avascular osteonecrosis; aseptic necrosis
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Introduction
Osteonecrosis can occur in any bone & is associated with a variety of disorders. When the process occurs at a bone end, it is known as avascular osteonecrosis.
Etiology
(associated disorders)
- connective tissue disease, esp systemic lupus erythematosus
- glucocorticoid use*
- alcoholism*
- hemoglobinopathies
- diabetes mellitus
- AIDS
- fat embolism
- gout
- hyperlipidemia
- pancreatitis
- immunosuppressive therapy
- radiation therapy
- chemotherapy (cytoxan, methotrexate, 5-FU, bleomycin, vincristine, vinblastine)
- trauma
- hip dislocation or fracture
- post arthroscopy
- thermal injury
- decompression syndrome (Caisson's disease)
- hematopoietic disorders
- Legg-Calve-Perthes disease in a child
* glucocorticoid use & alcoholism account for > 90% of cases of hip osteonecrosis[5]
Pathology
- bone death resulting from reduced arterial blood supply
- increased interosseous pressure
Genetics
- primary avascular necrosis of femoral head is associated with defects in COL2A1 (autosomal dominant)
Clinical manifestations
- hips, shoulders & knees most commonly affected
- patients may have bilateral disease with unilateral symptoms
- limited range of motion of involved joint (i.e. hip)[5]
- early stages of bone death may be associated with severe pain[5]
Radiology
- X-rays may be normal early in disease process
- radiolucent crescent line may be seen representing a plane of fracture
- MRI is most sensitive imaging modality
- bone scan shows increased uptake in adjacent bone segments
Management
- non-weight bearing of affected joint
- core decompression to relieve increased interosseous pressure
- arthroplasty
- bone grafting
More general terms
More specific terms
References
- ↑ Basic Radiology, Chen MYM, Pope TL & Ott DJ (eds), McGraw Hill, NY 1996
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 867
- ↑ Weiner, S in: Intensive Course in Geriatric Medicine & Board Review, Santa Monica, CA, Sept 20-23, 2000
- ↑ Weiner, S in: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ 5.0 5.1 5.2 5.3 5.4 Medical Knowledge Self Assessment Program (MKSAP) 16, 17. American College of Physicians, Philadelphia 2012, 2015
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ Amanatullah DF, Strauss EJ, Di Cesare PE. Current management options for osteonecrosis of the femoral head: part 1, diagnosis and nonoperative management. Am J Orthop (Belle Mead NJ). 2011 Sep;40(9):E186-92. PMID: https://pubmed.ncbi.nlm.nih.gov/22022684
- ↑ NIAMS: Osteonecrosis https://www.niams.nih.gov/health-topics/osteonecrosis
Patient information
avascular necrosis patient information