Avascular Necrosis
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
Domino, Frank J., et al., editors. "Avascular Necrosis." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816834/all/Avascular_Necrosis.
Avascular Necrosis. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816834/all/Avascular_Necrosis. Accessed December 3, 2024.
Avascular Necrosis. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816834/all/Avascular_Necrosis
Avascular Necrosis [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 December 03]. 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
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T1 - Avascular Necrosis
ID - 816834
ED - Domino,Frank J,
ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
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 - 33
DB - Medicine Central
DP - Unbound Medicine
ER -