Extract
Osteonecrosis is a devastating disease that primarily affects
weight-bearing joints. The hip is the most commonly affected joint. Although
hip osteonecrosis can affect patients of any age group, it typically presents
in young patients between the ages of twenty and forty
years1. The factors
that affect the progression of this disease are still not fully understood,
but radiographic lesion size, femoral head collapse (if present), and,
occasionally, clinical presentation at the time of diagnosis have been shown
to be predictive of the eventual clinical
outcome2,3.
After collapse, most patients will require a standard total hip
arthroplasty4,5.
However, because of the young age of many of these patients, a hip replacement
cannot be expected to last the patient's lifetime and therefore, when
feasible, attempts should be made to save the femoral head prior to collapse
with use of less invasive treatment modalities. The efficacy of these
procedures has been variable, with reported success rates ranging between 60%
and 80% at the time of short-term and midterm
follow-up6-8.
Current treatments range from pharmacotherapies to surgical interventions that
include core decompression, vascularized or nonvascularized bone-grafting, and
osteotomy. Recently there have been attempts to enhance these surgical
techniques with use of various growth and differentiation factors.