Non traumatic osteonecrosis of the femoral head: pathogenesis, diagnostic and treatment

Abstract

Bone avascular necrosis (AVN) can affect any bone. AVN of the femoral head is one of the most common affectations and it can be bilateral. Humerus and knee AVN follows in frequency. Diagnosis of avascular necrosis (AVN) of the femoral head depends on the combination of clinical symptoms and evaluation of radiographs and/or magnetic resonance imaging (MRI). To evaluate AVN of the femoral head the Ficat and the Association Research Circulation Osseous (ARCO) classification are commonly used .MRI is the most sensible and specific method for its study. If high clinical suspect is present and MRI did not evidence lesion, MRI should be performed again in the next 15 days. AVN of the femoral head produces pain, clinical function limitation, a collapse in loading areas which can produces an important secondary osteoarthritis. The treatment in pre-collapse stages of the disease improves symptoms and prevents disease progression. In advanced stages the requirement for total hip replacement is possible.