The Journal of Bone and Joint Surgery (American). 2006;88:1117-1132.
doi:10.2106/JBJS.E.01041
© 2006 The Journal of Bone and Joint Surgery, Inc.
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Current Concepts Review

Nontraumatic Osteonecrosis of the Femoral Head: Ten Years Later

Michael A. Mont, MD1, Lynne C. Jones, PhD2 and David S. Hungerford, MD2

1 Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address: rhondamont{at}aol.com
2 Division of Arthritis Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Good Samaritan Hospital, Professional Office Building, Suite G-1, 5601 Loch Raven Boulevard, Baltimore, MD 21239

Investigation performed at the Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, and the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Good Samaritan Hospital, Baltimore, Maryland

NOTE: The authors thank Dr. German Marulanda and Dr. Thorsten Seyler for their help with research background material.

The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The etiology of osteonecrosis of the hip may have a genetic basis. The interaction between certain risk factors and a genetic predisposition may determine whether this disease will develop in a particular individual.

The rationale for use of joint-sparing procedures in the treatment of this disease is based on radiographic measurements and findings with other imaging modalities.

Early diagnosis and intervention prior to collapse of the femoral head is key to a successful outcome of joint-preserving procedures.

The results of joint-preserving procedures are less satisfactory than the results of total hip arthroplasty for femoral heads that have already collapsed.

New pharmacological measures as well as the use of growth and differentiation factors for the prevention and treatment of this disease may eventually alter our treatment approach, but it is necessary to await results of clinical research with long-term follow-up of these patients.


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Detection of Osteonecrosis on MRI Requires Blood Flow.
James K. Brannon, M.D.
JBJS Online, 5 Jul 2006 [Full text]