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Current Practices of AAHKS Members in the Treatment of Adult Osteonecrosis of the Femoral Head
Brian J. McGrory, MD1; Sally C. York, MN, RNC2; Richard Iorio, MD3; William Macaulay, MD4; Richard R. Pelker, MD, PhD5; Brian S. Parsley, MD6; Steven M. Teeny, MD7
1 Orthopaedic Associates of Portland, 33 Sewall Street, Portland, ME 04104. E-mail address: mjri@yahoo.com
2 NorthWest Orthopaedic Institute, P.O. Box 1878, Tacoma, WA 98401
3 Lahey Clinic, 41 Mall Road, Burlington, MA 01805
4 Department of Orthopaedic Surgery, PH11, Columbia University, 622 West 168th Street, Room 1146, New York, NY 10032
5 Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, P.O. Box 208071, New Haven, CT 06520-8071
6 6550 Fannin, #2625, Houston, TX 77030
7 NorthWest Orthopaedic Institute, P.O. Box 1878, Tacoma, WA 98401
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from the American Association of Hip and Knee Surgeons (AAHKS). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A nonprofit research and education organization (NorthWest Orthopaedic Institute) paid or directed in any one year, or agreed to pay or direct, benefits of less than $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).
Note: The authors are grateful to the members of the AAHKS research committee as well as to Dr. Kenneth B. Mathis who gave helpful input regarding the design of the questionnaire. They are also indebted to Dr. Sondra T. Perdue, Research Director of the NorthWest Orthopaedic Institute, for her assistance with the statistical analysis and design. Finally, they thank Priscilla Majewski, executive Director of AAHKS, for her outstanding support throughout this study.
Investigation performed at the American Association of Hip and Knee Surgeons, Rosemont, Illinois

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Jun 01;89(6):1194-1204. doi: 10.2106/JBJS.F.00302
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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.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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