Avascular (Aseptic) Necrosis of the Femoral Head (Hip)
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- 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).
- Variable, depending on cause
- Steroid-induced avascular necrosis may have an underlying genetic predisposition.
- 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.
- Slipped capital femoral epiphysis
- Hip fracture
- Hip dislocation
- Complication of casting, bracing, surgery
- 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