This article reviews the literature regarding the outcomes of various nonoperative and operative treatment options for osteonecrosis of the hip. This article provides the orthopedic community with the latest evidence regarding the suitability of currently available treatment modalities in various stages of the disease.
Key points
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A multitude of medical treatment options have been described for the treatment of early stage osteonecrosis.
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Mesenchymal stem cell–based therapies with conventional methods of treatment have shown early promise in the treatment of the precollapse stage of osteonecrosis.
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Prospective randomized multicenter trials comparing pharmacotherapy with core decompression and stem cell–based therapies are needed in future.
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Cementless total hip arthroplasty with highly cross-linked polyethylene and new generation of ceramic bearings have shown excellent results at short-term to midterm follow-up.
Introduction
Osteonecrosis (ON) of the hip, with its varied causes and poorly understood pathogenesis, is an incapacitating disease primarily affecting the active population in the third and fourth decades of life. Management of ON has continued to remain a dilemma despite improvements in both medical and surgical treatment of this disease. The goal of management is to diagnose ON early in the precollapse stage and prevent subsequent progression to collapse and end-stage arthritis ( Fig. 1 ). Treatment has typically been based on the staging of ON ( Table 1 ); however, various other factors, such as the extent of the lesion, location, and causes, are often also taken into account when planning treatment. Although numerous studies reporting on a variety of operative and nonoperative methods have been published in the literature, there has been no consensus with regard to the ideal treatment of the precollapse stage of these lesions. Moreover, encouraging clinical outcomes following recent advances in short stem designs, porous biomaterials for cementless fixation, and ceramic or highly cross-linked polyethylene bearings have led to debate about the optimal implant for hip arthroplasty in patients with end-stage ON. This article presents a review of the current evidence regarding the outcomes of various nonoperative and operative treatment options for ON.
