Miscellaneous Procedures in the Treatment of Osteonecrosis of the Femoral Head

Osteonecrosis is the final pathologic response to a myriad of etiologies occurring in a variety of populations. The disease is variable in its progression and extent of involvement. Therefore, numerous therapeutic procedures have also been proposed since this condition has been identified. Treatment not only depends on the stage of the disease but also the expectations and demands placed on the hip by the individual patient. Choosing the most appropriate procedure is paramount to achieving the greatest likelihood of clinical success. Treatment and outcome studies have been difficult to assess as a result of the natural history and the fact that the exact etiology has not been fully elucidated. Furthermore, the goal of prevention of osteonecrosis has not yet been achieved and, without an animal model, will make this task difficult. As a result, some less frequently used and some more recently developed methods are also used to achieve relief of pain and potentially slow progression of degenerative arthritis of the hip. Some of these less commonly used surgical strategies continue to be used. Femoral endoprosthesis has largely given way to total hip replacement but continues to be justified in older and less demanding patients. Salvage procedures include resection arthroplasty and arthrodesis. The use of acrylic cement injection has had some success, whereas, more recently, the use of a porous tantalum rod has been reported with early favorable results and minimal morbidity. These " miscellaneous" procedures add to the armamentarium in the treatment of osteonecrosis of the femoral head.