgical options
- Primary outcome
- Summary of evidence on progression and treatment outcomes
- Key result
- Joint-preserving procedures are indicated before femoral head collapse, with good mid- to long-term results in several series; once collapse has occurred, total hip arthroplasty gives excellent long-term outcomes, whereas resurfacing and hemiresurfacing have performed poorly.
- Limitations
- Narrative review without systematic methods; much of the underlying evidence is from case series.
- Impact on practice
- Underpins the stage-based approach to osteonecrosis: early diagnosis in at-risk patients, head-preserving surgery before collapse, and total hip arthroplasty for advanced disease.