HSS Journal

, Volume 5, Issue 2, pp 99–113

SAS Weekly Rounds: Avascular Necrosis

  • Thomas W. Hamilton
  • Susan M. Goodman
  • Mark Figgie

DOI: 10.1007/s11420-009-9107-x

Cite this article as:
Hamilton, T.W., Goodman, S.M. & Figgie, M. HSS Jrnl (2009) 5: 99. doi:10.1007/s11420-009-9107-x


Osteonecrosis of the femoral head is a condition that affects upwards of 10,000 individuals in the USA each year. The peak incidence is in the fourth decade of life, and overall, there is a male preponderance. The condition accounts for up to 12% of total hip arthroplasties performed in developed countries. The etiology can be traumatic or non-traumatic, with 90% of atraumatic cases attributed to corticosteroid therapy or excess alcohol consumption. Osteonecrosis of the femoral head reflects the final common pathway of a range of insults to the blood supply and ultimately results in femoral head collapse, acetabular involvement, and secondary osteoarthritis. Currently, conservative treatment options, which aim to correct pathophysiologic features allowing revascularization and new bone formation, appear to be able to delay but not halt the progression of this condition. As a consequence of femoral head osteonecrosis, many individuals undergo surgical treatments including: core decompression, osteotomy, non-vascularized bone matrix grafting, free vascularized fibular grafts, limited femoral resurfacing, total hip resurfacing, and total hip arthroplasty.


osteonecrosis avascular necrosis femoral head 

Copyright information

© Hospital for Special Surgery 2009

Authors and Affiliations

  • Thomas W. Hamilton
    • 3
  • Susan M. Goodman
    • 1
  • Mark Figgie
    • 2
  1. 1.Department of MedicineHospital for Special SurgeryNew YorkUSA
  2. 2.Department of Orthopedic SurgeryHospital for Special SurgeryNew YorkUSA
  3. 3.Nuffield Department of Orthopaedics, Rheumatology and MusculoskeletalScience University of Oxford John Radcliffe HospitalHeadington OxfordUSA

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