JBJS - 2026-07-20 - Journal Article
Nontraumatic Osteonecrosis of the Femoral Head: An Update.
Mont MA, Smitterberg CW, Jones LC, Goodman SB, Lieberman JR, Parvizi J, Cheng EY
Topics
Key Takeaway
THA remains the most reliable treatment after femoral head collapse in nontraumatic osteonecrosis, while joint-preserving procedures are most effective only before structural collapse occurs.
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Summary
This narrative update reviews the diagnosis, staging, and management of nontraumatic osteonecrosis of the femoral head (ONFH). Key diagnostic points include MRI as the most sensitive early modality and bilateral involvement warranting contralateral imaging. Management is stratified by collapse status: joint-preserving procedures for pre-collapse disease, THA as the definitive option post-collapse.
Key Limitation
As a narrative review without a defined search strategy or inclusion criteria, it is subject to selection bias and cannot quantify treatment effect sizes or compare outcomes across joint-preserving techniques.
Original Abstract
➢ Nontraumatic osteonecrosis of the femoral head should be suspected in patients who are <50 years of age who have persistent hip pain despite normal radiographs.➢ Bilateral involvement is common; magnetic resonance imaging (MRI) of the contralateral hip is recommended.➢ MRI is the most sensitive modality for detecting early disease.➢ Femoral head sphericity is assessed on anteroposterior, lateral, and 30º view radiographs.➢ Small pre-collapse lesions have the best prognosis. Large lateral lesions and subchondral collapse predict rapid progression.➢ Systemic risk factors and multifocal disease should be actively evaluated.➢ Joint-preserving procedures are most effective before structural collapse.➢ Total hip arthroplasty remains the most reliable treatment after femoral head collapse.