title: Treatment with acetylsalicylic acid prevents short to mid-term radiographic progression of nontraumatic osteonecrosis of the femoral head: a pilot study.
abstract: BACKGROUND
  Nontraumatic osteonecrosis of the femoral head (ONFH) is a progressive disease in young adults producing substantial morbidity and frequently resulting in total hip arthroplasty. Although hip-preserving surgical procedures represent the current mainstay of treatment for early disease, medical therapies targeting specific pathways in the ONFH pathogenesis could help prevent disease progression while producing less morbidity. Acetylsalicylic acid (ASA) is a promising alternative to other therapies for ONFH owing to its anti-inflammatory and antithrombotic mechanisms of action and its relatively benign side effect profile.
  
  
  METHODS
  We followed a prospective cohort of 10 patients (12 hips) with precollapse ONFH who were given ASA to prevent disease progression. Their outcomes were compared with those of a historic control group taken from the literature.
  
  
  RESULTS
  Progression occurred in 1 of 12 (8%) patients taking ASA compared with 30 of 45 (66.6%) controls (p = 0.002) at a mean follow-up of 3.7 years. Patients taking ASA also tended to exhibit decreased femoral head involvement at the end of therapy.
  
  
  CONCLUSIONS
  This hypothesis-generating study leads us to believe that ASA may be a simple and effective treatment option for delaying disease progression in patients with early-stage ONFH.
authors.affiliation: The Department of Surgery, Division of Orthopaedic Surgery, McGill University Health Centre, Montreal General Hospital, Montréal, Que.
authors.forename: Anthony
authors.initials: A
authors.lastname: Albers
authors.affiliation: The Department of Surgery, Division of Orthopaedic Surgery, McGill University Health Centre, Montreal General Hospital, Montréal, Que.
authors.forename: Alberto
authors.initials: A
authors.lastname: Carli
authors.affiliation: The Department of Medicine, Divisions of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ont.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Routy
authors.affiliation: The Department of Surgery, Division of Orthopaedic Surgery, McGill University Health Centre, Montreal General Hospital, Montréal, Que.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Harvey
authors.affiliation: The Department of Medicine, Division of Haematology and Oncology, McGill University Health Centre, Montreal General Hospital, Montréal, Que.
authors.forename: Chantal
authors.initials: C
authors.lastname: Séguin
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D018450:Disease Progression; D004334:Drug Administration Schedule; D005260:Female; D005271:Femur Head Necrosis / Q000188:drug therapy*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin