Avascular Necrosis of Femoral Head-Overview and Current State of the Art

Overview

Journal Int J Environ Res Public Health

Publisher MDPI

Specialties Environmental Health
Public Health

Date 2022 Jun 24

PMID 35742595

Authors

Wojciech Konarski

Tomasz Pobozy

Andrzej Sliwczynski

Ireneusz Kotela

Jan Krakowiak

Martyna Hordowicz

Andrzej Kotela

Affiliations

Soon will be listed here.

Abstract

Avascular necrosis (AVN) of the femoral head is caused by disruption of the blood supply to the proximal femur. The alterations in the blood supply may occur following a traumatic event or result from a non-traumatic cause. Femoral neck fracture and hip dislocation and associated surgical procedures, corticosteroid therapy, and alcohol abuse frequently lead to AVN development. Type of fracture (displaced or undisplaced) and time between injury and surgery are the most critical factors in assessing the risk of developing AVN. Diagnosis of AVN can be established based on patients' complaints, medical history, and radiographic findings. There is no consensus on the treatment of patients with AVN to date. Non-surgical methods are dedicated to patients in the early pre-collapse stages of the disease and consist of pharmacotherapy and physiotherapy. Surgery is recommended for patients with advanced disease.

Citing Articles

Arthroscopic Treatment of Avascular Necrosis of the Femoral Head.

Afetse E, Kopolovich D, Jochl O, Hartman Budnik J, Nishimura H, Noorzad A Arthrosc Tech. 2025; 14(2):103233.

PMID: 40041349 PMC: 11873554. DOI: 10.1016/j.eats.2024.103233.

Advancements in 3D printing technologies for personalized treatment of osteonecrosis of the femoral head.

Chen T, Luo L, Li J, Li J, Lin T, Liu M Mater Today Bio. 2025; 31:101531.

PMID: 40026627 PMC: 11869124. DOI: 10.1016/j.mtbio.2025.101531.

Avascular Necrosis in Patients With Cushing Syndrome.

Tal N, Bannykh S, Learch T, Mamelak A, Cooper O JCEM Case Rep. 2025; 3(2):luaf001.

PMID: 39911682 PMC: 11795648. DOI: 10.1210/jcemcr/luaf001.

Bioinformatics and Gene Expression Omnibus Analysis of Key Candidate Genes and Pathways Associated with Femoral Head Necrosis.

Ding Y, Ma Y, Yan H, Zhang E Iran J Pharm Res. 2025; 23(1):e145223.

PMID: 39830663 PMC: 11742569. DOI: 10.5812/ijpr-145223.

First Case Report of Bilateral Avascular Necrosis in an Eosinophilic Esophagitis Patient on Swallowed Fluticasone.

Alakrad E, Al Teneiji K, Khan S, Al Zaabi M, Ben Ghashir N, Alahmad M Cureus. 2024; 16(11):e72815.

PMID: 39618773 PMC: 11608415. DOI: 10.7759/cureus.72815.

References

Tripathy S, Goyal T, Sen R . Management of femoral head osteonecrosis: Current concepts. Indian J Orthop. 2015; 49(1):28-45. PMC: 4292325. DOI: 10.4103/0019-5413.143911. View

Kang J, Moon K, Shin J, Shin E, Ahn C, Choi G . Clinical Results of Internal Fixation of Subcapital Femoral Neck Fractures. Clin Orthop Surg. 2016; 8(2):146-52. PMC: 4870316. DOI: 10.4055/cios.2016.8.2.146. View

Moya-Angeler J, Gianakos A, Villa J, Ni A, Lane J . Current concepts on osteonecrosis of the femoral head. World J Orthop. 2015; 6(8):590-601. PMC: 4573503. DOI: 10.5312/wjo.v6.i8.590. View

Meyers M . Resurfacing of the femoral head with fresh osteochondral allografts. Long-term results. Clin Orthop Relat Res. 1985; (197):111-4. View

Parker M, Stedtfeld H . Internal fixation of intracapsular hip fractures with a dynamic locking plate: initial experience and results for 83 patients treated with a new implant. Injury. 2009; 41(4):348-51. DOI: 10.1016/j.injury.2009.09.004. View

Li X, Brazauskas R, Wang Z, Al-Seraihy A, Baker K, Cahn J . Avascular necrosis of bone after allogeneic hematopoietic cell transplantation in children and adolescents. Biol Blood Marrow Transplant. 2014; 20(4):587-92. PMC: 3959243. DOI: 10.1016/j.bbmt.2013.12.567. View

Osarumwense D, Tissingh E, Wartenberg K, Aggarwal S, Ismail F, Orakwe S . The Targon FN system for the management of intracapsular neck of femur fractures: minimum 2-year experience and outcome in an independent hospital. Clin Orthop Surg. 2015; 7(1):22-8. PMC: 4329529. DOI: 10.4055/cios.2015.7.1.22. View

Mont M, Carbone J, Fairbank A . Core decompression versus nonoperative management for osteonecrosis of the hip. Clin Orthop Relat Res. 1996; (324):169-78. DOI: 10.1097/00003086-199603000-00020. View

Dasa V, Adbel-Nabi H, Anders M, Mihalko W . F-18 fluoride positron emission tomography of the hip for osteonecrosis. Clin Orthop Relat Res. 2008; 466(5):1081-6. PMC: 2311491. DOI: 10.1007/s11999-008-0219-2. View

10.

Wang C, Cheng J, Huang C, Yip H, Russo S . Extracorporeal shockwave therapy for avascular necrosis of femoral head. Int J Surg. 2015; 24(Pt B):184-7. DOI: 10.1016/j.ijsu.2015.06.080. View

11.

Keizer S, Kock N, Dijkstra P, Taminiau A, Nelissen R . Treatment of avascular necrosis of the hip by a non-vascularised cortical graft. J Bone Joint Surg Br. 2006; 88(4):460-6. DOI: 10.1302/0301-620X.88B4.16950. View

12.

Loizou C, Parker M . Avascular necrosis after internal fixation of intracapsular hip fractures; a study of the outcome for 1023 patients. Injury. 2009; 40(11):1143-6. DOI: 10.1016/j.injury.2008.11.003. View

13.

Elgeidi A, El Negery A, Abdellatif M, El Moghazy N . Dynamic hip screw and fibular strut graft for fixation of fresh femoral neck fracture with posterior comminution. Arch Orthop Trauma Surg. 2017; 137(10):1363-1369. DOI: 10.1007/s00402-017-2758-z. View

14.

Buckley P, Gearen P, PETTY R . Structural bone-grafting for early atraumatic avascular necrosis of the femoral head. J Bone Joint Surg Am. 1991; 73(9):1357-64. View

15.

Al Omran A . Multiple drilling compared with standard core decompression for avascular necrosis of the femoral head in sickle cell disease patients. Arch Orthop Trauma Surg. 2013; 133(5):609-13. DOI: 10.1007/s00402-013-1714-9. View

16.

Duckworth A, Bennet S, Aderinto J, Keating J . Fixation of intracapsular fractures of the femoral neck in young patients: risk factors for failure. J Bone Joint Surg Br. 2011; 93(6):811-6. DOI: 10.1302/0301-620X.93B6.26432. View

17.

Russo S, Sadile F, Esposito R, Mosillo G, Aitanti E, Busco G . Italian experience on use of E.S.W. therapy for avascular necrosis of femoral head. Int J Surg. 2015; 24(Pt B):188-90. DOI: 10.1016/j.ijsu.2015.11.038. View

18.

Bali K, Sudesh P, Patel S, Kumar V, Saini U, Dhillon M . Pediatric femoral neck fractures: our 10 years of experience. Clin Orthop Surg. 2011; 3(4):302-8. PMC: 3232358. DOI: 10.4055/cios.2011.3.4.302. View

19.

Zhao D, Zhang F, Wang B, Liu B, Li L, Kim S . Guidelines for clinical diagnosis and treatment of osteonecrosis of the femoral head in adults (2019 version). J Orthop Translat. 2020; 21:100-110. PMC: 7152793. DOI: 10.1016/j.jot.2019.12.004. View

20.

Siavashi B, Aalirezaei A, Moosavi M, Golbakhsh M, Savadkoohi D, Zehtab M . A comparative study between multiple cannulated screws and dynamic hip screw for fixation of femoral neck fracture in adults. Int Orthop. 2015; 39(10):2069-71. DOI: 10.1007/s00264-015-2881-9. View