Abstract
Osteonecrosis (ON) of the femoral head is a condition that afflicts approximately 20 000 new patients per year, at an average age of 38. Twenty-five percent of the patients seen in our institution are under 25. Without treatment, most of these patients can be expected to need a total hip replacement (THR). However preservative procedures have a significant failure rate, and some, significant morbidity.
It is desirable to avoid or delay THR, because most of the patients with ON will outlive the prosthesis, at the current state of the art. There are four issues that need to be weighed to arrive at a reasonable algorithm for the preservative treatment of ON; patient risk factors, morbidity of the proposed procedure, size of the lesion, and stage of the lesion.
Risk – risk of outliving a THR. Age, sex, weight, general health, associated diseases, and level of activity all influence the longevity of a THR. The greater the risk, the greater the indication for a preservative procedure.
Morbidity – There is a big difference between core decompression and a complex osteotomy. The overall risk of the procedure and the impact on THR must be considered.
Size – Large lesions do much worse than small lesions at any stage.
Stage – Pre-collapse lesions do better than post-collapse lesions.
Using the above issues might lead the surgeon to do a THR on a 25-year old with a large post-collapse lesion or a core decompression on a 60-year old with a small symptomatic pre-collapse lesion. All of the issues must be considered to make sense out of a complex clinical situation.
The abstracts were prepared by Mrs Dorothy L. Granchi, Course Coordinator. Correspondence should be addressed to her at PMB 295, 8000 Plaza Boulevard, Mentor, Ohio 44060, USA.
