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    Avascular Necrosis

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    BobyAnugrah
    A 20-year-old male with systemic lupus erythematosus (SLE) presented with left hip and knee pain that began after a fall. Imaging showed diffuse low signal in the left femoral head, neck, and shaft on MRI, consistent with avascular necrosis. Osteonecrosis, or avascular necrosis, is the death of bone cells due to loss of blood supply, and is a known complication in 5% of SLE patients. It leads to bone collapse if untreated. Treatment options range from rest for early-stage disease to surgical interventions like core decompression or joint replacement for later stages.

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    Avascular Necrosis

    Uploaded by

    BobyAnugrah
    78 views8 pages
    A 20-year-old male with systemic lupus erythematosus (SLE) presented with left hip and knee pain that began after a fall. Imaging showed diffuse low signal in the left femoral head, neck, and shaft on MRI, consistent with avascular necrosis. Osteonecrosis, or avascular necrosis, is the death of bone cells due to loss of blood supply, and is a known complication in 5% of SLE patients. It leads to bone collapse if untreated. Treatment options range from rest for early-stage disease to surgical interventions like core decompression or joint replacement for later stages.

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    A 20-year-old male with systemic lupus erythematosus (SLE) presented with left hip and knee pain that began after a fall. Imaging showed diffuse low signal in the left femoral head, neck, and shaft on MRI, consistent with avascular necrosis. Osteonecrosis, or avascular necrosis, is the death of bone cells due to loss of blood supply, and is a known complication in 5% of SLE patients. It leads to bone collapse if untreated. Treatment options range from rest for early-stage disease to surgical interventions like core decompression or joint replacement for later stages.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    78 views8 pages

    Avascular Necrosis

    Uploaded by

    BobyAnugrah
    A 20-year-old male with systemic lupus erythematosus (SLE) presented with left hip and knee pain that began after a fall. Imaging showed diffuse low signal in the left femoral head, neck, and shaft on MRI, consistent with avascular necrosis. Osteonecrosis, or avascular necrosis, is the death of bone cells due to loss of blood supply, and is a known complication in 5% of SLE patients. It leads to bone collapse if untreated. Treatment options range from rest for early-stage disease to surgical interventions like core decompression or joint replacement for later stages.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 8

    Osteonecrosis of the

    Femoral Head
    Matthew Orton
    Radiology Presentation
    7/20/2007

    HPI

    A 20 yo male with SLE reports to ER


    complaining of chronic L hip pain and
    new L knee pain that has not
    resolved since fall 1 week ago.
    PCP diagnosed SLE in 2004.
    Meds: Lisinoprol, Prednisone, Zantac,
    HCTZ, Imuran, Volteran,

    Sclerosis and density changes


    Crecent Sign = subcondral
    radiolucancy

    Loss of smooth spherical or collapse of


    femoral head.
    Joint space narrowing , degenerative changes.

    MRI of Femoral Head Osteonecrosis

    Coronal T1 MRI of
    both hips shows
    diffuse low signal
    throughout the left
    femoral head, neck,
    and proximal shaft.
    Axial T2 MRI of
    both hips shows
    diffuse high signal
    in the left femoral
    head consistent
    with the avascular
    necrosis.

    Images from: brighamrad.harvard.edu

    Osteonecrosis of Femoral Head

    Osteonecrosis = aseptic necrosis, avascular necrosis,


    ischemic necrosis and osteochondritis dessicans.
    Mechanism compromise of bone vasculature leading
    to death of bone and marrow cells and ultimately
    mechanical failure. Process is often progressive and
    results in joint destruction in 3-5 years if untreated.
    Exact pathogenesis still under debated. Some theories
    include intravascular necrosis, increased intraosseous
    pressure, mechanical stresses, or metabolic factors.

    Prevalence is 10,000-20,000 cases diagnosed in


    US/year. M:F = 8:1. 5% of patients with SLE will
    develop osteonecrosis.
    Staging

    Nontraumatic
    Corticosteroid
    Sickle cell
    Systemic lupus
    erythematosus
    Gauchers
    Disease
    Chronic renal
    failure or
    hemodialysis

    Radiation
    Stage 0 All diagnostic studies normal, diagnosis by
    histology
    Excessive ETOH
    Stage 1 Plain radiographs and computed tomography
    normal, magnetic resonance imaging positive and biopsy
    positive.
    Traumatic
    Stage 2 Radiographs positive but no collapse.
    Femoral Neck
    Stage 3 Early flattening of dome, crescent sign,
    Fracture
    computed tomography or tomograms may be needed.
    Stage 4 Flattening of femoral head with joint space
    Femoral
    narrowing, possible other signs of early osteoarthritis
    Dislocation

    Treatment of Osteonecrosis of
    Femoral Head

    Conservative management ( rest and pain


    control) if <15% femoral head involved.
    Bisphosphonates can slow progression
    Core decompression may slow
    progression.
    Osteotomy move areas of necrosis away
    from major load bearing and try to
    redistribute on healthy bone.
    Joint replacements (higher rate of
    complications and revisions)

    References
    1.

    2.

    3.

    Donohue, JP.UptoDate: Osteonecrosis


    (avascular necorsis of bone). 2007.
    Jones LC, Hungerford DS. Osteonecrosis:
    etiology, diagnosis, and treatment. Curr
    Opin Rheum 2004; 16: 443-449.
    Galindo M, Mateo I, Pablos JI. Multiple
    avasular necrossis of bone and
    polyarticular septic arthritis in patients
    with systemic lupus erythematosus.
    Rheumatol Int 2005; 25: 72-76.

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