Idiopathic Necrosis of the Femoral Head in Adults.

This work is based on a study of necrosis in 150 femoral heads in adults who had no evidence of such causal factors as a fracture, dislocation, caisson disease, sickle-cell anaemia or Gaucher’s disease (Fig. 1). This condition has been recognised during the last ten years: but only eleven cases were seen before 1958, and no less than 139 during the next five years. Idiopathic necrosis was described in 1925 by Haenisch and by Freund in 1939. A number of sporadic cases have been published, often with the diagnosis of osteochondritis dissecans: most of these, however, have been in adolescents with small lesions of the head of the femur. In 1936 Chandler emphasised the severity of the disease in adults and that it was often bilateral (Figs. 2 to 9), but it still seemed to be rare; thus Mankin and Brower in 1962 could find only twenty-four cases in the English literature, to which they added five.