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Avascular Necrosis

Avascular Necrosis is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Avascular necrosis (AVN) is death and eventual architectural collapse of bone as a result of ischemic injury or damage to bone or bone marrow elements. AVN most commonly affects the epiphysis of long bones; the hip (femoral head) is most susceptible but also can occur in the shoulder, knee, ankle, and wrist.
  • Bone collapse at these joints can lead to cartilage breakdown and arthritis.

Epidemiology

Incidence
  • About 20,000 to 30,000 new cases of AVN are reported each year.
  • AVN usually affects people <50 years of age (1).
  • Gender risk varies based on etiology.

Etiology and Pathophysiology

  • Combination of metabolic, genetic, lifestyle, and environmental causes
  • Traumatic (nonunion, Perthes disease, joint dislocation) accounts for most cases.
  • Chronic glucocorticoid use and alcohol abuse account for >80% of nontraumatic (2).
  • Bisphosphonates (AVN of the jaw) (1,2)
  • Embolic (decompression disease, sickle cell)

Risk Factors

  • Systemic lupus erythematosus (SLE) (3)
  • HIV and antiretroviral therapy
  • Radiation and chemotherapy

General Prevention

  • Avoid or limit medications and substances that can cause AVN, such as steroids or alcohol.
  • Monitor fractures for signs of nonunion.
  • High index of suspicion in high-risk population (SLE, steroid use, alcohol abuse)
  • Early surgical intervention prior to joint collapse

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Citation

Stephens, Mark B., et al., editors. "Avascular Necrosis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816834/all/Avascular_Necrosis.
Avascular Necrosis. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816834/all/Avascular_Necrosis. Accessed April 21, 2019.
Avascular Necrosis. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816834/all/Avascular_Necrosis
Avascular Necrosis [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 21]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816834/all/Avascular_Necrosis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Avascular Necrosis ID - 816834 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816834/all/Avascular_Necrosis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -