COPYRIGHT © 2007 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED  Current Practices of AAHKS Members in the Treatment of Adult Osteonecrosis of the Femoral Head By Brian J. McGrory, MD, Sally C. York, MN, RNC, Richard Iorio, MD, William Macaulay, MD, Richard R. Pelker, MD, PhD, Brian S. Parsley, MD, and Steven M. Teeny, MD Investigation performed at the American Association of Hip and Knee Surgeons, Rosemont, Illinois Background: There is currently no standardized protocol for evaluating and treating osteonecrosis of the femoral head in adults in the United States. We sought to understand current treatment practices of a group of surgeons who commonly treat this disease to determine if there was agreement on some aspects of care. Methods: We designed a two-staged mixed-mode (mailed and faxed) sixteen-question self-administered descriptive survey questionnaire to be sent to all 753 active members of the American Association of Hip and Knee Surgeons (AAHKS). The survey design was based on Dillman’s survey research methodology, and the questionnaire included hy- pothetical clinical scenarios based on the Steinberg classification system. The responses elucidated the opinions and treatment preferences of high-volume arthroplasty surgeons who treat adult patients with osteonecrosis of the femoral head. Results: Of the 753 active members of the AAHKS, 403 (54%) responded to the questionnaire. Total hip replace- ment was reported to be the most frequent intervention for treatment of postcollapse (Steinberg stage-IIIB, IVB, V, and VI) osteonecrosis; core decompression was reported to be the most commonly offered intervention for symptom- atic, precollapse (Steinberg stage-IB and IIB) osteonecrosis. Less frequently offered treatments included nonopera- tive management, osteotomy, vascularized and non-vascularized bone-grafting, hemiarthroplasty, and arthrodesis. Conclusions: The care of adults with osteonecrosis of the femoral head varies among American orthopaedic sur- geons specializing in hip and knee surgery. A consensus may evolve with a continued concerted effort on the part of interested surgeons, but it will require randomized, controlled, prospective studies of treatment of each stage of the disease and collaborative multicenter studies. Level of Evidence: Therapeutic Level V . See Instructions to Authors for a complete description of levels of evidence. steonecrosis of the femoral head in adults is thought to be caused by impaired microcirculation to a section of the femoral head, and its etiology is associated with a wide range of precipitating factors including trauma, certain systemic diseases, adverse responses to certain drugs or radia- tion, and occupational hazards 1,2 . According to the American Academy of Orthopaedic Surgeons, it is estimated that 10,000 to 20,000 new cases of osteonecrosis of the femoral head are di- agnosed each year in the United States and that 5% to 18% of the more than 500,000 total hip replacements performed each year are done to treat a diagnosis of osteonecrosis of the femoral head 3 . This diagnosis represents a series of disease processes that O Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from the American Association of Hip and Knee Surgeons (AAHKS). Neither they nor a member of their immediate fam- ilies received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A nonprofit research and education organization (NorthWest Orthopaedic Institute) paid or directed in any one year, or agreed to pay or direct, benefits of less than $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated. J Bone Joint Surg Am. 2007;89:1194-204 • doi:10.2106/JBJS.F.00302 A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).