Abstract
Management of symptomatic osteonecrosis of the hip includes either some type of head preservation procedure or a total hip arthroplasty (THA). In general, once there is collapse of the femoral head, femoral head preservation procedures have limited success. There are a number of different femoral head preservation procedures that are presently performed and there is no consensus regarding which one is most effective. These procedures involve a core decompression with some type of vascularised or nonvascularised grafting of the femoral head. Core decompression with bone grafting of the femoral head with stem cells harvested from the iliac crest and vascularised fibula grafts are the two most popular femoral head preservation procedures.
Once the femoral head has collapsed then a THA should be performed when the patient has significant disability. In the past, total hip arthroplasty in osteonecrosis patients was not considered a highly successful procedure because it was performed in younger patients (most patients are younger than fifty years of age) and longevity was limited by wear and osteolysis. The advent of reliable cementless acetabular and femoral fixation and alternative bearing surfaces (i.e. highly crosslinked polyethylene liners) has been associated with improved outcomes and enhanced longevity. THA is considered the procedure of choice even for young patients (less than 30 years old) with collapse of the femoral head and significant pain and disability.
