Physical therapy intervention in early-stage femoral head osteonecrosis

Abstract

Osteonecrosis of the femoral head is a progressively destructive disease of multifactorial origin. The etiology and pathogenesis of osteonecrosis of the femoral head are not yet clear. Management alternatives for the treatment of osteonecrosis of the femoral head consist of non-operative and operative treatment. The efficacy of non-operative treatment alone is the subject of heated debate in the literature. The purpose of this article is to review, update and summarize the non-operative treatment, particularly physical therapy modalities in patients with avascular necrosis of the femoral head in early stages. According to current literature these methods mainly include restriction techniques, electromagnetic stimulation, shockwave, immobilization-traction and rehabilitation training. Despite the evidence that these modalities when applied alone improve motor-function, pain relief and delay disease progression mainly through angiogenesis, osteogenesis and tissue regeneration, there is need for more research to elucidate their role and duration in early stages of avascular necrosis of the femoral head. Keywords: Femoral head, Non-operative treatment, Physical therapy, Osteonecrosis