Avascular necrosis of the femoral head

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
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.

General

Risk factors:

Oral steroids, e.g. prednisone.^[1]
Cushing disease.
Cushing syndrome.
Radiation.
Sickle cell disease.^[2]

Gross

Features:^[3]

Wedge-shaped pale yellow abnormality below cartilage.
+/-Cartilage separates from the bone.
+/-Deformation of femoral head.

Image:

AVN (flickr.com).

Microscopic

Features:^[4]

Empty lacunae (indicative of necrotic bone).

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.

References

↑ 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.
↑ 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.

[1] URL: http://www.merckmanuals.com/professional/musculoskeletal_and_connective_tissue_disorders/osteonecrosis/osteonecrosis.html. Accessed on: 30 April 2012.

[2] 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.

[Ref_Lester224-3] Lester, Susan Carole (2005). Manual of Surgical Pathology (2nd ed.). Saunders. pp. 224. ISBN 978-0443066450.

[pmid20513874-4] 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.

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