Osteonecrosis

Avascular necrosis is a painful bone condition that gets worse over time and can affect your mobility. It occurs when something cuts off blood flow to one of your bones. Causes include broken bones, dislocated hips, radiation therapy and alcohol misuse.

Causes #

Traumatic avascular necrosis #

This can happen after you break a bone or dislocate a joint.

Nontraumatic avascular necrosis #

This happens if you have an illness or medical condition that keeps blood from flowing to your bone tissue. Nontraumatic avascular necrosis often affects the same bones on both sides of the body. For example, if you have avascular necrosis in your right shoulder, you’re likely to have it in your left shoulder.

Medical causes #

There are several medical conditions or treatment that can lead to avascular necrosis:

• Osteoporosis - Elderly women (and some men) sometimes have spontaneous avascular necrosis of the knee (SPONK).

• Blood disorders, such as sickle cell anemia.

• Diabetes.

• Cancer treatments, such as radiation therapy.

• Decompression sickness in scuba divers.

• HIV.

• Lupus.

• Organ transplants.

Symptoms #

It might be weeks or months before you notice symptoms that might indicate you have avascular necrosis. Here are some symptoms that appear over time that could be signs of avascular necrosis:

• Intermittent pain that appears and eases when you put pressure on your bone and then remove the pressure.

• Increasing pain and stiff joints.

• Limited range of motion.

• Limping if you have avascular necrosis in your hips or knees.

• Difficulty climbing stairs, standing or walking.

Diagnosis #

Your healthcare provider will assess your symptoms and perform a physical exam. You may get one or more of these tests:

• X-rays to detect fractures and signs of arthritis.

• Magnetic resonance imaging (MRI).

Prevention #

• Quit smoking.

• Cut back on your alcohol intake.

• Watch your cholesterol levels.

• If you take corticosteroids for a chronic medical condition, talk to your healthcare provider about reducing your dosage.

Treatment #

• Cold packs.

• Heat treatment.

• Rest.

• Nonsteroidal anti-inflammatory drugs (NSAIDs).

• Physical therapy to ease joint tenderness and increase range of motion.

• Walking aids such as canes and crutches.

• Core decompression - Your surgeon drills small holes (cores) in your affected bone to improve blood flow to the affected bone. This procedure might be combined with injections or bone grafts to promote healing.

• Joint replacement - They replace your damaged joint with an artificial one. Hip replacements and knee replacements are 95% effective at relieving pain and restoring mobility in people with avascular necrosis.