Osteonecrosis of the femoral head: pathophysiology and current concepts of treatment

Abstract

Osteonecrosis of the femoral head is a disabling pathology affecting a young population (average age at treatment, 33 to 38 years) and is the most important cause of total hip arthroplasty in this population. It reflects the endpoint of various disease processes that result in a decrease of the femoral head blood flow. The physiopathology reflects an alteration of the vascularization of the fine blood vessels irrigating the anterior and superior part of the femoral head. This zone of necrosis is the source of the loss of joint congruence that leads to premature wear of the hip. Several different types of medication have been developed to reverse the process of ischemia and/or restore the vascularization of the femoral head. There is no consensus yet on a particular treatment. The surgical treatments aim to preserve the joint as far as the diagnosis could be made before the appearance of a zone of necrosis and the loss of joint congruence. They consist of bone marrow decompressions, osteotomies around the hip, vascular or non-vascular grafts. Future therapies include the use of biologically active molecules as well as implants impregnated with biologically active tissue. Cite this article: EFORT Open Rev 2019;4:85-97. DOI: 10.1302/2058-5241.4.180036

Short-Term Outcome and MRI Changes in Three Adult Patients with Sickle Cell Disease and Aseptic Osteonecrosis after Treatment with Hyperbaric Oxygen Therapy: A Preliminary Report

“…The prevalence of ON shows a significant variation (up to 10%) depending on age. Sickling of RBCs causes venous congestion, and thrombosis in the bone microvasculature resulting in ischemia that is enhanced by the increase of intraosseous pressure secondary to medullary hyperplasia [4,5]. Furthermore, elevated hemoglobin or hematocrit levels in combination with rheological problems lead to sickling and vaso-occlusion, especially in the femoral head sinusoids.…”

“…Furthermore, elevated hemoglobin or hematocrit levels in combination with rheological problems lead to sickling and vaso-occlusion, especially in the femoral head sinusoids. The most frequent identified ON sites are the hip (74.6%), shoulder, knee, and ankle [4,5]. The disease may involve the hips bilaterally, and it is common for ON to be asymptomatic, especially in early stages.…”

“…MRI is considered one of the best available imaging modalities to detect and to grade early bone changes. It might show areas of sclerosis and lucencies in the affected bone, articular surface collapse or flatting, attenuation of the epiphysis, and narrowing of joint space [5].…”

The effect of the necrotic area on the biomechanics of the femoral head - a finite element study

“…Osteonecrosis of the femoral head (ONFH) is a common orthopedic disease, which affects young and middle-aged patients originated from traumatic or non-traumatic issues. Without early intervention and appropriate treatment, up to 80% of ONFH cases eventually turn into femoral head collapse within 1 to 5 years [1][2][3]. Femoral head collapse is the most significant pathogenic complication of ONFH that requires total hip replacement eventually.…”

The potential roles of circular RNAs in osteonecrosis of the femoral head (Review)

“…The mechanism by which onFH develops remains unclear (19). The majority of experts agree that a lack of blood supply to the femoral head and bone marrow causes death of osteocytes, as explained by the microvascular injury theory, osteoporosis theory, apoptosis theory, osteogenic enhancement and adipogenic weakening theory of bone marrow mesenchymal stem cells (20)(21)(22)(23)(24). it has previously been reported that numerous circrnas are associated with onFH, which suggested that they may have a critical role in the development and progression of onFH (25).…”