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

摘要

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 out varies according to the disease etiology. Treatments include non-weight-bearing (NWB) therapy, physical support and the alteration of cytoactivity. Extracorporeal shock wave therapy (ESWT) is used to reduce osteoblast and osteocyte apoptosis. Other therapies used include hyperbaric oxygen (HBO) therapy and core decompression. Certain reports (4-6) suggest that bisphosphonates increase osteoclast apoptosis and prevent the collapse of the femoral head. Various femoral head-preserving procedures have been carried out in an attempt to prevent the requirement for a complete hip replacement. The present review focuses on treatments for ONFH (7,8).