Osteonecrosis of the Femoral Head
Osteonecrosis of the femoral head (ONFH) is a refractory disease caused by the disruption or impairment of blood supply to the femoral head. It is followed by the death of osteocytes and bone marrow as well as subsequent bone repair, which in turn leads t
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Osteonecrosis of the Femoral Head Changqing Zhang, Dongxu Jin, Jiagen Sheng, Weitao Jia, Junjie Guan, Sen Lin, Zhenzhong Zhu, Hao Wu, and Youshui Gao
7.1
Overview
Osteonecrosis of the femoral head (ONFH) is a refractory disease caused by the disruption or impairment of blood supply to the femoral head. It is followed by the death of osteocytes and bone marrow as well as subsequent bone repair, which in turn leads to the structural changes and collapse of the femoral head, and joint dysfunction. Since Munro first described ONFH in 1738, scholars around the world have conducted a lot of research work on it. This disease is more likely to occur in young and middle-aged people (30–50 years old), mostly bilateral, and the risk is much higher in Asian populations. Its incidence is estimated to be 10,000 to 20,000 new cases per year in the United States. Meanwhile, there are 50,000–100,000 new cases per year in China, which is the highest in the world. Once ONFH occurs in the patient, the necrosis of trabecular bone and bone marrow in the femoral head will take place. Then the cystic changes in the subchondral bone and collapses of articular cartilage ensue, leading to the secondary joint degeneration and osteophytes formation. It eventually leads to painful osteoarthritis, with the loss of hip function. The difficulty of the ONFH treatment and the subsequent high disability rate has brought huge economic and spiritual burdens to the patients, their families, and the entire society. The etiology of ONFH is complex, with multiple and composite factors, including traumatic factors (such as fem[translator and affiliation] Qian Tang, Fuzhou Xiang, Guangyi Li Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital (Instruction to FSV—see if there’s an option to capture translators information in COP like how you process series page. If there’s no option, then please add at the end of the chapter and before references the line stating “Translated by Qian Tang, Fuzhou Xiang and Guangyi Li”) C. Zhang (*) · D. Jin · J. Sheng · W. Jia · J. Guan · S. Lin · Z. Zhu H. Wu · Y. Gao Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China e-mail: [email protected]
oral neck fractures, acetabular fractures, hip joint dislocation, and slipped capital femoral epiphysis) and nontraumatic factors (e.g., steroids, alcohol, hematological disease, decompression sickness, pregnancy, radioactivity, vascular and connective tissue diseases, and idiopathic diseases). Nontraumatic factors are common in adolescence, and the number of ONFH cases has been increasing year by year. In China, the abuse of glucocorticoids and alcohol contributes to over 90% cases of nontraumatic ONFH. Until now, the specific pathogenesis and natural history of ONFH are still not fully elaborated. There are many hypotheses, among which the obstruction and ischemia of the vessels in femoral head is the most important pathophysiologic mechanism. For traumatic ONFH, the disruption of
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