American Board of Internal Medicine (ABIM) Certification Practice Exam

What is an initial treatment strategy for osteonecrosis of the femoral head?

1. Complete bed rest

2. Surgical intervention

3. Weight bearing exercises

4. Pain control and reduced weight bearing

The correct answer is: Pain control and reduced weight bearing

An initial treatment strategy for osteonecrosis of the femoral head focuses on implementing measures that alleviate pain and minimize further damage to the joint. Pain control is paramount, as patients often experience significant discomfort due to the necrotic changes in the bone. This can involve the use of analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain effectively. In addition to pain management, recommending reduced weight-bearing is crucial. This approach helps decrease the mechanical stress on the femoral head, which can limit further deterioration and slow the progression of the disease. By reducing weight-bearing activities, patients are provided an opportunity for the affected area to heal to some extent before more invasive treatments or interventions may be necessary. While complete bed rest may initially seem beneficial, it is not generally a practical or recommended long-term strategy for osteonecrosis, as it can lead to complications such as stiffness and deconditioning. Surgical interventions are typically considered later, once conservative measures have been exhausted or if the condition is severe. Weight-bearing exercises are contraindicated in the initial phases of treatment, as they can exacerbate pain and contribute to further joint damage. Therefore, a combination of pain control and reduced weight bearing stands out as an effective initial approach to managing osteonec