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September 5, 1977

Aseptic (Ischemic) Necrosis of the Femoral Head

JAMA. 1977;238(10):1059-1061. doi:10.1001/jama.1977.03280110063029

ASEPTIC (ischemic) necrosis of the femoral head may occur following trauma, without antecedent cause, with corticosteroid therapy, or may be associated with systemic disease. Greenfield1 has listed 54 entities that have been reported as causes of femoral head fragmentation. The major differential diagnostic considerations are listed in the Table.

An etiologic classification has been proposed by Edeiken et al.2 This divides the causes of ischemic necrosis into (1) vascular thrombosis, (2) diseases involving the vessel wall, (3) diseases of adjacent bone, and (4) traumatic and idiopathic causes. Although this classification is inherently logical, many of the etiologic subdivisions have been refuted by experimental data.

Clinical Symptoms  The early symptoms are usually nonspecific and consist of pain in the groin or buttock. The pain may radiate to the anterior thigh or knee. Later in the course of the untreated disorder, the symptoms increase in severity, and limp, limitation of