SYMPOSIUM

TREATMENT ALGORITHMS

Mont, M.A.
Johns Hopkins University School of Medicine;
Department of Orthopaedic Surgery; Baltimore, MD

There is no consensus in the medical community on the management of osteonecrosis of the femoral head. When approached by a patient with osteonecrosis, many physicians adopt a wait and see attitude- i.e., waiting until the joint destruction is severe enough to require total joint replacement. Several non-operative treatment regimens have been proposed for pre-collapse disease. Currently, there are centers, which are prescribing pharmaceuticals in an attempt to prevent, impede, or at least, halt the progression of the disease. These drugs have included Hydergine (ergoloid mesylates), naftidrofuryl, vincamine, nifedipine, stanozolol, and several vasoactive and lipid-lowering agents. The choice of medication is based upon the physician's view of the factors involved in the pathogenesis of this disease. Again, most studies have been performed in an uncontrolled manner with inadequate controls.

Multiple surgical alternatives have also been performed over the past several decades, including: core decompression with and without bone grafting or electrical stimulation, bone grafting alone (e.g., trap door procedure, light bulb), vascularized bone grafting, osteotomies, femoral head resurfacing, and femoral head replacement. Comparisons of the outcomes of each of these procedures have been difficult due to different patient selection criteria; different classification systems used, and lack of properly matched controls. A multicenter study is necessary to evaluate these treatments in an objective manner.

In an effort to encourage collaborative, multicenter studies, an open discussion of these varying treatment protocols with respect to radiographic extent of disease will be held in order to encourage a collaborative, multicenter effort.