Coexistence between avascular necrosis of the femoral and humeral heads: An exploratory narrative review with systematic features

Abstract

Introduction: Avascular necrosis is a condition characterized by bone cell death secondary to interruption of blood supply. It primarily affects the femoral head and, to a lesser extent, the humeral head; however, evidence on the coexistence between both locations remains limited. Objective: This study aims to explore available evidence and describe clinical patterns, risk factors, and diagnostic strategies. Methodology: An exploratory narrative review was conducted following the PRISMA-ScR guidelines for systematic reviews. Articles published in PubMed over the last eight years were searched using terms related to avascular necrosis of the femoral and humeral heads. Observational studies and case reports were included for qualitative analysis. Result: Nine articles were included (six case reports and three observational studies). The reviewed literature described a coexistence of femoral and humeral head avascular necrosis, with the hip being the most common initial site. Chronic corticosteroid use was the predominantly documented risk factor for both locations. Magnetic resonance imaging was the diagnostic method reported as most useful. Discussion: The findings suggest maintaining clinical suspicion for humeral involvement in patients with femoral head avascular necrosis presenting systemic risk factors. However, data heterogeneity and the retrospective nature of the included studies limit the interpretation of results. Conclusion: This review documents the coexistence of femoral and humeral head avascular necrosis in the presence of risk factors. Prospective studies with greater statistical power are required to characterize this relationship and guide diagnostic and therapeutic strategies.