title: Current practices of AAHKS members in the treatment of adult osteonecrosis of the femoral head.
abstract: BACKGROUND
  There is currently no standardized protocol for evaluating and treating osteonecrosis of the femoral head in adults in the United States. We sought to understand current treatment practices of a group of surgeons who commonly treat this disease to determine if there was agreement on some aspects of care.
  
  
  METHODS
  We designed a two-staged mixed-mode (mailed and faxed) sixteen-question self-administered descriptive survey questionnaire to be sent to all 753 active members of the American Association of Hip and Knee Surgeons (AAHKS). The survey design was based on Dillman's survey research methodology, and the questionnaire included hypothetical clinical scenarios based on the Steinberg classification system. The responses elucidated the opinions and treatment preferences of high-volume arthroplasty surgeons who treat adult patients with osteonecrosis of the femoral head.
  
  
  RESULTS
  Of the 753 active members of the AAHKS, 403 (54%) responded to the questionnaire. Total hip replacement was reported to be the most frequent intervention for treatment of postcollapse (Steinberg stage-IIIB, IVB, V, and VI) osteonecrosis; core decompression was reported to be the most commonly offered intervention for symptomatic, precollapse (Steinberg stage-IB and IIB) osteonecrosis. Less frequently offered treatments included nonoperative management, osteotomy, vascularized and non-vascularized bone-grafting, hemiarthroplasty, and arthrodesis.
  
  
  CONCLUSIONS
  The care of adults with osteonecrosis of the femoral head varies among American orthopaedic surgeons specializing in hip and knee surgery. A consensus may evolve with a continued concerted effort on the part of interested surgeons, but it will require randomized, controlled, prospective studies of treatment of each stage of the disease and collaborative multicenter studies.
  
  
  METHODS
  Therapeutic Level V.
authors.affiliation: American Association of Hip and Knee Surgeons, Rosemont, Illinois, USA. mjri@yahoo.com
authors.forename: Brian J
authors.initials: BJ
authors.lastname: McGrory
authors.forename: Sally C
authors.initials: SC
authors.lastname: York
authors.forename: Richard
authors.initials: R
authors.lastname: Iorio
authors.forename: William
authors.initials: W
authors.lastname: Macaulay
authors.forename: Richard R
authors.initials: RR
authors.lastname: Pelker
authors.forename: Brian S
authors.initials: BS
authors.lastname: Parsley
authors.forename: Steven M
authors.initials: SM
authors.lastname: Teeny
mesh_terms: D000077:Acetabulum / Q000473:pathology; D000328:Adult; D000367:Age Factors; D019299:Decompression, Surgical; D005260:Female; D005270:Femur Head / Q000473:pathology; D005271:Femur Head Necrosis / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012598:Sclerosis; D011795:Surveys and Questionnaires