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 rationale of CD is to reduce intramedullary pressure inside the femoral head and improve blood flow in early-stage ONFH. The ideal result is pain alleviation and bone regeneration and repair. The technique is the most commonly used surgical procedure for early-stage osteonecrosis and is superior to nonoperative management. A research from Europe showed the results of CD in different ARCO stages. [48] ARCO stage I (reversible early stage) or stage II (irreversible early stage) with necrotic lesions located on the medial side or central lesions and area of less than 30% of the femoral head showed better results than those in conservative therapy; CD can be used as a short-term pain relief option in ARCO stage III. Over time, the technique of CD has progressed and involved multiple percutaneous drillings and small trephine diameters. Pierce et al. [49] showed that improved multiple percutaneous drilling techniques had excellent outcomes in conjunction with growth factors in early-and precollapse-stage osteonecrosis compared with traditional CD. Hsu et al. [50] performed a retrospective study to evaluate CD for asymptomatic ONFH, and the result was unpredictable. Asymptomatic osteonecrosis particularly in the setting of bilateral disease should be closely observed, and surgery should be considered when symptoms occur.