Osteonecrosis

Abstract

Osteonecrosis (avascular necrosis, aseptic necrosis or subchondral avascular necrosis) is not a specific disease entity but the final common pathway of a number of conditions leading to bone death. The main predisposing factors (trauma, glucocorticosteroids, alcoholism and connective tissue disorders) should be carefully sought, but osteonecrosis can also be idiopathic in origin. Its most common localization is to the femoral head, followed by the humeral head, the knee and the small bones of the wrist and foot. New imaging techniques, especially magnetic resonance imaging, have improved the early diagnosis of osteonecrosis as radiographs may be normal in the initial stages. The outcome for the patient is influenced by many factors, the size and localization of the bone necrosis being of primary importance. Early intervention (both surgical and non-surgical) has definitively improved the outcome, but still nearly 50% of cases of femoral head osteonecrosis necessitate arthroplasty. In this chapter, we shall concentrate on patients at high risk of osteonecrosis, on evidence-based diagnosis, especially in the early stages, and on evidence-based treatment suited to the staging system of osteonecrosis.

Correlation of Functional Status of Hip with Quality of Life of Patients with Osteonecrosis of Femoral Head (ONFH)

“…There are very few epidemiological studies in literature which have assessed the risk factors for Osteonecrosis i.e. corticosteroid use [2][3][4], alcohol [2][3][4][5][6] systemic lupus erythematosus [7] or organ transplantation [8] and sickle cell disease [9] etc.…”

Avascular osteonecrosis of the hip in patient after adjuvant radiotherapy for rectal cancer

“…However, according to the literature, there is a growing incidence of osteonecrosis among children [2,6]. It has been assessed that at least 50% of atraumatic hip osteonecrosis have bilateral involvement.…”

Gene Expression Changes in Femoral Head Necrosis of Human Bone Tissue

“…More than one-third of the new cases compose the idiopathic form annually, and 5-12% of total hip arthroplasties each year are performed to treat this disease [1,2]. The condition is characterized by an insidious onset without specific clinical symptoms and signs.…”

“…There continue to be significant gaps in our knowledge concerning the pathogenesis, natural history, early diagnosis, and optimal treatment of ONFH. Osteonecrosis of femoral head is the result of an interruption of the circulation, which leads to a disparity between the oxygen need of the bone cell and the ability of the local circulation to supply that need [1]. The mechanism of ischemia and necrosis in non-traumatic ONFH is not clear.…”