Treatment strategies for avascular necrosis of the femoral head: A systematic review

Introduction

Avascular necrosis of the femoral head (ANFH) is a progressive condition caused by impaired blood supply to the subchondral bone, leading to femoral head collapse, cartilage damage, and secondary hip osteoarthritis. Major risk factors include corticosteroid therapy, trauma, and chronic alcohol consumption. ANFH primarily affects young, active adults aged 20–40 years. MRI is essential for early diagnosis. Early detection allows hip-preserving treatment, whereas advanced disease often requires total hip arthroplasty. Without appropriate treatment, secondary degenerative changes may develop in 70–80% of patients. Aim of the study: The aim of this review was to assess the current evidence regarding the treatment of avascular necrosis of the femoral head, with particular emphasis on non-surgical and hip-preserving surgical treatment options. The review evaluates their clinical and radiographic outcomes, effectiveness in preventing disease progression and delaying total hip arthroplasty, and identifies the most appropriate treatment strategies according to disease stage. Methods and materials: We reviewed the literature available in the PubMed database using the following keywords: “Avascular necrosis of the femoral head”; “Non-surgical treatment”; “Bisphosphonates”; “Statins”; “Iloprost”; “Hyperbaric oxygen therapy”; “Core decompression”; “Osteotomy”; “Nonvascularized bone graft”; “Vascularized bone graft”; and “Total hip arthroplasty”.