International Orthopaedics

, Volume 43, Issue 5, pp 1083–1087 | Cite as

Early diagnosis and treatment of steroid-induced osteonecrosis of the femoral head

  • Weimin Fu
  • Baoyi Liu
  • Benjie Wang
  • Dewei ZhaoEmail author
Original Paper



This study aims to investigate the early diagnosis and treatment of steroid-induced osteonecrosis of the femoral head.

Patients and methods

From January 2010 to January 2014, a total of 350 patients, who required the use of large amounts of hormones, were enrolled into the study. These patients were followed up every three months after starting the hormone therapy. A total of 62 cases were screened, among which nine cases were asymptomatic. Furthermore, 38 patients were diagnosed as stage I and were given low-molecular weight heparin (LMWH) and vasodilator drugs. Moreover, 22 cases were diagnosed as stage IIa/b and underwent core decompression. In addition, two cases were diagnosed as stage IIc and underwent pedicled bone transplantation. During the follow-up period, ARCO staging was used for radiological evaluation, the HHS score was applied to evaluate for clinical efficacy, and SPSS 22.0 statistical software was used for the data analysis.


A total of 60 patients were followed up for 24 months. Among these patients, 38 patients were diagnosed with ARCO stage I and underwent systematic therapy. No progress was found in 29 cases (76.3%). Furthermore, three cases progressed to stage IIb (7.8%), four cases progressed to stage IIc (10.5%), two cases progressed to stage III and IV, respectively (2.6%), and 16 cases (80%) did not progress after core decompression. In the 16 cases at stage IIa and four cases at stage IIb, and four cases (20%) progressed in stage III. The HHS score of stage I was 80.42 ± 3.25 before follow-up, while the HHS score was 86.46 ± 8.54 after follow-up, and the difference was statistically significant (P < 0.05). Furthermore, the HHS score of patients with stage IIa/b was 70.38 ± 4.62 before follow-up, while the HHS score was 80.28 ± 6.72 after follow-up, and the difference was statistically significant (P < 0.01).


MRI remains as the most effective method for the non-invasive diagnosis of osteonecrosis, at present. Enhanced MRI may be able to detect early osteonecrosis, but further research is needed. Drug treatment and core decompression can achieve satisfactory results at the early stage.


Steroid-induced osteonecrosis of the femoral head Diagnosis Treatment 


Compliance with ethical standards

All patients provided a signed informed consent prior to screening.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Zhao DW, Yu M, Hu K et al (2015) Prevalence of nontraumatic osteonecrosis of the femoral head and its associated risk factors in the Chinese population: results from a nationally representative survey. Chin Med J 128:2843–2850CrossRefGoogle Scholar
  2. 2.
    Mont MA, Jones LC, (2006) Hungerford DS. Nontraumatic osteonecrosis of the femoral head: ten years later. J Bone Joint Surg Am, 88: p. 1117–1132Google Scholar
  3. 3.
    Mont MA, (1995) Hungerford D S. Non-traumatic avascular necrosis of the femoral head. J Bone and Joint Surg, 77A: p. 459–469CrossRefGoogle Scholar
  4. 4.
    Mankin HJ (1992) Nontraumatic necrosis of bone (osteonecrosis). N Engl J Med 326:1473–1479CrossRefGoogle Scholar
  5. 5.
    Microsurgery Department of the Orthopedics Branch of the Chinese Medical Doctor Association, Group from the Osteonecrosis and Bone Defect Branch of the Chinese Association of Reparative and Reconstructive Surgery and Microsurgery and Reconstructive Surgery Group of the Orthopedics Branch of the Chinese Medical (2017) Chinese guideline for the diagnosis and treatment of osteonecrosis of the femoral head in adults. Orthop Surg 9:3–12CrossRefGoogle Scholar
  6. 6.
    Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51(4):737–755CrossRefGoogle Scholar
  7. 7.
    Fc Z, Zr L, Kj G (2012) Clinical analysis of osteonecrosis of the femoral head induced by steroids. Orthop Surg 4:28–34CrossRefGoogle Scholar
  8. 8.
    Hernigou P, Poignard A, Nogier A et al (2004) Fate of very small asymptomatic stage-I osteonecrotic lesions of the hip. JBJS 86(12):2589–2593CrossRefGoogle Scholar
  9. 9.
    Tsuji T, Sugano N, Sakai T, Yoshikawa H (2003) Evaluation of femoral perfusion in a non-traumatic rabbit osteonecrosis model with T2-weighted dynamic MRI. J Orthop Res 21(2):341–351CrossRefGoogle Scholar
  10. 10.
    Moutsatsou P, Kassi E, Papavassiliou AG (2012) Glucocorticoid receptor signaling in bone cells. Trends Mol Med 18(6):348–359CrossRefGoogle Scholar
  11. 11.
    Steinberg ME, Mont MA (2001) Osteonecrosis. In: Chapman MW (ed) Chapman’s orthopaedic surgery, 3rd edn. Lip-pincott, Philadelphia, p 3263Google Scholar
  12. 12.
    Cao F, Liu G, Wang W et al (2017) Combined treatment with an anticoagulant and a vasodilator prevents steroid-associated osteonecrosis of rabbit femoral heads by improving hypercoagulability. Biomed Res Int.
  13. 13.
    Zhao D, Xiaobing Y, Wang T et al (2013) Digital subtraction angiography in selection of the vascularized greater trochanter bone grafting for treatment of osteonecrosis of femoral head. Microsurgery 33(8):656–659CrossRefGoogle Scholar
  14. 14.
    Kerachian MA, Séguin C, Harvey EJ (2009) Glucocorticoids in osteonecrosis of the femoral head: a new understanding of the mechanisms of action. J Steroid Biochem Mol Biol 114(3–5):121–128CrossRefGoogle Scholar
  15. 15.
    Ficat P, Grijalvo P (1984) Long-term results of the forage-biopsy in grade I and II osteonecrosis of the femoral head. Apropos of 133 cases re-examined after an average time of 9 years 6 months. Rev Chir Orthop Reparatrice Appar Mot 70(3):253–255Google Scholar
  16. 16.
    Wang B, Zhao D, Liu B, Wang W (2013) Treatment of osteonecrosis of the femoral head by using the greater trochanteric bone flap with double vascular pedicles. Microsurgery 33(8):593–599CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of OrthopedicsThe Affiliated Zhongshan Hospital of Dalian UniversityDalianChina

Personalised recommendations