skip to main content

Bilateral AVN Management — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateRheumatologyBilateral AVN ManagementRACP Adult Medicine

A 35-year-old woman with SLE develops avascular necrosis of both hips (bilateral femoral head involvement). She has been on prednisolone 20 mg daily for 3 years. MRI confirms bilateral AVN (Ficat stage II – pre-collapse). What is the most important management principle at this stage?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Reduce prednisolone as much as possible to prevent further progression

At Ficat stage II (pre-collapse – sclerosis/cysts visible on X-ray/MRI but no subchondral collapse), there is still potential to preserve the femoral head. Core decompression (drilling into the necrotic area to relieve intraosseous pressure and promote revascularisation) has the best outcomes at this stage. Equally important is reducing the corticosteroid dose to the minimum necessary, as ongoing high-dose corticosteroid exposure drives further AVN. Switching to steroid-sparing immunosuppression for SLE is a priority. Total hip arthroplasty is reserved for advanced (stage III–IV) disease with femoral head collapse.

Reference: eTG – 2025 – Rheumatology; ASBMR – 2022 – AVN Management