title: Conservative surgery for the treatment of osteonecrosis of the femoral head: current options.
abstract: The prevention of femoral head collapse and the maintenance of hip function would represent a substantial achievement in the treatment of osteonecrosis of the femoral head; however it is difficult to identify appropriate treatment protocols to manage patients with pre-collapse avascular necrosis in order to obtain a successful outcome in joint preserving procedures. Conservative treatments, including pharmacological management and biophysical modalities, are not supported by any evidence and require further investigation. The appropriate therapeutic approach has not been identified. The choice of surgical procedures is based on patient clinical conditions and anatomopathological features; preservation of the femoral head by core decompression may be attempted in younger patients without head collapse. Biological factors, such as bone morphogenetic proteins and bone marrow stem cells, would improve the outcome of core decompression. Another surgical procedure proposed for the treatment of avascular necrosis consists of large vascularized cortical bone grafts, but its use is not yet common due to surgical technical issues. Use of other surgical technique, such as osteotomies, is controversial, since arthroplasty is considered as the first option in case of severe femoral head collapse without previous intervention.
authors.affiliation: Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, "Policlinico Tor Vergata" Foundation, Rome, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Gasbarra
authors.affiliation: Graduate School of Orthopaedics and Traumatology, University of Rome Tor Vergata, "Policlinico Tor Vergata" Foundation, Rome, Italy.
authors.forename: Fabio Luigi
authors.initials: FL
authors.lastname: Perrone
authors.affiliation: Graduate School of Orthopaedics and Traumatology, University of Rome Tor Vergata, "Policlinico Tor Vergata" Foundation, Rome, Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Baldi
authors.affiliation: Graduate School of Orthopaedics and Traumatology, University of Rome Tor Vergata, "Policlinico Tor Vergata" Foundation, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Bilotta
authors.affiliation: Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy.
authors.forename: Antimo
authors.initials: A
authors.lastname: Moretti
authors.affiliation: Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, "Policlinico Tor Vergata" Foundation, Rome, Italy.
authors.forename: Umbertto
authors.initials: U
authors.lastname: Tarantino
keywords: bone transplantation; femur head necrosis; orthopedic procedures; osteonecrosis