Avascular necrosis - hip joints
Bilateral hip pain with the history of steroid use.
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Frontal pelvic radiograph shows marked ﬂatening and sclerosis of both femoral heads representing advanced avascular necrosis (Ficat stage IV).
The femoral head is the most common location for AVN to occur. Etiology of the avascular necrosis can be remembered by the following mnemonic:
- Gaucher disease
- Idiopathic (Legg-Calvé-Perthes, Köhler, Chandler)
- Vasculitis (SLE, polyarteritis nodosa, rheumatoid arthritis)
- Environmental (frostbite, thermal injury)
- Neoplasia (associated coagulopathy)
- Fat (prolonged corticosteroid use increases marrow)
- Renal failure and dialysis
- Caisson disease
- Trauma (femoral neck fracture, hip dislocation)
- Sickle cell disease