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Avascular Necrosis caused by corticosteroids


I was initially instructed by the Claimant (a male aged 49) whom had developed side-effects (ITP) which it was thought might be connected to a smoking cessation drug – Zyban. Having obtained a report from a consultant pharmacologist it became apparent that he had in fact been overdosed with corticosteroids. The case pursued thereafter was a complex clinical negligence claim relating to the Claimant being prescribed corticosteroid treatment (prednisolone) to treat ITP (idiopathic thrombocytopenic purpura) leading to musculoskeletal problems in the form of multifocal avascular necrosis.

It was suggested by the Claimant’s experts that he had been prescribed prednisolone for too long and that the level which was too high (the Claimant’s medical team considered the total dosage had been over 7,000 mg). Both side’s experts were in agreement that the corticosteroid treatment had caused the osteonecrosis however, there was a significant dispute as to how much more severe the avascular necrosis was as a result of the higher dosage levels and whether the Claimant could have suffered avascular necrosis in any event due to the medication. It was accepted by both teams of experts that corticosteroids can cause osteonecrosis.

The Claimant’s case was therefore that the avascular necrosis had been wholly caused by the excessive prescription of corticosteroids and/or alternatively, if was found that some avascular necrosis could have developed in any event at normal dosage levels, the excessive prescription caused or materially contributed to multifocal lesions and therefore his condition to become far worse as a result.


Multi-focal avascular necrosis in both hips, both shoulders and right knee as a result of which, he underwent resurfacing hermiarthroplasty of his left shoulder, a right shoulder arthroplasty plus subacromial decompression with ACJ excision, resurfacing total hip replacement on the right and a core decompression on the left hip and right distal femur and is being reviewed for a total left knee replacement.


Settlement prior to Trial agreed at £ 750,000 global offer + £ 38,374.40 to be repaid to the CRU.

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