Abstract
Background
Avascular necrosis (AVN) of the femoral head is a severe, non-traumatic complication strongly associated with long-term corticosteroid use. Steroid-induced AVN remains poorly understood, with wide variation in reported incidence, timing of onset, and patient-specific risk factors. This systematic review evaluates current evidence on the relationship between prolonged corticosteroid exposure and the development of femoral head AVN.
Method
PubMed was searched systematically in accordance with PRISMA standards. Eligible studies included original research published within the past 10 years examining patients who developed AVN following chronic corticosteroid therapy. Eleven studies met the inclusion criteria and were incorporated into the final synthesis.
Results
Across the reviewed literature, corticosteroid-associated AVN was linked to decreased osteogenesis, increased intraosseous pressure, intramedullary adipocyte expansion, and microvascular occlusion, collectively impairing blood flow to the femoral head. Most cases occurred within the first three months of steroid exposure and were reported in high-dose and low-dose regimens, particularly among individuals with underlying autoimmune disease or transplant history. AVN of the femoral head can lead to significant morbidity, including pain, gait abnormalities, reduced range of motion, fractures, and progressive joint degeneration. Early diagnosis remains challenging due to limited predictive factors, genetic variability, and reliance on costly imaging modalities.
Conclusion
Current interventions include hyperbaric oxygen therapy and pharmacologic options such as bisphosphonates, which may reduce symptoms and delay progression. However, no established preventive therapy exists. Future research should prioritize prospective studies that track steroid-treated patients over time to clarify dose-response relationships, identify early biomarkers, and define patient-specific risk profiles to improve early detection and outcomes.
