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Treatment of Early Stage Osteonecrosis of the Femoral Head
David R. Marker, BS1; Thorsten M. Seyler, MD1; Mike S. McGrath, MD1; Ronald E. Delanois, MD1; Slif D. Ulrich, MD1; Michael A. Mont, MD1
1 Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M.A. Mont: mmont@lifebridgehealth.org; Rhondamont@aol.com
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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 Ossacur AG, Oberstenfeld, Germany. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits of less than $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Ossacur AG, Oberstenfeld, Germany). Also, a commercial entity (Ossacur AG, Oberstenfeld, Germany) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2008 Nov 01;90(Supplement 4):175-187. doi: 10.2106/JBJS.H.00671
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Osteonecrosis is a devastating disease that primarily affects weight-bearing joints. The hip is the most commonly affected joint. Although hip osteonecrosis can affect patients of any age group, it typically presents in young patients between the ages of twenty and forty years1. The factors that affect the progression of this disease are still not fully understood, but radiographic lesion size, femoral head collapse (if present), and, occasionally, clinical presentation at the time of diagnosis have been shown to be predictive of the eventual clinical outcome2,3. After collapse, most patients will require a standard total hip arthroplasty4,5. However, because of the young age of many of these patients, a hip replacement cannot be expected to last the patient's lifetime and therefore, when feasible, attempts should be made to save the femoral head prior to collapse with use of less invasive treatment modalities. The efficacy of these procedures has been variable, with reported success rates ranging between 60% and 80% at the time of short-term and midterm follow-up6-8. Current treatments range from pharmacotherapies to surgical interventions that include core decompression, vascularized or nonvascularized bone-grafting, and osteotomy. Recently there have been attempts to enhance these surgical techniques with use of various growth and differentiation factors.
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    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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