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Osteonecrosis of the Hip: Management in the Twenty-first Century by Jay R. Lieberman, Daniel J. Berry, Michael A. Montv, Roy K. Aaron, John J. Callaghan,

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Presentation on theme: "Osteonecrosis of the Hip: Management in the Twenty-first Century by Jay R. Lieberman, Daniel J. Berry, Michael A. Montv, Roy K. Aaron, John J. Callaghan,"— Presentation transcript:

1 Osteonecrosis of the Hip: Management in the Twenty-first Century by Jay R. Lieberman, Daniel J. Berry, Michael A. Montv, Roy K. Aaron, John J. Callaghan, Amar Rayadhyaksha, and James R. Urbaniak J Bone Joint Surg Am Volume 84(5):834-853 May 1, 2002 ©2002 by The Journal of Bone and Joint Surgery, Inc.

2 A concept of pathogenesis of osteonecrosis that unifies several hypotheses. Jay R. Lieberman et al. J Bone Joint Surg Am 2002;84:834- 853 ©2002 by The Journal of Bone and Joint Surgery, Inc.

3 A lateral radiograph of the hip, demonstrating the crescent sign. Jay R. Lieberman et al. J Bone Joint Surg Am 2002;84:834- 853 ©2002 by The Journal of Bone and Joint Surgery, Inc.

4 Fig. 3-A T1-weighted magnetic resonance image demonstrating a small osteonecrotic lesion on the right, a large lesion on the left, and loss of signal intensity beyond the lesion on the left. Jay R. Lieberman et al. J Bone Joint Surg Am 2002;84:834- 853 ©2002 by The Journal of Bone and Joint Surgery, Inc.

5 T1-weighted magnetic resonance image with low-intensity signal representing bone marrow edema in the femoral head, neck, and metaphysis consistent with transient osteopenia of bone. Jay R. Lieberman et al. J Bone Joint Surg Am 2002;84:834- 853 ©2002 by The Journal of Bone and Joint Surgery, Inc.

6 The fibular graft with the peroneal vessels is harvested from the ipsilateral calf for insertion into the core in the femoral neck and head. Jay R. Lieberman et al. J Bone Joint Surg Am 2002;84:834- 853 ©2002 by The Journal of Bone and Joint Surgery, Inc.

7 Cancellous bone harvested from the greater trochanteric area is inserted into the cavity formed by removal of the necrotic bone. Jay R. Lieberman et al. J Bone Joint Surg Am 2002;84:834- 853 ©2002 by The Journal of Bone and Joint Surgery, Inc.

8 Figs. 7-A, 7-B, and 7-C Anteroposterior radiographs of the right hip of a thirty-year-old woman who had Ficat Stage-III osteonecrosis of the femoral head. Jay R. Lieberman et al. J Bone Joint Surg Am 2002;84:834- 853 ©2002 by The Journal of Bone and Joint Surgery, Inc.

9 Schematic diagram demonstrating the cortical window at the femoral head-neck junction. Jay R. Lieberman et al. J Bone Joint Surg Am 2002;84:834- 853 ©2002 by The Journal of Bone and Joint Surgery, Inc.

10 Preoperative anteroposterior radiograph of the left hip joint, showing collapse of the femoral head with an intact joint space. Jay R. Lieberman et al. J Bone Joint Surg Am 2002;84:834- 853 ©2002 by The Journal of Bone and Joint Surgery, Inc.

11 Anteroposterior radiograph of the same hip joint three years after limited femoral resurfacing. Jay R. Lieberman et al. J Bone Joint Surg Am 2002;84:834- 853 ©2002 by The Journal of Bone and Joint Surgery, Inc.

12 Anteroposterior radiograph of a failed vascularized fibular graft used for treatment of osteonecrosis of the femoral head. Jay R. Lieberman et al. J Bone Joint Surg Am 2002;84:834- 853 ©2002 by The Journal of Bone and Joint Surgery, Inc.

13 Anteroposterior radiograph made after conversion to a cementless total hip arthroplasty. Jay R. Lieberman et al. J Bone Joint Surg Am 2002;84:834- 853 ©2002 by The Journal of Bone and Joint Surgery, Inc.


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