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Avascular Necrosis of the Hip
Hip Avascular Necrosis

Presentation

We report a 30-yr-old woman with Cushing's disease whose presenting manifestation was early AVN of the hip. Although plain x-ray was negative, magnetic resonance imaging (MRI) of the hip showed stage 2 AVN. [ncbi.nlm.nih.gov]

Entire Body System

  • Asymptomatic

    No significant differences were found regarding the total dose of corticosteroids and exposure time between patients with and patients without asymptomatic AVN. [ncbi.nlm.nih.gov]

    Small asymptomatic lesions do not warrant surgical intervention and are closely monitored with serial examination. If symptoms ensue, repeat imaging and surgical treatment are indicated. [iqb.es]

Musculoskeletal

  • Hip Pain

    Two weeks later she described left knee and left hip pain. On physical examination, motion in her left knee and hip was severely painful without inflammation but range of motion was not limited. [ncbi.nlm.nih.gov]

    Disponible en: https://www.uptodate.com/contents/approach-to-hip-pain-in-childhood?search=approach-to-hip-pain-in-childhood Lespasio MJ, Sodhi N, Mont MA. Osteonecrosis of the Hip: A Primer. [revistamedicasinergia.com]

    […] to rule out other conditions that may cause hip pain (eg, rheumatoid arthritis). [iqb.es]

  • Fracture

    Avascular necrosis of the femoral head at 2 years after pertrochanteric fracture surgery: Case report. Ann Med Surg (Lond). 2015; 22(5): 106-109. https://doi.org/10.1016/j.amsu.2015.12.053 Pouya F, Kerachian MA. [revistamedicasinergia.com]

    Furthermore, there is a 1% incidence of femoral neck fracture with this procedure. Lastly, the issue of metal ion release has spurred much debate, although there are no good data available to suggest injurious effects. [iqb.es]

    Our definition of immediate, early, and long term is arbitrary. prevalence and timing of joint loosening bone fracture infections intra‐operative bleeding complications of SCD during hospital admission, e.g. painful crises, acute chest syndrome and stroke [cochranelibrary.com]

Treatment

[…] as morphological changes on femoral head, and to classify them with standard classification methods, and (3) to analyse the research results and make a recommendation for the following treatment dilemma: when is the optimal time for an operative treatment [ncbi.nlm.nih.gov]

Prognosis

AVN carries a poor prognosis, if not treated early. The diagnostic procedure of choice is MRI, because plain radiographs are falsely negative in early stages. [ncbi.nlm.nih.gov]

Etiology

Osteonecrosis of the Femoral Head: Etiology, Investigations, and Management. Cureus. 2018;10(8): e3171. https://doi.org/10.7759/cureus.3171 Tripathy SK, Goyal T, Sen RK. Management of femoral head osteonecrosis: Current concepts. [revistamedicasinergia.com]

Furthermore, if no obvious cause of AVN is seen, medical consultation would be a reasonable measure in order to help discern less common etiologies. (See Clinical, Causes, above.) [iqb.es]

Pathophysiology

Osteonecrosis of the femoral head: pathophysiology and current concepts of treatment. [revistamedicasinergia.com]

The pathophysiology of SCD has been reviewed extensively (Hebbel 2004; Steinberg 2006; Stuart 2004; Weatherall 2006). [cochranelibrary.com]

Prevention

This case illustrates that AVN can be the presenting manifestation of CS; to prevent irreversible effects on the femoral head, core decompression should not be delayed for the purpose of evaluation and treatment of CS. [ncbi.nlm.nih.gov]

Inhibition of the vascular endothelial growth factor may hold promise in preventing femoral head collapse because revascularization compromises bone structural integrity. [iqb.es]

There is an argument for early prevention and effective treatment for people with SCD with suspected AVN, but as yet no evidence base to support operative intervention. [cochranelibrary.com]

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