Short-term corticosteroids and avascular necrosis: medical and legal realities

Short-term corticosteroids (CSs), most commonly defined as short-term prednisone (STP) 40 to 60 mg or its equivalent, either tapered or level, prescribed over a few days to 3 weeks (total dose, 400-600 mg), often are used to treat acute and self-limiting diseases. Serious side effects, though uncommon, can occur; however, they receive little attention. The literature contains scattered case reports and legal cases that highlight the relationship between STP and avascular necrosis (AVN). The orthopedic literature finds that CSs are one of the most common causes of AVN. An Internet search of AVN identifies several commercial pages prepared for lawyers that describe references and supplies relevant to initiating lawsuits. Court cases consistently find that patients must be informed of treatment risks and options. Informed consent and thorough documentation are required when prescribing STP.