Osteonecrosis or avascular necrosis is the end result of loss of blood supply to a bone. This results in death of the bone and compromises the structural integrity of the bone. This process can affect the cancellous part of the bone (the marrow part) or the area just at the level of a joint such as the hip or knee. When this occurs near a joint the bone becomes fragile and prone to fracture and collapse. Without the proper blood supply the bone loses its ability to respond to the stress of everyday life such as running and jumping as well as simpler activities such as walking. When the bone collapses this leaves an irregular surface at the joint that is painful and causes enough irritation and mechanical problems that arthritis will inevitably evolve.

Risk factors for the development of osteonecrosis are use of cortisone- either intravenous (IV) or oral (pills), alcohol abuse, pregnancy, high lipids, deep sea diving, sickle cell disease and other blood disorders. Patients who have these risk factors and pain in joints are advised to seek evaluation for the possibility of having developed osteonecrosis. MRI scan is the most sensitive tool available for diagnosing osteonecrosis.

 

At the Denver Clinic for Extremities at Risk we have assembled a multi-tiered approach to the patient with osteonecrosis which takes into account the severity or stage of the process, patient lifestyle and other health issues. Orthopaedic surgeons are the physicians most commonly involved in the care of osteonecrosis and generally recommend the best treatment option. For some procedures microvascular surgeons are consultated and are involved in the decision making process and treatment protocol.

 

Many areas of the body can be affected by osteonecrosis including the hip, knee, ankle, shoulder, elbow and spine.