Avascular Necrosis Follow-up

Updated: Oct 10, 2017
  • Author: Sunny B Patel, MD; Chief Editor: Herbert S Diamond, MD  more...
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Follow-up

Deterrence/Prevention

The following precautions can be taken to minimize the risk of developing avascular necrosis (AVN) and to improve outcomes in these patients:

  • Use the minimum effective dose of systemic corticosteroids; when possible, initiate use steroid-sparing agents
  • Early diagnosis and treatment are important; the earlier AVN is detected, the more treatment (and less invasive) options available to the patient
  • Provide patient education for high-risk patients
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Complications

See the list below:

  • The natural history of AVN involves subchondral necrosis, subchondral fracture and collapse of bone, deformity of the articular surface, and osteoarthritis.
  • In later stages, sclerosis and total destruction of the joint may occur.
  • Nonunion of fracture and secondary muscle wasting are potential complications.
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Prognosis

The prognosis of AVN depends on the disease stage at the time of diagnosis and the presence of any underlying conditions. More than 50% of patients with AVN require surgical treatment within 3 years of diagnosis. Half of patients with subchondral collapse of the femoral head develop AVN in the contralateral hip. [35]

Poor prognostic factors include the following:

  • Age older than 50 years
  • Advanced disease (stage 3 or worse) at the time of diagnosis
  • Necrosis of more than one third of the weight-bearing area of the femoral head on MRI
  • Lateral involvement of femoral head (compared with medial lesions)
  • Non-modifiable risk factors such as cumulative dose of corticosteroids (corticosteroid-induced AVN)
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Patient Education

See the list below:

  • Patients should discuss with their primary provider if they are at risk for AVN

  • Patients should be advised to report joint symptoms as soon as possible to facilitate early diagnosis and treatment

  • If possible, at risk patients or those with radiographic findings of AVN should be evaluated by a specialist (preferably Rheumatologist or Orthopedic Surgeon)

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