The Pathology of Osteonecrosis of the Femoral Head

Although the precise etiology of nontraumatic osteonecrosis of the femoral head (ON) is still unclear, this condition has generally been considered to result from an ischemia to the bone and bone marrow tissues. The first pathologic description of the femoral head osteonecrosis was reported in a case of caisson disease in 1888 [1]. In 1915, the microscopic appearances of the necrotic bone caused by a circulatory disturbance (ischemia) were described by Phemister [2], who also described that reparative process was observed around the dead bone (creeping substitution) [3]. Thereafter, both alcohol- and corticosteroid-related osteonecrosis have been reported clinically, and their pathologic appearances have also been described based on the histological examinations [4, 5].