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Osteonecrosis
Avascular necrosis; Bone infarction; Ischemic bone necrosis; AVN; Aseptic necrosis
Osteonecrosis is bone death caused by poor blood supply. It is most common in the hip and shoulder, but can affect other large joints such as the knee, elbow, wrist and ankle.
Causes
Osteonecrosis occurs when part of the bone does not get blood and dies. After a while, the bone can collapse. If osteonecrosis is not treated, the joint deteriorates, leading to severe arthritis.
Osteonecrosis can be caused by disease or by severe trauma, such as a fracture or dislocation , that affects the blood supply to the bone. Osteonecrosis can also occur without trauma or disease. This is called idiopathic -- meaning it occurs without any known cause.
Fracture
If more pressure is put on a bone than it can stand, it will split or break. A break of any size is called a fracture. If the broken bone punctures...
Dislocation
A dislocation is a separation of 2 bones where they meet at a joint. Joints are areas where 2 bones come together. A dislocated joint is a joint whe...
The following are possible causes:
- Using oral or intravenous steroids
- Excessive alcohol use
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Sickle cell disease
Sickle cell disease
Sickle cell anemia is a disease passed down through families. The red blood cells that are normally shaped like a disc take on a sickle or crescent ...
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Radiation therapy
Radiation therapy
Radiation therapy uses high-powered x-rays, particles, or radioactive seeds to kill cancer cells.
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Gaucher disease
Gaucher disease
Gaucher disease is a rare genetic disorder in which a person lacks an enzyme called glucocerebrosidase (GBA).
ImageRead Article Now Book Mark Article - Decompression sickness from a lot of deep sea diving
- Dislocation or fractures around a joint
- Clotting disorders
- HIV or taking HIV drugs
When osteonecrosis occurs in the shoulder joint, it is usually due to long-term treatment with steroids or a history of trauma to the shoulder.
Legg-Calvé-Perthes disease is a similar condition seen in children and adolescents.
Legg-Calvé-Perthes disease
Legg-Calve-Perthes disease occurs when the ball of the thigh bone in the hip does not get enough blood, causing the bone to die.
Symptoms
There are no symptoms in the early stages. As bone damage worsens, you may have the following symptoms:
- Pain in the joint that may increase over time and becomes severe if the bone collapses
- Pain that occurs even at rest
- Limited range of motion
- Groin pain, if the hip joint is affected
- Limping, if the condition occurs in or below the hip
Exams and Tests
Your health care provider will do a physical exam to find out if you have any diseases or conditions that may affect your bones. You will be asked about your symptoms and medical history.
Be sure to let your provider know about any medicines or vitamin supplements you are taking, even over-the-counter medicine.
After the exam, your provider will order one or more of the following tests:
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X-ray
X-ray
X-rays are a type of electromagnetic radiation, just like visible light. An x-ray machine sends individual x-ray particles through the body. The im...
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MRI
MRI
A magnetic resonance imaging (MRI) scan is an imaging test that uses powerful magnets and radio waves to create pictures of the body. It does not us...
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Bone scan
Bone scan
A bone scan is an imaging test used to diagnose bone diseases and find out how severe they are.
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CT scan
CT scan
A computed tomography (CT) scan is an imaging method that uses x-rays to create pictures of cross-sections of the body. Related tests include:Abdomin...
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Treatment
If your provider knows the cause of osteonecrosis, part of the treatment will be aimed at the underlying condition. For example, if a blood clotting disorder is the cause, treatment will consist, in part, of clot-dissolving medicine.
If the condition is caught early, you will take pain relievers and limit use of the affected area. This may include using crutches if your hip, knee, or ankle is affected. You may need to do range-of-motion exercises. Nonsurgical treatment can often slow the progression of osteonecrosis, but most people will need surgery.
Surgical options include:
-
A
bone graft
Bone graft
A bone graft is surgery to place new bone or bone substitutes into spaces around a broken bone or bone defects.
ImageRead Article Now Book Mark Article - A bone graft along with its blood supply (vascularized bone graft)
- Cutting the bone and changing its alignment to relieve stress on the bone or joint (osteotomy)
- Total joint replacement
- Removing part of the inside of the bone (core decompression) to relieve pressure and allow new blood vessels to form
Support Groups
You can find more information and support resources at the following organizations:
- National Osteonecrosis Foundation -- www.nonf.org
- The Arthritis Foundation -- www.arthritis.org
Outlook (Prognosis)
How well you do depends on the following:
- The cause of the osteonecrosis
- Stage of the disease when it was diagnosed
- Amount of bone involved
- Your age and overall health
Outcome can vary from complete healing to permanent damage in the affected bone.
Possible Complications
Advanced osteonecrosis can lead to osteoarthritis and permanent decreased mobility. Severe cases may require joint replacement.
Osteoarthritis
Osteoarthritis (OA) is the most common joint disorder. It is due to aging and wear and tear on a joint.
When to Contact a Medical Professional
Call your provider if you have symptoms.
Prevention
Many cases of osteonecrosis do not have a known cause, so prevention may not be possible. In some cases, you can reduce your risk by doing the following:
- Avoid drinking excessive amounts of alcohol.
- When possible, avoid high doses and long-term use of corticosteroids.
- Dive safely to avoid decompression sickness.
References
McAlindon T, Ward RJ. Osteonecrosis. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology . 6th ed. Philadelphia, PA: Elsevier Mosby; 2015:chap 184.
Whyte MP. Osteonecrosis, osteosclerosis/hyperstosis, and other disorders of the bone. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 248.
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Aseptic necrosis - illustration
Aseptic necrosis is bone death caused from a disruption in the blood supply. It is most common in the hip, knee, and shoulder.
Aseptic necrosis
illustration
Review Date: 5/9/2015
Reviewed By: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
