47. Femoral head necrosis

Osteonecrosis, also called avascular necrosis, refers to ischaemic necrosis of bone caused by impaired blood supply. It may affect any part of the bone but most commonly the knee and femoral head. It's most common in children and adolescents.

• Avascular necrosis of the hip
  • Osteonecrosis of the hip, also called femoral head necrosis, is the most common localisation of osteonecrosis. The femoral head is the most frequent area of osteonecrosis probably due to the intricate blood supply.
  • Occurs in middle-aged, male > female
  • A common indication for total hip replacement
  • Etiology
    • Idiopathic (Perthes disease)
    • Trauma
      • Femoral head fracture
    • Chronic steroid
    • Alcoholism
    • Radiation
  • Clinical features
    • Insidious onset of pain
    • Affects both hips most of the time
  • Diagnosis: MRI
  • Treatment
    • Conservative
      • Bisphosphonates
      • Exercise
    • Surgery