Abstract
Glucocorticoid use is one of the commonest and most important causes of non-traumatic ON. Postulated pathogenetic mechanisms of glucocorticoid-induced ON include fat hypertrophy, fat emboli and intravascular coagulation. MRI is the gold standard diagnostic method to detect ON in the early stage. Preservation of the native hip is the goal of treatment for young and active patients. Early diagnosis and intervention prior to collapse of the femoral head is the key to a successful outcome of joint preserving procedures. There are no specific biomarkers for ON diagnostic. There is not a gold standard treatment and frequently it is necessary a multi - disciplinary approach. Replacement procedure remains the gold standard treatment after failure of preserving procedures and in the late - stage ON, involving collapse of the femoral head and degenerative changes to the acetabulum. More recently, reports have shown excellent results, but implant longevity and following revisions are still outstanding problems.
References
2. Bin Wu, Zhong Dong, Shuyuan Li, and Hongmei Song. Steroid-induced ischemic bone necrosis of femoral head: Treatment strategies. Pak J Med Sci. 2015 Mar-Apr; 31(2): 471–476.
3. Dallas Burton Phemister. Repair of Bone in the Presence of Aseptic Necrosis Resulting from Fractures, Transplantations, and Vascular Obstruction. Clin Orthop Relat Res; (2008) 466:1020–1033
4. Michelangelo Scaglione, Luca Fabbri, Fabio Celli, Francesco Casella, and Giulio GuidoClin Cases Miner. Hip replacement in femoral head osteonecrosis: current concepts. Bone Metab. 2015 Jan-Apr; 12(Suppl 1): 51– 54.Published online 2016 Apr 7.
5. Patrick D. Millikan, Vasili Karas, and Samuel S. Wellman. Treatment of osteonecrosis of the femoral head with vascularized bone grafting. Curr Rev Musculoskelet Med. 2015 Sep; 8(3): 252–259. Published online 2015 Jun 12.
6. Ramesh Kumar Sen. Management of avascular necrosis of femoral head at pre-collapse stage. Indian J Orthop. 2009 Jan-Mar; 43(1): 6–16
7. Robert S. Weinstein Glucocorticoid-induced osteonecrosis Endocrine. 2012 Apr; 41(2): 183–190.