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News Letter

What Is Osteonecrosis? Print E-mail

Literally, osteonecrosis means death of bone. It occurs when an area of bone loses its blood supply. Without a blood supply the area affected will breakdown and collapse in that area. This process is also called avascular necrosis.

Osteonecrosis affects the hip, knee and ankle joints in adults.  However, osteonecrosis of the hip accounts for more than 90 percent of all osteonecrosis cases. This disease may affect one bone or several at the same time or at different times. Children are also affected but act differently because they are growing and their bones respond more quickly. This disease primarily develops in people 20 to 40 years old, with men being more susceptible. The average age of onset is 38.

Children and teenagers can develop a form of osteonecrosis called Legg-Calve-Perthe's disease.  It occurs in the hip or head of the thighbone (femur).  In osteonecrosis, circulation is lost and bone cells begin to die.  The bones become soft and are prone to collapse under pressure. Bone tissues break down faster than the body can repair them. If left untreated, the head of the femur will heal in a collapsed position, leading to stiffness, pain and arthritis.

Causes of Osteonecrosis

Osteonecrosis or death of bone may occur after an injury or fracture blocks the blood supply to an area of a bone. Studies have suggested that this type of osteonecrosis may develop in about 20 percent of all people who dislocate their hip joint. Minor injuries will not result in osteonecrosis.

Long-term corticosteriod use may also cause osteonecrosis to form. Corticosteriods are used to treat inflammation in diseases, such as rheumatoid arthritis. Doctors are not sure why long-term use of corticosteriod puts people at a higher risk. If you are concerned, talk to your doctor about your particular situation.

Excessive alcohol use is also a common cause of osteonecrosis. Other diseases, such as kidney disease, lupus and blood disorders, are also risk factors for developing osteonecrosis. However, in approximately 30 percent of osteonecrosis cases, the cause is unknown.

Symptoms of Osteonecrosis

Often a person will experience little or no symptoms in the early stages of osteonecrosis. Commonly, the first symptoms felt are pain and aching in the affected joint when it is being used. In hip cases, the pain will most likely be concentrated in the groin area. As the disease progresses, pain may be felt even when the joint is at rest. If it is left untreated and the joint surface collapses, the pain will most likely increase greatly.

Your doctor will be able to use x-rays to diagnose the disease if it has progressed beyond the earliest stages. An x-ray shows the area of the bone that is involved. Beyond x-rays, your doctor may use MRIs (Magnetic Resonance Imaging) to look for tissue changes. If necessary, he or she may also order a CAT scan which is a series of x-rays projected in a three dimensional image.

Treatment of Osteonecrosis

In order to stop or prevent the breakdown of joints, appropriate treatment is necessary. If the disease has progressed without detection for a long period of time, it will be harder to save the joint. If left untreated, motion will become very difficult and painful. In children, non-weight bearing may prevent collapse and deformity of the bone but it may take a few years.

Walkers and crutches may help when the hip is affected. The use of these assistive devices may stop the progression of the disease while you consider treatment options. In most cases, some type of surgery is necessary. Your doctor will first try to save your original hip but may have to recommend a total hip replacement if you are an adult.

Experts are currently trying out ways to encourage the growth of new bone and blood vessels through medications and combination therapies. At this time, however, most doctors treat osteonecrosis through surgery.

There are several surgical treatment options for osteonecrosis, including:

  • Core decompression --This simple procedure works best in cases that are mild and before the collapse of a joint. A hole is created and a thin layer of bone is removed. This reduces pressure within the bone while increasing blood flow to the bone.

  • Bone grafting - After core decompression, a bone graft may be used to support a joint. In this complex procedure, healthy bone is transplanted from one part of the body to the diseased area. The dead bone is removed and a bone graft is put in its place. Crutches and/or walkers will need to be used for up to a year to help the healing process.
  • Osteotomy - This uncommon procedure has a lengthy recovery period and is used in advanced cases and for those patients with a large area of affected bone. The bone is cut below the infected area and turned so that another portion of the bone that is not affected by osteonecrosis is the new weight-bearing area.
  • Total hip replacement/Arthroplasty - If the hip joint is destroyed or the hip socket is affected, a total hip replacement may be necessary. In this procedure, the diseased hip joint will be completely replaced with an artificial hip. Once the disease has progressed to the point the hip socket is affected, a total hip replacement may be necessary. Different types of hip replacements are available. You should talk to your doctor about your specific needs.

 

Only you and your doctor can determine the best course of treatment for your osteonecrosis after examining all the options from conservative treatment through total joint replacement.

 

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Community Talk July 28, 2014 6:30pm

Join Dr. Nicholas Abidi, M.D., Dr. Peter Reynolds, M.D. and  Dr. Christian Heywood, M.D. as they discuss knee and hip pain and the available treatment options.

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