The utility of conservative treatment modalities in the management of osteonecrosis: A systematic review

Feroz Osmani, Savyasachi Thakkar, Jonathan Vigdorchik

Research output: Contribution to journalReview articlepeer-review

14 Scopus citations

Abstract

Introduction: Osteonecrosis is an ischemic pathologic process associated with a number of conditions affecting a range of age groups. The problem faced in the management of osteonecrosis is whether conservative treatment is a viable and effective option for patients. In this systematic review, we investigated the efficacy of various nonoperative treatment modalities for hip and knee osteonecrosis, including pharmacological management and biophysical modalities. Methods: We identified 16 studies based on electronic searches through the PubMed, Embase, CINAHL Plus, and Cochrane databases from January 2001 to November 2015. The therapies we assessed for the conservative osteonecrosis management included bisphosphonates, prostaglandin agents, enoxaparin, statins, hyperbaric oxygen, extracorporeal shockwave therapy, and pulsed electromagnetic field therapy. Results: Several studies have reported that early intervention (Fiscat stage I/II) osteonecrosis can be effectively managed conservatively. Pain levels and rate of bone necrosis was decreased with bisphosphonate use. Iloprost was seen to have improvement in pain, functional, and radiological outcomes. Progression of osteonecrosis was curbed with enoxaparin use. Statin use was seen to have protective effects on bone in patients taking high dose corticosteroids. The biophysical modalities (hyperbaric oxygen, extracorporeal shockwave therapy, and pulsed electromagnetic field therapy) all saw delay and partial reversal of disease progression. Conclusion: Generally, stage I and II, prior to subchondral collapse, can be approached with both pharmacological and biophysical treatment modalities before more invasive measures, such as core decompression, are considered. At stage III and beyond, these conservative treatments are no longer viable treatment options. Further research must be performed to determine which modality carries the best cost to risk to benefit ratio in order to establish a standard of care for the treatment of osteonecrosis.

Original languageEnglish
Pages (from-to)186-192
Number of pages7
JournalBulletin of the Hospital for Joint Disease (2013)
Volume75
Issue number3
StatePublished - 2017
Externally publishedYes

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