Skip to main content
SpringerLink
Log in

New Trends in Osteonecrosis of the Femoral Head

  • Chapter
  • First Online:
European Instructional Lectures

Part of the book series: European Instructional Lectures ((EICL,volume 12))

  • 841 Accesses

Abstract

Avascular necrosis or Osteonecrosis (ON) of the femoral head (ONFH) is a clinical entity resulting from the establishment of an infarct in the subchondal bone, which affects young adults and results progressively in mechanical failure of the articular surface, collapse of the femoral head and eventually, in degeneration of the hip joint. A variety of associated risk factors have been identified with ON, but the actual aetiology and pathogenesis of the disease have not been fully elucidated. Early diagnosis and intervention prior to collapse of the articular surface, is key to a successful outcome of joint preserving procedures. Hip arthroplasty, although not desirable for the young age of the patients, remains the treatment of choice for the end stage of the disease. Research efforts today are directed towards the identification of factors revealing genetic predisposition to exogenous risk factors that might allow use of pharmacological and biological agents for the prevention, early diagnosis and treatment of this recalcitrant disease.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Aldridge JM 3rd, Urbaniak JR (2007) Avascular necrosis of the femoral head: role of vascularized bone grafts. Orthop Clin North Am 38:13–22

    Article  PubMed  Google Scholar 

  2. Aldridge JM 3rd, Urbaniak JR (2008) Vascularized fibular grafting for osteonecrosis of the femoral head with unusual indications. Clin Orthop Relat Res 466:1117–1124

    Article  PubMed  Google Scholar 

  3. Aldridge JM 3rd, Berend KR, Gunneson EE et al (2004) Free vascularized fibular grafting for the treatment of postcollapse osteonecrosis of the femoral head. Surgical technique. J Bone Joint Surg Am 86-A(Suppl 1):87–101

    PubMed  Google Scholar 

  4. Alves EM, Angrisani AT, Santiago MB (2009) The use of extracorporeal shock waves in the treatment of osteonecrosis of the femoral head: a systematic review. Clin Rheumatol 28:1247–1251

    Article  PubMed  Google Scholar 

  5. ARCO (Association Research Circulation Osseous) (1992) Committee on Terminology and Classification. ARCO News 4:41–46

    Google Scholar 

  6. Beaule PE, Schmalzried TP, Campbell P et al (2001) Duration of symptoms and outcome of hemiresurfacing for hip osteonecrosis. Clin Orthop Relat Res 385:104–117

    Article  PubMed  Google Scholar 

  7. Berend KR, Gunneson EE, Urbaniak JR (2003) Free vascularized fibular grafting for the treatment of postcollapse osteonecrosis of the femoral head. J Bone Joint Surg Am 85:987–993

    PubMed  Google Scholar 

  8. Bjorkman A, Svensson PJ, Hillarp A et al (2004) Factor V Leiden and prothrombin gene mutation: risk factors for osteonecrosis of the femoral head in adults. Clin Orthop Relat Res 425:168–172

    Article  PubMed  Google Scholar 

  9. Boss JH, Misselevich I (2003) Osteonecrosis of the femoral head of laboratory animals: the lessons learned from a comparative study of osteonecrosis in man and experimental animals. Vet Pathol 40:345–354

    Article  PubMed  CAS  Google Scholar 

  10. Brav EA (1962) Traumatic dislocation of the hip: army experience and results over a twelve-year period. J Bone Joint Surg Am 44:1115–1134

    Google Scholar 

  11. Cardozo JB, Andrade DM, Santiago MB (2008) The use of bisphosphonate in the treatment of avascular necrosis: a systematic review. Clin Rheumatol 27:685–688

    Article  PubMed  Google Scholar 

  12. Chan WP, Liu YJ, Huang GS et al (2011) Relationship of idiopathic osteonecrosis of the femoral head to perfusion changes in the proximal femur by dynamic contrast-enhanced MRI. AJR Am J Roentgenol 96:637–643

    Article  Google Scholar 

  13. Chao YC, Wang SJ, Chu HC et al (2003) Investigation of alcohol metabolizing enzyme genes in Chinese alcoholics with avascular necrosis of hip joint, pancreatitis and cirrhosis of the liver. Alcohol Alcohol 38:431–436

    PubMed  CAS  Google Scholar 

  14. Dastane MR, Long WT, Wan Z et al (2008) Metal-on-metal hip arthroplasty does equally well in osteonecrosis and osteoarthritis. Clin Orthop Relat Res 466:1148–1153

    Article  PubMed  Google Scholar 

  15. Dean MT, Cabanela ME (1993) Transtrochanteric anterior rotational osteotomy for avascular necrosis of the femoral head. Long-term results. J Bone Joint Surg Br 75:597–601

    PubMed  CAS  Google Scholar 

  16. Ferrari P, Schroeder V, Anderson S et al (2002) Association of plasminogen activator inhibitor-1 genotype with avascular osteonecrosis in steroid-treated renal allograft recipients. Transplantation 74:1147–1152

    Article  PubMed  CAS  Google Scholar 

  17. Ficat RP (1985) Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br 67:3–9

    PubMed  CAS  Google Scholar 

  18. Foulk DM, Mullis BH (2010) Hip dislocation: evaluation and management. J Am Acad Orthop Surg 18:199–209

    PubMed  Google Scholar 

  19. Garino JP, Steinberg ME (1997) Total hip arthroplasty in patients with avascular necrosis of the femoral head: a 2- to 10-year follow-up. Clin Orthop Relat Res 334:108–115

    Article  PubMed  Google Scholar 

  20. Glueck CJ, Freiberg R, Glueck HI et al (1995) Idiopathic osteonecrosis, hypofibrinolysis, high plasminogen activator inhibitor, high lipoprotein(a), and therapy with Stanozolol. Am J Hematol 48:213–220

    Article  PubMed  CAS  Google Scholar 

  21. Glueck CJ, Fontaine RN, Gruppo R et al (1999) The plasminogen activator inhibitor-1 gene, hypofibrinolysis, and osteonecrosis. Clin Orthop Relat Res 366:133–146

    Article  PubMed  Google Scholar 

  22. Glueck CJ, Freiberg RA, Fontaine RN et al (2001) Hypofibrinolysis, thrombophilia, osteonecrosis. Clin Orthop Relat Res 386:19–33

    Article  PubMed  Google Scholar 

  23. Glueck CJ, Freiberg RA, Boppana S et al (2008) Thrombophilia, hypofibrinolysis, the eNOS T-786C polymorphism, and multifocal osteonecrosis. J Bone Joint Surg Am 90:2220–2229

    Article  PubMed  Google Scholar 

  24. Griffith JF, Antonio GE, Kumta SM et al (2005) Osteonecrosis of hip and knee in patients with severe acute respiratory syndrome treated with steroids. Radiology 235:168–175

    Article  PubMed  Google Scholar 

  25. Ha YC, Kim HJ, Kim SY et al (2008) THA using an anatomic stem in patients with femoral head osteonecrosis. Clin Orthop Relat Res 466:1141–1147

    Article  PubMed  Google Scholar 

  26. Hadjigeorgiou GM, Malizos K, Dardiotis E et al (2007) Paraoxonase 1 gene polymorphisms in patients with osteonecrosis of the femoral head with and without cerebral white matter lesions. J Orthop Res 25:1087–1093

    Article  PubMed  CAS  Google Scholar 

  27. Hadjigeorgiou G, Dardiotis E, Dardioti M et al (2008) Genetic association studies in osteonecrosis of the femoral head: mini review of the literature. Skeletal Radiol 37:1–7

    Article  PubMed  Google Scholar 

  28. Hernigou P, Habibi A, Bachir D et al (2006) The natural history of asymptomatic osteonecrosis of the femoral head in adults with sickle cell disease. J Bone Joint Surg Am 88:2565–2572

    Article  PubMed  Google Scholar 

  29. Hirota Y, Hirohata T, Fukuda K et al (1993) Association of alcohol intake, cigarette smoking, and occupational status with the risk of idiopathic osteonecrosis of the femoral head. Am J Epidemiol 137:530–538

    PubMed  CAS  Google Scholar 

  30. Hong JM, Kim TH, Chae SC et al (2007) Association study of hypoxia inducible factor 1alpha (HIF1alpha) with osteonecrosis of femoral head in a Korean population. Osteoarthritis Cartilage 15:688–694

    Article  PubMed  Google Scholar 

  31. Hong JM, Kim TH, Kim HJ et al (2010) Genetic association of angiogenesis- and hypoxia-related gene polymorphisms with osteonecrosis of the femoral head. Exp Mol Med 42:376–385

    Article  PubMed  CAS  Google Scholar 

  32. Hungerford DS, Mont MA (1998) The natural history of untreated asymptomatic hips in patients who have non-traumatic osteonecrosis. J Bone Joint Surg Am 80:765–766

    PubMed  CAS  Google Scholar 

  33. Inoue S, Horii M, Asano T et al (2003) Risk factors for nontraumatic osteonecrosis of the femoral head after renal transplantation. J Orthop Sci 8:751–756

    Article  PubMed  Google Scholar 

  34. Jacobs MA, Hungerford DS, Krackow KA (1989) Intertrochanteric osteotomy for avascular necrosis of the femoral head. J Bone Joint Surg Br 71:200–204

    PubMed  CAS  Google Scholar 

  35. Johannson HR, Zywiel MG, Marker DR et al (2011) Osteonecrosis is not a predictor of poor outcomes in primary total hip arthroplasty: a systematic literature review. Int Orthop 35:465–473

    Article  PubMed  Google Scholar 

  36. Jones JP Jr (1993) Fat embolism, intravascular coagulation, and osteonecrosis. Clin Orthop Relat Res 292:294–308

    PubMed  Google Scholar 

  37. Jones LC, Johnson AJ, Mont MA et al (2011) Osteonecrosis of the hip in adults. Clin Rev Bone Miner Metab 9:13–22

    Article  Google Scholar 

  38. Kabata T, Maeda T, Tanaka K et al (2011) Hemi-resurfacing versus total resurfacing for osteonecrosis of the femoral head. J Orthop Surg (Hong Kong) 19:177–180

    Google Scholar 

  39. Kawate K, Yajima H, Sugimoto K et al (2007) Indications for free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head. BMC Musculoskelet Disord 8:78

    Article  PubMed  Google Scholar 

  40. Kim TH, Hong JM, Oh B et al (2008) Genetic association study of polymorphisms in the catalase gene with the risk of osteonecrosis of the femoral head in the Korean population. Osteoarthritis Cartilage 16:1060–1066

    Article  PubMed  Google Scholar 

  41. Koo KH, Lee JS, Lee YJ et al (2006) Endothelial nitric oxide synthase gene polymorphisms in patients with nontraumatic femoral head osteonecrosis. J Orthop Res 24:1722–1728

    Article  PubMed  CAS  Google Scholar 

  42. Lavernia CJ, Sierra RJ, Griego FR (1999) Osteonecrosis of the femoral head. J Am Acad Orthop Surg 74:250–261

    Google Scholar 

  43. Lieberman JR, Berry DJ, Mont MA et al (2002) Osteonecrosis of the hip: management in the 21st century. J Bone Joint Surg Am 84:834–853, review (2003) Instr Course Lect 52:337–55

    Google Scholar 

  44. Malizos KN, Soucacos PN, Beris AE (1995) Osteonecrosis of the femoral head. Hip salvaging with implantation of a vascularized fibular graft. Clin Orthop Relat Res 314:67–75

    PubMed  Google Scholar 

  45. Malizos KN, Karantanas AH, Varitimidis SE et al (2007) Osteonecrosis of the femoral head: etiology, imaging and treatment. Eur J Radiol 63:16–28

    Article  PubMed  Google Scholar 

  46. Mankin HJ (1992) Non traumatic necrosis of bone (osteonecrosis). N Engl J Med 28:1473–1479

    Google Scholar 

  47. Matsuo K, Hirohata T, Sugioka Y et al (1988) Influence of alcohol intake, cigarette smoking, and occupational status on idiopathic osteonecrosis of the femoral head. Clin Orthop 234:115–123

    PubMed  Google Scholar 

  48. Min BW, Song KS, Cho CH et al (2008) Untreated asymptomatic hips in patients with osteonecrosis of the femoral head. Clin Orthop Relat Res 466:1087–1092

    Article  PubMed  Google Scholar 

  49. Miyanishi K, Noguchi Y, Yamamoto T et al (2000) Prediction of the outcome of transtrochanteric rotational osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg Br 82:512–516

    Article  PubMed  CAS  Google Scholar 

  50. Mont MA, Hungerford DS (1995) Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am 77:459–474

    PubMed  CAS  Google Scholar 

  51. Mont MA, Carbone JJ, Fairbank AC (1996) Core decompression versus nonoperative management for osteonecrosis of the hip. Clin Orthop Relat Res 324:169–178

    Article  PubMed  Google Scholar 

  52. Mont MA, Fairbank AC, Krackow KA et al (1996) Corrective osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg Am 78:1032–1038

    PubMed  CAS  Google Scholar 

  53. Mont MA, Ragland PS, Etienne G (2004) Core decompression of the femoral head for osteonecrosis using percutaneous multiple small-diameter drilling. Clin Orthop Relat Res 429:131–138

    Article  PubMed  Google Scholar 

  54. Mont MA, Jones LC, Hungerford DS (2006) Nontraumatic osteonecrosis of the femoral head: ten years later. J Bone Joint Surg Am 88:1117–1132

    Article  PubMed  Google Scholar 

  55. Mont MA, Ulrich SD, Seyler TM et al (2008) Bone scanning of limited value for diagnosis of ­symptomatic oligofocal and multifocal osteonecrosis. J Rheumatol 35:1629–1634

    PubMed  Google Scholar 

  56. Mont MA, Zywiel MG, Marker DR et al (2010) The natural history of untreated asymptomatic osteonecrosis of the femoral head: a systematic literature review. J Bone Joint Surg Am 92:2165–2170

    Article  PubMed  Google Scholar 

  57. Ohzono K, Saito M, Sugano N et al (1992) The fate of nontraumatic avascular necrosis of the femoral head. A radiologic classification to formulate prognosis. Clin Orthop Relat Res 277:73–78

    PubMed  Google Scholar 

  58. Oinuma K, Harada Y, Nawata Y et al (2001) Osteonecrosis in patients with systemic lupus ­erythematosus develops very early after starting high dose corticosteroid treatment. Ann Rheum Dis 60:1145–1148

    Article  PubMed  CAS  Google Scholar 

  59. Plakseychuk AY, Shah M, Varitimidis SE et al (2001) Classification of osteonecrosis of the femoral head. Reliability, reproducibility, and prognostic value. Clin Orthop Relat Res 386:34–41

    Article  PubMed  Google Scholar 

  60. Sahin V, Karakaş ES, Aksu S et al (2003) Traumatic dislocation and fracture-dislocation of the hip: a long-term follow-up study. J Trauma 54:520–529

    Article  PubMed  Google Scholar 

  61. Saito S, Ohzono K, Ono K (1992) Early arteriopathy and postulated pathogenesis of osteonecrosis of the femoral head. The intracapital arterioles. Clin Orthop Relat Res 277:98–110

    PubMed  Google Scholar 

  62. Sakagoshi D, Kabata T, Umemoto Y et al (2010) A mechanical analysis of femoral resurfacing implantation for osteonecrosis of the femoral head. J Arthroplasty 25:1282–1289

    Article  PubMed  Google Scholar 

  63. Scher MA, Jakim I (1993) Intertrochanteric osteotomy and autogenous bone-grafting for avascular necrosis of the femoral head. J Bone Joint Surg Am 75:1119–1133

    PubMed  CAS  Google Scholar 

  64. Scher MA, Jakim I (1999) Late follow-up of femoral head avascular necrosis managed by intertrochanteric osteotomy and bone grafting. Acta Orthop Belg 65S:73–77

    Google Scholar 

  65. Sekiya F, Yamaji K, Yang K et al (2010) Investigation of occurrence of osteonecrosis of the femoral head after increasing corticosteroids in patients with recurring systemic lupus erythematosus. Rheumatol Int 30:1587–1593

    Article  PubMed  CAS  Google Scholar 

  66. Shibatani M, Fujioka M, Arai Y et al (2008) Degree of corticosteroid treatment within the first 2 months of renal transplantation has a strong influence on the incidence of osteonecrosis of the femoral head. Acta Orthop 79:631–636

    Article  PubMed  Google Scholar 

  67. Song WS, Yoo JJ, Kim YM et al (2007) Results of multiple drilling compared with those of conventional methods of core decompression. Clin Orthop Relat Res 454:139–146

    Article  PubMed  Google Scholar 

  68. Soucacos PN, Beris AE, Malizos K et al (2001) Treatment of avascular necrosis of the femoral head with vascularized fibular transplant. Clin Orthop Relat Res 386:120–130

    Article  PubMed  Google Scholar 

  69. Steffen RT, Athanasou NA, Gill HS et al (2010) Avascular necrosis associated with fracture of the femoral neck after hip resurfacing: histological ­assessment of femoral bone from retrieval specimens. J Bone Joint Surg Br 92:787–793

    Article  PubMed  CAS  Google Scholar 

  70. Steinberg ME, Hayken GD, Steinberg DR (1995) A quantitative system for staging avascular necrosis. J Bone Joint Surg Br 77:34–41

    PubMed  CAS  Google Scholar 

  71. Stulberg BN, Davis AW, Bauer TW et al (1991) Osteonecrosis of the femoral head. A prospective ­randomized treatment protocol. Clin Orthop Relat Res 268:140–151

    PubMed  Google Scholar 

  72. Sugioka Y (1978) Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip: a new osteotomy operation. Clin Orthop Relat Res 130:191–201

    PubMed  Google Scholar 

  73. Sugioka Y, Yamamoto T (2008) Transtrochanteric posterior rotational osteotomy for osteonecrosis. Clin Orthop Relat Res 466:1104–1109

    Article  PubMed  Google Scholar 

  74. Sugioka Y, Hotokebuchi T, Tsutsui H (1992) Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head. Indications and long-term results. Clin Orthop Relat Res 277:111–120

    PubMed  Google Scholar 

  75. Tang S, Chan TM, Lui SL et al (2000) Risk factors for avascular bone necrosis after renal transplantation. Transplant Proc 32:1873–1875

    Article  PubMed  CAS  Google Scholar 

  76. Tektonidou MG, Malagari K, Vlachoyiannopoulos PG et al (2003) Asymptomatic avascular necrosis in patients with primary antiphospholipid syndrome in the absence of corticosteroid use: a prospective study by magnetic resonance imaging. Arthritis Rheum 48:732–736

    Article  PubMed  Google Scholar 

  77. Thorey F, Reck F, Windhagen H et al (2008) Influence of bone density on total hip resurfacing arthroplasty in patients with osteonecrosis of the femoral head – a radiological analysis. Technol Health Care 16:151–158

    PubMed  Google Scholar 

  78. Urbaniak JR, Coogan PG, Gunneson EB et al (1995) Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. A long-term followup study of one hundred and three hips. J Bone Joint Surg Am 77:681–694

    PubMed  CAS  Google Scholar 

  79. Wang GJ, Cui Q, Balian G (2000) The Nicolas Andry award. The pathogenesis and prevention of steroid-induced osteonecrosis. Clin Orthop Relat Res 370:295–310

    Article  PubMed  Google Scholar 

  80. Varitimidis SE, Dimitroulias AP, Karachalios TS et al (2009) Outcome after tantalum rod implantation for treatment of femoral head osteonecrosis: 26 hips followed for an average of 3 years. Acta Orthop 80:20–25

    Article  PubMed  Google Scholar 

  81. Yamamoto T, Ikemura S, Iwamoto Y et al (2010) The repair process of osteonecrosis after a transtrochanteric rotational osteotomy. Clin Orthop Relat Res 468:3186–3191

    Article  PubMed  Google Scholar 

  82. Yeh CH, Chang JK, Wang YH et al (2008) Ethanol may suppress Wnt/beta-catenin signaling on human bone marrow stroma cells: a preliminary study. Clin Orthop Relat Res 466:1047–1053

    Article  PubMed  Google Scholar 

  83. Yoo MC, Kim KI, Hahn CS et al (2008) Long-term followup of vascularized fibular grafting for femoral head necrosis. Clin Orthop Relat Res 466:1133–1140

    Article  PubMed  Google Scholar 

  84. Zaidi M, Sun L, Robinson LJ et al (2010) ACTH protects against glucocorticoid-induced osteonecrosis of bone. Proc Natl Acad Sci USA 107:8782–8787

    Article  PubMed  CAS  Google Scholar 

  85. Zalavras C, Dailiana Z, Elisaf M et al (2000) Potential aetiological factors concerning the development of osteonecrosis of the femoral head. Eur J Clin Invest 30:215–221

    Article  PubMed  CAS  Google Scholar 

  86. Zalavras CG, Malizos KN, Dokou E et al (2002) The 677C ® T mutation of the methylene-tetrahydrofolate reductase gene in the pathogenesis of osteonecrosis of the femoral head. Haematologica 87:111–112

    PubMed  Google Scholar 

  87. Zalavras CG, Vartholomatos G, Dokou E et al (2002) Factor V Leiden and prothrombin gene mutations in femoral head osteonecrosis. Thromb Haemost 87:1079–1080

    PubMed  CAS  Google Scholar 

  88. Zalavras CG, Vartholomatos G, Dokou E et al (2004) Genetic background of osteonecrosis: associated with thrombophilic mutations? Clin Orthop Relat Res 422:251–255

    Article  PubMed  Google Scholar 

  89. Zhang NF, Li ZR, Wei HY et al (2008) Steroid-induced osteonecrosis: the number of lesions is related to the dosage. J Bone Joint Surg Br 90:1239–1243

    Article  PubMed  Google Scholar 

  90. Zibis AH, Karantanas AH, Roidis NT et al (2007) The role of MR imaging in staging femoral head osteonecrosis. Eur J Radiol 63:3–9

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University of Thessalia, 41110, Larissa, Greece

    Konstantinos N. Malizos & Loukia K. Papatheodorou

Authors
  1. Konstantinos N. Malizos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Loukia K. Papatheodorou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Konstantinos N. Malizos .

Editor information

Editors and Affiliations

  1. Royal National Orthopaedic Hospital Trus, Brockley Hill, Stanmore, HA 7 4LP, Middlesex, United Kingdom

    George Bentley

Rights and permissions

Reprints and permissions

Copyright information

© 2012 EFORT

About this chapter

Cite this chapter

Malizos, K.N., Papatheodorou, L.K. (2012). New Trends in Osteonecrosis of the Femoral Head. In: Bentley, G. (eds) European Instructional Lectures. European Instructional Lectures, vol 12. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-27293-6_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-27293-6_13

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-27292-9

  • Online ISBN: 978-3-642-27293-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation