TREATMENT STRATEGIES FOR AVASCULAR NECROSIS OF THE FEMORAL HEAD: A SYSTEMATIC REVIEW

Abstract

Introduction: Avascular necrosis of the femoral head (ANFH) is a progressive condition caused by impaired blood supply to the subchondral bone, leading to femoral head collapse, cartilage damage, and secondary hip osteoarthritis. Major risk factors include corticosteroid therapy, trauma, and chronic alcohol consumption. ANFH primarily affects young, active adults aged 20–40 years. MRI is essential for early diagnosis. Early detection allows hip-preserving treatment, whereas advanced disease often requires total hip arthroplasty. Without appropriate treatment, secondary degenerative changes may develop in 70–80% of patients. Aim of the study: The aim of this review was to assess the current evidence regarding the treatment of avascular necrosis of the femoral head, with particular emphasis on non-surgical and hip-preserving surgical treatment options. The review evaluates their clinical and radiographic outcomes, effectiveness in preventing disease progression and delaying total hip arthroplasty, and identifies the most appropriate treatment strategies according to disease stage. Methods and materials: We reviewed the literature available in the PubMed database using the following keywords: “Avascular necrosis of the femoral head”; “Non-surgical treatment”; “Bisphosphonates”; “Statins”; “Iloprost”; “Hyperbaric oxygen therapy”; “Core decompression”; “Osteotomy”; “Nonvascularized bone graft”; “Vascularized bone graft”; and “Total hip arthroplasty”. Conclusion: The treatment of avascular necrosis of the femoral head should be tailored to disease stage and patient characteristics. Early diagnosis is crucial for enabling joint-preserving treatment and delaying disease progression. Pharmacological therapies may benefit selected patients, although their efficacy remains inconclusive. Hip-preserving surgery shows promising results, particularly in early-stage ANFH. In advanced disease with femoral head collapse, total hip arthroplasty remains the most effective treatment, improving pain, hip function, and quality of life.