Osteonecrosis-Natural History

The Natural History of Untreated Asymptomatic Osteonecrosis of the Femoral Head

A Systematic Literature Review

Michael A. Mont, MD¹, Michael G. Zywiel, MD¹, David R. Marker, MD¹, Mike S. McGrath, MD¹ and Ronald E. Delanois, MD¹

Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. 

The Journal of Bone and Joint Surgery (American). 2010;92:2165-2170.
doi:10.2106/JBJS.I.00575

Conclusions of this study:

• small, medially located lesions have a slow rate of progression,
• asymptomatic medium-sized, and  large, osteonecrotic lesions  progress in substantial number of patients
• Non operative treatment maybe useful for small, medially located lesions, especially  small lesions occupying <25% of the femoral head and those that spared involvement of the lateral two-thirds of the weight-bearing portion of the femoral head
• consider joint-preserving surgeries in asymptomatic patients with a medium-sized or large, and/or laterally located, lesion.
• Patients with sickle cell disease had the highest frequency of progression, and patients diagnosed to have systemic lupus erythematosus had the most benign course.