The Natural History of Untreated Asymptomatic Osteonecrosis of the Femoral Head

Abstract

Data extracted from previously published studies suggest that asymptomatic osteonecrosis has a high prevalence of progression to symptomatic disease and femoral head collapse. While small, medially located lesions have a low rate of progression, the natural history of asymptomatic medium-sized, and especially large, osteonecrotic lesions is progression in a substantial number of patients. For this reason, it may be beneficial to consider joint-preserving surgical treatment in asymptomatic patients with a medium-sized or large, and/or laterally located, lesion.

Osteonecrosis of the femoral head: diagnosis and classification systems

“…While there is no universal agreement in classification systems, it is well established that the prognosis is directly related to several factors: the extent of the osteonecrotic lesion [48,[62][63][64][65], the presence of a subchondral fracture [66,67], and the location of the lesion [68,69]. Most classification systems are based upon these prognostic factors.…”

Osteonecrosis of the femoral head: An update in year 2012

“…Patients are generally younger adults age 35 years to 45 years, and risk factors for 75%-90% of cases include chronic steroid use, alcoholism, smoking, hip trauma including femoral neck fractures and hip dislocations, and prior hip surgery. Other potential etiologies for osteonecrosis include childhood history of slipped capital femoral epiphysis (SCFE), deep sea diving or other hyperbaric conditions, systemic lupus erythematosus (SLE) and other connective tissue disorders, autoimmune diseases causing vasculitis, sickle cell anemia, coagulopathy such as thrombophilia or disseminated intravascular coagulation, human immunodeficiency virus (HIV) infection, hyperlipidemia, fat embolus syndrome, treatment of developmental hip dysplasia, chemotherapy and/or radiation, organ transplantation, chronic liver disease, Gaucher disease, gout, and metabolic bone disease [3,4,[6][7][8][9][10] . Males are affected up to three times more than females, and bilateral femoral head osteonecrosis is found in up to 75% of cases [3,5] .…”

“…However, these methods have no role in treatment of late stage osteonecrosis and show limited success in preventing disease progression, even in early stage (Steinberg stage Ⅰ and Ⅱ) disease [9,28] . Patients can be encouraged to abstain from or decrease alcohol consumption and smoking [29] .…”

The Prevalence of Avascular Necrosis in Adults With Sickle Cell Disease in King Fahad Hospital.

“…It has been reported that even patients with mild forms of SCD present with AVN frequently [9]. Patients with AVN can be either symptomatic complaining of hip pain, pain with movement and restriction of joints range of movement or can be asymptomatic especially in early stages [10]. Although it is the commonest clinical presentation of SCD, it has not been investigated sufficiently [7,11].…”