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

Basics

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.

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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