title: Key pathway to prevent the collapse of femoral head in osteonecrosis.
abstract: OBJECTIVE
  Osteonecrosis of the femoral head (ONFH) is a multifactorial disease, with unclear pathogenesis. The collapse of the femoral head is an important turning point in ONFH, especially for young patients. Many methods have been proposed, but the best treatment lacks consensus among orthopedic surgeons. Thus, understanding the collapse mechanism of the femoral head in ONFH is the key to a successful outcome of joint preservation. This review aims to provide an update of the collapse mechanism of the femoral head in ONFH and to focus on the most appropriate therapeutic strategies to adopt in clinical practice.
  
  
  METHODS
  We reviewed the international literature to identify studies focusing on ONFH and therapeutic options. PubMed, Medline and Cochrane Library databases were searched for English language papers.
  
  
  RESULTS
  An imbalance between bone resorption and bone formation as well as stress distribution on insufﬁcient trabecular bone may be the most important collapse mechanism in ONFH.
  
  
  CONCLUSIONS
  Treatment to avoid femoral head collapse should focus on local effective mechanical support with modification of bone remodeling in the femoral head.
authors.affiliation: Instistute of Orthopaedics, Chinese PLA General Hospital, Haidian District, Beijing, P.R. China. pengjiang301@126.com.
authors.forename: W-L
authors.initials: WL
authors.lastname: Gou
authors.forename: Q
authors.initials: Q
authors.lastname: Lu
authors.forename: X
authors.initials: X
authors.lastname: Wang
authors.forename: Y
authors.initials: Y
authors.lastname: Wang
authors.forename: J
authors.initials: J
authors.lastname: Peng
authors.forename: S-B
authors.initials: SB
authors.lastname: Lu
mesh_terms: D016723:Bone Remodeling; D005270:Femur Head / Q000473:pathology*; D005271:Femur Head Necrosis / Q000473:pathology / Q000517:prevention & control*; D006801:Humans; D010012:Osteogenesis; D010020:Osteonecrosis / Q000473:pathology / Q000517:prevention & control*