Seminar on Osteonecrosis of femoral head

1. Dr. Shubhanshu
Guide - Dr John Mukhopadhaya

2. History

3. Introduction
 Osteonecrosis of the femoral head (ONFH) is the
final common pathway of a series of derangements
 Decrease in blood flow
I. cellular death
II. Fracture
III. collapse of the articular surface

4.  in young
 60% B/L
 Spontaneous regression is rare
 Untreated patients :collapse 67% in asymptomatic
and 85% of symptomatic.

7. Etiology
 Idiopathic
 Genetic
 Metabolic factors
 Local factors

15. Anterolateral Sequestrum

17. Cresent Sign
Sclerosis
Cystic changes
Loss of spherical weight
bearing dome Partial collapse of head
Lytic lesion

28. Algorithm for the management and treatment of patients with osteonecrosis of
the femoral head. ONFH: Osteonecrosis of the femoral head; FHCD: Femoral head core
decompression; NVBG: Non vascularized bone graft; BA: Biologic agents; VBG:
Vascularized bone graft;

29. AIM Of Treatment
 Early intervation
 Preserve rather than replacing femoral head and
cartilage

30. Medical Management
 For small, asymptomatic lesion
 When surgery is contraindicated or declined

31. Medical Management
 Anabolic androgenic steriod
 Motomura et al found incidence of steroid induced
osteonecrosis using combination of warfarin,
probucol.
 Enoxaparin- 12wks prevent progression of stage 1 & 2
ONFN on 2 year followup
 Ilioprost- in bone marrow syndrome and ON

32. Medical Management
 Alendronate: Agrawala et al reported that
improvement in pain
 Bisphosphonates for pain invovement
 Pulsed Electromagnetic field stimulation

33.  Wang et al compared harris hip scores showed
effective result in 79% Extracorporeal shockwave
therapy and 29% non vacularised fibular graft.
 Hyperbaric oxygen: Reis et al, 13/16 patient with stage 1
appeared normal MRI after 100 days therapy