Surgical management of avascular necrosis of the femoral head: an update

Osteonecrosis or avascular necrosis of the femoral head (ANFH) is a progressive, multifactorial, and disabling disease that can result in significant clinical morbidity and affect patients of any age, including young and active patients. The pathogenesis and etiology of non-traumatic ANFH has not been elucidated completely, but could be mainly due to an inadequate blood supply, causing death of osteocytes and bone marrow cells. Surgical procedures like core decompression, nonvascularized autologous bone grafts, porous tantalum implant procedures, and various osteotomies have been used to delay progression of the disease and conversion to total hip arthroplasty. Noninvasive treatment modalities like pharmacologic measures, electrical stimulation, shock wave therapy, and electromagnetic field therapy are also used to treat ANFH. Various efforts have been made in an attempt to enhance the healing of osseous defects at the femoral head before collapse occurs. Current treatment techniques for ANFH have varying results, according to the patient population and disease stage involved. With modifications of older techniques and developing technologies, treatment strategies have the ability to alter the course of ANFH. Further management options are required for the treatment of ANFH, and will be widely studied in the coming decades.