Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today?

Abstract

➤ Although multiple theories have been proposed, no one pathophysiologic mechanism has been identified as the etiology for the development of osteonecrosis of the femoral head. However, the basic mechanism involves impaired circulation to a specific area that ultimately becomes necrotic.➤ A variety of nonoperative treatment regimens have been evaluated for the treatment of precollapse disease, with varying success. Prospective, multicenter, randomized trials are needed to evaluate the efficacy of these regimens in altering the natural history of the disease.➤ Joint-preserving procedures are indicated in the treatment of precollapse disease, with several studies showing successful outcomes at mid-term and long-term follow-up.➤ Studies of total joint arthroplasty, once femoral head collapse is present, have described excellent outcomes at greater than ten years of follow-up, which is a major advance and has led to a paradigm shift in treating these patients.➤ The results of hemiresurfacing and total resurfacing arthroplasty have been suboptimal, and these procedures have restricted indications in patients with osteonecrosis of the femoral head.

Tao-Hong-Si-Wu Decoction ameliorates steroid-induced avascular necrosis of the femoral head by regulating the HIF-1α pathway and cell apoptosis

“…The current study attempted to establish a link between THSWD and HIF-1α/VEGF pathways in order to clarify whether THSWD is able to regulate the apoptosis of bone cells. Although the mechanisms SANFH are unclear, the consensus view is that the final result of SANFH is an interruption of bone microcirculation (27), mainly through disruption of angiogenesis and limiting of the penetration of new vessels into necrotic bone (1). Regular angiogenesis is thus crucial to ameliorating SANFH, since angiogenesis is closely correlated with increased circulation of oxygen and nutrients in bone tissues (28).…”

Overactivated autophagy contributes to steroid-induced avascular necrosis of the femoral head

“…Thus far, there are no effective preventive measures for SANFH (14). Although multiple theories underlying this complication have been proposed, no pathophysiologic mechanism has been identified as the etiology for the development of osteonecrosis of the femoral head (15). In the present study, the IHC results revealed that Beclin 1 protein expression was increased in the femoral head of SANFH patients, indicating that autophagy was overactivated.…”

Single US Guided HA Injection Reduced Hip Pain and Improved Function for 20 Months: A Case of Osteonecrosis

“…subcondral cysts are seen on both sides of the left joint with mild reactive synovitis while keeping in mind that the natural course of the disease will not be altered [21].…”