Osteonecrosis is a debilitating disease that may progress to collapse of the subchondral bone and articular cartilage of the joint. Despite our best efforts, we still do not fully understand the pathogenesis of this disease. Consequently, there is no established preventive treatment for osteonecrosis at this time. Studies to determine the pathogenic mechanisms of specific etiological factors are necessary. Animal models are needed that are similar to the pathology and biomechanics of the human disease. A number of surgical treatment options attempt to preserve the integrity of the joint, but multicenter studies with large series of patients will give us a better understanding of the long-term survival of these techniques. Comparative studies using similar patient populations, staging systems, and outcome measures will help us to refine the treatment algorithm for the early stages of the disease. Total joint replacement is the only realistic option for end stage disease. The results for cementless implants appear to be better than past experience with cemented prostheses. The literature this year has included research pertaining to the etiology, pathogenesis, diagnosis, and treatment of this disease.
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