Osteonecrosis – Causes, Symptoms, Diagnosis, & Treatment
What is osteonecrosis?
Osteonecrosis, also called avascular necrosis, refers to the death of bone tissue due to the poor blood supply. This condition occurs most commonly in the hips and shoulders, but can also occur in other large joints such as the knees, elbows, wrists, and ankles. If osteonecrosis is not treated, the affected joint deteriorates, leading to severe arthritis.
What causes osteonecrosis?
Osteonecrosis occurs due to interruption of blood supply to a part of parts of the bone. The bone tissue can die due to lack of blood supply. 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, disease, or a known cause. This is called idiopathic osteonecrosis.
The following are possible causes that result in osteonecrosis:
- Dislocation or fractures around a joint
- Clotting disorders
- Using oral or intravenous steroids
- Excessive alcohol use
- Sickle cell disease
- HIV or taking HIV drugs
- Radiation therapy
- Gaucher disease
- Systemic lupus erythematosus
- Legg-Calve-Perthes disease
- Decompression sickness due to excessive deep sea diving
What are the symptoms of osteonecrosis?
There are no symptoms in the early stages of the condition. The following symptoms appear as the bone damage worsens:
- Progressive pain in the joint that may become severe if the bone collapses
- Groin pain, if the hip joint is affected
- Limping, if the condition occurs in the leg
- Limited range of motion
- Feel pain even at rest
How is osteonecrosis diagnosed?
Your doctor will do a physical exam, take your medical history, and review the symptoms. The physical exam focuses on finding out if you have any diseases or conditions that may affect your bones.
The doctor may order one or more of the following tests:
- Bone scan
- CT scan
How is osteonecrosis treated?
Usually, treatment comprises nonsurgical and surgical. Along with treatment to reduce pain and protect the affected bone, your doctor will also treat the underlying condition that caused osteonecrosis based on the results of diagnostic tests.
If the condition is detected in early stage, the doctor will recommend pain relievers and ask the patient to limit the use of the affected area. He/she may recommend using crutches if the hip, knee, or ankle is affected. The doctor may recommend range-of-motion exercises.
Nonsurgical treatment can slow the progression of osteonecrosis, but surgery is a need for most people.
The doctor may recommend the following surgical treatment options:
- A bone graft
- Vascularized bone graft (bone graft along with its blood supply)
- Osteotomy (cutting the bone and changing its alignment to relieve stress on the bone or joint)
- Total joint replacement
- Core decompression (removing part of the inside of the bone to relieve pressure and allow new blood vessels to form)
This feature is for informational purposes only and is not intended to substitute the expert guidance of a doctor. We advise seeing a doctor if you have any health concerns.