Corticosteroid-induced Osteonecrosis of the Femoral Head

Abstract

Objective:This review aimed to provide a current recommendation to multidisciplinary physicians for early detection, diagnosis, and treatment of corticosteroid-induced osteonecrosis of the femoral head (ONFH) based on a comprehensive analysis of the clinical literature.Data Sources:For the purpose of collecting potentially eligible articles, we searched for articles in the PubMed, Cochrane Library, Embase, and CNKI databases up to February 2017, using the following key words: “corticosteroid”, “osteonecrosis of the femoral head”, “risk factors”, “diagnosis”, “prognosis”, and “treatment”.Study Selection:Articles on relationships between corticosteroid and ONFH were selected for this review. Articles on the diagnosis, prognosis, and intervention of earlier-stage ONFH were also reviewed.Results:The incidence of corticosteroid-induced ONFH was associated with high doses of corticosteroids, and underlying diseases in certain predisposed individuals mainly occurred in the first 3 months of corticosteroid prescription. The enhanced awareness and minimized exposure to the established risk factors and earlier definitive diagnosis are essential for the success of joint preservation. When following up patients with ONFH, treatment should be started if necessary. Surgical treatment yielded better results than conservative therapy in earlier-stage ONFH. The ideal purpose of earlier intervention and treatment is permanent preservation of the femoral head without physical restrictions in daily living.Conclusions:Clinicians should enhance their precaution awareness of corticosteroid-induced ONFH. For high-risk patients, regular follow-up is very important in the 1st year after high-dose prescription of corticosteroids. Patients with suspected ONFH should be referred to orthopedists for diagnosis and treatment in its earlier stage to preserve the joint.

Pericollapse Stage of Osteonecrosis of the Femoral Head

“…If left untreated, almost all symptomatic ONFH will progress to collapse and eventually disabling arthritis that requires hip arthroplasty; however, to date, for the intervention concerning asymptomatic ONFH, there is still no consensus. [ 10 39 47 48 49 ] The Chinese guideline for the diagnosis and treatment of ONFH recommends that the same principles should be applied to both symptomatic and silent hips; namely, only those patients with Stage I/II M type ONFH could wait for spontaneous repair with mere follow-up. [ 2 ] However, Mont et al .…”

“…[ 2 46 ] Currently, joint-preserving techniques for pericollapse and postcollapse ONFH mainly include CD (normally combined with bone grafting), femoral osteotomy, nonvascularized bone grafting (NVBG), and vascularized bone grafting (VBG), with many studies showing successful outcomes at medium-term and long-term follow-up periods. [ 3 49 ]…”

“…Compared with CD alone, NVBG is more suitable for ONFH at the pericollapse stage. [ 49 57 58 59 ] In Steinberg et al . 's[ 60 ] study, for lesions in Steinberg Stage III, CD combined with autologous bone grafting could decrease the need for THA from 82% to 23%, while the joint-preserving rate in Steinberg IV is only approximately 50%.…”

Huo Xue Tong Luo capsule, a vasoactive herbal formula prevents progression of asymptomatic osteonecrosis of femoral head: A prospective study

“…However, until now, the current therapies for asymptomatic ONFH remain controversial. Owing to the stability of clinical symptoms during progression, some proposed that asymptomatic ONFH did not require a systemic treatment such as physical therapy or impact graft implant surgery, especially in some patients with small- or medium-sized necrotic lesions [16]. In contrast, some researchers have proposed that aggressive treatments at an early stage are truly important, on account of the dynamic development of clinical symptoms in the vast majority of patients [17].…”

IGF-1 polymorphisms modulate the susceptibility to osteonecrosis of the femoral head among Chinese Han population

“…[4,5] Up to now, a variety of risk factors have been confirmed for initiation of nontrauma ONFH include the application of corticosteroid hormones, alcohol consumption, and other aspects (like decompression disease and sickle-cell anemia). [6–8] However, not all the individuals exposing to the risk factors will develop ONFH. It is generally considered that the initiation of ONFH is regulated by the interactions between certain risk factors and a series of genetic factors.…”