Corticosteroid-induced Osteonecrosis of the Femoral Head: Detection, Diagnosis, and Treatment in Earlier Stages

Liu, Li-Hua; Zhang, Qing-Yu; Sun, Wei; Li, Zi-Rong; Gao, Fu-Qiang

The size, location, and extent of necrotic lesions are crucial factors for the prognosis of osteonecrosis. A review of the progression of asymptomatic osteonecrosis by Mont et al. [44] noted that asymptomatic osteonecrosis had a high prevalence of progression to symptomatic disease and femoral head collapse, while small, medially located lesions had a low rate of progression. This suggested that it might be beneficial to consider joint-preserving surgical treatments in asymptomatic patients with medium-sized or large and/or laterally located lesions. The stage of ONFH and the time from discerning corticosteroid use to the diagnosis of ONFH are important factors in predicting its spontaneous regression. Regression is more likely to occur when earlier-stage diagnosis and shorter-time discernment exist. Discontinuation of corticosteroids does not seem to affect the regression process of ONFH. The underlying factors may also contribute to the prognosis. Different underlying diseases have different prognoses. The review of Mont et al. [44] indicated that patients affected with sickle cell disease had a high risk of head collapse (74%), whereas patients with SLE had a quite low risk (17%). The intervention methods may also play a great role in osteonecrosis progression. Another literature review by Mont et al. [45] covered 42 reports and 2025 hips. Compared with the nonoperative management group, the core decompression (CD) group had a notable effect on the natural history and clinical progression in the early stages of ONFH. Patients with high-risk factors should be suggested to receive preventive methods and regular follow-up in the next 12 months and should be diagnosed early. When following up a patient with osteonecrosis, treatments should be prepared if necessary.