Osteonecrosis of the femoral head.

New cases of osteonecrosis of the femoral head in the United States number between 10,000 and 20,000 per year. This disease usually affects patients in their late 30s and early 40s. Although a number of authors have related specific risk factors to this disease, its etiology, pathogenesis, and treatment remain a source of considerable controversy. This disorder has been associated with corticosteroid use, substance abuse, and various systemic medical conditions. Either direct damage to osteocytes (e.g., by toxin production) or indirect damage (e.g., due to disorders in fat metabolism or hypoxia) may lead to osteonecrosis. Patients at increased risk for osteonecrosis should be monitored closely. Unfortunately, most cases are diagnosed in an advanced stage of disease, when minimally invasive surgical procedures are no longer helpful. Furthermore, patients in the advanced stage of the disease must undergo total hip replacement at a young age, which carries a poor long-term prognosis.

[1]  M. Steinberg,et al.  Total hip arthroplasty in patients with avascular necrosis of the femoral head: a 2- to 10-year follow-up. , 1997, Clinical orthopaedics and related research.

[2]  J. Thomine,et al.  The conservative surgical treatment of idiopathic aseptic necrosis of the femoral head. , 1974, The Journal of bone and joint surgery. British volume.

[3]  K. Tomita,et al.  Histopathologic study of veins in steroid treated rabbits. , 1997, Clinical orthopaedics and related research.

[4]  T. Fehring,et al.  Core decompression of the osteonecrotic femoral head. , 1995, The Journal of bone and joint surgery. American volume.

[5]  C. Colwell,et al.  Osteonecrosis of the femoral head in patients with inflammatory arthritis or asthma receiving corticosteroid therapy. , 1996, Orthopedics.

[6]  Y. Sugioka,et al.  Influence of Alcohol Intake, Cigarette Smoking, and Occupational Status on Idiopathic Osteonecrosis of the Femoral Head , 1988, Clinical orthopaedics and related research.

[7]  R. Wilson,et al.  Aseptic Necrosis in the Femur after Renal Transplantation , 1972, Annals of surgery.

[8]  A. Gächter,et al.  Cyclosporin A and osteonecrosis of the femoral head. , 1987, The Journal of bone and joint surgery. American volume.

[9]  Gwo‐Jaw Wang,et al.  Lovastatin Prevents Steroid Induced Adipogenesis and Osteonecrosis , 1997 .

[10]  H. Moriya,et al.  Prediction of collapse with magnetic resonance imaging of avascular necrosis of the femoral head. , 1994, The Journal of bone and joint surgery. American volume.

[11]  Glimcher Mj,et al.  Accumulative cell stress: the multifactorial etiology of idiopathic osteonecrosis. , 1985 .

[12]  H P Chandler,et al.  Total hip replacement in patients younger than thirty years old. A five-year follow-up study. , 1981, The Journal of bone and joint surgery. American volume.

[13]  J. Nunley,et al.  Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. A long-term follow-up study of one hundred and three hips. , 1995, The Journal of bone and joint surgery. American volume.

[14]  H. Pilmore,et al.  Acute Bone Pain following Renal Transplantation: Differentiation between Benign Bone Edema and Avascular Necrosis , 1998, American Journal of Nephrology.

[15]  W. Enneking,et al.  The silent hip in idiopathic aseptic necrosis. Treatment by bone-grafting. , 1973, The Journal of bone and joint surgery. American volume.

[16]  E. Vichinsky,et al.  Core decompression in avascular necrosis of the hip in sickle‐cell disease , 1996, American journal of hematology.

[17]  D. Hungerford,et al.  Risk factors for osteonecrosis in systemic lupus erythematosus. , 1997, The Journal of rheumatology.

[18]  K. Tomita,et al.  Early magnetic resonance imaging and histologic findings in a model of femoral head necrosis. , 1997, Clinical orthopaedics and related research.

[19]  K. Sullivan,et al.  Avascular necrosis following bone marrow transplantation: a case-control study. , 1998, Bone.

[20]  H. Moriya,et al.  Osteonecrosis of the femoral head: a prospective study with MRI. , 1997, The Journal of bone and joint surgery. British volume.

[21]  J. Kuhn,et al.  John Caffey Award paper. Avascular necrosis: early MR imaging and histologic findings in a canine model. , 1991, AJR. American journal of roentgenology.

[22]  J. Jones,et al.  Fat embolism, intravascular coagulation, and osteonecrosis. , 1993, Clinical orthopaedics and related research.

[23]  C. Glueck,et al.  Thrombophilia and hypofibrinolysis: pathophysiologies of osteonecrosis. , 1997, Clinical orthopaedics and related research.

[24]  D. Hungerford,et al.  Non-traumatic avascular necrosis of the femoral head. , 1995, The Journal of bone and joint surgery. American volume.

[25]  K. Katz,et al.  The Natural History of Osteonecrosis of the Femoral Head in Children and Adolescents Who Have Gaucher Disease* , 1996, The Journal of bone and joint surgery. American volume.

[26]  H. Rubash,et al.  Free vascularized fibula grafting for the treatment of osteonecrosis of the femoral head. , 1997, Clinical orthopaedics and related research.

[27]  H. Mankin,et al.  The Effect of Cortisone on Femoral and Humeral Heads in Rabbits An Experimental Study , 1972, Clinical orthopaedics and related research.

[28]  K. Ono,et al.  Intramedullary haemorrhage as a possible cause of avascular necrosis of the femoral head. The histology of 16 femoral heads at the silent stage. , 1987, The Journal of bone and joint surgery. British volume.

[29]  Kenzora Je.  Ischemic necrosis of femoral head. Part I. Accumulative cell stress: a hypothesis for the etiology of idiopathic osteonecrosis. , 1983 .

[30]  K. Koo,et al.  Quantifying the extent of osteonecrosis of the femoral head. A new method using MRI. , 1995, The Journal of bone and joint surgery. British volume.

[31]  C. Colwell,et al.  Core decompression of the femoral head for osteonecrosis. , 1986, The Journal of bone and joint surgery. American volume.

[32]  D. Steinberg,et al.  A quantitative system for staging avascular necrosis. , 1995, The Journal of bone and joint surgery. British volume.

[33]  D. Hungerford.  Treatment of avascular necrosis in the young patient. , 1995, Orthopedics.

[34]  C E Lehner,et al.  Dysbaric Osteonecrosis in Divers and Caisson Workers: An Animal Model , 1997, Clinical orthopaedics and related research.

[35]  D. Hungerford,et al.  Alcoholism associated ischemic necrosis of the femoral head. Early diagnosis and treatment. , 1978, Clinical orthopaedics and related research.

[36]  W. F. Conway,et al.  CT and MR imaging of the hip. , 1996, Radiology.