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Hip Arthroscopy and Hip Joint Preservation Surgery pp 1–15Cite as

Avascular Necrosis: Overview

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Abstract

Avascular necrosis (AVN) of the femoral head is a progressive disease that predominantly affects younger patients. The disease is characterized by a vascular insult to the femoral head blood supply, which can lead to collapse of the femoral head and subsequent degenerative changes. The exact pathophysiology underlying AVN has yet to be elucidated, although a number of risk factors have been determined. The diagnosis of AVN is commonly made based on clinical and radiological findings. Radiographs are initially performed; however, MRI has become the gold standard for diagnosis and has proven beneficial in staging patients. Most surgeons attempt to diagnose and treat AVN in the early stages, prior to collapse of the femoral head. There are a number of nonoperative and operative treatments that have been investigated for early stage AVN. Nonoperative modalities include statins, stanozolol, and bisphosphonates. Operative treatments include core decompression alone, core decompression with injection of bone marrow aspirate, or placement of some form of bone substitute and osteotomies. Nonsurgical options are ineffective after femoral head collapse, and treatment options become more invasive. Bone-preserving techniques utilized for post-collapse AVN include vascularized fibula grafts and osteotomies, but their results are unpredictable. The ultimate salvage options include hip resurfacing, bipolar arthroplasty, and total hip arthroplasty. While the reconstructive options offer excellent pain relief, there are many operative and clinical considerations given to the young age of this patient population.

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Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA

    Dr. Matthew T. Houdek M.D. (Medical Doctor), Dr. John R. Martin M.D. (Medical Doctor) & Prof. Rafael J. Sierra M.D. (Medical Doctor)

Authors
  1. Dr. Matthew T. Houdek M.D. (Medical Doctor)
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  2. Dr. John R. Martin M.D. (Medical Doctor)
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  3. Prof. Rafael J. Sierra M.D. (Medical Doctor)
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Corresponding author

Correspondence to Rafael J. Sierra M.D. (Medical Doctor) .

Editor information

Editors and Affiliations

  1. Dept. of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA

    Shane Nho

  2. Dept. Orthopaedics, Hip Service, Schulthess Clinic, Zurich, Switzerland

    Michael Leunig

  3. Caspary Building, Ground Floor, Center for Hip Pain and Preservation, New York, New York, USA

    Bryan Kelly

  4. Department of Orthopaedics, University of Michigan Domino's Farms Lobby A, Ann Arbor, Michigan, USA

    Asheesh Bedi

  5. Twin Cities Orthopedics - Edina, Edina, Minnesota, USA

    Christopher Larson

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Houdek, M.T., Martin, J.R., Sierra, R.J. (2014). Avascular Necrosis: Overview. In: Nho, S., Leunig, M., Kelly, B., Bedi, A., Larson, C. (eds) Hip Arthroscopy and Hip Joint Preservation Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7321-3_92-1

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  • DOI: https://doi.org/10.1007/978-1-4614-7321-3_92-1

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  • Online ISBN: 978-1-4614-7321-3

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Chapter history

  1. Latest

    Osteonecrosis of the Femoral Head: Overview
    Published:
    28 November 2021

    DOI: https://doi.org/10.1007/978-1-4614-7321-3_92-2

  2. Original

    Avascular Necrosis: Overview
    Published:
    02 June 2014

    DOI: https://doi.org/10.1007/978-1-4614-7321-3_92-1

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