| Abstract [eng] |
Osteonecrosis of the femoral head is a progressive and potentially disabling disorder that predominantly affects young- and middle-aged adults and may lead to femoral head collapse, secondary osteoarthritis, and the need for total hip arthroplasty. Despite various treatment options, the optimal management of non-traumatic osteonecrosis of the femoral head remains controversial due to the lack of a universally accepted treatment algorithm and heterogeneous evidence regarding treatment effectiveness. The aim of this thesis was to evaluate and compare current treatment strategies for adult non-traumatic osteonecrosis of the femoral head, with particular consideration of the role of disease stage in guiding clinical decision-making. A structured narrative literature review was conducted based on a systematic PubMed search. Studies published from 2010 onwards were screened according to predefined criteria. A total of 17 clinical studies were included, comprising randomized controlled trials, prospective cohort studies, and one retrospective study. Extracted data included patient characteristics, treatment modalities, and clinical and radiological outcomes such as Harris Hip Score, Visual Analogue Scale, radiographic progression, and the need for total hip arthroplasty. The findings demonstrated considerable heterogeneity in treatment outcomes. Less invasive strategies showed inconsistent effects, with some improvement in clinical symptoms but limited impact on structural disease progression. Core decompression, the most frequently investigated joint-preserving procedure, was associated with improved clinical outcomes, particularly in early-stage disease. Biological augmentation of core decompression showed potential benefits in selected cases; however, results were inconsistent and appeared to depend on disease stage and the type of augmentation used. In advanced stages, the effectiveness of joint-preserving techniques decreased, and more invasive interventions, including structural reconstruction and arthroplasty, were associated with improved functional outcomes. Overall, treatment selection in osteonecrosis of the femoral head should primarily be guided by disease stage. Joint-preserving strategies are most appropriate in early-stage disease, whereas advanced stages often require more invasive interventions. Patient-related factors such as age, lesion characteristics, and aetiology further influence outcomes and should be considered in clinical decision-making. However, the available evidence remains limited and heterogeneous, highlighting the need for further high-quality, stage-specific research to support more individualized treatment strategies. |
