Issue 1 Orthopaedic Surgery | KeckZine Orthopaedic Surgery ← Back


Osteonecrosis: clinical care and translational research

qh_sidebarOsteonecrosis can occur in any bone but it most often affects the femoral head.4 Osteonecrosis of the femoral head is often misdiagnosed as a strained groin and patients may not receive a timely diagnosis or therapy for osteonecrosis.

The goal of therapy for osteonecrosis is to preserve the femoral head and avoid a total hip arthroplasty whenever possible. At USC Orthopaedic Surgery, we aim to give patients with osteonecrosis the ability to perform activities of daily living with minimal discomfort.

The most common treatment that we perform to preserve the femoral head with osteonecrosis is core decompression with bone grafting. In this procedure, bone marrow is harvested from the iliac crest and concentrated stem cells are used to bone graft the femoral head. Another option for some patients is vascularized fibula graft. When implemented in a timely manner, core decompression of the femoral head results in a successful outcome for 80 percent of patients.4-6


Osteonecrosis Research

Complementing our robust clinical program, investigators at USC Orthopaedic Surgery are conducting research in osteonecrosis. Two clinical research projects are currently underway. The first is a prospective study of patients with bilateral osteonecrosis of the femoral head, for whom one side is asymptomatic. This study will follow patients for up to four years to determine how osteonecrosis progresses on the asymptomatic opposite hip.

The second study is a prospective study of patients with unilateral osteonecrosis of the femoral head. In this study, patients will be followed to determine if osteonecrosis develops on the contralateral side. Patients with idiopathic osteonecrosis meet the inclusion criteria for this study.

The future of osteonecrosis care in Southern California begins at Keck Medicine of USC. We remain dedicated to designing, developing and testing the most current therapies through clinical trials and research studies.


  1. Zalavras CG, Lieberman JR. Osteonecrosis of the femoral head: evaluation and treatment. J Am Acad Orthop Surg. 2014;22(7):455-464.
  2. Mont MA, Cherian JJ, Sierra RJ, Jones LC, Lieberman JR. Nontraumatic osteonecrosis of the femoral head: where do we stand today? A ten-year update. J Bone Joint Surg Am. 2015;97(19):1604-1627.
  3. Lieberman JR, Engstrom SM, Meneghini RM, SooHoo NF. Which factors influence preservation of the osteonecrotic femoral head? Clin Orthop Relat Res. 2012;470(2):525-534.

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