Osteonecrosis of the femoral head: Surgical perspective

SummaryOsteonecrosis of the femoral head (ONFH) has had a great socioeconomic impact on Asian populations. The etiology of the disease is not fully understood. Corticosteroid use is the most firmly established risk factor. Recent studies have pointed out the genetic basis of nontraumatic ONFH. The common fate of various contributing factors is microcirculation disturbance. In general, the treatment for early-stage ONFH is core decompression surgery with adjuvant measures such as various types of bone grafts. Hip replacement, either hemiarthroplasty or total hip replacement, can lead to good results. Recent studies have shed some light on non-operative treatments for early-stage disease, although long-term results are still lacking. The modes of treatment include shock wave therapy and oral administration of bisphosphonate, vitamin E, and vitamin K2. Advances in tissue engineering may make biological joint replacement possible in the near future.