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Difference between revisions of "Avascular necrosis of the femoral head"
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Avascular necrosis of the femoral head (view source)
Revision as of 12:09, 30 May 2014
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Necrotic bone -- very high mag.jpg | |||
| Width = | |||
| Caption = Necrotic bone in a case of AVN. [[H&E stain]]. | |||
| Micro = bone with empty lacunae (indicative of necrosis) | |||
| Subtypes = | |||
| LMDDx = | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[femoral head]] | |||
| Assdx = +/-[[sickle cell disease]] | |||
| Syndromes = | |||
| Clinicalhx = +/-oral steroids, +/-radiation | |||
| Signs = | |||
| Symptoms = pain | |||
| Prevalence = uncommon | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = benign | |||
| Other = | |||
| ClinDDx = | |||
}} | |||
'''Avascular necrosis of the femoral head''' is [[necrosis]] of the head of the femur to the vascular compromise. | '''Avascular necrosis of the femoral head''' is [[necrosis]] of the head of the femur to the vascular compromise. | ||
It is often just referred to as '''avascular necrosis''', abbreviated '''AVN'''. | It is often just referred to as '''avascular necrosis''', abbreviated '''AVN'''. | ||
In children idiopathic AVN of the of capital femoral epiphysis is known as ''[[Legg–Calvé–Perthes disease]]''.<ref name=pmid24267210>{{cite journal |author=Shah H |title=Perthes disease: evaluation and management |journal=Orthop. Clin. North Am. |volume=45 |issue=1 |pages=87–97 |year=2014 |month=January |pmid=24267210 |doi=10.1016/j.ocl.2013.08.005 |url=}}</ref> | |||
==General== | ==General== | ||
| Line 9: | Line 40: | ||
*[[Cushing syndrome]]. | *[[Cushing syndrome]]. | ||
*Radiation. | *Radiation. | ||
*[[Sickle cell disease]].<ref>{{Cite journal | last1 = Al Omran | first1 = A. | title = Multiple drilling compared with standard core decompression for avascular necrosis of the femoral head in sickle cell disease patients. | journal = Arch Orthop Trauma Surg | volume = 133 | issue = 5 | pages = 609-13 | month = May | year = 2013 | doi = 10.1007/s00402-013-1714-9 | PMID = 23494112 }}</ref> | |||
Clinical: | |||
*Pain.<ref name=pmid15885478>{{Cite journal | last1 = Magnussen | first1 = RA. | last2 = Guilak | first2 = F. | last3 = Vail | first3 = TP. | title = Cartilage degeneration in post-collapse cases of osteonecrosis of the human femoral head: altered mechanical properties in tension, compression, and shear. | journal = J Orthop Res | volume = 23 | issue = 3 | pages = 576-83 | month = May | year = 2005 | doi = 10.1016/j.orthres.2004.12.006 | PMID = 15885478 }}</ref> | |||
*Locking.<ref>{{Cite journal | last1 = McCarthy | first1 = J. | last2 = Puri | first2 = L. | last3 = Barsoum | first3 = W. | last4 = Lee | first4 = JA. | last5 = Laker | first5 = M. | last6 = Cooke | first6 = P. | title = Articular cartilage changes in avascular necrosis: an arthroscopic evaluation. | journal = Clin Orthop Relat Res | volume = | issue = 406 | pages = 64-70 | month = Jan | year = 2003 | doi = 10.1097/01.blo.0000043045.84315.d9 | PMID = 12579001 }}</ref> | |||
*Catching. | |||
==Gross== | ==Gross== | ||
| Line 22: | Line 59: | ||
Features:<ref name=pmid20513874>{{Cite journal | last1 = Steffen | first1 = RT. | last2 = Athanasou | first2 = NA. | last3 = Gill | first3 = HS. | last4 = Murray | first4 = DW. | title = Avascular necrosis associated with fracture of the femoral neck after hip resurfacing: histological assessment of femoral bone from retrieval specimens. | journal = J Bone Joint Surg Br | volume = 92 | issue = 6 | pages = 787-93 | month = Jun | year = 2010 | doi = 10.1302/0301-620X.92B6.23377 | PMID = 20513874 }} | Features:<ref name=pmid20513874>{{Cite journal | last1 = Steffen | first1 = RT. | last2 = Athanasou | first2 = NA. | last3 = Gill | first3 = HS. | last4 = Murray | first4 = DW. | title = Avascular necrosis associated with fracture of the femoral neck after hip resurfacing: histological assessment of femoral bone from retrieval specimens. | journal = J Bone Joint Surg Br | volume = 92 | issue = 6 | pages = 787-93 | month = Jun | year = 2010 | doi = 10.1302/0301-620X.92B6.23377 | PMID = 20513874 }} | ||
</ref> | </ref> | ||
*Empty lacunae ( | *Empty lacunae - indicative of necrotic bone (osteonecrosis). | ||
*Degnerative changes of the cartilage overlying the necrotic bone.<ref name=pmid15885478/> | |||
DDx: | |||
*Suboptimal [[tissue fixation]].<ref>{{Cite journal | last1 = Fondi | first1 = C. | last2 = Franchi | first2 = A. | title = Definition of bone necrosis by the pathologist. | journal = Clin Cases Miner Bone Metab | volume = 4 | issue = 1 | pages = 21-6 | month = Jan | year = 2007 | doi = | PMID = 22460748 }}</ref> | |||
===Images=== | |||
<gallery> | |||
Image: Necrotic bone -- intermed mag.jpg | AVN - intermed. mag. (WC/Nephron) | |||
Image: Necrotic bone -- high mag.jpg | AVN - high mag. (WC/Nephron) | |||
Image: Necrotic bone -- very high mag.jpg | AVN - very high mag. (WC/Nephron) | |||
</gallery> | |||
==Sign out== | ==Sign out== | ||
| Line 58: | Line 105: | ||
Joint capsule tissue with focal lymphocytes and plasma cells is present. | Joint capsule tissue with focal lymphocytes and plasma cells is present. | ||
===Remote AVN with focal lesion=== | |||
<pre> | |||
FEMORAL HEAD AND SURROUNDING TISSUE, RIGHT, HIP ARTHROPLASTY: | |||
- FOCAL DEGENERATIVE CHANGES OF THE CARTILAGE WITH AN UNDERLYING WEDGE OF FIBROSIS | |||
AND REMODELLED BONE COMPATIBLE WITH A HISTORY OF AVASCULAR NECROSIS. | |||
- DEGENERATIVE JOINT DISEASE. | |||
- BENIGN FIBROADIPOSE TISSUE AND CARTILAGE. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
==See also== | ==See also== | ||
*[[Femoral head]]. | *[[Femoral head]]. | ||
*[[Legg–Calvé–Perthes disease]]. | |||
==References== | ==References== | ||