Osteonecrosis treatment. Treatment and procedures

The treatment of osteonecrosis of the femoral head involves a continuum bas ed on a radiographic spectrum of disease. Core decompression or pharmacolog ical agents can be utilized for the earliest small or medium-sized pre-coll apsed lesions. For these types of lesions, osteotomy has been tried by vari ous authors with moderate success. For small or medium lesions that are pos t-collapse, various bone grafting procedures have been used. This approach should be tempered with a look at the articular cartilage if this is damage d or the lesion is large. Limited femoral resurfacing can be used for hips that do not have acetabular involvement. If there is acetabular involvement , total hip replacement remains the treatment of choice. There are present innovations in total hip arthroplasty that hopefully will lead to increased longevity of these prostheses with newer polyethylenes a s well as the use of ceramic and other types of interfaces. Another possibl e advance for this disease would be the use of metal on metal standard pros theses, as well as metal on metal resurfacing arthroplasties. In terms of a salvage of the femoral head, all of the different procedures - core decomp ression, osteotomy, bone grafting - can be enhanced by new advances in the development of the utilization of bioactive factors. These range from osteo inductive agents such as cytokines, angiogenic stimulating factors, and bon e morphogenetic proteins. In addition, osteoconductive substances may be helpful and can be combined with osteoinductive substances. These bioactive factors are described in de tail in another chapter of this issue. With the ushering in of the millenni um, there is hope for better results with this disease.