Reprint requests to: publications@acr.org Osteonecrosis Noninvasive therapy for osteonecrosis has so far gained limited supporting data. They include statins, bisphosphonates, anticoagulants, extracorporeal shock wave therapy, and hyperbaric oxygen [16-18]. Invasive therapies for early osteonecrosis aim at preventing articular collapse and delaying/preventing the need for joint replacement. Core decompression can be performed in various locations including femoral head, humeral head, and talus. Core decompression can be supplemented with injection of autologous bone marrow cells, vascular fibular grafting, or electric stimulation. However, overall efficacy of core decompression at preventing eventual articular collapse remains controversial [11,19-22]. For late-stage femoral or humeral head osteonecrosis with articular collapse, resurfacing hemiarthroplasty may be needed, whereas total joint arthroplasty is performed in cases of severe secondary osteoarthritis [23]. Femoral head osteonecrosis accounts for 10% of indications for total hip replacements in the United States [24]. For late-stage talar osteonecrosis, talar resection/replacement with arthroplasty or tibiotalar joint fusion may be performed [11]. OR Discussion of Procedures by Variant Variant 1: Clinically suspected osteonecrosis. Initial imaging. The body regions covered in this clinical scenario are chest, pelvis, hip, femur, knee, tibia/fibula, ankle, foot, shoulder, humerus, elbow, forearm, wrist, and hand. Radiography Area of Interest Radiography is beneficial as the initial imaging study for clinically suspected osteonecrosis. Although radiographs are less sensitive for detection of early osteonecrosis, they help to exclude other causes of extremity pain such as fracture, primary arthritis, or tumor. Anteroposterior, lateral (frog-leg lateral for hip), and oblique (eg, ankle/knee) views are recommended to exclude subchondral collapse in cases of epiphyseal osteonecrosis [27,28].
Osteonecrosis PCAs. Reprint requests to: publications@acr.org Osteonecrosis Noninvasive therapy for osteonecrosis has so far gained limited supporting data. They include statins, bisphosphonates, anticoagulants, extracorporeal shock wave therapy, and hyperbaric oxygen [16-18]. Invasive therapies for early osteonecrosis aim at preventing articular collapse and delaying/preventing the need for joint replacement. Core decompression can be performed in various locations including femoral head, humeral head, and talus. Core decompression can be supplemented with injection of autologous bone marrow cells, vascular fibular grafting, or electric stimulation. However, overall efficacy of core decompression at preventing eventual articular collapse remains controversial [11,19-22]. For late-stage femoral or humeral head osteonecrosis with articular collapse, resurfacing hemiarthroplasty may be needed, whereas total joint arthroplasty is performed in cases of severe secondary osteoarthritis [23]. Femoral head osteonecrosis accounts for 10% of indications for total hip replacements in the United States [24]. For late-stage talar osteonecrosis, talar resection/replacement with arthroplasty or tibiotalar joint fusion may be performed [11]. OR Discussion of Procedures by Variant Variant 1: Clinically suspected osteonecrosis. Initial imaging. The body regions covered in this clinical scenario are chest, pelvis, hip, femur, knee, tibia/fibula, ankle, foot, shoulder, humerus, elbow, forearm, wrist, and hand. Radiography Area of Interest Radiography is beneficial as the initial imaging study for clinically suspected osteonecrosis. Although radiographs are less sensitive for detection of early osteonecrosis, they help to exclude other causes of extremity pain such as fracture, primary arthritis, or tumor. Anteroposterior, lateral (frog-leg lateral for hip), and oblique (eg, ankle/knee) views are recommended to exclude subchondral collapse in cases of epiphyseal osteonecrosis [27,28].