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Pathophysiology of Avascular Necrosis of the Femoral Head

  • E. De Santis
  • L. Proietti
  • V. De Santis
  • G. Falcone

Abstract

The interruption of arterial blood flow in the superior segment of the femoral epiphysis is a common event in pathological conditions, e.g., gas embolism in Caisson disease, traumatic vessel injuries in neck femoral fractures or hip dislocation, vascular occlusion in Gaucher’s disease, sickle cell anemia, and radiation exposure. When arterial blood impairment occurs without a documented etiology, the term idiopathic avascular necrosis must be employed.

Keywords

Femoral Head Articular Cartilage Synovial Membrane Ischemic Event Avascular Necrosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Reference

  1. 1.
    Mont MA, Hungerford DS (1995) Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am 77:459–474PubMedGoogle Scholar
  2. 2.
    Chandler FA (1948) Coronary disease of the hip. J Int Coll Surg 11:34–36PubMedGoogle Scholar
  3. 3.
    Merle d’Aubignè R, Postel M, Mazabraud A et al (1965) Idiopathic necrosis of the femoral head in adults. J Bone Joint Surg Br 47:612–633PubMedGoogle Scholar
  4. 4.
    Boettcher WG, Bonfiglio M, Hamilton HH et al (1970) Non-traumatic necrosis of the femoral head. I. Relation of altered hemostasis to etiology. J Bone Joint Surg Am 52:312–321PubMedGoogle Scholar
  5. 5.
    Fisher DE, Bickel WH, Holley KE (1969) Demonstration of fat emboli in aseptic necrosis associated with hypercortisonism. Mayo Clin Proc 44:252–259PubMedGoogle Scholar
  6. 6.
    Fisher DE, Bickel WH, Holley KE, Ellefson RD (1972) Corticosteroid-induced aseptic necrosis. II. Experimental study. Clin Orthop 84:200–206PubMedCrossRefGoogle Scholar
  7. 7.
    Cruess RL, Ross D, Crawshaw E (1975) The etiology of steroid-induced avascular necrosis of bone. A laboratory and clinical study. Clin Orthop 113:178–183CrossRefGoogle Scholar
  8. 8.
    Fisher DE (1978) The role of fat embolism in the etiology of corticosteroid-induced avascular necrosis: clinical and experimental results. Clin Orthop 130:68–80PubMedGoogle Scholar
  9. 9.
    Korompilias AV, Gilkeson GS, Seaber AV, Urbaniak JR (2001) Hemorrhage and thrombus formation in early experimental osteonecrosis. Clin Orthop 386:11–18PubMedCrossRefGoogle Scholar
  10. 10.
    Glueck CJ, Freiberg RA, Fontaine RN et al (2001) Hypofibrinolysis, thrombophilia, osteonecrosis. Clin Orthop 386:19–33PubMedCrossRefGoogle Scholar
  11. 11.
    Jones JP Jr, Sakovich L (1966) Fat embolism of bone. A roentgenographic and histological investigation, with use of intra-arterial lipiodol, in rabbits. J Bone Joint Surg Am 48:149–164PubMedGoogle Scholar
  12. 12.
    Jones JP Jr (1992) Intravascular coagulation and osteonecrosis. Clin Orthop 277:41–53PubMedGoogle Scholar
  13. 13.
    Jones JP Jr, Engleman EP (1966) Osseous avascular necrosis associated with systemic abnormalities. Arthritis Rheum 9:728–736PubMedCrossRefGoogle Scholar
  14. 14.
    Fisher DE, Bickel WH (1971) Corticosteroid-induced avascular necrosis. A clinical study of seventy-seven patients. J Bone Joint Surg Am 53:859–873PubMedGoogle Scholar
  15. 15.
    De Santis E, Nizegorodcew T, De Vecchis L (1978) Non traumatic aseptic ischemic necrosis of the femur head in the adult (clinico-pathologic observations and therapeutic evaluation of a review of 33 cases). Arch Putti Chir Organi Mov 29:181–208PubMedGoogle Scholar
  16. 16.
    Jones JP Jr (1971) Alcohlism, hypercortisonism, fat embolism and osseous avascular necrosis. In: Zimm WM (ed) Idiopathic ischemic necrosis of the femoral head in adults. University Park Press, Baltimore, pp 112–132Google Scholar
  17. 17.
    Miyanishi K, Yamamoto T, Irisa T et al (2002) Bone marrow fat cell enlargement and a rise in intraosseous pressure in steroid-treated rabbits with osteonecrosis. Bone 30:185–190PubMedCrossRefGoogle Scholar
  18. 18.
    Wang GJ, Sweet DE, Reger SI, Thompson RC (1977) Fat-cell changes as a mechanism of avascular necrosis of the femoral head in cortisone-treated rabbits. J Bone Joint Surg Am 59:729–735PubMedGoogle Scholar
  19. 19.
    Wang GJ, Lennox DW, Reger SI et al (1981) Cortisone-induced intrafemoral head pressure change and its response to a drilling decompression method. Clin Orthop 159:274–278PubMedGoogle Scholar
  20. 20.
    Starklint H, Lausten GS, Arnoldi CC (1995) Microvascular obstruction in avascular necrosis. Immunohistochemistry of 14 femoral heads. Acta Orthop Scand 66:9–12PubMedCrossRefGoogle Scholar
  21. 21.
    Ohzono K, Takaoka K, Saito S et al (1992) Intraosseous arterial architecture in non-traumatic avascular necrosis of the femoral head. Microangiographic and histologic study. Clin Orthop 277:79–88Google Scholar
  22. 22.
    Theron J (1977) Superselective angiography of the hip. Technique, normal features, and early results in idiopathic necrosis of the femoral head. Radiology 124:649–657PubMedGoogle Scholar
  23. 23.
    Laurent J, Meunier P, Courpron P et al (1973) Research on the pathogenesis of aseptic necrosis of the femoral head. Evaluation of the constitutional bony factors in 35 cases of iliac crest biopsy. Nouv Presse Med 30:1755–1760Google Scholar
  24. 24.
    Zinn WM (1971) Idiopathic ischaemic necrosis of the femoral head in adults. Mod Trends Rheumatol 2:348–365PubMedGoogle Scholar
  25. 25.
    Kenzora JE, Steele RE, Yosipovitch ZH, Glimcher MJ (1978) Experimental osteonecrosis of the femoral head in adult rabbits. Clin Orthop 130:8–46PubMedGoogle Scholar
  26. 26.
    Glimcher MJ, Kenzora JE (1979) The biology of osteonecrosis of the human femoral head and its clinical implications. 1. Tissue biology. Clin Orthop 138:284–309Google Scholar
  27. 27.
    Bonar LC, Glimcher MJ (1970) Thermal denaturation of mineralized and demineralized bone collagens. J Ultrastruct Res 32:545–548PubMedCrossRefGoogle Scholar
  28. 28.
    Bonucci E (1981) New knowledge on the origin, function and fate of osteoclasts. Clin Orthop 158:252–269PubMedGoogle Scholar
  29. 29.
    Calandruccio RA, Anderson WE 3rd (1980) Post-fracture avascular necrosis of the femoral head: correlation of experimental and clinical studies. Clin Orthop 152:49–84PubMedGoogle Scholar
  30. 30.
    De Santis E, Fabbriciani C (1981) Osteochondrosis dissecans of the knee in juveniles. Arch Putti Chir Organi Mov 31:35–53PubMedGoogle Scholar
  31. 31.
    Fineschi G, De Santis E (1982) La osteonecrosis idiopatica della testa femorale: patogenesi e fisiopatologia. LXVII Congresso SIOT, 20-23 October, TurinGoogle Scholar

Copyright information

© Springer-Verlag Italia 2004

Authors and Affiliations

  • E. De Santis
    • 1
  • L. Proietti
    • 1
  • V. De Santis
    • 1
  • G. Falcone
    • 1
  1. 1.Orthopaedic DepartmentCatholic UniversityRomeItaly

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