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    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., editor. "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 April 25, 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 April 25]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617704/all/Avascular__Aseptic__Necrosis_of_the_Femoral_Head__Hip_.
    * Article titles in AMA citation format should be in sentence-case
    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 -