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Avascular Necrosis

John M. Doan, DO and Matthew T. Melson, DO Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Avascular necrosis (AVN) is death and eventual architectural collapse of bone as a result of ischemic injury or damage to bone or bone marrow elements. AVN most commonly affects the ...

DIAGNOSIS

HISTORY

Signs and symptoms 
  • Can be asymptomatic in early disease

  • Pain is the most common symptom. Groin and buttock pain are associated with AVN of femoral head.

  • Pain with weight bearing or join...

TREATMENT

GENERAL MEASURES

  • Native joint preservation should always be attempted first. Initial treatment includes protected weight bearing to reduce joint pressure and pain.

  • Patients who have continued ...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

Depending on the severity of the disease, patients usually attempt conservative therapy and use MRI to determine progression of the disease; ear...

REFERENCES

1
Assouline-Dayan Y, Chang C, Greenspan A, et al. Pathogenesis and natural history of osteonecrosis. Semin Arthritis Rheum.  2002;32(2):94–124. {L-End} [View Abstract on OvidMedline]
2
A...

ADDITIONAL READING

  • http://nonf.org/

  • Moya-Angeler J, Gianakos AL, Villa JC, et al. Current concepts on osteonecrosis of the femoral head. World J Orthop.  2015;6(8):590–601.

  • Wilson JJ, Furukawa M. E...

CODES

ICD10

  • M87.9 Osteonecrosis, unspecified

  • M87.059 Idiopathic aseptic necrosis of unspecified femur

  • M87.219 Osteonecrosis due to previous trauma, unspecified shoulder

  • M87.256 Osteonecrosis due to previo...

CLINICAL PEARLS

  • AVN is higher on the differential for hip and other joint pain in 30- to 50-year-old men > women.

  • Risk factors for AVN include chronic corticosteroid use, alcoholism, radiation, and ...

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