Aseptic Necrosis
(Avascular Necrosis or Osteonecrosis)
Medical Author:
William C. Shiel Jr., MD, FACP, FACR
What is aseptic necrosis?
Aseptic necrosis is a bone condition that results from poor blood
supply to an area of bone causing bone death. This is a serious
condition because the dead areas of bone do not function normally,
are weakened, and can collapse. Aseptic necrosis is also referred to as avascular necrosis
or osteonecrosis.
What causes aseptic necrosis?
Aseptic necrosis can be caused by trauma and damage
to the blood vessels that supply bone its oxygen. Other causes
of poor blood circulation to the bone include a blockage by air
or fat (embolism) that obstructs the blood flow through the blood vessels,
abnormally
thick blood (hypercoagulable state), and inflammation of the blood
vessel walls (vasculitis).
What conditions are associated with aseptic
necrosis?
Conditions that are associated with aseptic necrosis
include alcoholism, cortisone medications, Cushing's syndrome, radiation
exposure, sickle cell disease, pancreatitis, Gaucher disease,
and systemic lupus erythematosus. Aseptic necrosis of the jaw bone has been rarely reported in
association with the use of bisphosphonate medication, particularly intravenously including zolendronate
(Zometa) and pamidronate (Aredia ).
What are symptoms of aseptic necrosis?
Aseptic necrosis begins as a painless bone abnormality. It can remain painless. The involved bone often later develops pain, especially with use. For example, if a hip joint develops avascular necrosis in the ball of the hip joint, pain can be noted - especially with weight-bearing. As the ball of the hip joint collapses from the degeneration of the bone from aseptic necrosis, pain in the groin can be felt with hip rotation and pain can sometimes be noted with rest after weight-bearing.
How is aseptic necrosis
diagnosed?
The diagnosis of aseptic necrosis can often, but not always, be made with
x-rays. By the time changes are apparent by plain film x-ray testing there has been substantial damage to the bone affected. Bone changes visible on plain film x-ray are therefore considered a later-stage finding. Earlier signs of avascular
necrosis can be detected with an MRI scan or suggested by a nuclear
bone scan.
What is the treatment for aseptic necrosis?
The treatment of aseptic necrosis is critically dependent
on the stage of the condition. Early aseptic necrosis (before
x-ray changes are evident) can be treated with a surgical operation
called a core decompression. This procedure involves removing
a core of bone from the involved area and sometimes grafting new
bone into the area. This allows new blood supply to form, preserving
the bone. Weight bearing or impact of the involved joint is restricted.
Later stages of aseptic necrosis (when x-ray changes
have occurred) typically lead to seriously damaged bone and joints,
requiring joint replacement surgery. For related information, please read the following articles;
Total Hip Replacement and
Total Knee Replacement.
Reference:
Clinical Primer of Rheumatology, Lippincott Williams & Wilkens, edited by William Koopman, et. al., 2003.
Kelley's Textbook of Rheumatology, W B Saunders Co, edited by Shaun Ruddy, et.al., 2000.
Last Editorial Review: 9/25/2006
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