July 4, 1977

Avascular Necrosis of the Femoral Head

Author Affiliations

Medical College of Virginia Virginia Commonwealth University Richmond

JAMA. 1977;238(1):29. doi:10.1001/jama.1977.03280010029013

To the Editor.—  The article by Drs Appell and Weiss (236:2886, 1976) entitled "Retroperitoneal Fibrosis and Avascular Necrosis of the Femoral Head" suggests an association between these two diseases.I am aware of only one other case report of this association, and it is in a recent article.1 However, the authors of that article state their patient admitted to the heavy use of alcohol. This admission could be highly significant, since another group listed alcoholism as the cause of avascular necrosis of the hip in 17% of their patients.2There are many theories as to the cause of avascular necrosis in alcoholics, but none are proved. One theory is that alcoholism produces a fatty liver, which in turn unleashes fatty emboli that eventually occlude the circulation to the femoral head.3 Systemic adrenocorticosteroids are known to produce avascular necrosis, probably in a similar manner. Possibly, the lipemia arises