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Abstract
Avascular necrosis of the femoral head is a multifactorial pathology characterized by the progressive destruction of the bone architecture in the hip joint, secondary to an alteration of local blood flow, and which, if not intervened in time, generates total joint collapse. It can have both a symptomatic presentation, in which pain is the main reason for consultation; and asymptomatic presentation, being an incidental image finding. It affects individuals of any age, but its incidence is higher during adulthood, particularly in the years of greatest labor production. It is associated with a wide range of both traumatic and medical etiologies, among which femur fractures, prolonged use of glucocorticoids, and excessive alcohol consumption stand out. The diagnosis is made through a detailed review of risk factors, history of previous trauma and mainly radiological evaluation, in which magnetic resonance imaging is the gold standard. Currently, treatment can be conservative or surgical depending on the degree of compromise, with total joint replacement being reserved for the most severe cases with joint collapse.
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References
Jones LC, Mont M. Osteonecrosis (Avascular necrosis of the bone). Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. 2018. Disponible en: https://www.uptodate.com/contents/osteonecrosis-avascular-necrosis-of-bone?search=Osteonecrosis-(avascular-necrosis-of-bone)
Matthews AH, Stitson D. Osteonecrosis (Avascular Necrosis). StatPearls [Internet]. StatPearls Publishing; 2020 Jan -. Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK537007/
McCarthy EF, Frassica FJ. Osteonecrosis. En: Pathology of Bone and Joint Disorders: With Clinical and Radiographic Correlation. 2nd ed. Cambridge: Cambridge University Press; 2014. P-130-146. https://doi.org/10.1017/CBO9781139946247.008
Narayanan A, Khanchandani P, Borkar RM, Ambati CR, Roy A, Han X, Bhoskar RN, Ragampeta S, Gannon F, Mysorekar V, Karanam B, V SM, Sivaramakrishnan V. Avascular Necrosis of Femoral Head: A Metabolomic, Biophysical, Biochemical, Electron Microscopic and Histopathological Characterization. Scientific Reports. 2017; 7(1): 10721. https://doi.org/10.1038/s41598-017-10817-w
Hong YC, Zhong HM, Lin T, Shi JB. Comparison of core decompression and conservative treatment for avascular necrosis of femoral head at early stage: a meta-analysis. Int J Clin Exp Med. 2015; 8(4): 5207-5216.
Deleanu B, Prejbeanu R, Vermesan D, Honcea L, Mioc ML, Tsiridis E, Predescu V. Avascular necrosis of the femoral head at 2 years after pertrochanteric fracture surgery: Case report. Ann Med Surg (Lond). 2015; 22(5): 106-109. https://doi.org/10.1016/j.amsu.2015.12.053
Pouya F, Kerachian MA. Avascular Necrosis of the Femoral Head: Are Any Genes Involved? Arch Bone Jt Surg. 2015; 3(3): 149-55.
Hsu H, Nallamothu SV. Hip Osteonecrosis. StatPearls [Internet]. StatPearls Publishing; 2020 Jan-. Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK499954/
Nigrovic P. Approach to hip pain in childhood. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. 2019. Disponible en: https://www.uptodate.com/contents/approach-to-hip-pain-in-childhood?search=approach-to-hip-pain-in-childhood
Lespasio MJ, Sodhi N, Mont MA. Osteonecrosis of the Hip: A Primer. Perm J. 2019; 23: 18-100. https://doi.org/10.7812/TPP/18-100
Moya-Angeler J, Gianakos A, Villa JC, Ni A, Lane JM. Current concepts on osteonecrosis of the femoral head. World J Orthop. 2015; 6(8): 590-601. https://doi.org/10.5312/wjo.v6.i8.590
Arbab D, König DP. Atraumatic Femoral Head Necrosis in Adults. Dtsch Arztebl Int. 2016 Jan 22;113(3):31-8. https://doi.org/10.3238/arztebl.2016.0031
Paoloni J. Approach to the adult with unspecified hip pain. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. 2019. Disponible en: https://www.uptodate.com/contents/approach-to-the-adult-with-unspecified-hip-pain?search=Approach-to-the-adult-with-unspecified-hip-pain
Shah KN, Racine J, Jones LC, Aaron RK. Pathophysiology and risk factors for osteonecrosis. Curr Rev Musculoskelet Med. 2015; 8(3): 201-209. https://doi.org/10.1007/s12178-015-9277-8
Lamb JN, Holton C, O’Connor P, Giannoudis PV. Avascular necrosis of the hip. BMJ. 2019; 365: l2178. https://doi.org/10.1136/bmj.l2178
Baig SA, Baig MN. Osteonecrosis of the Femoral Head: Etiology, Investigations, and Management. Cureus. 2018;10(8): e3171. https://doi.org/10.7759/cureus.3171
Tripathy SK, Goyal T, Sen RK. Management of femoral head osteonecrosis: Current concepts. Indian J Orthop. 2015; 49(1): 28-45. https://doi.org/10.4103/0019-5413.143911
Barbhaiya M, Dong Y, Sparks JA, Losina E, Costenbader KH, Katz JN. Administrative Algorithms to identify Avascular necrosis of bone among patients undergoing upper or lower extremity magnetic resonance imaging: a validation study. BMC Musculoskelet Disord. 2017; 18(1): 268. https://doi.org/10.1186/s12891-017-1626-x
Choi HR, Steinberg ME, Y Cheng E. Osteonecrosis of the femoral head: diagnosis and classification systems. Curr Rev Musculoskelet Med. 2015; 8(3): 210-20. https://doi.org/10.1007/s12178-015-9278-7
Petek D, Hannouche D, Suva D. Osteonecrosis of the femoral head: pathophysiology and current concepts of treatment. EFORT Open Rev. 2019. 15; 4(3): 85-97. https://doi.org/10.1302/2058-5241.4.180036
Zhou CH, Meng JH, Zhao CC, Ye CY, Zhu HX, Hu B, Heng BC, Shen Y, Lin T, Yang XB, Shi ZL, Shen WL, Yan SG. PTH[1-34] improves the effects of core decompression in early-stage steroid-associated osteonecrosis model by enhancing bone repair and revascularization. PLoS One. 2017; 12(5): e0178781. https://doi.org/10.1371/journal.pone.0178781
Papachristos IV, Rankine J, Giannoudis PV. Hip arthrodiastasis combined with core decompression and diamond concept for postcollapse femoral head avascular necrosis. BMJ Case Rep. 2019; 12: e231081. https://doi.org/10.1136/bcr-2019-231081