Specific Causes of AVN

- Inciting Causes of AVN of Femoral Head Include:

     - AVN following femoral neck fracture: (see femoral neck frx:)
            - distention of hip joint capsule by fluid or pus may produce pressures that exceed epiphyseal marrow pressure & thereby cut off its circulation;
     - Posterior Hip Dislocation
     - AVN following IM nailing
            - reference:
                   - Fat-cell changes as a mechanism of avascular necrosis of the femoral head in cortisone-treated rabbits
     - Steroids
            - especially large doses of steroids may be directly related to AVN in large joints;
            - references:
                   - Risk factors of avascular necrosis of the femoral head in patients with systemic lupus erythematosus under high-dose corticosteroid therapy.
                   - Avascular necrosis of bone after cardiac transplantation. Prevalence and relationship to administration and dosage of steroids
                   - Complications Associated With Treatment of Malignancies: A Focus on Avascular Necrosis of the Bone 
                   - 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.
                   - Steroid-induced avascular necrosis of the hip in neurosurgical patients: epidemiological study.
                   - The pathogenesis of osteonecrosis and the relationships to corticosteroids

     - Coagulopathy:
            - references:
                   - Factor V Leiden and Prothrombin Gene Mutation: Risk Factors for Osteonecrosis of the Femoral Head in Adults
                   - Intravascular coagulation and osteonecrosis.
     - ETOH
     - Gout
     - Diabetes
     - Sickle Cell Anemia:
            - ref: Deformities of the hip in adults who have sickle-cell disease and had avascular necrosis in childhood. A natural history of fifty-two patients
     - Gaucher's disease
     - Decompression Sickness
            - infarction can also occur in the shafts of the long bones, probably from emboli in the nutrient artery,  as seen after caisson disease when nitrogen bubbles become entrapped in the marrow vessels;
     - SCFE
     - Legg-Calve-Perthes' Disease;
            - occurs most often in male children between the ages of 5 and 10;
            - one theory of its cause is compression of capsular vessels from swelling due to unrecognized trauma;
     - Transplant Surgery:
            - occurs in 3% of patients after cardiac transplant surgery, but may occur in upto 25% of patients following renal transplantation;
            - cyclosporine is most responsible for decreasing the incidence (most likely by decreasing the need for steroids);
            - average time of onset is 5 months post surgery;
            - references:
                   - Osteonecrosis after renal transplantation in children.
                   - Osteonecrosis in the transplant recipient
                   - Avascular necrosis of bone after cardiac transplantation. Prevalence and relationship to administration and dosage of steroids
                   - Avascular necrosis of bone: a common serious complication of allogeneic bone marrow transplantation.
     - AVN in Pregnancy: (see considerations in pregnancy)
            - references:
                   - Osteonecrosis of the femoral head during pregnancy.
                   - Osteonecrosis of the femoral head during pregnancy
                   - Aseptic necrosis of the femoral head during pregnancy.
                   - Osteonecrosis of the femoral head associated with pregnancy. Report of three cases.




Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, January 21, 2013 8:32 pm