Avascular necrosis of hip

Background

• Etiologies
  • Steroid use
  • Trauma
  • Pancreatitis
  • EtOH
  • Radiation
  • Sickle cell disease
  • Infiltrative disease
  • HIV
  • Malignancy
  • Decompression sickness (Caisson disease)

Imaging

• Plain XR is poorly sensitive in early stages, as low as 41%
• Radiographic changes may be delayed by years
• MRI ~90% sensitivity and specificity

Disposition

• Initial supportive care until later stages of disease
• Orthopedic consultation for repeat imaging and risk stratification for surgical treatment

References

• Stoica Z et al. Imaging of Avascular Necrosis of Femoral Head: Familiar Methods and Newer Trends. Curr Health Sci J. 2009 Jan-Mar; 35(1): 23–28.
• Kelly JD et al. Femoral head avascular necrosis treatment & management. Aug 16, 2015. http://emedicine.medscape.com/article/86568-treatment#showall.