Early Diagnosis and Treatment of Ischemic Necrosis of the Femoral Head

  • D. S. Hungerford
Part of the Progress in Orthopaedic Surgery book series (ORTHOPAEDIC, volume 5)

Abstract

A review of the literature would seem to indicate that ischemic necrosis of the femoral head (INFH) is growing in importance as a clinical entity. In 1962, Mankin and Brower found only 22 cases in the English literature, to which they added five of their own. Since then, series with more than 100 cases have been reported (Ficat et al. 1971; Merle d’Aubigne et al. 1965). In 1948, Chandler postulated that blockage of the posterolateral retinacular artery leads to infarction and eventual collapse of the anterolateral area of the femoral head. The typical X-ray picture supported that hypothesis in what appeared to be a wedge-shaped bone infarct (Fig. 1). This concept of “coronary disease of the hip” seemed almost self-evident and was widely accepted. Although this might be the case for post-traumatic INFH, a wide variety of other apparent etiologic associations, including alcohol abuse (18), both endogenous and exogenous steroid excess (Cruess et al. 1968; Edstrom 1971; Harrington et al. 1971; Soloman 1973), connective tissues diseases, especially systemic lupus erythematosis (Dubois 1960; Zizic et al. 1980), gout, Gaucher’s disease, and hemoglobinopathy (Dubois 1960), all have a similar morphological localization which would seem to transcend the simple mechanical involvement of a single artery. The mechanisms by which these diverse presumed etiologic associations produce such a similar clinical pattern have been the source of considerable controversy.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Arlet J, Ficat P (1968) Diagnostic de l’osteonecrose fémoro-eapitale au stade I. Rev Chir Orthop 54: 637PubMedGoogle Scholar
  2. Arnoldi CC, Linderholm H, Mussbichler H (1972) Venous engorgement and intraosseous hyper-tension in osteoarthritis of the hip. J Bone Joint Surg [Br] 54: 409Google Scholar
  3. Arnoldi CC, Lemperg RK, Linderholm H (1975) Intraosseous hypertension and pain in the knee. J Bone Joint Surg [Br] 3: 360Google Scholar
  4. Boettcher WG, Bonfiglio M, Smith K (1970) Non-traumatic necrosis of the femoral head. Part II. Experiences in treatment J Bone Joint Surg [Am] 52: 322Google Scholar
  5. Bonfiglio M, Voke EM (1968) Aseptic necrosis of the femoral head and non-union of the femoral head. J Bone Joint Surg [Am] 50: 48Google Scholar
  6. Chandler FA (1948) Coronary disease of the hip. J Int Coll Surg 11: 34PubMedGoogle Scholar
  7. Chung SMK, Ralston EL (1969) Necrosis of the femoral head associated with sickle-cell anemia and its genetic variants: a review of the literature and study of thirteen cases. J Bone Joint Surg [Am] 51: 33Google Scholar
  8. Cruess RL, Blennerhassett J, Macdonald FR, MacLean LD, Dossetor J (1968) Aseptic necrosis following renal transplantation. J Bone Joint Surg [Am] 50: 1577Google Scholar
  9. Dubois EL (1960) Avascular (aseptic) bone necrosis associated with systemic lupus erythematosus. JAMA 174: 966PubMedGoogle Scholar
  10. Edstrom G (1961) Destruction of hip-joint in rheumatoid arthritis during long-term steroid therapy. Acta Rheum Scand 7: 151PubMedCrossRefGoogle Scholar
  11. Ficat P, Arlet J (1968) Diagnostic de l’osteonecrose femoro-capitale primitive au stade I (stade preradiologique). Rev Chir Orthop 54: 637PubMedGoogle Scholar
  12. Ficat RP, Arlet J (1980) Ischemia and necroses of bone. Williams & Wilkins, BaltimoreGoogle Scholar
  13. Ficat P, et al. (1971) Resultats therapeutiques du forage biopsie dans les osteonecroses femorocapitales primitives (100 cas). Rev Rhum Mai Osteoartic 38: 269Google Scholar
  14. Glimcher MJ, Kenzora JE (1979) The biology of osteonecrosis of the human femoral head and its clinical implications III. Clin Orthop 140: 273PubMedGoogle Scholar
  15. Harrington KD, Murray WR, Kountz SL, Belzer FO (1971) Avascular necrosis of bone after renal transplantation. J Bone Joint Surg [Am] 53: 203Google Scholar
  16. Hungerford DS (1975) Early diagnosis of ischemic necrosis of the femoral head. Johns Hopkins Med J 137: 270PubMedGoogle Scholar
  17. Hungerford DS (1979) Bone marrow pressure, venography, and core decompression in ischemic necrosis of the femoral head. In: The Hip. Proc. 1th Hip Soc. Meeting Mosby, St. Louis, p 218Google Scholar
  18. Hungerford DS, Zizic TM (1972) Alcohol associated ischemic necrosis of the femoral head. Clin Orthop 130: 144Google Scholar
  19. Jacqueline F, Rabinowicz TH (1973) Lesions de la hanche secondaires a la fracture du col du femur. In: Proceedings of the first international symposium on circulation of bone. Inserm, Paris, p 283Google Scholar
  20. Jones JP (1971) Alcoholism, hypercortisonism, fat embolism and osseous avascular necrosis. In: Zinn WM (ed) Idiopathic ischemic necrosis of the femoral head in adults. Thieme, Stuttgart, p 112Google Scholar
  21. Kerboul M, Thomine J, Postel M, Merle D’Aubigne R (1974) The conservative surgical treatment of idiopathic aseptic necrosis of the femoral head. J Bone Joint Surg [Br] 56: 291Google Scholar
  22. Larsen RM (1938) Intramedullary pressure with particular reference to massive diaphyseal bone necrosis: experimental observations. Ann Surg 108: 127PubMedCrossRefGoogle Scholar
  23. Lynch JA (1974) Venous abnormalities and intraosseous hypertension associated with osteoarthritis of the knee. In: Ingweren O, et al. (eds) The knee joint Excerpta Medica, Amsterdam, p 87Google Scholar
  24. Mankin H, Brower TD (1962) Bilateral idiopathic aseptic necrosis of the femur in adults: Chandler’s disease. Bull Hosp Joint Dis 23: 42Google Scholar
  25. Marcus ND, Enneking WF, Massam RA (1973) The silent hip in idiopathic aseptic necrosis. J Bone Joint Surg [Am] 55: 1351Google Scholar
  26. Merle D’Aubigne R, Postel M, Mazabraud A, et al. (1965) Idiopathic necrosis of the femoral head in adults. J Bone Joint Surg [Br] 47: 612Google Scholar
  27. Meyers MH (1978) The treatment of osteonecrosis of the hip with fresh osteochondral allografts and with the muscle pedicle graft technique. Clin Orthop 130: 202PubMedGoogle Scholar
  28. Phemister DB (1949) Treatment of the necrotic head of the femur in adults. J Bone Joint Surg [Am] 31: 55Google Scholar
  29. Pooley J, Walder DN (1980) Reduction in bone marrow blood flow during simulated dives: investigation of the mechanism. J Bone Joint Surg [Br] 62: 635Google Scholar
  30. Romer U, Wettstein P (1971) Results of treatment of eighty-one Swiss patients with INFH. In: Zinn WM (ed) Idiopathic ischemic necrosis of the femoral head in adults. University Park Press, Baltimore, p 205Google Scholar
  31. Rutishauser E, Rhoner A, Held D (1960) Experimentelle Untersuchungen iiber die Wirkung der Ischamie auf den Knochen und das Mark. Virehows Arch [Pathol Anat] 33: 101CrossRefGoogle Scholar
  32. Serre H, Simon L (1961) L’osteonecrose primitive de la tete femorale chez l’adulte. Acta Rheum Scand 7: 265PubMedCrossRefGoogle Scholar
  33. Soloman L (1973) Drug-induced arthropathy and necrosis of the femoral head. J Bone Joint Surg [Br] 53: 246Google Scholar
  34. Sugioka K (1978) Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip. Clin Orthop 130: 191PubMedGoogle Scholar
  35. Wagner H (1964) Behandlung der partiellen Hiiftkopfnekrose. Verh Dtsch Orthop Ges [Suppl 51] 100: 359Google Scholar
  36. Wang GJ, Sweet DE, Reger SI, Thompson RC (1977) Fat cell changes as a mechanism of avascular necrosis of the femoral head in cortisone-treated rabbits. J Bone Joint Surg [Am] 59: 729Google Scholar
  37. Wang GJ, Lennox DW, Reger SI, Stamp RC, Hubbard S (1980) Cortisone induced intrafemoral head pressure changes and its response to drilling decompression method. Proc 26th Annu Orthop Res Soc 5: 45Google Scholar
  38. Wilkes CH, Visscher MB (1975) Some physiological aspects of bone marrow pressure. J Bone Joint Surg [Am] 57: 49Google Scholar
  39. Zizic TM, Hungerford DS, Stevens MB (1980) Ischemic necrosis of bone in systemic lupus erythe-matosus. I. Early diagnosis. Medicine (Baltimore) 59: 134Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1981

Authors and Affiliations

  • D. S. Hungerford

There are no affiliations available

Personalised recommendations