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Musculoskeletal > Avascular necrosis of the femur > Flashcards

Avascular necrosis of the femur Flashcards

1
Q

What is avascular necrosis of the femur?

A

This is a failure of blood supply to the femoral head

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2
Q

What are some possible causes of avascular necrosis of the femur?

A

Idiopathic
Trauma

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3
Q

What is the supposed pathophysiology of idiopathic avascular necrosis?

A
  • Coagulation of intraosseous microcirculation →
  • Venous thrombosis →
  • Retrograde arterial occlusion →
  • Intraosseous hypertension →
  • Decreased blood flow to femoral head →
  • Necrosis of the femoral head →
  • Chondral fractures and collapse
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4
Q

How can trauma lead to avascular necrosis of the femur>

A

Injury to the femoral head blood supply (medial femoral circumflex) causes necrosis

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5
Q

Who is most likely to develop avascular necrosis of the femur?

A

Males
Ages 35 - 50

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6
Q

What percentage of cases of avascular necrosis are bilateral?

A

80%

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7
Q

What are some factors that increase risk of avascular necrosis of the femur?

A
  • Irradiation (Radiotherapy)
  • Trauma
  • Haematologic disease (e.g. leukaemia, sickle cell)
  • Dysbaric disorders (e.g. The bends, Caisson disease)
  • Alcoholism
  • Steroid use
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8
Q

How will avascular necrosis of the femur usually present?

A

Insidious onset of groin pain, exacerbated by stairs or impact

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9
Q

What will examination show in avascular necrosis of the femur?

A

Examination is usually normal, unless the disease has advanced to collapse

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10
Q

What are some tests used in diagnosis of avascular necrosis of the femur?

A

MRI scan is the most sensitive and specific

Radiographs are often normal in early disease

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11
Q

What are the 6 stages of classification of avascular necrosis of the femur?

A
  • Stage 0 - Normal x-ray, normal MRI
  • Stage I - Normal x-ray, abnormal MRI
  • Stage II - Cystic or sclerotic changes on x-ray
  • Stage III - Crescent sign (Subchondral collapse) on x-ray
  • Stage IV - Flattening of femoral head on x-ray
  • Stage V - Narrowing of joint on x-ray
  • Stage VI - advanced degenerative changes on x-ray
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12
Q

Which stages of avascular necrosis of the femur are reversible?

A

Stages 0 - II

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13
Q

Which stages of avascular necrosis of the femur are irreversible?

A

Stages III - VI

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14
Q

How can reversible avascular necrosis of the femur be managed?

A
  • Biphosphonates
  • Core decompression ± Bone grafting
  • Curettage and bone grafting
  • Vascularised fibular bone graft
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15
Q

How is severe reversible or mild irreversible avascular necrosis of the femur managed?

A

Rotational osteotomy

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16
Q

How is irreversible disease managed in avascular necrosis of the femur?

A

Total hip replacement

Musculoskeletal (123 decks)

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