Question
My 14 year old daughter was recently diagnosed with Avascular Necrosis in a "small" area of her right hip following a right hip fracture that happened when she was 13.  Her current doctor said that if the area is small enough, we could "wait and see".  Shouldn't she be treated more aggressively?  Once it's started, how likely is it that it will extend throughout her femur bone?  Also, any suggestions for an excellent pediatric orthopedic doctor?  Thanks.

Answer
Kelly

I had AVN at age 14 resulting from the use of prednisone for a kidney transplant.  It's been my experience that AVN is not a reversible illness and may become worse as she ages.

You really need to get her to a place that specializes in this type of disease.  I would suggest three places.  In New York, you should look at the Hospital of Bone and Joint Diseases or the Hospital of Special Surgery.  In Arlington VA, you can look at the Anderson Clinic which is run by Charles Engh.  The Anderson Clinic may have changed names and may be known as Inova Clinic now.  They work out of Mount Vernon Hospital in Arlington VA.

Those are the best places I can think of.

If those places are not convenient for you, please look at the largest teaching hospital in your area.  Teaching hospitals are on the cutting edge of technology and can be the best resources for you.

When I was treated, I was treated by orthopedists who worked with pediatric nephrologists to figure out the best course of treatment for me so it's important that all your daughters doctors are on the same page in her healthcare.  I would be sure to ask her doctors to look at her vitamin D and calcium levels, and to take bone density scans to ensure that her bones are not at risk for further deterioration.

I hope I have answered your questions, if you would like further clarification please contact me again.

Sharon