Osteonecrosis: Symptom, Diagnosis, Treatment

Overview

Osteonecrosis, formerly known as avascular necrosis, refers to the death of bone tissue due to the loss of blood supply to the bone. It can cause severe pain, disability and even bone collapse. It mostly occurs in the hip. Other parts that can be affected include jaw, shoulder, knees, and ankles.

Anyone can get osteonecrosis, but it is most common in people between 30-50 years old. In America, as many as 20,000 people develop osteonecrosis each year. Most people with osteonecrosis need treatment. Your treatment options may be nonsurgical, surgical, or both.

Causes

Bone is living tissue that requires blood. If the supply of the blood is interrupted or reduced, eventually this process can cause the bone to collapse.

Risk factors that may lead to the loss of blood supply include:

  • Bone factures
  • Joint dislocation
  • Excessive alcohol use
  • Chronic use of corticosteroids
  • Fatty deposits in blood vessels that can block small blood vessels
  • Medical conditions, such as sickle cell anemia and Gaucher’s disease
  • Certain medical treatments, like radiation therapy and organ transplantation

For about 25 percent of people with osteonecrosis, the cause of interrupted blood flow is unknown.

Symptom

The most typical sign and symptom for osteonecrosis is the pain in the affected joint. In the early stages of the condition, many people are symptom-free. As the condition worsens, you may experience pain when you put pressure on the affected bone. Over time, you may feel pain in the joint even when you are resting.

If the disease continues and the bone and surrounding joint collapse, you may feel severe pain, leading to your disability to use your joint. The time between the first symptoms and collapse of the bone may range from several months to more than a year.

Diagnosis

There is no single test for osteonecrosis. If your doctor suspects you have osteonecrosis, he or she will ask you about the medical history and do a physical exam. During the physical exam, your doctor will press around your joints to check for tenderness. Your doctor might also move the joints through a variety of positions to see if your range of motion has been reduced.

Some imaging tests can help pinpoint the source of pain. They include:

  • X-rays.

They can reveal bone changes that occur in the later stages of osteonecrosis. In the early stages, X-rays usually appear normal.

  • MRI and CT scan.

These tests produce detailed images that can show early changes associated with osteonecrosis in bone.

  • Bone scan.

A small amount of radioactive material is injected into your vein. It travels to the parts of your bones that are injured and shows up as bright spots on the imaging plate.

Bone biopsy may also be helpful by taking a sample of the bone tissue to check if it is in normal function.

Treatment

Unluckily, there is no clear proof showing the best way to treat osteonecrosis. But starting treatment as early as possible is the best.

The goals of treatment options for osteonecrosis are to improve use of the joint, prevent further damage and protect bones and joints. Options may vary depending on the age of the patients, severity and affected area of the disorder.

General medications that can be used to treat osteonecrosis are:

Therapies that may be helpful involve:

  • Taking weight off the joint

Your doctor may suggest you use crutches to take weight off joints with osteonecrosis. This may slow bone damage and allow some healing.

  • Range-of-motion exercises

Your doctor may recommend you exercise the joints with osteonecrosis to help improve their range of motion.

  • Electrical Stimulation

This can help bone growth.

Most people with osteonecrosis eventually need surgery as the disease worsens. Some people with early stage disease may need surgery if non-surgical treatments do not help.

Surgical options include:

  • Core decompression, a procedure that removes part of the inside of the bone to relieve pressure and allow new blood vessels to form
  • Bone grafts, which takes healthy bone from one part of the body and using it to replace the damaged bone
  • Osteotomy, a procedure that involves cutting the bone and changing its alignment to relieve stress on the bone or joint
  • Total joint replacement, which replaces the joint with a man-made one

Your doctor will decide if you need a surgery and what type is best for you.


Keywords: osteonecrosis; avascular necrosis.

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What are the Common Types of Bone Disorders?

* The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.