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Current State of Diagnosis and Treatment of AVN of the Hip

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Advances in Specialist Hip Surgery

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Abstract

Nontraumatic avascular necrosis (AVN) of the hip affects mainly young patients and leads to secondary arthritis of the hip. In our three-decade experience, the disease is underdiagnosed as many hips reach the state of secondary arthritis before the diagnosis of AVN. The treatment for AVN of the hip is still challenging for the orthopedic surgeon since the survival of total hip arthroplasties in those young patients is inferior. Core decompression, intertrochanteric osteotomy, transtrochanteric rotational osteotomy, transtrochanteric curved varus osteotomy, nonvascularized bone transplantation, and vascularized fibula transplantation are previously reported as joint-preserving treatments for AVN patients. Well-established classification systems such as the Association Research Circulation Osseous (ARCO) classification or the Japanese Investigation Committee (JIC) classification are useful not only to predict the prognosis but also to determine the optimal joint-preserving treatment for AVN patients. In this chapter, the current state of diagnosis and treatment of AVN of the hip is summarized.

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Abbreviations

ARCO:

Association Research Osseous Circulation

AVN:

Avascular necrosis

FSE:

Fat-suppressed spin echo

GWAS:

Genome-wide association study

JIC:

Japanese Investigation Committee

MPSL:

Methylprednisolone

MRI:

Magnetic resonance imaging

ON:

Osteonecrosis

ONFH:

Osteonecrosis of the femoral head

ROM:

Range of motion

SIF:

Subchondral insufficiency fracture

STIR:

Short T1 inversion recovery

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Authors and Affiliations

  1. Department of Orthopedics, RWTH Aachen University Hospital, Aachen, Germany

    Wolf R. Drescher

  2. Orthopedic Surgery of the Lower Limb and Arthroplasty, Rummelsberg Hospital, Schwarzenbruck, Germany

    Wolf R. Drescher

  3. Department of Anatomy and Cell Biology, RWTH Aachen University, Aachen, Germany

    Yusuke Kubo & Thomas Pufe

  4. Faculty of Medicine, Department of Orthopaedic Surgery, Fukuoka University, Fukuoka, Japan

    Takuaki Yamamoto

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  1. Wolf R. Drescher
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  2. Yusuke Kubo
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  3. Thomas Pufe
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  4. Takuaki Yamamoto
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Correspondence to Wolf R. Drescher .

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Editors and Affiliations

  1. Department of Orthopedics, RWTH Aachen University Hospital, Aachen, Germany

    Wolf R. Drescher

  2. Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea (Republic of)

    Kyung-Hoi Koo

  3. Orthopaedic Surgery, Hip and Knee Replacement, Hospital of Special Surgery, New York, NY, USA

    Russell E. Windsor

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Drescher, W.R., Kubo, Y., Pufe, T., Yamamoto, T. (2021). Current State of Diagnosis and Treatment of AVN of the Hip. In: Drescher, W.R., Koo, KH., Windsor, R.E. (eds) Advances in Specialist Hip Surgery . Springer, Cham. https://doi.org/10.1007/978-3-030-61830-8_9

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