Osteonecrosis of the Femoral Head: Current state of Therapy and Outcomes Strategical Step-by-Step Approach
Main Article Content
Keywords
Osteonecrosis of the femoral head, Joint preserving surgery, Hip arthroplasty
Abstract
Osteonecrosis of the femoral head (ONFH) is a challenging multifactorial condition that affects mainly young patients. The disease can lead to collapse of the femoral head and secondary degenerative osteoarthritis of the hip joint. Various therapies for different stages of ONFH have been well established. However, results are largely heterogeneous and there is still no universal consensus regarding the optimal approach. In this article, the current therapies of ONFH and their outcomes will be reviewed and categorized based on the ARCO classification.
References
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2. Drescher W, Kyung-Hoi, Windsor, Russell E. Advances in specialist hip surgery (S.293). Springer Nature Switzerland AG 2021.
3. Salem KH, Brockert A-K, Mertens R, et al. Avascular necrosis after chemotherapy for haematological malignancy in childhood. J Bone Joint Surg. 2013;95-B (12):1708–13. https://doi.org/10.1302/0301-620X.95B12.30688
4. Mont MA, Jones LC, Hungerford DS. Nontraumatic osteonecrosis of the femoral head: Ten years later. J Bone Joint Surg Am. 2006;88(5):1117–32. https://doi.org/10.2106/JBJS.E.01041
5. Min BW, Song KS, Cho CH, et al. Untreated asymptomatic hips in patients with osteonecrosis of the femoral head. Clin Orthop Relat Res. 2008;466(5):1087–92. https://doi.org/10.1007/s11999-008-0191-x
6. Lavernia CJ, Sierra RJ, Grieco FR. Osteonecrosis of the femoral head. J Am Acad Orthop Surg. 1999;7(4):250–61. https://doi.org/10.5435/00124635-199907000-00005
7. Radl R, Hungerford M, Materna W, et al. Higher failure rate and stem migration of an uncemented femoral component in patients with femoral head osteonecrosis than in patients with osteoarthrosis. Acta Orthop. 2005;76(1):49–55. https://doi.org/10.1080/00016470510030319
8. Castro FP Jr, Barrack RL. Core decompression and conservative treatment for avascular necrosis of the femoral head: A meta-analysis. Am J Orthop (Belle Mead NJ). 2000;29(3):187–94.
9. Ficat Rp, Arlet J. Diagnostic de I’osteonecrose femorocapitale primitive au stade I (stade pre-radiologique). Rev Chir Orthop. 1968;54:637–48.
10. Chughtai M, Piuzzi NS, Khlopas A, et al. An evidence-based guide to the treatment of osteonecrosis of the femoral head. Bone Joint J. 2017 Oct;99-B (10):1267–79. https://doi.org/10.1302/0301-620X.99B10.BJJ-2017-0233.R2
11. Pierce TP, Jauregui JJ, Elmallah RK, et al. A current review of core decompression in the treatment of osteonecrosis of the femoral head. Curr Rev Musculoskelet Med. 2015;8(3):228–32. https://doi.org/10.1007/s12178-015-9280-0
12. Calori GM, Mazza E, Colombo A, et al. Core decompression and biotechnologies in the treatment of avascular necrosis of the femoral head. EFORT Open Rev. 2017;2(2):41–50. https://doi.org/10.1302/2058-5241.2.150006
13. Tripathy SK, Goyal T, Sen RK. Management of femoral head osteonecrosis: Current concepts. Indian J Orthop. 2015;49:28–45. https://doi.org/10.4103/0019-5413.143911
14. Wang A, Ren M, Wang J. The pathogenesis of steroid-induced osteonecrosis of the femoral head: A systematic review of the literature. Gene. 2018;671:103–9. https://doi.org/10.1016/j.gene.2018.05.091
15. Hernigou P, Beaujean F, Lambotte JC. Decrease in the mesenchymal stem-cell pool in the proximal femur in corticosteroid-induced osteonecrosis. J Bone Joint Surg Br. 1999;81(2):349–55. https://doi.org/10.1302/0301-620x.81b2.8818
16. Sun Y, Feng Y, Zhang C. The effect of bone marrow mononuclear cells on vascularization and bone regeneration in steroid-induced osteonecrosis of the femoral head. Joint Bone Spine 2009;76:685–90. https://doi.org/10.1016/j.jbspin.2009.04.002
17. Lee HS, Huang GT, Chiang H, et al. Multipotential mesenchymal stem cells from femoral bone marrow near the site of osteonecrosis. Stem Cells. 2003;21(2):190–9. https://doi.org/10.1634/stemcells.21-2-190
18. Li C, Li G, Liu M, et al. Paracrine effect of inflammatory cytokine-activated bone marrow mesenchymal stem cells and its role in osteoblast function. J Biosci Bioeng. 2016;121(2):213–9. https://doi.org/10.1016/j.jbiosc.2015.05.017
19. Gangji V, Toungouz M, Hauzeur JP. Stem cell therapy for osteonecrosis of the femoral head. Expert Opin Biol Ther. 2005;5(4):437–42. https://doi.org/10.1517/14712598.5.4.437
20. Hernigou P, Beaujean F. Treatment of osteonecrosis with autologous bone marrow grafting. Clin Orthop Relat Res. 2002;(405):14–23. https://doi.org/10.1097/00003086-200212000-00003
21. Ma Y, Wang T, Liao J, et al. Efficacy of autologous bone marrow buffy coat grafting combined with core decompression in patients with avascular necrosis of femoral head: A prospective, double-blinded, randomized, controlled study. Stem Cell Res Ther. 2014;5(5):115. https://doi.org/10.1186/scrt505
22. Hernigou P, Dubory A, Homma Y, et al. Cell therapy versus simultaneous contralateral decompression in symptomatic corticosteroid osteonecrosis: A thirty year follow-up prospective randomized study of one hundred and twenty five adult patients. Int Orthop. 2018;42(7):1639–49. https://doi.org/10.1007/s00264-018-3941-8
23. Hauzeur JP, De Maertelaer V, Baudoux E. Inefficacy of autologous bone marrow concentrate in stage three osteonecrosis: A randomized controlled double-blind trial. Int Orthop. 2018;42(7):1429–35. https://doi.org/10.1007/s00264-017-3650-8
24. Eppley BL, Woodell JE, Higgins J. Platelet quantification and growth factor analysis from platelet-rich plasma: Implications for wound healing. Plast Reconstr Surg. 2004;114(6):1502–8. https://doi.org/10.1097/01.prs.0000138251.07040.51
25. Yokota K, Ishida O, Sunagawa T, et al. Platelet-rich plasma accelerated surgical angio-genesis in vascular-implanted necrotic bone: An experimental study in rabbits. Acta Orthop. 2008;79(1):106–10. https://doi.org/10.1080/17453670710014842
26. Tao SC, Yuan T, Rui BY, et al. Exosomes derived from human platelet-rich plasma prevent apoptosis induced by glucocorticoid-associated endoplasmic reticulum stress in rat osteonecrosis of the femoral head via the Akt/Bad/Bcl-2 signal pathway. Theranostics. 2017;7(3):733–50. https://doi.org/10.7150/thno.17450
27. Tong S, Yin J, Liu J. Platelet-rich plasma has beneficial effects in mice with osteonecrosis of the femoral head by promoting angiogenesis. Exp Ther Med. 2018;15(2):1781–8. https://doi.org/10.3892/etm.2017.5655
28. Han J, Gao F, Li Y, et al. The use of platelet-rich plasma for the treatment of osteonecrosis of the femoral head: A systematic review. Biomed Res Int. 2020;2020:2642439. https://doi.org/10.1155/2020/2642439
29. Aggarwal AK, Poornalingam K, Jain A, et al. Combining platelet-rich plasma instillation with core decompression improves functional outcome and delays progression in early-stage avascular necrosis of femoral head: A 4.5-to 6-year prospective randomized comparative study. J Arthroplasty. 2021;36(1):54–61. https://doi.org/10.1016/j.arth.2020.07.010
30. Rocchi M, Del Piccolo N, Mazzotta A, et al. Core decompression with bone chips allograft in combination with fibrin platelet-rich plasma and concentrated autologous mesenchymal stromal cells, isolated from bone marrow: Results for the treatment of avascular necrosis of the femoral head after 2 years minimum follow-up. Hip Int. 2020;30(2_suppl):3–12. https://doi.org/10.1177/1120700020964996
31. Davis JB, Fagan TE, Beals RK. Follow-up notes on articles previously published in the journal. Muscle-pedicle bone graft in hip fusion. J Bone Joint Surg Am. 1971;53(8):1645–7.
32. Yang F, Wei Q, Chen X, et al. Vascularized pedicle iliac bone grafts as a hip-preserving surgery for femur head necrosis: A systematic review. J Orthop Surg Res. 2019;14(1):270. https://doi.org/10.1186/s13018-019-1262-2
33. Plakseychuk AY, Kim SY, Park BC, et al. Vascularized compared with nonvascularized fibular grafting for the treatment of osteonecrosis of the femoral head. J Bone Joint Surg Am. 2003;85(4):589–96. https://doi.org/10.2106/00004623-200304000-00001
34. Yen CY, Tu YK, Ma CH, et al. Osteonecrosis of the femoral head: Comparison of clinical results for vascularized iliac and fibula bone grafting. J Reconstr Microsurg. 2006;22(1):21–4. https://doi.org/10.1055/s-2006-931902
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May 5, 2023
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El Rabih, Z., Doro, A., Kubo, Y., Pufe, T., & Drescher, W. (2023). Osteonecrosis of the Femoral Head: Current state of Therapy and Outcomes: Strategical Step-by-Step Approach. Biologic Orthopedics Journal, 3(SP1), e57-e65. https://doi.org/10.22374/boj.v3iSP1.22
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