Current Treatment Options for Nontraumatic Femoral Head Necrosis

Nontraumatic femoral head necrosis (bone death of the ball of the hip joint) develops when the blood flow to the hip joint is impaired. It generally affects the younger population and is difficult to treat.  If left untreated, the bone will continue to die and eventually will collapse, resulting in the necessity of a total hip replacement. No one really understands why this happens but risk factors include alcoholism and tobacco use, HIV, corticosteroid use, and cancer treatments.

Despite the question on what initially begins necrosis (lack of blood flow causing bone death), once the necrosis is established the disease progresses predictably. If femoral head necrosis is suspected, an MRI can detect the size of the area affected, which is the greatest indicator of how things will progress.

The stage of the necrosis determines the treatment.  A small, symptomatic area of necrosis is treated with a decompression (drilling holes in the bone to encourage new blood vessel growth), bone grafting, an osteotomy (cutting away the dead bone), or a combination of these.  If the small lesion is not painful, sometimes surgeons will choose to monitor the necrosis, however this is rarely successful. Once the necrotic area becomes big enough, the head of the femur will begin to collapse, at which point the only consistent and reliable outcome is a total hip replacement.  Luckily, there are excellent results and patient satisfaction following a total hip replacement.  The one downside is that in a younger population, the chance of needing another hip replacement is high as the hardware is only to meant to last about ten years. A recent follow up study showed the success rate in 94 per cent of cases at a mean of 16 years.

Authors of a recent review of all pertinent evidence conclude that a total hip replacement remains the mainstay treatment for advanced nontraumatic femoral necrosis, but further studies are needed to delineate more specific protocols for treatment of less involved lesions.

References: Mont, M., MD et. al. Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today? A Ten Year Update. The Journal of Bone and Joint Surgery. October 7, 2015. Vol. 97A, No. 19 D. Pp. 1604-1627.

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