The Journal of Hip Surgery 2019; 03(03): 142-150
DOI: 10.1055/s-0039-1693422
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Osteonecrosis of the Femoral Head: Can Arthroplasty be Avoided—A Brief Review of Common Interventions

Thomas A. Einhorn
1   Department of Orthopedic Surgery, NYU Langone Health, Langone Orthopedic Hospital, New York
,
Afshin A. Anoushiravani
2   Department of Orthopaedic Surgery, Albany Medical Center, Albany, New York
,
Kevin K. Chen
1   Department of Orthopedic Surgery, NYU Langone Health, Langone Orthopedic Hospital, New York
,
Thomas Draper
2   Department of Orthopaedic Surgery, Albany Medical Center, Albany, New York
,
Tony Tsismenakis
1   Department of Orthopedic Surgery, NYU Langone Health, Langone Orthopedic Hospital, New York
,
Richard Iorio
1   Department of Orthopedic Surgery, NYU Langone Health, Langone Orthopedic Hospital, New York
› Author Affiliations
Further Information

Publication History

07 May 2018

18 April 2019

Publication Date:
30 July 2019 (online)

Abstract

Osteonecrosis of the femoral head (ONFH) is a rapidly progressive degenerative disease frequently affecting individuals within their fourth and fifth decade of life. Though often asymptomatic, patients with ONFH may present with a wide range of symptoms, including deep groin pain. There are many classification systems used to stratify disease severity, of which the Association of Research Circulation Osseous (ARCO) classification system is currently the most comprehensive. Once diagnosed, an estimated 75% of patients will experience femoral head collapse within three years of diagnosis if left untreated. Currently, the only definitive intervention available for ONFH is total hip arthroplasty (THA). However, recent advancements have been made with respect to the available treatment modalities. In this article, the author review the management of ONFH, providing clinicians with the necessary information to counsel their patients.

 
  • References

  • 1 Lieberman JR, Berry DJ, Mont MA. , et al. Osteonecrosis of the hip: management in the 21st century. Instr Course Lect 2003; 52: 337-355
  • 2 Merle D'Aubigné R, Postel M, Mazabraud A, Massias P, Gueguen J, France P. Idiopathic necrosis of the femoral head in adults. J Bone Joint Surg Br 1965; 47 (04) 612-633
  • 3 Ficat RP, Arlet J. Forage-biopsie de la tete femorale dans I'osteonecrose primative. Observations histo-pathologiques portant sur huit forages. Rev Rhum 1964; (31) 257-264
  • 4 Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br 1985; 67 (01) 3-9
  • 5 Smith SW, Meyer RA, Connor PM, Smith SE, Hanley Jr EN. Interobserver reliability and intraobserver reproducibility of the modified Ficat classification system of osteonecrosis of the femoral head. J Bone Joint Surg Am 1996; 78 (11) 1702-1706
  • 6 Nishii T, Sugano N, Miki H, Hashimoto J, Yoshikawa H. Does alendronate prevent collapse in osteonecrosis of the femoral head?. Clin Orthop Relat Res 2006; 443 (443) 273-279
  • 7 Jw G. A new international classification of osteonecrosis of the ARCO Committee on terminology and classification. J Jpn Orthop Assoc. 1992; 66: 18-20
  • 8 Schmitt-Sody M, Kirchhoff C, Mayer W, Goebel M, Jansson V. Avascular necrosis of the femoral head: inter- and intraobserver variations of Ficat and ARCO classifications. Int Orthop 2008; 32 (03) 283-287
  • 9 Agarwala S, Jain D, Joshi VR, Sule A. Efficacy of alendronate, a bisphosphonate, in the treatment of AVN of the hip. A prospective open-label study. Rheumatology (Oxford) 2005; 44 (03) 352-359
  • 10 Mont MA, Cherian JJ, Sierra RJ, Jones LC, Lieberman JR. Nontraumatic osteonecrosis of the femoral head: where do we stand today? A ten-year update. J Bone Joint Surg Am 2015; 97 (19) 1604-1627
  • 11 Agarwala S, Sule A, Pai BU, Joshi VR. Study of alendronate in avascular necrosis of bone. J Assoc Physicians India 2001; 49: 949-950
  • 12 Agarwala S, Shah S, Joshi VR. The use of alendronate in the treatment of avascular necrosis of the femoral head: follow-up to eight years. J Bone Joint Surg Br 2009; 91 (08) 1013-1018
  • 13 Lai KA, Shen WJ, Yang CY, Shao CJ, Hsu JT, Lin RM. The use of alendronate to prevent early collapse of the femoral head in patients with nontraumatic osteonecrosis. A randomized clinical study. J Bone Joint Surg Am 2005; 87 (10) 2155-2159
  • 14 Chen CH, Chang JK, Lai KA, Hou SM, Chang CH, Wang GJ. Alendronate in the prevention of collapse of the femoral head in nontraumatic osteonecrosis: a two-year multicenter, prospective, randomized, double-blind, placebo-controlled study. Arthritis Rheum 2012; 64 (05) 1572-1578
  • 15 Lee YK, Ha YC, Cho YJ. , et al. Does zoledronate prevent femoral head collapse from osteonecrosis? A prospective, randomized, open-label, multicenter study. J Bone Joint Surg Am 2015; 97 (14) 1142-1148
  • 16 Stulberg BN, Davis AW, Bauer TW, Levine M, Easley K. Osteonecrosis of the femoral head. A prospective randomized treatment protocol. Clin Orthop Relat Res 1991; (268) 140-151
  • 17 Koo KH, Kim R. Quantifying the extent of osteonecrosis of the femoral head. A new method using MRI. J Bone Joint Surg Br 1995; 77 (06) 875-880
  • 18 Neumayr LD, Aguilar C, Earles AN. , et al; National Osteonecrosis Trial in Sickle Cell Anemia Study Group. Physical therapy alone compared with core decompression and physical therapy for femoral head osteonecrosis in sickle cell disease. Results of a multicenter study at a mean of three years after treatment. J Bone Joint Surg Am 2006; 88 (12) 2573-2582
  • 19 Hernigou P, Beaujean F. Treatment of osteonecrosis with autologous bone marrow grafting. Clin Orthop Relat Res 2002; (405) 14-23
  • 20 Hernigou P, Poignard A, Zilber S, Rouard H. Cell therapy of hip osteonecrosis with autologous bone marrow grafting. Indian J Orthop 2009; 43 (01) 40-45
  • 21 Gangji V, De Maertelaer V, Hauzeur JP. Autologous bone marrow cell implantation in the treatment of non-traumatic osteonecrosis of the femoral head: five year follow-up of a prospective controlled study. Bone 2011; 49 (05) 1005-1009
  • 22 Chang T, Tang K, Tao X. , et al. Treatment of early avascular necrosis of femoral head by core decompression combined with autologous bone marrow mesenchymal stem cells transplantation [in Chinese]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2010; 24 (06) 739-743
  • 23 Sen RK, Tripathy SK, Aggarwal S, Marwaha N, Sharma RR, Khandelwal N. Early results of core decompression and autologous bone marrow mononuclear cells instillation in femoral head osteonecrosis: a randomized control study. J Arthroplasty 2012; 27 (05) 679-686
  • 24 Tabatabaee RM, Saberi S, Parvizi J, Mortazavi SM, Farzan M. Combining concentrated autologous bone marrow stem cells injection with core decompression improves outcome for patients with early-stage osteonecrosis of the femoral head: a comparative study. J Arthroplasty 2015; 30 (9, Suppl) 11-15
  • 25 Piuzzi NS, Chahla J, Jiandong H. , et al. Analysis of cell therapies used in clinical trials for the treatment of osteonecrosis of the femoral head: a systematic review of the literature. J Arthroplasty 2017; 32 (08) 2612-2618
  • 26 Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg 1975; 55 (05) 533-544
  • 27 Urbaniak JR, Coogan PG, Gunneson EB, Nunley JA. Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. A long-term follow-up study of one hundred and three hips. J Bone Joint Surg Am 1995; 77 (05) 681-694
  • 28 Scully SP, Aaron RK, Urbaniak JR. Survival analysis of hips treated with core decompression or vascularized fibular grafting because of avascular necrosis. J Bone Joint Surg Am 1998; 80 (09) 1270-1275
  • 29 Berend KR, Gunneson EE, Urbaniak JR. Free vascularized fibular grafting for the treatment of postcollapse osteonecrosis of the femoral head. J Bone Joint Surg Am 2003; 85-A (06) 987-993
  • 30 Yoo MC, Kim KI, Hahn CS, Parvizi J. Long-term followup of vascularized fibular grafting for femoral head necrosis. Clin Orthop Relat Res 2008; 466 (05) 1133-1140
  • 31 Eward WC, Rineer CA, Urbaniak JR, Richard MJ, Ruch DS. The vascularized fibular graft in precollapse osteonecrosis: is long-term hip preservation possible?. Clin Orthop Relat Res 2012; 470 (10) 2819-2826
  • 32 Kane SM, Ward WA, Jordan LC, Guilford WB, Hanley Jr EN. Vascularized fibular grafting compared with core decompression in the treatment of femoral head osteonecrosis. Orthopedics 1996; 19 (10) 869-872
  • 33 Sotereanos DG, Plakseychuk AY, Rubash HE. Free vascularized fibula grafting for the treatment of osteonecrosis of the femoral head. Clin Orthop Relat Res 1997; (344) 243-256
  • 34 Ligh CA, Nelson JA, Fischer JP, Kovach SJ, Levin LS. The effectiveness of free vascularized fibular flaps in osteonecrosis of the femoral head and neck: a systematic review. J Reconstr Microsurg 2017; 33 (03) 163-172
  • 35 Shuler MS, Rooks MD, Roberson JR. Porous tantalum implant in early osteonecrosis of the hip: preliminary report on operative, survival, and outcomes results. J Arthroplasty 2007; 22 (01) 26-31
  • 36 Gaskill TR, Urbaniak JR, Aldridge III JM. Free vascularized fibular transfer for femoral head osteonecrosis: donor and graft site morbidity. J Bone Joint Surg Am 2009; 91 (08) 1861-1867
  • 37 Elmalı N, Ertem K, Karakaplan M, Pepele D, Dağgez C, Topgül H. Vascular pedicled iliac bone grafting is effective in patients with an early stage of femoral head avascular necrosis. Eklem Hastalik Cerrahisi 2014; 25 (01) 2-7
  • 38 Pavlovčič V, Dolinar D, Arnež Z. Femoral head necrosis treated with vascularized iliac crest graft. Int Orthop 1999; 23 (03) 150-153
  • 39 Eisenschenk A, Lautenbach M, Schwetlick G, Weber U. Treatment of femoral head necrosis with vascularized iliac crest transplants. Clin Orthop Relat Res 2001; (386) 100-105
  • 40 Zhao D, Xu D, Wang W, Cui X. Iliac graft vascularization for femoral head osteonecrosis. Clin Orthop Relat Res 2006; 442: 171-179
  • 41 Yen C-Y, Tu YK, Ma C-H, Yu S-W, Kao F-C, Lee MS-S. Osteonecrosis of the femoral head: comparison of clinical results for vascularized iliac and fibula bone grafting. J Reconstr Microsurg 2006; 22 (01) 21-24
  • 42 Chen CC, Lin CL, Chen WC, Shih HN, Ueng SWN, Lee MS. Vascularized iliac bone-grafting for osteonecrosis with segmental collapse of the femoral head. J Bone Joint Surg Am 2009; 91 (10) 2390-2394
  • 43 Tay J, Levesque JP, Winkler IG. Cellular players of hematopoietic stem cell mobilization in the bone marrow niche. Int J Hematol 2017; 105 (02) 129-140
  • 44 Song HJ, Lan BS, Cheng B. , et al. Treatment of early avascular necrosis of femoral head by small intestinal submucosal matrix with peripheral blood stem cells. Transplant Proc 2011; 43 (05) 2027-2032
  • 45 Pak J, Lee JH, Jeon JH, Lee SH. Complete resolution of avascular necrosis of the human femoral head treated with adipose tissue-derived stem cells and platelet-rich plasma. J Int Med Res 2014; 42 (06) 1353-1362
  • 46 Koren L, Ginesin E, Melamed Y, Norman D, Levin D, Peled E. Hyperbaric oxygen for stage I and II femoral head osteonecrosis. Orthopedics 2015; 38 (03) e200-e205
  • 47 Bosco G, Vezzani G, Mrakic Sposta S. , et al. Hyperbaric oxygen therapy ameliorates osteonecrosis in patients by modulating inflammation and oxidative stress. J Enzyme Inhib Med Chem 2018; 33 (01) 1501-1505
  • 48 Vezzani G, Quartesan S, Cancellara P. , et al. Hyperbaric oxygen therapy modulates serum OPG/RANKL in femoral head necrosis patients. J Enzyme Inhib Med Chem 2017; 32 (01) 707-711
  • 49 Xie K, Mao Y, Qu X. , et al. High-energy extracorporeal shock wave therapy for nontraumatic osteonecrosis of the femoral head. J Orthop Surg Res 2018; 13 (01) 25
  • 50 Dedes V, Stergioulas A, Kipreos G, Dede AM, Mitseas A, Panoutsopoulos GI. Effectiveness and safety of shockwave therapy in tendinopathies. Mater Sociomed 2018; 30 (02) 131-146
  • 51 Algarni AD, Al Moallem HM. Clinical and radiological outcomes of extracorporeal shock wave therapy in early-stage femoral head osteonecrosis. Adv Orthop 2018; 2018: 7410246
  • 52 Gangji V, Hauzeur JP, Matos C, De Maertelaer V, Toungouz M, Lambermont M. Treatment of osteonecrosis of the femoral head with implantation of autologous bone-marrow cells. A pilot study. J Bone Joint Surg Am 2004; 86-A (06) 1153-1160