Treatments ofavascular osteonecrosis of the hip：Current treatments

Conservativetreatments for aseptic osteonecrosis of the femoral head have their ancestor inthe core decompression of the femoral neck, recommended by Ficat. Due toinconsistent results, this treatment has been optimized by either vascularizedfibular grafting, or by injecting autologous stem cells into the necrotic zone.The French promoters have published long-term results, showing efficacy in theearly stages of the disease, where the femoral head has not yet lost itssphericity. Over the last 10years, comparative studies, sometimes randomized,opposing them to simple core decompression, have been published bynon-promoters, confirming the possibility of stabilization or even regressionof necrosis area. But these techniques are not easy to implement. Cell therapyrequires treatment of marrow samples by centrifugation to obtain a pellet witha high concentration of haematopoietic cells. The now proven long-term efficacyas well as the safety of this technique make it the method of choice fortreating young patients detected at the sub-radiological stage by MRI.Unfortunately, many are seen late with detached cephalic cartilage or collapsedfemoral head and have no other option than total hip arthroplasty. Thistechnique is very reliable. With alumina ceramics, results of more than 20yearsshow the absence of wear and osteolysis, although other complications such asinstability or periprosthetic fractures may occur in these young and activepatients.

文獻出處：Massin P.Treatments of avascular osteonecrosis of the hip: Current treatments. Morphologie. 2021 Jun; 105(349): 120-126. doi: 10.1016/j.morpho.2020.06.003. Epub2020 Jul 8. PMID: 32653168.