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Aminian A, Mokhtari K, Aris A. Clinical Implications and Therapeutic Strategies for Avascular Necrosis of the Femoral Head. JROS 2024; 11 (3) :119-134
URL: http://jros.iums.ac.ir/article-1-2266-en.html

Avascular necrosis of the femoral head (ANFH) is a debilitating condition caused by ischemia, which leads to bone necrosis and collapse. This condition involves a complex interplay of endothelial dysfunction, coagulation pathways, lipid biosynthesis disturbances, and apoptotic mechanisms, all of which contribute to the progression of ANFH. The integrity of the vascular system is crucial for bone repair and remodeling, and the disruption of angiogenesis plays a central role in the development of ANFH. This review discusses the role of endothelial cells in maintaining vascular health, how impaired angiogenesis exacerbates the condition, and the impact of coagulation pathways, lipid biosynthesis, and apoptosis in the pathophysiology of ANFH. Furthermore, the paper examines the significance of bone remodeling and the potential genetic factors linked to inherited forms of ANFH. Also, the potential for therapeutic strategies targeting these mechanisms, including pro-angiogenic factors, metabolic modulation, and anticoagulant therapies, is examined. Understanding these molecular and cellular processes holds promise for effective treatment and prevention of femoral head collapse, with implications for clinical management and future research.