Which factors influence preservation of the osteonecrotic femoral head?

Jay R. Lieberman, Stephen M. Engstrom, R. Meneghini, Nelson Fong Soohoo

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

Background: Although surgeons use many procedures to preserve the femoral head in patients with hip osteonecrosis, there is no consensus regarding the best procedure. Questions/purposes: We raised the following questions: (1) Is one surgical treatment preferred based on published data? (2) What are the rates of radiographic progression or conversion to THA after treatment of pre- and postcollapse hips? (3) Does lesion size in the femoral head influence progression? And (4) does the extent of involvement of the weightbearing surface of the femoral head influence outcome? Methods: We searched MEDLINE and Scopus for articles published between 1998 and 2010. We included only articles assessing an operative intervention for hip osteonecrosis and having a level of evidence of I to IV. We included 54 of the 488 reviewed manuscripts. Results: No procedure was superior to others. In pre- and postcollapse hips, 264 of 864 hips (31%) and 419 of 850 hips (49%), respectively, exhibited radiographic disease progression. There were lower failure rates when the lesion involved less than 15% of the femoral head or had a necrotic angle of less than 200° (14%-25%) and when the osteonecrotic lesion involved only the medial 1/3 of the weightbearing surface (4.6%). Conclusions: The best treatment of precollapse lesions is difficult to determine due to the limitations of the available literature. However, the data suggest operative intervention prevents collapse of small lesions of the femoral head or when there is a limited amount of the weightbearing surface involved. Patients with head collapse have a high progression rate after a femoral head-saving procedure.

Original languageEnglish
Pages (from-to)525-534
Number of pages10
JournalClinical Orthopaedics and Related Research
Volume470
Issue number2
DOIs
StatePublished - Feb 2012

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Thigh
Hip
Weight-Bearing
Osteonecrosis
Tacrine
Manuscripts
MEDLINE
Disease Progression
Therapeutics
Head

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Which factors influence preservation of the osteonecrotic femoral head? / Lieberman, Jay R.; Engstrom, Stephen M.; Meneghini, R.; Soohoo, Nelson Fong.

In: Clinical Orthopaedics and Related Research, Vol. 470, No. 2, 02.2012, p. 525-534.

Research output: Contribution to journalArticle

Lieberman, Jay R. ; Engstrom, Stephen M. ; Meneghini, R. ; Soohoo, Nelson Fong. / Which factors influence preservation of the osteonecrotic femoral head?. In: Clinical Orthopaedics and Related Research. 2012 ; Vol. 470, No. 2. pp. 525-534.
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