- Related Resources - Aseptic Necrosis (Avascular Necrosis or Osteonecrosis)
- Rheumatoid Arthritis Slideshow Pictures
- Joint-Friendly Exercises to Reduce RA Pain Slideshow
- Take the RA Quiz
- Patient Comments: Aseptic Necrosis - Cause
- Patient Comments: Aseptic Necrosis - Symptoms
- Patient Comments: Aseptic Necrosis - Risk Factors
- Patient Comments: Aseptic Necrosis - Treatments
- Aseptic necrosis facts
- What is aseptic necrosis?
- What causes aseptic necrosis?
- What are risk factors for aseptic necrosis?
- What are aseptic necrosis symptoms and signs?
- How do physicians diagnose aseptic necrosis?
- What is the treatment for aseptic necrosis?
- What is the prognosis of aseptic necrosis?
- Is it possible to prevent aseptic necrosis?
Aseptic necrosis facts
- Aseptic necrosis is a bone condition that results from poor blood supply to an area of bone, causing localized bone death.
- Aseptic necrosis can be caused by trauma, damage to the blood vessels that supply bone its oxygen, poor blood circulation to the bone, abnormally thick blood (hypercoagulable state), atherosclerosis, or inflammation of the blood vessel walls (vasculitis).
- Steroid medications (cortisone, such as prednisone [Deltasone, Liquid Pred] and methylprednisolone [Medrol, Depo-Medrol]) are the most common medications to cause aseptic necrosis.
- Risk factors for aseptic necrosis include alcoholism, cortisone medications, Cushing's syndrome, radiation exposure, smoking cigarettes, sickle cell disease, pancreatitis, Gaucher disease, and systemic lupus erythematosus.
- Aseptic necrosis may or may not cause pain.
- The treatment of aseptic necrosis is critically dependent on the stage of the condition.
What is aseptic necrosis?
Aseptic necrosis is a bone condition that results from poor blood supply to an area of bone, causing localized 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), atherosclerosis (hardening of the arteries), or inflammation of the blood vessel walls (vasculitis). Steroid medications (cortisone, such as prednisone [Deltasone, Liquid Pred] and methylprednisolone [Medrol, Depo-Medrol]) are the most common medications to cause aseptic necrosis. Typical bones affected by steroids include the femur bone of the hip, the humerus bone of the shoulder, and the tibia bone of the knee, sometimes in combinations and frequently affecting both sides of the body (bilateral). Aseptic necrosis of the jawbone has been associated with the use of medications (bisphosphonates) used to treat high blood calcium levels from cancer.
What are risk factors for aseptic necrosis?
Conditions that are risk factors associated with aseptic necrosis include alcoholism, cortisone medications, Cushing's syndrome, radiation exposure, smoking cigarettes, sickle cell disease, pancreatitis, hyperlipidemia, Caisson's disease (dysbarism), Gaucher disease, and systemic lupus erythematosus. Aseptic necrosis of the jawbone has been rarely reported in association with the use of bisphosphonate medication, particularly intravenously including zoledronate (Zometa) and pamidronate (Aredia).
What are aseptic necrosis symptoms and signs?
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 upon 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. Aseptic necrosis of the knee is often associated with pain or limping with walking. Aseptic necrosis of the shoulder can be associated with pain and loss of range of motion of the shoulder joint.
How do physicians diagnose aseptic necrosis?
The diagnosis of aseptic necrosis can often, but not always, be made with plain film 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 image or suggested by a nuclear bone scan image.
What is the treatment for aseptic necrosis?
The treatment of aseptic necrosis is critically dependent on the stage of the condition. Very early stage aseptic necrosis may be managed nonoperatively with rest, partial-weight-bearing crutches, progressive weight-bearing, and observation. Nevertheless, there is often progression of the joint damage. Early aseptic necrosis (before X-ray image 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 image changes are apparent) typically lead to seriously damaged bone and joints, requiring joint replacement surgery.
What is the prognosis of aseptic necrosis?
Aseptic necrosis causes a serious injury to affected bone. Frequently, this leads to permanent destruction of the adjacent joint. Early core decompression is generally necessary to prevent collapse of affected bone. Aseptic necrosis can be complicated by complete loss of joint function.
Is it possible to prevent aseptic necrosis?
People can prevent aseptic necrosis by minimizing the use of steroid medications when possible and by treating underlying medical conditions, such as those described above, that can increase the risk of developing aseptic necrosis. Avoiding trauma to joints can prevent posttraumatic aseptic necrosis. Avoiding smoking can decrease risk of developing aseptic necrosis.
- 'Virtual' Driver Program Could Make Driving Safer for Teens With ADHD
- Fatal Drug Overdoses Among U.S. Seniors Have Tripled Since 2000
- CDC Will Test New Areas for Polio in Wastewater
- Shortages of Antibiotics, Antivirals Are Making a Tough Illness Season Worse
- Two Veterinary Meds Show Promise Against a Tough Foe: Bed Bugs
- More Health News »
Health Solutions From Our Sponsors
Koopman, William, et al., eds. "Clinical Primer of Rheumatology." Philadelphia: Lippincott Williams & Wilkins, 2003.
Ruddy, Shaun, et al., eds. "Kelley's Textbook of Rheumatology." Philadelphia: W.B. Saunders Co., 2000.
Top Aseptic Necrosis Related Articles
CT Scan (Computerized Tomography)A CT scan is an X-ray procedure that combines many X-ray images with the aid of a computer to generate cross-sectional and three-dimensional images of internal organs and structures of the body. A CT scan is a low-risk procedure. Contrast material may be injected into a vein or the spinal fluid to enhance the scan.
Cushing's SyndromeCushing's syndrome, sometimes referred to as hypercortisolism, is a hormonal disorder caused by prolonged exposure to high levels of the hormone cortisol. Symptoms may include obesity, thinning arms and legs, a rounded face, and increased fat around the neck. Some causes of Cushing's syndrome is from taking glucocorticoid hormones such as prednisone for inflammatory diseases. Treatment for Cushing's syndrome depends on the cause.
LeprosyLeprosy (Hansen's disease) is a disfiguring disease caused by infection with Mycobacterium leprae bacteria. The disease is spread from person to person through nasal secretions or droplets. Symptoms and signs of leprosy include numbness, loss of temperature sensation, painless ulcers, eye damage, loss of digits, and facial disfigurement. Leprosy is treated with antibiotics and the dosage and length of time of administration depends upon which form of leprosy the patient has.
MRI (Magnetic Resonance Imaging Scan)MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. MRI scanning is painless and does not involve X-ray radiation. Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyes cannot be scanned with MRI because of the effect of the magnet.
Peripheral Vascular DiseasePeripheral vascular disease (PVD) refers to diseases of the blood vessels (arteries and veins) located outside the heart and brain. While there are many causes of peripheral vascular disease, doctors commonly use the term peripheral vascular disease to refer to peripheral artery disease (peripheral arterial disease, PAD), a condition that develops when the arteries that supply blood to the internal organs, arms, and legs become completely or partially blocked as a result of atherosclerosis. Peripheral artery disease symptoms include intermittent leg pain while walking, leg pain at rest, numbness in the legs or feet, and poor wound healing in the legs or feet. Treatment for peripheral artery disease include lifestyle measures, medication, angioplasty, and surgery.
prednisone (Prednisone Intensol, Rayos) Corticosteroid
Prednisone is a drug that belongs to the corticosteroid drug class, and is an anti-inflammatory and immune system suppressant. It's used to treat a variety of diseases and conditions, for example: inflammatory bowel disease (Crohn's disease and ulcerative colitis), lupus, asthma, cancers, and several types of arthritis.
Common side effects are weight gain, headache, fluid retention, and muscle weakness. Other effects and adverse events include glaucoma, cataracts, obesity, facial hair growth, moon face, and growth retardation in children. This medicine also causes psychiatric problems, for example: depression, insomnia, mood swings, personality changes, and psychotic behavior. Serious side effects include reactions to diabetes drugs, infections, and necrosis of the hips and joints.
Corticosteroids like prednisone, have many drug interactions; examples include: estrogens, phenytoin (Dilantin), diuretics, warfarin (Coumadin, Jantoven), and diabetes drugs. Prednisone is available as tablets of 1, 2.5, 10, 20, and 50 mg; extended release tablets of 1, 2, and 5mg; and oral solution of 5mg/5ml. It's use during the first trimester of pregnancy may cause cleft palate. This medicine is secreted in breast milk and can cause side effects in infants who are nursing. You should not stop taking prednisone abruptly because it can cause withdrawal symptoms and adrenal failure. Talk with your doctor, pharmacist, or other medical professional if you have questions about beta-blockers. Talk with your doctor, pharmacist, or other medical professional if you have questions about prednisone.
Sickle Cell Disease (Anemia)Sickle cell anemia (sickle cell disease), a blood disease which shortens life expectancy, is caused by an inherited abnormal hemoglobin.
Symptoms of sickle cell anemia may include bacterial infections, painful swelling of the hands and feet, fever, leg ulcers, fatigue, anemia, eye damage, and lung and heart injury.
Treatment for sickle cell anemia aims to manage and prevent the worst manifestations of the disease and focuses on therapies that block red blood cells from stacking together, which can lead to tissue and organ damage and pain.
Predinsone Side Effects (Adverse Effects)Prednisone is an anti-inflammatory and immune system suppressant drug that belongs to the corticosteroid drug class. Prednisone is used to treat a variety of diseases and conditions of the skin, gut, lungs, endocrine system, eyes, and blood. Examples include inflammatory bowel disease (Crohn's disease and ulcerative colitis), lupus, asthma, cancers, and several types of arthritis. Review side effects and adverse events before using this medication.
Lupus (Systemic Lupus Erythematosus or SLE)Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous system. When only the skin is involved, the condition is called discoid lupus. When internal organs are involved, the condition is called systemic lupus erythematosus (SLE).
Total Hip ReplacementDuring total hip replacement, diseased hip cartilage and bone is replaced with artificial materials. Risks of the surgery include blood clots in the lower extremities, difficulty with urination, infection, bone fracture, scarring, limited range of motion, and prosthesis failure.
Knee Replacement Surgery and Recovery TimeDuring total knee replacement surgery, the diseased knee joint is replaced with artificial material. The risks include blood clots in the legs, urinary tract infection, nausea and vomiting, chronic knee pain, nerve damage, and infection.
VasculitisVasculitis (arteritis, angiitis) is a general term for a group of uncommon diseases which feature inflammation of the blood vessels. Each form of vasculitis has its own characteristic pattern of symptoms. The diagnosis of vasculitis is definitively established after a biopsy of involved tissue demonstrates the pattern of blood vessel inflammation. Treatment is directed toward decreasing the inflammation of the arteries and improving the function of affected organs.