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Avascular Necrosis

Nicole Madrilejo, MD and Crystal L Hnatko, DO, CAQSM Reviewed 06/2022
 


BASICS

DESCRIPTION

  • Avascular necrosis (AVN) is death of cellular bone components due to disruption of subchondral blood supply, which can lead to collapse of an entire joint in severe cases.

  • Most common...

DIAGNOSIS

HISTORY

  • Assess for risk factors such as recent trauma, autoimmune disorders, steroid use, alcohol/tobacco use

  • Signs and symptoms

    • Often asymptomatic in early disease

    • Pain is the most...

TREATMENT

GENERAL MEASURES

  • Initial goals should be directed toward native joint preservation and may include immobilization, restricted weight bearing, physical therapy, and various surgical interventi...

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
 Matthews AH, Davis DD, Fish MJ, et al. Avascular necrosis. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2021.
2
Shah KN, Racine J, Jones LC, et al. Pathophysiology...

ADDITIONAL READING

Wilson  JJ, Furukawa  M. Evaluation of the patient with hip pain. Am Fam Physician.  2014;89(1):27–34. [View Abstract on OvidMedline]  

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.

  • Plain radiographs may be normal. Low threshold to obtain MRI in those with risk fact...

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