title: Management of Ficat stage III and IV osteonecrosis of the hip.
abstract: Management of Ficat stage III and IV osteonecrosis of the hip remains controversial. Because patients usually require a surgical intervention in their mid 30s, the initial procedure is often the first step in a lifelong treatment plan. Long-term results of total hip arthroplasty in these young, active patients have been disappointing. New alternative bearing surfaces (metal-on-metal, ceramic-on-ceramic, and highly cross-linked polyethylene) and improved methods of fixation may lead to better long-term results. Nevertheless, bone- and joint-preserving procedures, such as free-vascularized fibular graft, trapdoor grafting, redirectional osteotomy, or hemiresurfacing hip arthroplasty, should be considered. The choice of option depends on patient age, the cause of osteonecrosis, the extent of femoral head involvement, and the condition of the acetabular articular cartilage. The goals of treatment are to relieve pain, improve function, minimize morbidity, and maintain options for secondary procedures.
authors.affiliation: Joint Replacement Institute, David Geffen School of Medicine at University of California Los Angeles, 2400 South Flower Street, Los Angeles, CA 90007, USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Beaulé
authors.forename: Harlan C
authors.initials: HC
authors.lastname: Amstutz
mesh_terms: D000328:Adult; D000367:Age Factors; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D010147:Pain Measurement; D011379:Prognosis; D011474:Prosthesis Design; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome