Avascular (Aseptic) Necrosis of the Femoral Head (Hip)

Avascular (Aseptic) Necrosis of the Femoral Head (Hip) is a topic covered in the 5-Minute Pediatric Consult.

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Basics

Description

Avascular (aseptic) necrosis results from the interruption of the blood supply to bone (either traumatic or nontraumatic occlusion).
The femoral head is the most common site.
A self-limiting idiopathic avascular necrosis of the hip that occurs in children is known as Perthes disease (see “Perthes Disease” chapter).

Risk Factors

Genetics

Variable, depending on cause
Steroid-induced avascular necrosis may have an underlying genetic predisposition.

Pathophysiology

Death and necrosis of bone with gradual return of blood supply
Necrotic bone gradually resorbed and replaced by new bone
During bone resorption, structural integrity of femoral head may be reduced, leading to collapse.

Etiology

Traumatic
- Slipped capital femoral epiphysis
- Hip fracture
- Hip dislocation
- Complication of casting, bracing, surgery
Nontraumatic
- Steroids or chemotherapy
- Malignancy (leukemia)
- Idiopathic (older, after physeal closure); similar to adult avascular necrosis
- Idiopathic (younger, before physeal closure, Perthes disease)
- Caisson disease
- Sickle cell disease
- Septic arthritis
- Gaucher disease
- Viral infection (HIV, CMV)
- Radiation therapy
- Hypercoagulable states

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Citation

Cabana, Michael D.. "Avascular (Aseptic) Necrosis of the Femoral Head (Hip)." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617704/all/Avascular__Aseptic__Necrosis_of_the_Femoral_Head__Hip_.

Avascular (Aseptic) Necrosis of the Femoral Head (Hip). In: Cabana MD, ed. 5-Minute Pediatric Consult. 8th ed. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617704/all/Avascular__Aseptic__Necrosis_of_the_Femoral_Head__Hip_. Accessed January 17, 2019.

Avascular (Aseptic) Necrosis of the Femoral Head (Hip). (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult. Available from https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617704/all/Avascular__Aseptic__Necrosis_of_the_Femoral_Head__Hip_

Avascular (Aseptic) Necrosis of the Femoral Head (Hip) [Internet]. In: Cabana MD, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2019 January 17]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617704/all/Avascular__Aseptic__Necrosis_of_the_Femoral_Head__Hip_

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TY - ELEC T1 - Avascular (Aseptic) Necrosis of the Femoral Head (Hip) ID - 617704 ED - Cabana,Michael D, BT - 5-Minute Pediatric Consult UR - https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617704/all/Avascular__Aseptic__Necrosis_of_the_Femoral_Head__Hip_ PB - Wolters Kluwer ET - 8 DB - Pediatrics Central DP - Unbound Medicine ER -