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.
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