Early osteonecrosis

Data that is important to our practice in India has been published in the last issue of JBJS (A). One paper, by Cheng E et al, describes how some patients with early, asymptomatic osteonecrosis, with a small size, can resolve. The other article, by Hernigou P et al, shows that these very same, small, asymptomatic lesions, seen usually on the opposite side of a symptomatic lesion, usually progress (88%) clinically and collapse (73%) over time. They followed up these lesions for almost 10 years.

Both these articles, though appearing to say different things, do tell us quite a bit about the natural history of these small, initially asymptomatic Stage 1 osteonecrotic areas. Some may resolve, but those that don't, probably progress and it is necessary therefore to regularly follow these lesions up with MRI. At what intervals though, is uncertain.