“…Postoperative HHO has been reported after arthroscopic débridement and rotator cuff repair in patients with no known risk factors for osteonecrosis. 9 , 17 Other uncommon etiologies of atraumatic HHO reported in the literature include fat embolism secondary to pancreatitis, 36 hypofibrinolysis and thrombophilic state induced by estrogen excess in pregnant women, 2 , 15 smoking, 53 chemotherapy (bevacizumab), 45 and radiation exposure. 52 Patients with systemic lupus erythematosus (SLE) are at greater risk for developing osteonecrosis, and SLE has been considered an independent risk factor for osteonecrosis.…”