HIP ISSN 1120-7000 HIP International 2018, Vol. 28(1) 90–95 © The Author(s) 2017 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.5301/hipint.5000535 journals.sagepub.com/home/hpi ORIGINAL RESEARCH ARTICLE Several factors infuence disease progression, including size of lesion, age, aetological risk factors, and there are varying levels of evidence for pharmacological and other nonopera- tve treatments to modify risk factors (3). Several classifcaton systems are in use but no accepted way of relatng the dis- ease stages between systems (1, 4). Of 76,448 primary hip replacements undertaken in the UK in 2012, the vast major - ity (92%) were performed for osteoarthrits (5). Only 2% were performed for ON but this accounted for 24% of all patents undergoing total hip arthroplasty (THA) under 30 and 19% of patents under 40 years old (5). In 2005, McGrory et al (6) conducted a survey of mem- bers of the American Associaton of Hip and Knee Surgeons (AAHKS) regarding their current practce in management of ON of the femoral head. Of the 403 (54%) actve members who responded core decompression (CD) was the most com- mon interventon for pre-collapse ON, and THA was the most common for post-collapse ON. The authors recognised a wide variaton in reported practce and advocated conductng of multcentre prospectve randomised controlled trials to de- termine best practce. To our knowledge, no similar study has been performed in the UK, and it would be interestng to compare variatons in Current practce of BHS members in the treatment of osteonecrosis of the femoral head in adults Henry B. Colaço 1 , Jerome A. Davidson 2 , Dominic Davenport 3 , Mark. C. Norris 4 , Marcus J.K. Bankes 3 , Zameer Shah 3 1 Trauma and Orthopaedics Department, Royal Free Hospital, London - UK 2 Royal Natonal Orthopaedic Hospital, Stanmore - UK 3 Department of Orthopaedics, Guy’s and St. Thomas’ NHS Foundaton Trust, London - UK 4 Department of Orthopaedics, Darent Valley Hospital, Dartord - UK Introducton Avascular necrosis of the femoral head (ON) presents a unique set of challenges to the orthopaedic surgeon. It is most prevalent in younger individuals in their 3 rd and 4 th decades (1). The natural history of the conditon is failure of bone remodeling progressing to subchondral fracture, col- lapse, and ultmately hip arthrits (2). Management of ON of the femoral head is controversial, and there remains a wide variaton in practce worldwide. Marker et al (1) suggested a treatment algorithm in 2008, but no established guidelines in the UK exist for this conditon. ABSTRACT Introducton: The management of osteonecrosis (ON) of the femoral head remains controversial. It is unclear the extent to which non-arthroplasty procedures are used and there has been no previous report of the trends in operatve management of ON in the UK. Our objectve is to report current trends in management of ON of the femoral head amongst specialist hip surgeons in the UK. Methods: A single-stage internet-based survey was e-mailed to 352 eligible members of the Britsh Hip Society (BHS). This consisted of 10 queston stems including 16 hypothetcal clinical scenarios with imaging. Results: 115 actve Consultant members of the BHS completed the survey. For symptomatc pre-collapse ON we found core decompression (CD) was the most common operatve interventon and for post-collapse ON we found that total hip arthroplasty (THA) was the most common operatve interventon. We found no diference in the rate of operatve interventon between 24 and 48-year-old patents at any stage of ON but joint preserving pro- cedures were more ofen selected for the younger patent and arthroplasty for the older patent. Surgeons were more likely to ofer arthroplasty to a 48-year-old patent at an earlier stage of disease. Conclusions: Our respondents would ofer diferent operatve interventons dependent on stage of ON and pa- tent age. Core decompression (CD) and arthroplasty were common but variaton in treatment optons ofered suggests a lack of consensus amongst UK hip surgeons. We suggest that further research such as a prospectve RCT is needed to gain consensus on management of this conditon. Keywords: Arthroplasty, Avascular necrosis, Conservatve hip surgery, Core decompression, Osteonecrosis, Young adult hip Accepted: May 10, 2017 Published online: September 5, 2017 Corresponding author: Dominic Davenport Department of Orthopaedics Guy’s Hospital Great Maze Pond SE1 9RT, London, UK dominic.davenport@nhs.net