Osteonecrosis caput femur

Supervisor :
dr. Essy Dwi Damayanthi Sp.OT

Hendy Buana Vijaya

Pendahuluan
• Osteonecrosis yang juga dikenal sebagai avascular necrosis (AVN),
aseptik nekrosis atau nekrosis tulang iskemik
• penyakit yang dapat mempengaruhi beberapa tulang sebagai akibat
dari terputusnya/hilangnya suplai darah ke suatu bagian tulang,
sehingga menyebabkan kematian pada tulang tersebut.
• Pada stadium awal pasien tidak menunjukkan gejala, tetapi dengan
berjalannya waktu, osteonecrosis menyebabkan kerusakan pada
sendi, sehingga memerlukan pembedahan, dan pada tahap akhir
penyakit ini memerlukan penggantian panggul total (THR)
Anatomi
Definisi
• Osteonecrosis of the femoral head, also referred to as
avascular necrosis, is a pathological state with multiple
possible etiologies that causes decreased vascular supply
to the subchondral bone of the femoral head, resulting
in osteocyte death and collapse of the articular surface

Kaushik A, Das A, Cui Q. Osteonecrosis of femoral head : an update in year 2012. World Journal
Orthopedic. 2012 3(5) : 49-57
Epidemiologi
• In US there are approximately 10.000-20.000 case per years have
been report.
• Incidency of ON of femoral head ratio about male : female depending
patient comorbidity.
• Patients are generally younger adults age 35 years to 45 years and risk
factors for 75%-90% of cases include chronic steroid use, alcoholism,
smoking, hip trauma including femoral neck fractures and hip
dislocations, and prior hip surgery.
Etiologi dan faktor resiko

Zibis A. H, Fyllos A. H, Karantanas A. H, Arvanitis D. L, Dailiana D. H, et al. Osteonecrosis of the

femoral heal – diagnosis and management. Precis Med. 2015 ; 2 : 1-8
 Patogenesis

Seamon J, Keller T, Saleh J, Cui Q. The

pathogenetic of nontraumatic
osteonecrosis. Review article. 2012 :
1-11
Patogenesis
Modified Ficat – Arlet classification
University of Pennsylvania classification of
osteonecrosis
ARCO classification
Diagnosis
Presentation-History
• Trauma
• Corticosteroid use
• Alcohol intake
• Medical conditions – malignancy, thrombophilia, SLE
• Pain – progressive, severity correlates with size of infarct
• Deformity and stiffness – later stages
Presentation - examination
 Limp

 Antalgic gait

 Restricted ROM

 Tenderness around bone

 Joint deformity
X ray examination of the hip joint

Flattening Cresent sign

MRI examination of the hip joint
Management - conservative
• Offloading affected joints with use of crutches
• Immobilisation
• Analgesia
• Bisphosphonates to delay femoral head collapse
• Statins in patients on high dose corticosteroids – reduced lipid
deposition
Core decompression
 Indicated in ARCO I and II

 8 – 10 mm anterolateral core of bone

 Filled with bone graft (vascularised/non vascularised)

 Decompresses medullary cavity, reduces pain

 Vascularised graft may reverse necrosis

Realignment osteotomy

 Indicated in ARCO III & IV

 Used to relocate necrotic area from weight bearing portion of femoral head

 Angular osteotomies more common

 Multiple techniques for holding the fixation

 Sugano intertrochanteric rotational osteotomy technically demanding but higher

success rate
Arthroplasty

 Indicated in ARCO IV onwards

 Main aim is pain reduction

 Young patients will need revision

 Higher failure rates than in OA

 Hemi arthroplasty an option

Terima Kasih