Abstract

THE PATHOPHYSIOLOGY AND INTERVENTIONS OF AVASCULAR NECROSIS IN FEMORAL HEAD: A SYSTEMATIC REVIEW OF CONSERVATIVE AND SURGICAL MANAGEMENT OPTIONS

Rupali Chavan*, Akash P. Dhoke, Shubhada A. Ganvir, Siddharth Kumar Bansal, M. D. Kitukale

Abstract

Avascular necrosis (AVN) of the femoral head is a debilitating condition characterized by the death of bone tissue due to interrupted blood supply, often leading to joint collapse and severe functional impairment. The condition poses significant challenges for both diagnosis and management, as its etiology is multifactorial, ranging from trauma to corticosteroid use and idiopathic causes. This systematic review aims to comprehensively analyze the pathophysiology of AVN and evaluate the effectiveness of conservative and surgical management strategies. A systematic search of PubMed, Cochrane, and Scopus databases followed the PRISMA guidelines. Studies published between 2010 and 2024 were included based on predefined inclusion criteria focusing on clinical outcomes of treatment modalities. Conservative approaches such as pharmacotherapy, core decompression without grafting, and physiotherapy were compared with surgical interventions like bone grafting, osteotomies, and total hip arthroplasty. Findings indicate that early-stage AVN responds well to conservative measures, whereas advanced cases often require surgical interventions. Emerging technologies, including stem cell therapies and 3Dprinted implants, show promise but need further investigation. Despite advancements, gaps in the understanding of optimal treatment protocols persist. This review highlights the importance of tailored treatment strategies to preserve joint function and improve patient outcomes. Future research should focus on bridging these gaps and developing standardi zed guidelines for managing AVN.

Keywords: Avascular necrosis , Femoral head , Conservative managemen t, Surgical interventions , Pathophysiology , Joint preservation , Total hip arthroplasty , Bone grafting