Early diagnosis and treatment of steroid-induced osteonecrosis
of the femoral head
Received: 16 May 2018 / Accepted: 28 May 2018
SICOT aisbl 2018
Objective This study aims to investigate the early diagnosis and treatment of steroid-induced osteonecrosis of the femoral head.
Patients and methods From January 2010 to January 2014, a total of 350 patients, who required the use of large amounts of
hormones, were enrolled into the study. These patients were followed up every three months after starting the hormone therapy. A
total of 62 cases were screened, among which nine cases were asymptomatic. Furthermore, 38 patients were diagnosed as stage I
and were given low-molecular weight heparin (LMWH) and vasodilator drugs. Moreover, 22 cases were diagnosed as stage IIa/b
and underwent core decompression. In addition, two cases were diagnosed as stage IIc and underwent pedicled bone transplan-
tation. During the follow-up period, ARCO staging was used for radiological evaluation, the HHS score was applied to evaluate
for clinical efficacy, and SPSS 22.0 statistical software was used for the data analysis.
Results A total of 60 patients were followed up for 24 months. Among these patients, 38 patients were diagnosed with ARCO
stage I and underwent systematic therapy. No progress was found in 29 cases (76.3%). Furthermore, three cases progressed to
stage IIb (7.8%), four cases progressed to stage IIc (10.5%), two cases progressed to stage III and IV, respectively (2.6%), and 16
cases (80%) did not progress after core decompression. In the 16 cases at stage IIa and four cases at stage IIb, and four cases
(20%) progressed in stage III. The HHS score of stage I was 80.42 ± 3.25 before follow-up, while the HHS score was 86.46 ±
8.54 after follow-up, and the difference was statistically significant (P < 0.05). Furthermore, the HHS score of patients with stage
IIa/b was 70.38 ± 4.62 before follow-up, while the HHS score was 80.28 ± 6.72 after follow-up, and the difference was statis-
tically significant (P <0.01).
Conclusion MRI remains as the most effective method for the non-invasive diagnosis of osteonecrosis, at present. Enhanced MRI
may be able to detect early osteonecrosis, but further research is needed. Drug treatment and core decompression can achieve
satisfactory results at the early stage.
Keywords Steroid-induced osteonecrosis of the femoral head
Osteonecrosis of the femoral head (ONFH) is a common, but
refractory, disease in the field of orthopedics. ONFH can be
divided into two categories: traumatic and non-traumatic. The
former is mainly caused by hip trauma (femoral neck fracture,
joint dislocation, etc.), while the latter is mainly caused by the
application of corticosteroids, heavy drinking, and decom-
pression sickness. Hormonal osteonecrosis of the femoral
head (SONFH) refers to the pathological process that results
from the death of femoral head active ingredients (osteocytes,
myeloid haematopoietic cells, and adipocytes) caused by high
doses of hormones. SONFH accounts for the top incidences of
non-invasive necrosis .
ONFH is a progressive disease that progresses to collapse
within one to three years in 80% of patients without effective
treatment . Once the collapse of the femoral head appears
(subchondral fracture and positive crescent sign), the course of
the disease is difficult to reverse. Within a few years, the
majority of patients will develop severe osteoarthritis and will
require artificial joint replacement. SONFH mainly occurs in
middle-aged and young individuals , but the long-term ef-
fect of artificial joint replacement remains difficult to predict.
Therefore, it is particularly important to search for effective
* Dewei Zhao
Department of Orthopedics, The Affiliated Zhongshan Hospital of
Dalian University, Dalian, Liaoning, China