Clinical Characteristics, Current Treatment Options, Potential Mechanisms, Biomarkers and Therapeutic Targets in Avascular Necrosis of Femoral Head

• Published in: Medical principles and practice pp. 1 - 18
• Main Authors: Khanchandani, Prakash, Narayanan, Aswath, Naik, Ashwin A, Kannan, Vishnu, Pradhan, Sanwid, Shrimad Bhagavatam, Sai Krishna, Pulukool, Sujith Kumar, Sivaramakrishnan, Venketesh
• Format: Journal Article
• Language: English
• Published: Switzerland 21.08.2024
• ISSN: 1011-7571; 1423-0151; 1423-0151
• DOI: 10.1159/000541044

Avascular Necrosis of Femoral Head (AVNFH) is a debilitating disease of young, affecting the quality of life significantly and eventually leading to total hip replacement surgery. The disease is diagnosed clinico-radiologically and MRI is the investigation of choice to diagnose early stages of the disease. There is neither an early biomarker for detection nor is there a permanent cure for the disease and most of the patients are managed with various combinations of surgical and medical management protocols. In this review we comprehensively address the etiopathogenesis, clinical characteristics, therapeutic procedures, bone characteristics, histopathology, Multi-omic studies, finite element modelling and systems analysis that has been performed in AVNFH. The etiology includes various factors that compromise the blood supply to the femoral head which also includes contributions by environmental and genetic factors. Multi-Omic analysis has shown association of deregulated pathways with the disease. The cell types involved include mesenchymal stem cells, osteoblasts, osteoclasts, endothelial and immune cells. Biochemical, hematological, Histopathology, IHC and other bone remodeling and degradation marker studies have been performed. A systems analysis using multi-omic data sets from published literature was carried out, the relevance of which is discussed to delineate potential mechanisms in etiopathogenesis, diagnosis and effective management of this debilitating disease.