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
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://www.ncbi.nlm.nih.gov/pubmed/22022684 - ↑ NIAMS: Osteonecrosis https://www.niams.nih.gov/health-topics/osteonecrosis
Patient information
avascular necrosis patient information