Osteonecrosis of the Femoral Head in Patients with Hypercoagulability—From Pathophysiology to Therapeutic Implications

Abstract

Osteonecrosis of the femoral head (ONFH) is a debilitating disease with major social and economic impacts. It frequently affects relatively young adults and has a predilection for rapid progression to femoral head collapse and end-stage hip arthritis. If not diagnosed and treated properly in the early stages, ONFH has devastating consequences and leads to mandatory total hip arthroplasty. The pathophysiology of non-traumatic ONFH is very complex and not fully understood. While multiple risk factors have been associated with secondary ONFH, there are still many cases in which a clear etiology cannot be established. Recognition of the prothrombotic state as part of the etiopathogeny of primary ONFH provides an opportunity for early medical intervention, with implications for both prophylaxis and therapy aimed at slowing or stopping the progression of the disease. Hereditary thrombophilia and hypofibrinolysis are associated with thrombotic occlusion of bone vessels. Anticoagulant treatment can change the natural course of the disease and improve patients’ quality of life. The present work focused on highlighting the association between hereditary thrombophilia/hypofibrinolysis states and ONFH, emphasizing the importance of identifying this condition. We have also provided strong arguments to support the efficiency and safety of anticoagulant treatment in the early stages of the disease, encouraging etiological diagnosis and prompt therapeutic intervention. In the era of direct oral anticoagulants, new therapeutic options have become available, enabling better long-term compliance.

Emerging role of mesenchymal stem/stromal cells (MSCs) and MSCs-derived exosomes in bone- and joint-associated musculoskeletal disorders: a new frontier

“…Although osteonecrosis usually ensues in the hip joint (femoral head), termed osteonecrosis of the femoral head (ONFH), it can be may also happen in other anatomical regions, such as the shoulder, knee, and ankle [ 187 ]. In ONFH, the inadequate blood supply brings about subchondral bone loss and often marked damage to BM [ 188 ].…”

Editorial: Bone and Cartilage Diseases—The Role and Potential of Natural Products

“…Osteonecrosis of femoral head (ONFH), a progressive hip joint disorder, is associated with impaired blood supply to the femoral head. The pathogenesis mechanism of ONFH is not fully elucidated ( Rezus et al, 2021 ). Peng et al found that serum amyloid A (SAA), an acute phase lipophilic protein, increased significantly in the serum of ONFH patients.…”

A Pilot Experiment to Measure the Initial Mechanical Stability of the Femoral Head Implant in a Cadaveric Model of Osteonecrosis of Femoral Head Involving up to 50% of the Remaining Femoral Head

“…Subsequently, this results in the degradation of the organic elements of the bone and the marrow, thus commonly leading to a collapse of subchondral bone in the femoral head [ 1 , 2 , 3 , 4 ]. As such, ONFH is a debilitating, progressive joint disease of idiopathic origin; it is an interesting topic from both clinical and economic perspectives [ 5 , 6 , 7 ]. Over the past few years, there has been an increase in the prevalence of ONFH [ 8 ].…”