osteonecrosis

You would know as a hip arthroplasty doctor, atypical femur fractures, they're quite rare.

osteonecrosis of the jaw, it's quite rare, like on the low number, one in 100,000, but there's actually, it may not even be that high.

The risk is a little, I'm talking about bisphosphonates, the risk is a little higher of AVN on the jaw if bisphosphonates are being used in the setting of cancer treatment, like women on aromatase inhibitors get put on kind of a more frequent dose.

But so in any case, yes, the benefits are, do heavily outweigh the risk, massive reduction in future fracture risk, which has then a significant association with death.

Fractures, a couple of years after a hip fracture, approximately 30% of people are dead.

There's a medication called Avenity, which is a once-monthly injection for a year that has been shown to make it more effective to do a year of Avenity than a bisphosphonate, than just a bisphosphonate, for example.

There's, of course, Prolia as another example.

Prolia may also have some AVN risk.

These are the true things you can't miss, the eight, or actually seven, but there's eight orthopedic medical emergencies.

Open fractures or dislocations, hip dislocations, because the risk of AVN, neural compromise, especially when it comes to spinal cord injuries, acute septic arthritis and osteomyelitis, compartment syndrome, vascular injuries to include knee dislocations, and then pelvic fractures or exsanguinating pelvic fractures.

That eighth one is traumatic amputations, which is not really demonstrated on this slide.

I wanna say if at any time I am going too fast, let me know.

He's got full motion, no pain, and he's got his life back.

He wants the other side done, to Dr. Givens' point, because this, unfortunately, when you get this AVN, it hits all your joints.

Hopefully it doesn't hit every single one, but it's a terrible problem.

The other guy who's a police officer, you know, I'm in Tampa, Hillsborough County, great sheriff's department.

Yes.

In Loader's original series, which has been corroborated by decades of subsequent registry data, stable slips have an AVN rate approaching zero.

It's incredibly rare.

Unstable slips, conversely, carry an AVN rate that can soar as high as 50%.

50 percent.

That is terrifying.

Their work demonstrated that in expert hands, and that caveat is non-negotiable, it must be an expert hip preservation surgeon performing a high volume of these cases.

The modified DUNN procedure successfully restores normal proximal femoral anatomy and demonstrate a remarkable preservation of the blood supply.

as it should be.

In this patient, he's flagged for us that he's at, probably has a retinopathy, but he also flagged for us that he could have AVN.

And so we'll talk as I understand more about his pain, the frequency, how he's using to treat it.

I would tell him even the first visit, let's go in a stepwise fashion.