What causes avascular necrosis (AVN)?

Updated: Dec 05, 2020
  • Author: Sunny B Patel, MD; Chief Editor: Herbert S Diamond, MD  more...
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AVN may be primary or idiopathic. For AVN that is secondary or associated with an underlying condition or exposure, the following factors have been identified:

  • Systemic corticosteroid use or Cushing disease [13]
  • Trauma
  • Alcohol abuse
  • Systemic lupus erythematosus (with or without  antiphospholipid syndrome), as well as other connective-tissue diseases
  • Hemoglobinopathies or hemophilic disorders (eg, sickle cell disease, hemophilia A or B)
  • Osteoporosis medications (ie, bisphosphonates, denosumab)
  • Hyperlipidemia
  • Bone disorders (slipped capital femoral epiphysis, congenital dysplasia of the hip, Legg-Calve-Perthes disease)
  • Allogeneic bone marrow transplantation [16, 17]
  • Radiation therapy
  • Gaucher disease
  • Malignancy (marrow infiltration, malignant fibrous histiocytoma)
  • Caisson disease (uncommon diving-related decompression illness)
  • Pregnancy
  • Psoriasis [12]
  • Inflammatory bowel disease [18]

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