Difference between revisions of "Avascular necrosis of the femoral head"
Jump to navigation
Jump to search
| (13 intermediate revisions by the same user not shown) | |||
| Line 15: | Line 15: | ||
| Grossing = | | Grossing = | ||
| Site = [[femoral head]] | | Site = [[femoral head]] | ||
| Assdx = | | Assdx = +/-[[sickle cell disease]] | ||
| Syndromes = | | Syndromes = | ||
| Clinicalhx = +/-oral steroids, +/-radiation | | Clinicalhx = +/-oral steroids, +/-radiation | ||
| Line 31: | Line 31: | ||
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 39: | Line 41: | ||
*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> | *[[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 52: | 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 - indicative of necrotic bone. | *Empty lacunae - indicative of necrotic bone (osteonecrosis). | ||
*Degnerative changes of the cartilage overlying the necrotic bone.<ref name=pmid15885478/> | |||
DDx: | 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> | *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> | ||
| Line 98: | 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== | ||
Latest revision as of 12:09, 30 May 2014
| Avascular necrosis of the femoral head | |
|---|---|
| Diagnosis in short | |
 Necrotic bone in a case of AVN. H&E stain. | |
|
| |
| LM | bone with empty lacunae (indicative of necrosis) |
| Site | femoral head |
|
| |
| Associated Dx | +/-sickle cell disease |
| Clinical history | +/-oral steroids, +/-radiation |
| Symptoms | pain |
| Prevalence | uncommon |
| Prognosis | benign |
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.
In children idiopathic AVN of the of capital femoral epiphysis is known as Legg–Calvé–Perthes disease.[1]
General
Risk factors:
- Oral steroids, e.g. prednisone.[2]
- Cushing disease.
- Cushing syndrome.
- Radiation.
- Sickle cell disease.[3]
Clinical:
Gross
Features:[6]
- Wedge-shaped pale yellow abnormality below cartilage.
- +/-Cartilage separates from the bone.
- +/-Deformation of femoral head.
Image:
Microscopic
Features:[7]
- Empty lacunae - indicative of necrotic bone (osteonecrosis).
- Degnerative changes of the cartilage overlying the necrotic bone.[4]
DDx:
- Suboptimal tissue fixation.[8]
Images
AVN - intermed. mag. (WC/Nephron)
AVN - high mag. (WC/Nephron)
AVN - very high mag. (WC/Nephron)
Sign out
FEMORAL HEAD, RIGHT, HIP ARTHROPLASTY: - AVASCULAR NECROSIS OF THE FEMORAL HEAD.
AVN and degenerative joint disease
FEMORAL HEAD AND JOINT CAPSULE, LEFT, HIP ARTHROPLASTY: - AVASCULAR NECROSIS OF THE FEMORAL HEAD. - DEGENERATIVE JOINT DISEASE WITH MILD SYNOVITIS AND VILLOUS HYPERPLASIA. - NEGATIVE FOR MALIGNANCY.
FEMORAL HEAD AND JOINT CAPSULE, RIGHT, HIP ARTHROPLASTY: - AVASCULAR NECROSIS OF THE FEMORAL HEAD. - DEGENERATIVE JOINT DISEASE. - BENIGN JOINT CAPSULE TISSUE. - NEGATIVE FOR MALIGNANCY.
Remote AVN
FEMORAL HEAD AND JOINT CAPSULE, LEFT, HIP ARTHROPLASTY: - FEMORAL HEAD WITH DEGENERATIVE JOINT DISEASE AND MARKED DEFORMATION CONSISTENT WITH A HISTORY OF AVASCULAR NECROSIS. - JOINT CAPSULE WITH MINIMAL CHRONIC INFLAMMATION.
Micro
The sections show a femoral head with loss of cartilage and focal vertical cleft formation in the remaining thinned cartilage. Subchondral sclerosis is present. The underlying bone is viable. Bone marrow is present. The red blood cells have a sickled morphology.
Joint capsule tissue with focal lymphocytes and plasma cells is present.
Remote AVN with focal lesion
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.
See also
References
- ↑ Shah H (January 2014). "Perthes disease: evaluation and management". Orthop. Clin. North Am. 45 (1): 87–97. doi:10.1016/j.ocl.2013.08.005. PMID 24267210.
- ↑ URL: http://www.merckmanuals.com/professional/musculoskeletal_and_connective_tissue_disorders/osteonecrosis/osteonecrosis.html. Accessed on: 30 April 2012.
- ↑ Al Omran, A. (May 2013). "Multiple drilling compared with standard core decompression for avascular necrosis of the femoral head in sickle cell disease patients.". Arch Orthop Trauma Surg 133 (5): 609-13. doi:10.1007/s00402-013-1714-9. PMID 23494112.
- ↑ 4.0 4.1 Magnussen, RA.; Guilak, F.; Vail, TP. (May 2005). "Cartilage degeneration in post-collapse cases of osteonecrosis of the human femoral head: altered mechanical properties in tension, compression, and shear.". J Orthop Res 23 (3): 576-83. doi:10.1016/j.orthres.2004.12.006. PMID 15885478.
- ↑ McCarthy, J.; Puri, L.; Barsoum, W.; Lee, JA.; Laker, M.; Cooke, P. (Jan 2003). "Articular cartilage changes in avascular necrosis: an arthroscopic evaluation.". Clin Orthop Relat Res (406): 64-70. doi:10.1097/01.blo.0000043045.84315.d9. PMID 12579001.
- ↑ Lester, Susan Carole (2005). Manual of Surgical Pathology (2nd ed.). Saunders. pp. 224. ISBN 978-0443066450.
- ↑ Steffen, RT.; Athanasou, NA.; Gill, HS.; Murray, DW. (Jun 2010). "Avascular necrosis associated with fracture of the femoral neck after hip resurfacing: histological assessment of femoral bone from retrieval specimens.". J Bone Joint Surg Br 92 (6): 787-93. doi:10.1302/0301-620X.92B6.23377. PMID 20513874.
- ↑ Fondi, C.; Franchi, A. (Jan 2007). "Definition of bone necrosis by the pathologist.". Clin Cases Miner Bone Metab 4 (1): 21-6. PMID 22460748.