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Total Hip Arthroplasty for Management of Osteonecrosis of the Femoral Head
Osteonecrosis of the femoral head with accompanying femoral head collapse can result from a variety of etiologies. The resulting structural compromise can be a source of substantial pain and functional limitation for the patient. Etiologies that lead to collapse in young patients (younger than 50 years) include ongoing disease states and their treatment, such as systemic lupus erythematosus, hemophilia, and sickle cell disease, which have low likelihood of stabilization or reversibility, as well as potentially modifiable factors such as alcohol abuse or episodic steroid treatment. Osteonecrosis and collapse of the femoral head in young patients is frequently mediated through venous or bone marrow abnormalities. In these patients, total hip arthroplasty (THA) is appropriate in patients either with femoral head collapse or with late precollapse disease with substantial involvement of the femoral head (greater than 30%; University of Pennsylvania [that is, Steinberg] stage IIC), for whom joint-preserving treatment options will be less predictable. In older patients (50 years or older), osteonecrosis is more commonly mediated by arterial abnormalities. In this patient population, THA is the treatment of choice, even in patients with University of Pennsylvania stage IIC disease (precollapse but with quantitatively defined head involvement), when nonsurgical interventions have been unsuccessful in alleviating pain or improving function.