Background: There is currently no standardized protocol for
evaluating and treating osteonecrosis of the femoral head in adults in the
United States. We sought to understand current treatment practices of a group
of surgeons who commonly treat this disease to determine if there was
agreement on some aspects of care.
Methods: We designed a two-staged mixed-mode (mailed and faxed)
sixteen-question self-administered descriptive survey questionnaire to be sent
to all 753 active members of the American Association of Hip and Knee Surgeons
(AAHKS). The survey design was based on Dillman's survey research methodology,
and the questionnaire included hypothetical clinical scenarios based on the
Steinberg classification system. The responses elucidated the opinions and
treatment preferences of high-volume arthroplasty surgeons who treat adult
patients with osteonecrosis of the femoral head.
Results: Of the 753 active members of the AAHKS, 403 (54%) responded
to the questionnaire. Total hip replacement was reported to be the most
frequent intervention for treatment of postcollapse (Steinberg stage-IIIB,
IVB, V, and VI) osteonecrosis; core decompression was reported to be the most
commonly offered intervention for symptomatic, precollapse (Steinberg stage-IB
and IIB) osteonecrosis. Less frequently offered treatments included
nonoperative management, osteotomy, vascularized and non-vascularized
bone-grafting, hemiarthroplasty, and arthrodesis.
Conclusions: The care of adults with osteonecrosis of the femoral
head varies among American orthopaedic surgeons specializing in hip and knee
surgery. A consensus may evolve with a continued concerted effort on the part
of interested surgeons, but it will require randomized, controlled,
prospective studies of treatment of each stage of the disease and
collaborative multicenter studies.
Level of Evidence: Therapeutic Level V. See Instructions
to Authors for a complete description of levels of evidence.