Advertisement

Osteonecrosis

  • Thorsten M. Seyler
  • David Marker
  • Michael A. Mont

Abstract

Osteonecrosis (ON), also often termed avascular necrosis, is a disease that leads pathologically to dead bone. There are many direct and indirect causes of ON, which may be multifactorial and lead to joint destruction. ON of the femoral head, the most common location for this disease, is the focus of this chapter. In more than 10% of cases, symptomatic ON of the hip also involves the knee and shoulder. In approximately 3% of patients, more than three anatomic sites are involved. Between 10,000 and 20,000 patients are diagnosed with this disease each year, and approximately 10% of the hip replacements performed in the United States are related to ON. The disease usually occurs in the fourth decade of life, but the age range of patients is wide. Because of the relative youth of many patients with ON, joint replacements in many cases are unlikely to last the full life expectancy of the patient. Thus, much effort has been aimed at preserving the femoral head.

Keywords

Femoral Head Total Joint Arthroplasty Total Joint Replacement Extracorpeal Shock Wave Therapy Core Decompression 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld Y, Gershwin ME. Pathogenesis and natural history of ON. Semin Arthritis Rheum 2002;32:94–124.PubMedGoogle Scholar
  2. 2.
    Levin D, Norman D, Zinman C, Misselevich I, Reis DN, Boss JH. Osteoarthritis-like disorder in rats with vascular deprivation-induced necrosis of the femoral head. Pathol Res Pract 1999;195:637–647.PubMedGoogle Scholar
  3. 3.
    Atsumi T, Kuroki Y, Yamano K. A microangiographic study of idiopathic ON of the femoral head. Clin Orthop 1989:186–194.Google Scholar
  4. 4.
    Kikkawa M, Imai S, Hukuda S. Altered postnatal expression of insulin-like growth factor-I (IGF-I) and type X collagen preceding the Perthes’ disease-like lesion of a rat model. J Bone Miner Res 2000;15:111–119.CrossRefPubMedGoogle Scholar
  5. 5.
    Jones LC, Hungerford DS. Osteonecrosis: etiology, diagnosis, and treatment. Curr Opin Rheumatol 2004;16:443– 449.CrossRefPubMedGoogle Scholar
  6. 6.
    Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am 1995; 77:459–474.PubMedGoogle Scholar
  7. 7.
    Mont MA, Jones LC, Hungerford DS. Nontraumatic osteonecrosis of the femoral head: ten years later. J Bone Joint Surg Am 2006;88:1117–1132.CrossRefPubMedGoogle Scholar
  8. 8.
    Koo KH, Kim R, Kim YS, et al. Risk period for developing osteonecrosis of the femoral head in patients on steroid treatment. Clin Rheumatol 2002;21:299–303.CrossRefPubMedGoogle Scholar
  9. 9.
    Liu YF, et al. Type II collagen gene variants and inherited osteonecrosis of the femoral head. N Engl J Med 2005; 352:2294–2301.CrossRefPubMedGoogle Scholar
  10. 10.
    Mont MA, Marulanda GA, Jones LC, et al. Systemic analysis of classification systems of osteonecrosis of the femoral head. J Bone Joint Surg Am. 2006;88(Suppl 3):126–130.CrossRefGoogle Scholar
  11. 11.
    Mont MA, Carbone JJ, Fairbank AC. Core decompression versus nonoperative management for osteonecrosis of the hip. Clin Orthop 1996:169–178.Google Scholar
  12. 12.
    Mont MA, Tomek IM, Hungerford DS. Core decompression for avascular necrosis of the distal femur: long term followup. Clin Orthop 1997:124–130.Google Scholar
  13. 13.
    Mont MA, Ragland PS, Etienne G. Core decompression of the femoral head for osteonecrosis using percutaneous multiple small-diameter drilling. Clin Orthop 2004:131–138.Google Scholar
  14. 14.
    Mont MA, Seyler TM, Marker DR, Marulanda GA, Delanois RE. Use of metal-on-metal total hip resurfacing for osteonecrosis of the femoral head: an analysis of 42 hips compared to osteoarthritis. J Bone Joint Surg Am. 2006;88(Suppl 3):90–97.CrossRefPubMedGoogle Scholar
  15. 15.
    Pritchett JW. Statin therapy decreases the risk of osteonecrosis in patients receiving steroids. Clin Orthop 2001: 173–178.Google Scholar
  16. 16.
    Agarwala S, Jain D, Joshi VR, et al. Efficacy of alendronate, a bisphosphonate, in the treatment of AVN of the hip. A prospective open-label study. Rheumatology (Oxford) 2005;44:352–359.CrossRefGoogle Scholar
  17. 17.
    Lai KA, Shen WJ, Yang CY, et al. The use of alendronate to prevent early collapse of the femoral head in patients with nontraumatic osteonecrosis. A randomized clinical study. J Bone Joint Surg Am 2005;87:2155–2159.CrossRefPubMedGoogle Scholar
  18. 18.
    Disch AC, Matziolis G, Perka C, et al. The management of necrosis-associated and idiopathic bone-marrow oedema of the proximal femur by intravenous iloprost. J Bone Joint Surg Br 2005;87:560–564.CrossRefPubMedGoogle Scholar
  19. 19.
    Glueck CJ, Freiberg RA, Sieve L, et al. Enoxaparin prevents progression of stages I and II osteonecrosis of the hip. Clin Orthop 2005:164–170.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Thorsten M. Seyler
    • 1
  • David Marker
    • 2
  • Michael A. Mont
    • 2
  1. 1.Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital of BaltimoreBaltimoreUSA
  2. 2.Rubin Institute for Advanced Orthopedics, Sinai Hospital of BaltimoreBaltimoreUSA

Personalised recommendations