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EFORT Open Rev. 2020 Jan 28;4(12):647-658. doi: 10.1302/2058-5241.4.180073. eCollection 2019 Dec.

Joint-preserving procedures for osteonecrosis of the femoral head.

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Hacettepe University Department of Orthopaedics and Traumatology, Ankara, Turkey.
Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.


Osteonecrosis of the femoral head is a poorly understood condition that may lead to progressive destruction of the hip joint. Its incidence is common between the third and fifth decades of life and it is the diagnosis behind 5-18% of annually performed total hip arthroplasties (THAs) in the USA.Regarding the high rate of complications of THA in that age group, authors have agreed on the importance of joint-preservation techniques for this disease but techniques vary to establish a generally accepted algorithmic approach.Surgical head-preserving procedures, core decompression with or without graft, stem cell augmentation, or biologic adjuncts, vascularized bone grafting, and proximal femoral osteotomies have all been published on with heterogeneous results and with limited evidence to date.Consensus states that the prognosis of patients with osteonecrosis of the femoral head can be significantly improved with early diagnosis and timely intervention. Cite this article: EFORT Open Rev 2019;4:647-658. DOI: 10.1302/2058-5241.4.180073.


avascular necrosis; core decompression; femoral head; hip; osteonecrosis; total hip arthroplasty

Conflict of interest statement

ICMJE Conflict of interest statement: JP reports consultancy to Zimmer Biomet, Stryker, TissueGene, Corentec, Ethicon, Tenor, KCI, Heraeus and 3M; royalties from Corentec, Parvizi Surgical Innovations, Hip Innovation Technology, Alphaeon, Joint Purification Systems, Ceribell, PRN, PRNVeterinary, MD-Valuate, Intellijoint, MicroGenDx and Corentec, all outside the submitted work. The other authors declare no conflict of interest relevant to this work.

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