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      Summary of the various treatments for osteonecrosis of the femoral head by mechanism: A review

      research-article
      , ,
      Experimental and Therapeutic Medicine
      D.A. Spandidos
      osteonecrosis, osteoblast, osteoclast, bisphosphonates

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          Abstract

          Osteonecrosis of the femoral head (ONFH), also known as femoral head avascular necrosis, is a pathological state with a number of possible etiologies including steroid administration, alcohol abuse, traumatic events, vascular injury and idiopathic origins. ONFH causes a reduction in the vascular supply to the subchondral bone of the femoral head, which results in osteocyte death and the collapse of the articular surface. Treatments for ONFH include non-weight-bearing therapy, physical support, the promotion of osteoclast apoptosis, and the reduction of osteoblast and osteocyte apoptosis. The aim of the present review was to summarize the treatments for ONFH by mechanism from a new perspective and to describe the condition with an emphasis on treatment options.

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          Non-traumatic avascular necrosis of the femoral head.

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            Core decompression versus nonoperative management for osteonecrosis of the hip.

            A complete review of the literature disclosed that there were 42 reports of 2025 hips treated by either core decompression (1206 hips) or nonoperative management (819 hips), excluding electrical stimulation, for osteonecrosis of the femoral head. The peer-reviewed published reports included general surveys, prospective studies, and multicenter studies, but excluded case reports. Satisfactory clinical results were reported in 63.5% of hips in 24 studies of core decompression and in 22.7% of hips in 21 studies of nonoperative management. When looking at only precollapse hips, there were 71% versus 34.5% good results, respectively. Recalculation excluding reports by the 4 centers that do the most core decompressions (and report the best results) showed a clinical success rate for core decompression of 53% versus 22.7% for the nonoperatively treated group. Investigators of multiple studies have reported that nonoperative management leads to extremely poor results. Core decompression has been reported to have a notable effect on the natural history and clinical progression in early stages of osteonecrosis of the femoral head. In view of the limitations of this data, further clarification of this effect only can be obtained by large prospective randomized studies.
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              Do modern techniques improve core decompression outcomes for hip osteonecrosis?

              Core decompression procedures have been used in osteonecrosis of the femoral head to attempt to delay the joint destruction that may necessitate hip arthroplasty. The efficacy of core decompressions has been variable with many variations of technique described. To determine whether the efficacy of this procedure has improved during the last 15 years using modern techniques, we compared recently reported radiographic and clinical success rates to results of surgeries performed before 1992. Additionally, we evaluated the outcomes of our cohort of 52 patients (79 hips) who were treated with multiple small-diameter drillings. There was a decrease in the proportion of patients undergoing additional surgeries and an increase in radiographic success when comparing pre-1992 results to patients treated in the last 15 years. However, there were fewer Stage III hips in the more recent reports, suggesting that patient selection was an important reason for this improvement. The results of the small-diameter drilling cohort were similar to other recent reports. Patients who had small lesions and were Ficat Stage I had the best results with 79% showing no radiographic progression. Our study confirms core decompression is a safe and effective procedure for treating early stage femoral head osteonecrosis.
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                Author and article information

                Journal
                Exp Ther Med
                Exp Ther Med
                ETM
                Experimental and Therapeutic Medicine
                D.A. Spandidos
                1792-0981
                1792-1015
                September 2014
                26 June 2014
                26 June 2014
                : 8
                : 3
                : 700-706
                Affiliations
                Institute of Orthopedics, Chinese PLA General Hospital, Beijing 100853, P.R. China
                Author notes
                Correspondence to: Professor Jiang Peng, Institute of Orthopedics, Chinese PLA General Hospital, 28 Fuxing Road, Haidian, Beijing 100853, P.R. China. E-mail: pengjiang301@ 123456126.com
                Article
                etm-08-03-0700
                10.3892/etm.2014.1811
                4113634
                25120585
                234ad9dc-4e1d-4199-b786-c92ebf15d2e6
                Copyright © 2014, Spandidos Publications

                This is an open-access article licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License. The article may be redistributed, reproduced, and reused for non-commercial purposes, provided the original source is properly cited.

                History
                : 16 January 2014
                : 04 June 2014
                Categories
                Articles

                Medicine
                osteonecrosis,osteoblast,osteoclast,bisphosphonates
                Medicine
                osteonecrosis, osteoblast, osteoclast, bisphosphonates

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