title: Osteonecrosis of the femoral head: the total hip replacement solution.
abstract: Symptomatic hip osteonecrosis is a disabling condition with a poorly understood aetiology and pathogenesis. Numerous treatment options for hip osteonecrosis are described, which include non-operative management and joint preserving procedures, as well as total hip replacement (THR). Non-operative or joint preserving treatment may improve outcomes when an early diagnosis is made before the lesion has become too large or there is radiographic evidence of femoral head collapse. The presence of a crescent sign, femoral head flattening, and acetabular involvement indicate a more advanced-stage disease in which joint preserving options are less effective than THR. Since many patients present after disease progression, primary THR is often the only reliable treatment option available. Prior to the 1990 s, outcomes of THR for osteonecrosis were poor. However, according to recent reports and systemic reviews, it is encouraging that with the introduction of newer ceramic and/or highly cross-linked polyethylene bearings as well as highly-porous fixation interfaces, THR appears to be a reliable option in the management of end-stage arthritis following hip osteonecrosis in this historically difficult to treat patient population.
authors.affiliation: Sinai Hospital of Baltimore, 2401 W Belvedere Ave Baltimore, Maryland 21215, USA.
authors.forename: K
authors.initials: K
authors.lastname: Issa
authors.forename: R
authors.initials: R
authors.lastname: Pivec
authors.forename: B H
authors.initials: BH
authors.lastname: Kapadia
authors.forename: S
authors.initials: S
authors.lastname: Banerjee
authors.forename: M A
authors.initials: MA
authors.lastname: Mont
mesh_terms: D000465:Algorithms; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D003952:Diagnostic Imaging; D018450:Disease Progression; D005271:Femur Head Necrosis / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D011474:Prosthesis Design
keywords: Total hip replacement; arthroplasty osteonecrosis; avascular necrosis; clinical outcomes; implant survivorship