Avascular necrosis: Difference between revisions
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{{Infobox medical condition | |||
| name = Avascular necrosis | |||
| image = [[File:Head_of_femur_avascular_necrosis.jpg|250px]] | |||
| caption = Avascular necrosis of the head of the femur | |||
| synonyms = Osteonecrosis, bone infarction, aseptic necrosis, ischemic bone necrosis | |||
| specialty = [[Orthopedic surgery]], [[Rheumatology]] | |||
| symptoms = [[Joint pain]], limited range of motion | |||
| complications = [[Osteoarthritis]], joint collapse | |||
| onset = Gradual | |||
| duration = Long-term | |||
| causes = [[Trauma]], [[steroid use]], [[alcoholism]], [[sickle cell disease]], [[Gaucher's disease]], [[lupus]] | |||
| risks = [[Smoking]], [[radiation therapy]], [[chemotherapy]] | |||
| diagnosis = [[X-ray]], [[MRI]], [[CT scan]] | |||
| differential = [[Arthritis]], [[fracture]], [[bone infection]] | |||
| prevention = Avoidance of risk factors | |||
| treatment = [[Medication]], [[physical therapy]], [[surgery]] | |||
| medication = [[Bisphosphonates]], [[anticoagulants]], [[statins]] | |||
| prognosis = Variable, depends on stage and treatment | |||
| frequency = 10,000 to 20,000 cases per year in the United States | |||
}} | |||
== Pronunciation == | == Pronunciation == | ||
Ay-VAS-kyoo-ler neh-KROH-sis | Ay-VAS-kyoo-ler neh-KROH-sis | ||
[[File:Osteonecrosis femur 2img.jpg|alt=Osteonecrosis femur|thumb|Osteonecrosis femur]] | [[File:Osteonecrosis femur 2img.jpg|alt=Osteonecrosis femur|left|thumb|Osteonecrosis femur]] | ||
== Definition == | == Definition == | ||
'''Avascular necrosis''' ( is a condition in which there is a loss of [[blood flow]] to bone tissue, which causes the bone to [[die]]. | '''Avascular necrosis''' ( is a condition in which there is a loss of [[blood flow]] to bone tissue, which causes the bone to [[die]]. | ||
| Line 16: | Line 37: | ||
== Bones affected== | == Bones affected== | ||
It is most common in the [[hips]], [[knees]], [[shoulders]], and [[ankles]]. | It is most common in the [[hips]], [[knees]], [[shoulders]], and [[ankles]]. | ||
==Causes== | ==Causes== | ||
* It may be caused by long-term use of [[steroid medicines]], [[alcohol abuse]], joint injuries, and certain diseases, such as [[cancer]] and [[arthritis]]. | * It may be caused by long-term use of [[steroid medicines]], [[alcohol abuse]], joint injuries, and certain diseases, such as [[cancer]] and [[arthritis]]. | ||
* It may also occur at some point in time after [[cancer]] treatment that included [[methotrexate]], [[bisphosphonates]], or [[corticosteroids]]. | * It may also occur at some point in time after [[cancer]] treatment that included [[methotrexate]], [[bisphosphonates]], or [[corticosteroids]]. | ||
[[File:Head of femur avascular necrosis ligamentum.jpg|alt=Head of femur avascular necrosis ligamentum|thumb|Head of femur avascular necrosis ligamentum]] | [[File:Head of femur avascular necrosis ligamentum.jpg|alt=Head of femur avascular necrosis ligamentum|left|thumb|Head of femur avascular necrosis ligamentum]] | ||
== Signs and symptoms == | == Signs and symptoms == | ||
* Osteonecrosis may be asymptomatic when it first develops. | * Osteonecrosis may be asymptomatic when it first develops. | ||
| Line 27: | Line 47: | ||
* Pain caused by osteonecrosis may be mild or severe. | * Pain caused by osteonecrosis may be mild or severe. | ||
* If it causes your bone and joint to collapse, you may have severe pain and not be able to use the joint. | * If it causes your bone and joint to collapse, you may have severe pain and not be able to use the joint. | ||
[[File:Crescentsign.jpg|alt=Crescent sign|thumb|Crescent sign]] | [[File:Crescentsign.jpg|alt=Crescent sign|left|thumb|Crescent sign]] | ||
== Investigations == | == Investigations == | ||
Investigations include imaging studies, blood work, [[bone scan]] and rarely [[bone biopsy]]. | Investigations include imaging studies, blood work, [[bone scan]] and rarely [[bone biopsy]]. | ||
| Line 35: | Line 55: | ||
* Bone scan. | * Bone scan. | ||
* Bone biopsy. | * Bone biopsy. | ||
== Treatment == | == Treatment == | ||
Treatment depends on the bone affected, and the persons age, and other medical conditions, and the cause. | Treatment depends on the bone affected, and the persons age, and other medical conditions, and the cause. | ||
| Line 42: | Line 61: | ||
* Stop further damage. | * Stop further damage. | ||
* Protect bones and joints. | * Protect bones and joints. | ||
[[File:Osteoradionecrosis 04.jpg|alt=Osteoradionecrosis |thumb|Osteoradionecrosis ]] | [[File:Osteoradionecrosis 04.jpg|alt=Osteoradionecrosis |left|thumb|Osteoradionecrosis ]] | ||
The treatment options may include surgery or nonsurgical treatments, such as medicines. Factors affecting treatment include: | The treatment options may include surgery or nonsurgical treatments, such as medicines. Factors affecting treatment include: | ||
* Your age. | * Your age. | ||
| Line 48: | Line 67: | ||
* Where and how much bone has osteonecrosis. | * Where and how much bone has osteonecrosis. | ||
* The cause, if known. If the cause is steroid or alcohol use, treatment may not work unless you stop using those substances. | * The cause, if known. If the cause is steroid or alcohol use, treatment may not work unless you stop using those substances. | ||
=== Nonsurgical Treatments === | === Nonsurgical Treatments === | ||
Non-surgical treatments do not cure osteonecrosis, but they may help manage the disease. Your doctor may recommend one or more non-surgical treatments, especially if the disease is in its early stages. | Non-surgical treatments do not cure osteonecrosis, but they may help manage the disease. Your doctor may recommend one or more non-surgical treatments, especially if the disease is in its early stages. | ||
==== Medications ==== | ==== Medications ==== | ||
* '''Nonsteroidal anti-inflammatory drugs''' (NSAIDs) are used to reduce pain and swelling. | * '''Nonsteroidal anti-inflammatory drugs''' (NSAIDs) are used to reduce pain and swelling. | ||
* If you have blood-clotting problems, '''blood thinners''' may be used to prevent clots that block the blood supply to the bone. | * If you have blood-clotting problems, '''blood thinners''' may be used to prevent clots that block the blood supply to the bone. | ||
* If you take steroid medicines, '''cholesterol-lowering drugs''' may be used to reduce fat in the blood. | * If you take steroid medicines, '''cholesterol-lowering drugs''' may be used to reduce fat in the blood. | ||
[[File:X-ray of pelvis with total arthroplasty.jpg|alt=X-ray of pelvis with total arthroplasty|thumb|'''X-ray of pelvis with total arthroplasty''']] | [[File:X-ray of pelvis with total arthroplasty.jpg|alt=X-ray of pelvis with total arthroplasty|left|thumb|'''X-ray of pelvis with total arthroplasty''']] | ||
==== Taking Weight Off the Joint ==== | ==== Taking Weight Off the Joint ==== | ||
Your doctor may suggest you limit your activity or use crutches to take weight off joints with osteonecrosis. This may slow bone damage and allow some healing. If combined with NSAIDs, it may help you avoid or delay surgery. | Your doctor may suggest you limit your activity or use crutches to take weight off joints with osteonecrosis. This may slow bone damage and allow some healing. If combined with NSAIDs, it may help you avoid or delay surgery. | ||
==== Range-of-Motion Exercises ==== | ==== Range-of-Motion Exercises ==== | ||
Your doctor may recommend you exercise the joints with osteonecrosis to help improve their range of motion. | Your doctor may recommend you exercise the joints with osteonecrosis to help improve their range of motion. | ||
==== Electrical Stimulation ==== | ==== Electrical Stimulation ==== | ||
Your doctor may recommend electrical stimulation therapy to help bone growth. | Your doctor may recommend electrical stimulation therapy to help bone growth. | ||
==== Surgery ==== | ==== Surgery ==== | ||
Most people with osteonecrosis eventually need surgery as the disease worsens. Some people with early stage disease may need surgery if non-surgical treatments do not help. | Most people with osteonecrosis eventually need surgery as the disease worsens. Some people with early stage disease may need surgery if non-surgical treatments do not help. | ||
[[File:Necrotic bone -- very high mag.jpg|alt=Necrotic bone|thumb|'''Necrotic bone''']] | [[File:Necrotic bone -- very high mag.jpg|alt=Necrotic bone|left|thumb|'''Necrotic bone''']] | ||
There are four types of surgery. Your doctor will decide if you need surgery and what type is best for you. | There are four types of surgery. Your doctor will decide if you need surgery and what type is best for you. | ||
* '''Core decompression surgery,''' which lowers the pressure inside the bone. This increases blood flow to the bone. | * '''Core decompression surgery,''' which lowers the pressure inside the bone. This increases blood flow to the bone. | ||
* '''Osteotomy,''' which reshapes the bone. This reduce stress on the damaged joint. | * '''Osteotomy,''' which reshapes the bone. This reduce stress on the damaged joint. | ||
* '''Bone graft,''' which takes healthy bone from one part of the body and uses it to replace diseased bone. | * '''Bone graft,''' which takes healthy bone from one part of the body and uses it to replace diseased bone. | ||
* '''Total joint replacement,''' which replaces the joint with a man-made one. | * '''Total joint replacement,''' which replaces the joint with a man-made one. | ||
==Other names== | ==Other names== | ||
Also called aseptic necrosis, ischemic necrosis, and osteonecrosis. | Also called aseptic necrosis, ischemic necrosis, and osteonecrosis. | ||
== Epidemiology == | == Epidemiology == | ||
It is most common in men and people in their 30s, 40s, and 50s. | It is most common in men and people in their 30s, 40s, and 50s. | ||
{{stub}} | {{stub}} | ||
{{Osteochondropathy}} | {{Osteochondropathy}} | ||
{{underwater diving|divmed}} | {{underwater diving|divmed}} | ||
{{Authority control}} | {{Authority control}} | ||
{{DEFAULTSORT:Avascular Necrosis}} | {{DEFAULTSORT:Avascular Necrosis}} | ||
[[Category:Osteopathies]] | [[Category:Osteopathies]] | ||
Latest revision as of 17:09, 4 April 2025
Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD's medical weight loss NYC, sleep center NYC
Philadelphia medical weight loss and Philadelphia sleep clinics
| Avascular necrosis | |
|---|---|
| |
| Synonyms | Osteonecrosis, bone infarction, aseptic necrosis, ischemic bone necrosis |
| Pronounce | N/A |
| Specialty | Orthopedic surgery, Rheumatology |
| Symptoms | Joint pain, limited range of motion |
| Complications | Osteoarthritis, joint collapse |
| Onset | Gradual |
| Duration | Long-term |
| Types | N/A |
| Causes | Trauma, steroid use, alcoholism, sickle cell disease, Gaucher's disease, lupus |
| Risks | Smoking, radiation therapy, chemotherapy |
| Diagnosis | X-ray, MRI, CT scan |
| Differential diagnosis | Arthritis, fracture, bone infection |
| Prevention | Avoidance of risk factors |
| Treatment | Medication, physical therapy, surgery |
| Medication | Bisphosphonates, anticoagulants, statins |
| Prognosis | Variable, depends on stage and treatment |
| Frequency | 10,000 to 20,000 cases per year in the United States |
| Deaths | N/A |
Pronunciation[edit]
Ay-VAS-kyoo-ler neh-KROH-sis
Definition[edit]
Avascular necrosis ( is a condition in which there is a loss of blood flow to bone tissue, which causes the bone to die.
Bones affected[edit]
It is most common in the hips, knees, shoulders, and ankles.
Causes[edit]
- It may be caused by long-term use of steroid medicines, alcohol abuse, joint injuries, and certain diseases, such as cancer and arthritis.
- It may also occur at some point in time after cancer treatment that included methotrexate, bisphosphonates, or corticosteroids.
Signs and symptoms[edit]
- Osteonecrosis may be asymptomatic when it first develops.
- As the disease gets worse, you may feel pain when you put your weight on a joint that is affected by osteonecrosis.
- Over time, you may feel pain in the joint even when you are resting.
- Pain caused by osteonecrosis may be mild or severe.
- If it causes your bone and joint to collapse, you may have severe pain and not be able to use the joint.
Investigations[edit]
Investigations include imaging studies, blood work, bone scan and rarely bone biopsy.
- X-ray.
- Magnetic resonance imaging (MRI).
- Computed tomography (CT) scan.
- Bone scan.
- Bone biopsy.
Treatment[edit]
Treatment depends on the bone affected, and the persons age, and other medical conditions, and the cause. The goals of treatments include:
- Improve use of the joint.
- Stop further damage.
- Protect bones and joints.
The treatment options may include surgery or nonsurgical treatments, such as medicines. Factors affecting treatment include:
- Your age.
- The stage of the disease.
- Where and how much bone has osteonecrosis.
- The cause, if known. If the cause is steroid or alcohol use, treatment may not work unless you stop using those substances.
Nonsurgical Treatments[edit]
Non-surgical treatments do not cure osteonecrosis, but they may help manage the disease. Your doctor may recommend one or more non-surgical treatments, especially if the disease is in its early stages.
Medications[edit]
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce pain and swelling.
- If you have blood-clotting problems, blood thinners may be used to prevent clots that block the blood supply to the bone.
- If you take steroid medicines, cholesterol-lowering drugs may be used to reduce fat in the blood.
Taking Weight Off the Joint[edit]
Your doctor may suggest you limit your activity or use crutches to take weight off joints with osteonecrosis. This may slow bone damage and allow some healing. If combined with NSAIDs, it may help you avoid or delay surgery.
Range-of-Motion Exercises[edit]
Your doctor may recommend you exercise the joints with osteonecrosis to help improve their range of motion.
Electrical Stimulation[edit]
Your doctor may recommend electrical stimulation therapy to help bone growth.
Surgery[edit]
Most people with osteonecrosis eventually need surgery as the disease worsens. Some people with early stage disease may need surgery if non-surgical treatments do not help.
There are four types of surgery. Your doctor will decide if you need surgery and what type is best for you.
- Core decompression surgery, which lowers the pressure inside the bone. This increases blood flow to the bone.
- Osteotomy, which reshapes the bone. This reduce stress on the damaged joint.
- Bone graft, which takes healthy bone from one part of the body and uses it to replace diseased bone.
- Total joint replacement, which replaces the joint with a man-made one.
Other names[edit]
Also called aseptic necrosis, ischemic necrosis, and osteonecrosis.
Epidemiology[edit]
It is most common in men and people in their 30s, 40s, and 50s.
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