Spontaneous Resolution of Osteonecrosis of the Femoral Head

• Published in: Journal of bone and joint surgery. American volume 2004-12, Vol.86 (12), p.2594-2599
• Main Authors: Cheng, Edward Y, Thongtrangan, Issada, Laorr, Alan, Saleh, Khaled J
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Diseases of the osteoarticular system; Female; Femur Head Necrosis - diagnosis; Femur Head Necrosis - etiology; Femur Head Necrosis - pathology; Femur Head Necrosis - surgery; Hip Joint - pathology; Humans; Immunosuppressive Agents - adverse effects; Magnetic Resonance Imaging; Male; Medical sciences; Organ Transplantation - adverse effects; Prognosis; Remission, Spontaneous; Vascular bone diseases
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/00004623-200412000-00002

BackgroundThe decision to proceed with surgical treatment of asymptomatic osteonecrosis of the femoral head is controversial. The purpose of the present study was to determine (1) if spontaneous resolution of osteonecrosis of the femoral head occurs, (2) how long it takes for resolution to occur, and (3) if there are predictors of spontaneous resolution.MethodsPatients with asymptomatic osteonecrosis of the femoral head were identified from two National Institutes of Health-funded screening studiesa prospective screening study for osteonecrosis of the femoral head after organ transplantation and a study in which patients who had had surgical treatment of symptomatic osteonecrosis of the femoral head were screened for osteonecrosis of the contralateral, asymptomatic hip. The cohort of patients with asymptomatic osteonecrosis of the femoral head was then analyzed.ResultsThirteen asymptomatic hips in ten patients were identified in the prospective screening study for osteonecrosis after organ transplantation, and seventeen hips in seventeen patients were identified in the contralateral hip-screening study. Three hips, all from the group of patients who had had organ transplantation, had Association Research Circulation Osseous stage-I disease with spontaneous resolution occurring later as evidenced by serial magnetic resonance imaging scans. In these three hips, the modified index of necrotic extent measured 11.10, 12.72, and 20.83, with the estimated percentage of femoral head involvement being 15% to 30% in two of the hips and