Femoral Head Avascular Necrosis Follow-up

  • Author: John D Kelly IV, MD; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Feb 28, 2010
 

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AVN of the hip is generally a contraindication to sports participation. Even when this condition is successfully treated, impact sports should be discouraged. The athlete can maintain fitness with pursuits that are easy on the joints, such as swimming, biking, and using elliptical training devices.

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Complications

In most cases, progression from femoral head AVN to femoral head collapse requires arthroplasty.

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Prevention

Abstinence from excessive alcohol intake and taking the lowest possible dose of a corticosteroid (when indicated) are the 2 chief means of AVN prevention.

There are some data regarding cholesterol-lowering statin therapy as a means of decreasing the risk of AVN for those receiving corticosteroids.[4] Given the relatively favorable safety profile of these agents, such therapy should be considered.

Cutaneous electrical stimulation, in the form of capacitive coupling, is purported by some to have a disease-modifying effect, although long-term studies are lacking.

Anticoagulation therapy in the form of enoxaparin was shown in one investigation to retard progression of early AVN.[14] This lends support to the "thrombophilia theory" of AVN disease etiology.

Lastly, the antiresorptive, alendronate, was demonstrated to prevent collapse of early AVN.[15] This finding adds credence to the argument that the bone's repair response (resorption), rather than the actual infarction, leads to femoral head collapse and the subsequent morbidity.

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Prognosis

If AVN of the femoral head is untreated, progression to subchondral collapse occurs in approximately 67% of individuals with asymptomatic hips and in more than 85% of those who have symptomatic hips.

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Education

Information regarding the deleterious effects of alcohol and corticosteroids on femoral head circulation should be disseminated to those who are at risk for AVN.

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Contributor Information and Disclosures
Author

John D Kelly IV, MD  Associate Professor, Department of Orthopedic Surgery, University of Pennsylvania, Consulting Surgeon Shriner's Hospital for Surgery

John D Kelly IV, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Eastern Orthopaedic Association, Pennsylvania Orthopaedic Society, and Philadelphia County Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

David Wald, DO, FACOEP  Assistant Program Director, Assistant Professor, Department of Medicine, Division of Emergency Medicine, Temple University School of Medicine

David Wald, DO, FACOEP is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Gerard A Malanga, MD  Director of Pain Management, Overlook Hospital; Director of PM&R Sports Medicine Fellowship, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Cephalon Honoraria Speaking and teaching; Endo Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD  Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

References

  1. Lavernia CJ, Sierra RJ, Grieco FR. Osteonecrosis of the femoral head. J Am Acad Orthop Surg. Jul-Aug 1999;7(4):250-61. [Medline].

  2. Vail TP, Covington DB. The incidence of osteonecrosis. In: Urbaniak JR, Jones JR, eds. Osteonecrosis: Etiology, Diagnosis, Treatment. Rosemont, Ill: American Academy of Orthopedic Surgeons; 1997:43-9.

  3. Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am. Mar 1995;77(3):459-74. [Medline].

  4. Pritchett JW. Statin therapy decreases the risk of osteonecrosis in patients receiving steroids. Clin Orthop Relat Res. May 2001;386:173-8. [Medline].

  5. Arlet J, Ficat P. [Non-traumatic avascular femur head necrosis. New methods of examination and new concepts] [Polish]. Chir Narzadow Ruchu Ortop Pol. 1977;42(3):269-76. [Medline].

  6. Steinberg ME. Avascular necrosis: diagnosis, staging, and management. J Musculoskel Med. 1997;14(11):13-25.

  7. Steinberg ME. Diagnostic imaging and the role of stage and lesion size in determining outcome in osteonecrosis of the femoral head. Techniques in Orthopaedics. Mar 2001;16(1):6-15. [Full Text].

  8. McGrory BJ, York SC, Iorio R, et al. Current practices of AAHKS members in the treatment of adult osteonecrosis of the femoral head. J Bone Joint Surg Am. Jun 2007;89(6):1194-204. [Medline].

  9. Ciombor DM, Aaron RK. Biologically augmented core decompression for the treatment of osteonecrosis of the femoral head. Techniques in Orthopaedics. Mar 2001;16(1):32-8. [Full Text].

  10. Katz MA, Urbaniak JR. Free vascularized fibular grafting of the femoral head for the treatment of osteonecrosis. Techniques in Orthopaedics. Mar 2001;16(1):44-60. [Full Text].

  11. McCarthy J, Puri L, Barsoum W, et al. Articular cartilage changes in avascular necrosis: an arthroscopic evaluation. Clin Orthop Relat Res. Jan 2003;406:64-70. [Medline].

  12. Ivankovich DA, Rosenberg AG, Malamis A. Reconstructive options for osteonecrosis of the femoral head. Techniques in Orthopaedics. Mar 2001;16(1):66-79. [Full Text].

  13. Squire M, Fehring TK, Odum S, Griffin WL, Bohannon Mason J. Failure of femoral surface replacement for femoral head avascular necrosis. J Arthroplasty. Oct 2005;20(7 suppl 3):108-14. [Medline].

  14. Glueck CJ, Freiberg RA, Sieve L, Wang P. Enoxaparin prevents progression of stages I and II osteonecrosis of the hip. Clin Orthop Relat Res. Jun 2005;435:164-70. [Medline].

  15. [Best Evidence] Lai KA, Shen WJ, Yang CY, et al. The use of alendronate to prevent early collapse of the femoral head in patients with nontraumatic osteonecrosis. A randomized clinical study. J Bone Joint Surg Am. Oct 2005;87(10):2155-9. [Medline].

  16. DeLee JC. Fractures and dislocations of the hip. In: Rockwood CA, Green DP, Bucholz RW, eds. Rockwood and Green's Fractures in Adults. 4th ed. Philadelphia, Pa: Lippincott-Raven; 1996:1661-9.

  17. Etienne G, Mont MA, Khanuja HS, Hungerford DS. Nonvascularized bone grafts for osteonecrosis of the femoral head: current concepts and techniques. Techniques in Orthopaedics. Mar 2001;16(1):39-43. [Full Text].

  18. Kim SY, Kim YG, Kim PT, et al. Vascularized compared with nonvascularized fibular grafts for large osteonecrotic lesions of the femoral head. J Bone Joint Surg Am. Sep 2005;87(9):2012-8. [Medline].

  19. Urbaniak JR, Barnes CJ. Meeting the challenge of osteonecrosis in adults. J Musculoskel Med. 2001;18:395-403.

 
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