TY - JOUR
T1 - Nontraumatic Osteonecrosis of the Femoral Head
T2 - Where Do We Stand Today? A 5-Year Update
AU - Mont, Michael A.
AU - Salem, Hytham S.
AU - Piuzzi, Nicolas S.
AU - Goodman, Stuart B.
AU - Jones, Lynne C.
N1 - Funding Information:
Disclosure: This work was supported by grant R34-AR073505-01A1 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the U.S. National Institutes of Health (L.C.J., S.B.G., and M.A.M.). The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/F832 ).
Publisher Copyright:
COPYRIGHT Ó 2020 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED.
PY - 2020/6/17
Y1 - 2020/6/17
N2 - Clinicians should exercise a high level of suspicion in at-risk patients (those who use corticosteroids, consume excessive alcohol, have sickle cell disease, etc.) in order to diagnose osteonecrosis of the femoral head in its earliest stage. Nonoperative treatment modalities have generally been ineffective at halting progression. Thus, nonoperative treatment is not appropriate in early stages when one is attempting to preserve the native joint, except potentially on rare occasions for small-sized, medially located lesions, which may heal without surgery. Joint-preserving procedures should be attempted in early-stage lesions to save the femoral head. Cell-based augmentation of joint-preserving procedures continues to show promising results, and thus should be considered as an ancillary treatment method that may improve clinical outcomes. The outcomes of total hip arthroplasty in the setting of osteonecrosis are excellent, with results similar to those in patients who have an underlying diagnosis of osteoarthritis.
AB - Clinicians should exercise a high level of suspicion in at-risk patients (those who use corticosteroids, consume excessive alcohol, have sickle cell disease, etc.) in order to diagnose osteonecrosis of the femoral head in its earliest stage. Nonoperative treatment modalities have generally been ineffective at halting progression. Thus, nonoperative treatment is not appropriate in early stages when one is attempting to preserve the native joint, except potentially on rare occasions for small-sized, medially located lesions, which may heal without surgery. Joint-preserving procedures should be attempted in early-stage lesions to save the femoral head. Cell-based augmentation of joint-preserving procedures continues to show promising results, and thus should be considered as an ancillary treatment method that may improve clinical outcomes. The outcomes of total hip arthroplasty in the setting of osteonecrosis are excellent, with results similar to those in patients who have an underlying diagnosis of osteoarthritis.
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U2 - 10.2106/JBJS.19.01271
DO - 10.2106/JBJS.19.01271
M3 - Review article
C2 - 32282421
AN - SCOPUS:85086692944
SN - 0021-9355
VL - 102
SP - 1084
EP - 1099
JO - Journal of Bone and Joint Surgery
JF - Journal of Bone and Joint Surgery
IS - 12
ER -