Insights into Avascular Necrosis of the Femoral Head: Learning for the Trainees and Professionals

Foreword
Preface
Contents
Editors and Contributors
About the Editors
Contributors
1: Femoral Head: Anatomical Considerations
	1.1	 Introduction
	1.2	 Articular Surface (Fig. 1.2)
	1.3	 Structure of the Head of the Femur (Fig. 1.3)
	1.4	 Femoral Offset (Fig. 1.4)
	1.5	 Ligament of the Head of the Femur (Ligamentum Capitis Femoris) (Fig. 1.2)
	1.6	 Femoral Neck
	1.7	 Surface Landmark
	1.8	 Relations (Fig. 1.5a–c)
	1.9	 Vascular Supply (Fig. 1.6)
	1.10	 Nerve Supply
	1.11	 Development (Fig. 1.7)
	1.12	 Conclusion
	References
2: Avascular Necrosis of the Hip: Historical Perspective
	2.1	 Introduction
	2.2	 Pathogenesis
	2.3	 Evolution of Classification Systems
	2.4	 Treatment
	2.5	 Preservation of the Femoral Head
		2.5.1	 Core Decompression
		2.5.2	 Grafting
	2.6	 Joint Reconstruction
	2.7	 Conclusion
	References
3: Epidemiology and Risk Factors
	3.1	 Introduction
	3.2	 Epidemiology
	3.3	 Risk Factors for AVN Hip
		3.3.1	 Non-modifiable Risk Factors
			3.3.1.1	 Age
			3.3.1.2	 Genetic Predisposition
			3.3.1.3	 Race
		3.3.2	 Modifiable Risk Factors
			3.3.2.1	 Substance Abuse
			3.3.2.2	 Drug Intake
			3.3.2.3	 Autoimmune Disease
			3.3.2.4	 Trauma
			3.3.2.5	 Metabolic Disorders
			3.3.2.6	 Irradiation
			3.3.2.7	 Dysbaric Diseases
			3.3.2.8	 Hematological
	3.4	 Conclusion
	References
4: Etiology and Pathophysiology of AVN
	4.1	 Introduction
	4.2	 Etiology of Avascular Necrosis
	4.3	 Blood Supply of the Femoral Head
	4.4	 Pathoanatomy of Traumatic AVN
	4.5	 Pathoanatomy of Nontraumatic AVN
		4.5.1	 Intravascular Changes
		4.5.2	 Extravascular Changes
	4.6	 Genetic Associations of AVN
	4.7	 Pathophysiology of AVN
		4.7.1	 Pathological Changes in Bone
		4.7.2	 Pathological Changes in Articular Cartilage
		4.7.3	 Pathological Changes in Synovium
	4.8	 Quantification of the Necrotic Segment
	4.9	 Conclusion
	References
5: Clinical Features and Staging of AVN Hip
	5.1	 Introduction
	5.2	 Clinical Features
	5.3	 Classification Systems for AVN Hip
	5.4	 Ficat and Arlet Classification System [2, 10]
	5.5	 Association Research Circulation Osseous (ARCO) [3, 13]
	5.6	 Steinberg Classification (University of Pennsylvania Classification) [4, 14]
	5.7	 The Japanese Investigation Committee Classification [15]
	5.8	 Conclusion
	References
6: Avascular Necrosis Hip: How to Examine a Suspected Case
	6.1	 History
	6.2	 Past Medical, Family, and Personal History
	6.3	 General Examination
	6.4	 Gait
	6.5	 Local Examination
	6.6	 Summary
	References
7: AVN Hip: Radiology
	7.1	 Introduction
	7.2	 Pathophysiology
	7.3	 Radiological Features
		7.3.1	 Radiographs
		7.3.2	 CT
		7.3.3	 MRI
		7.3.4	 Nuclear Imaging
	7.4	 Predicting Subchondral Collapse
	7.5	 Radiological Differential Diagnosis
	7.6	 Summary
	References
8: Treatment Principles: An Overview
	8.1	 Background
	8.2	 Pre-collapse Stages
		8.2.1	 Biophysical Treatments
	8.3	 Post-collapse
	8.4	 Conclusion
	References
9: Core Decompression
	9.1	 Introduction
	9.2	 Indications
	9.3	 Contraindications
	9.4	 Conventional Technique (Hungerford)
		9.4.1	 Position
		9.4.2	 Incision
		9.4.3	 Exposure
		9.4.4	 Entry Point and Reaming
		9.4.5	 Precautions
	9.5	 Common Errors
	9.6	 Modifications of Technique
	9.7	 Augmentation of CD
	9.8	 Outcomes
	9.9	 Postoperative Rehabilitation
	9.10	 Conclusion
	References
10: Osteotomies for Osteonecrosis Hip
	10.1	 Introduction
	10.2	 Indications
	10.3	 Preoperative Work-Up
	10.4	 Positioning and Anesthesia
	10.5	 Osteotomies
	10.6	 Conclusion
	References
11: Head Preservation: Recent Advances
	11.1	 Introduction
	11.2	 Diagnosis and Assessment
	11.3	 Treatment Strategies
	11.4	 Recent Advances in Hip Preservation
		11.4.1	 Adjuncts Used Along CD
	11.5	 Conclusion
	References
12: Hip Arthrodesis: Current Concepts
	12.1	 Background
	12.2	 Indications
	12.3	 Contraindications
	12.4	 Optimal Position
	12.5	 Surgical Technique
	12.6	 Problems and Outcome
	12.7	 Current Status
	12.8	 Summary
	References
13: Hip Arthroplasty
	13.1	 Background
	13.2	 Excision Arthroplasty
	13.3	 Bipolar Hemiarthroplasty
	13.4	 Hip Resurfacing Arthroplasty
	13.5	 Total Hip Arthroplasty
	13.6	 Implant Options
		13.6.1	 Cemented Femoral Stem
		13.6.2	 Cementless Femoral Stem
		13.6.3	 Cemented Acetabular Components
		13.6.4	 Cementless Acetabular Components
		13.6.5	 Hybrid THA
		13.6.6	 Reverse Hybrid THA
	13.7	 Bearing Options
		13.7.1	 Ultrahigh Molecular Weight Polyethylene
		13.7.2	 Metal-on-Metal Articulations (MoM)
		13.7.3	 Ceramic-on-Ceramic Articulations
	13.8	 Literature
	13.9	 Conclusion
	References
14: Avascular Necrosis of the Hip: Replace or Resurface?
	14.1	 Introduction
	14.2	 History of Hip Resurfacing
	14.3	 Patient Selection for Hip Resurfacing
	14.4	 Indications
	14.5	 Contraindications
	14.6	 Hip Resurfacing Versus Total Hip Arthroplasty
	14.7	 Conclusion
	References
15: AVN Hip: Bedside Case Presentation
	15.1	 History
		15.1.1	 General Points to Be Remembered for History [1]
		15.1.2	 Demographics
		15.1.3	 Chief Complaints
		15.1.4	 Past History
		15.1.5	 Personal History
		15.1.6	 Family History
		15.1.7	 Summary After History
	15.2	 Examination [2–4]
		15.2.1	 General Points to Be Remembered for Examination
		15.2.2	 General Physical Examination [1]
		15.2.3	 Systemic Examination
		15.2.4	 Local Examination
			15.2.4.1	 Gait
			15.2.4.2	 Inspection
			15.2.4.3	 Palpation
			15.2.4.4	 Deformity and Movements
			15.2.4.5	 Measurements
			15.2.4.6	 Special Tests [4, 5]
			15.2.4.7	 Miscellaneous Tests
		15.2.5	 Summary After Examination
			15.2.5.1	 Radiological Investigations [3]
	15.3	 Conclusion
	References
16: Frequently Asked Viva Questions (AVN Hip)
	16.1	 Introduction
	References
17: Multiple-Choice Questions
	References