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Osteonecrosis: Causes, Symptoms and Treatment

Osteonecrosis is the death of bone tissue caused by a disrupted blood supply. It commonly affects the hip, knee, or shoulder and can lead to severe joint damage if left untreated.

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Things worth knowing about "Osteonecrosis"

Osteonecrosis is the death of bone tissue caused by a disrupted blood supply. It commonly affects the hip, knee, or shoulder and can lead to severe joint damage if left untreated.

What Is Osteonecrosis?

Osteonecrosis (also known as avascular necrosis or bone necrosis) is a condition in which bone tissue dies due to a lack of adequate blood supply. Without sufficient blood flow and oxygen, bone cells called osteocytes cannot survive and begin to die. Over time, this can cause the affected bone to collapse and lead to severe joint damage. The most commonly affected site is the femoral head (the ball of the hip joint), but the knee, shoulder, ankle, and wrist can also be involved.

Causes

Osteonecrosis can be triggered by a variety of factors. It is generally classified as either traumatic or non-traumatic:

Traumatic causes: Fractures or dislocations that damage the blood vessels supplying the bone.
Corticosteroids: Long-term use of cortisone-based medications is one of the most common non-traumatic causes.
Alcohol abuse: Chronic excessive alcohol consumption damages blood vessels and can promote fatty deposits that block circulation.
Medical conditions: Sickle cell disease, lupus erythematosus, pancreatitis, and Gaucher disease are among the conditions associated with increased risk.
Decompression sickness: Rapid ascent during diving can cause gas bubbles to form in blood vessels, blocking blood flow to bone.
Radiation therapy: Radiation can damage blood vessels and surrounding bone tissue.
Idiopathic: In some cases, no clear cause can be identified.

Symptoms

Symptoms of osteonecrosis often develop gradually and depend on the location and extent of the affected bone:

Pain in the affected joint -- initially only during activity, later also at rest
Limited range of motion and stiffness of the joint
Limping or altered gait when the hip is affected
In early stages, the condition may be entirely asymptomatic
In advanced stages: joint collapse with severe pain and significant loss of function

Diagnosis

Several imaging techniques are used to diagnose osteonecrosis:

X-ray: Often normal in early stages; structural changes become visible as the disease progresses
MRI (Magnetic Resonance Imaging): The gold standard for diagnosis; can detect the condition reliably in its earliest stages
CT (Computed Tomography): Provides detailed images of changes in bone structure
Bone scintigraphy: Can detect changes in bone metabolic activity
Blood tests may also be performed to identify any underlying conditions.

Treatment

Treatment of osteonecrosis depends on the stage of the disease, the size of the affected area, and the overall health of the patient:

Conservative Treatment

Reduced weight-bearing on the affected joint (e.g., using crutches)
Pain management with analgesics or anti-inflammatory medications
Physiotherapy to maintain joint mobility
Treatment of the underlying cause (e.g., tapering or discontinuing corticosteroids)

Surgical Treatment

Core decompression: Drilling into the bone to relieve elevated intraosseous pressure; most effective in early stages
Osteotomy: Repositioning the bone to redistribute load away from the damaged area
Bone grafting: Transplanting healthy bone or vascularized tissue grafts to restore blood supply
Joint replacement (arthroplasty): Used as a last resort in cases of advanced joint collapse

References

Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. Journal of Bone and Joint Surgery, 1995.
Assouline-Dayan Y et al. Pathogenesis and natural history of osteonecrosis. Seminars in Arthritis and Rheumatism, 2002.
Markers of osteonecrosis: clinical guidelines and evidence-based recommendations. European League Against Rheumatism (EULAR), 2019.

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