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avascular osteonecrosis; aseptic necrosis

Osteonecrosis can occur in any bone & is associated with a variety of disorders. When the process occurs at a bone end, it is known as avascular osteonecrosis. Etiology: (associated disorders) 1) connective tissue disease, esp systemic lupus erythematosus 2) glucocorticoid use* 3) alcoholism* 4) hemoglobinopathies 5) diabetes mellitus 6) AIDS 7) fat embolism 8) gout 9) hyperlipidemia 10) pancreatitis 11) immunosuppressive therapy 12) radiation therapy 13) chemotherapy (cytoxan, methotrexate, 5-FU, bleomycin, vincristine, vinblastine) 14) trauma a) hip dislocation or fracture b) post arthroscopy 15) thermal injury a) burns b) electrical injuries c) frostbite 16) decompression syndrome (Caisson's disease) 17) hematopoietic disorders a) hemophilia b) histiocytosis c) polycythemia d) Gaucher's disease e) leukemias & lymphomas f) sickle cell disease [5] 18) Legg-Calve-Perthes disease in a child * glucocorticoid use & alcoholism account for > 90% of cases of hip osteonecrosis [5] Pathology: a) bone death resulting from reduced arterial blood supply b) increased interosseous pressure Genetics: - primary avascular necrosis of femoral head is associated with defects in COL2A1 (autosomal dominant) Clinical manifestations: 1) hips, shoulders & knees most commonly affected 2) patients may have bilateral disease with unilateral symptoms 3) limited range of motion of involved joint (i.e. hip) [5] 4) early stages of bone death may be associated with severe pain [5] Radiology: 1) X-rays may be normal early in disease process 2) radiolucent crescent line may be seen representing a plane of fracture 3) MRI is most sensitive imaging modality 4) bone scan shows increased uptake in adjacent bone segments Management: 1) non-weight bearing of affected joint 2) core decompression to relieve increased interosseous pressure 3) arthroplasty 4) bone grafting

Specific

Legg-Calve-Perthes disease; pseudocoxalgia; avascular necrosis of the hip

General

avascular necrosis (AVN) osteonecrosis

Database Correlations

OMIM 608805

References

  1. Basic Radiology, Chen MYM, Pope TL & Ott DJ (eds), McGraw Hill, NY 1996
  2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 867
  3. Weiner, S in: Intensive Course in Geriatric Medicine & Board Review, Santa Monica, CA, Sept 20-23, 2000
  4. Weiner, S in: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  5. Medical Knowledge Self Assessment Program (MKSAP) 16, 17. American College of Physicians, Philadelphia 2012, 2015 - Amanatullah DF, Strauss EJ, Di Cesare PE. Current management options for osteonecrosis of the femoral head: part 1, diagnosis and nonoperative management. Am J Orthop (Belle Mead NJ). 2011 Sep;40(9):E186-92. PMID: 22022684
  6. NIAMS: Osteonecrosis https://www.niams.nih.gov/health-topics/osteonecrosis