Coagulopathies and osteonecrosis

The treatment of osteonecrosis of the femoral head is considerably more successful at early stages of the disease and the diagnosis of osteonecrosis at an early stage is critical for hip preservation. The ability to diagnose osteonecrosis at an early stage depends on the identification of individuals at high risk. An understanding of the pathogenic and etiological factors in osteonecrosis enables the screening of at-risk individuals and facilitates early diagnosis. Within the past 5 years, investigation of generic factors has suggested that individuals with heritable or acquired hypercoagulability formation are at risk for osteonecrosis when challenged by environmental factors including corticosteroids, ethanol, and trauma. Certain coagulopathies, notably those associated with antiphospholipid antibodies and hypofibrinolysis, have been associated with osteonecrosis of the femoral head. However, the sensitivity and specificity of the observations has been questioned since similar coagulopathies have been seen in osteoarthritis in the bone marrow edema syndrome. This review explores these conflicting observations. The search for genetic predispositions to circulatory impairments in bone provides insight to the imminent arrival of molecular medicine in orthopedics.