Skip to main content

Pathophysiology of Ischemic Diseases of the Hip: Osteonecrosis, Borderline Necrosis, and Bone Marrow Edema Syndrome

  • Chapter
  • First Online:
Osteonecrosis

Abstract

Osteonecrosis (ON) of the femoral head is an evolutionary process involving (1) marrow necrosis and osteocytic death, (2) reparative process around the necrotic zone, and (3) collapse of necrotic bone and subsequent degenerative arthritis of the hip [1–3].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Arlet J. Nontraumatic avascular necrosis of the femoral head. Past, present, and future. Clin Orthop Relat Res. 1992;277:12–21.

    PubMed  Google Scholar 

  2. Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am. 1995;77(3):459–74.

    CAS  PubMed  Google Scholar 

  3. Jones LC, Hungerford DS. Osteonecrosis: etiology, diagnosis, and treatment. Curr Opin Rheumatol. 2004;16(4):443–9.

    Article  PubMed  Google Scholar 

  4. Prosnitz LR, Lawson JP, Friedlaender GE, Farber LR, Pezzimenti JF. Avascular necrosis of bone in Hodgkin’s disease patients treated with combined modality therapy. Cancer. 1981;47(12):2793–7.

    Article  CAS  PubMed  Google Scholar 

  5. Shim K, MacKenzie MJ, Winquist E. Chemotherapy-associated osteonecrosis in cancer patients with solid tumours: a systematic review. Drug Saf. 2008;31(5):359–71.

    Article  CAS  PubMed  Google Scholar 

  6. Hungerford DS, Lennox DW. The importance of increased intraosseous pressure in the development of osteonecrosis of the femoral head: implications for treatment. Orthop Clin North Am. 1985;16(4):635–54.

    CAS  PubMed  Google Scholar 

  7. Jones Jr JP, Engleman EP, Najarian JS. Systemic fat embolism after renal homotransplantation and treatment with corticosteroids. N Engl J Med. 1965;273(27):1453–8. doi:10.1056/nejm196512302732703.

    Article  PubMed  Google Scholar 

  8. Wang GJ, Sweet DE, Reger SI, Thompson RC. Fat-cell changes as a mechanism of avascular necrosis of the femoral head in cortisone-treated rabbits. J Bone Joint Surg Am. 1977;59(6):729–35.

    CAS  PubMed  Google Scholar 

  9. Jones Jr JP. Concepts of etiology and early pathogenesis of osteonecrosis. Instr Course Lect. 1994;43:499–512.

    PubMed  Google Scholar 

  10. Koo KH, Jeong ST, Jones Jr JP. Borderline necrosis of the femoral head. Clin Orthop Relat Res. 1999;358:158–65.

    Article  PubMed  Google Scholar 

  11. Jones Jr JP. Alcoholism, hypercortisonism, fat embolism and osseous avascular necrosis. 1971. Clin Orthop Relat Res. 2001;393:4–12.

    Article  PubMed  Google Scholar 

  12. Seamon J, Keller T, Saleh J, Cui Q. The pathogenesis of nontraumatic osteonecrosis. Arthritis. 2012;2012:601763. doi:10.1155/2012/601763.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Asano T, Takahashi KA, Fujioka M, Inoue S, Okamoto M, Sugioka N, et al. ABCB1 C3435T and G2677T/A polymorphism decreased the risk for steroid-induced osteonecrosis of the femoral head after kidney transplantation. Pharmacogenetics. 2003;13(11):675–82. doi:10.1097/01.fpc.0000054135.14659.65.

    Article  CAS  PubMed  Google Scholar 

  14. Chao YC, Wang SJ, Chu HC, Chang WK, Hsieh TY. Investigation of alcohol metabolizing enzyme genes in Chinese alcoholics with avascular necrosis of hip joint, pancreatitis and cirrhosis of the liver. Alcohol Alcohol. 2003;38(5):431–6.

    Article  CAS  PubMed  Google Scholar 

  15. Koo KH, Lee JS, Lee YJ, Kim KJ, Yoo JJ, Kim HJ. Endothelial nitric oxide synthase gene polymorphisms in patients with nontraumatic femoral head osteonecrosis. J Orthop Res. 2006;24(8):1722–8. doi:10.1002/jor.20164.

    Article  CAS  PubMed  Google Scholar 

  16. Chang JD, Hur M, Lee SS, Yoo JH, Lee KM. Genetic background of nontraumatic osteonecrosis of the femoral head in the Korean population. Clin Orthop Relat Res. 2008;466(5):1041–6. doi:10.1007/s11999-008-0147-1.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Kim T, Hong JM, Lee J, Oh B, Park EK, Lee C, et al. Promoter polymorphisms of the vascular endothelial growth factor gene is associated with an osteonecrosis of the femoral head in the Korean population. Osteoarthritis Cartilage. 2008;16(3):287–91. doi:10.1016/j.joca.2007.06.017.

    Article  Google Scholar 

  18. Kim TH, Hong JM, Oh B, Cho YS, Lee JY, Kim HL, et al. Genetic association study of polymorphisms in the catalase gene with the risk of osteonecrosis of the femoral head in the Korean population. Osteoarthritis Cartilage. 2008;16(9):1060–6. doi:10.1016/j.joca.2008.02.004.

    Article  PubMed  Google Scholar 

  19. Glueck CJ, Freiberg RA, Boppana S, Wang P. Thrombophilia, hypofibrinolysis, the eNOS T-786C polymorphism, and multifocal osteonecrosis. J Bone Joint Surg Am. 2008;90(10):2220–9. doi:10.2106/JBJS.G.00616. 90/10/2220 [pii].

    Article  PubMed  Google Scholar 

  20. Lee YJ, Lee JS, Kang EH, Lee YK, Kim SY, Song YW, et al. Vascular endothelial growth factor polymorphisms in patients with steroid-induced femoral head osteonecrosis. J Orthop Res. 2012;30(1):21–7. doi:10.1002/jor.21492.

    Article  PubMed  Google Scholar 

  21. Arlet J, Durroux R, Fauchier C, Thiechart M. Histopathology of the nontraumatic necrosis of the femoral head: topographic and evaluative aspect. In: Bone circulation. Baltimore: Williams & Wilkins; 1984.

    Google Scholar 

  22. Hauzeur JP, Perlmutter N, Appelboom T, Pasteels JL. Medullary impairment at early stage of non-traumatic osteonecrosis of the femoral head. Rheumatol Int. 1991;11(4–5):215–7.

    Article  CAS  PubMed  Google Scholar 

  23. Hofmann S, Engel A, Neuhold A, Leder K, Kramer J, Plenk Jr H. Bone-marrow oedema syndrome and transient osteoporosis of the hip. An MRI-controlled study of treatment by core decompression. J Bone Joint Surg Br. 1993;75(2):210–6.

    CAS  PubMed  Google Scholar 

  24. Hauzeur JP, Sintzoff Jr S, Appelboom T, De Maertelaer V, Bentin J, Pasteels JL. Relationship between magnetic resonance imaging and histologic findings by bone biopsy in nontraumatic osteonecrosis of the femoral head. J Rheumatol. 1992;19(3):385–92.

    CAS  PubMed  Google Scholar 

  25. Hauzeur JP, Pasteels JL, Orloff S. Bilateral non-traumatic aseptic osteonecrosis in the femoral head. An experimental study of incidence. J Bone Joint Surg Am. 1987;69(8):1221–5.

    CAS  PubMed  Google Scholar 

  26. Koo KH, Kim R, Cho SH, Song HR, Lee G, Ko GH. Angiography, scintigraphy, intraosseous pressure, and histologic findings in high-risk osteonecrotic femoral heads with negative magnetic resonance images. Clin Orthop Relat Res. 1994;308:127–38.

    PubMed  Google Scholar 

  27. Sugano N, Nishii T, Shibuya T, Nakata K, Masuhara K, Takaoka K. Contralateral hip in patients with unilateral nontraumatic osteonecrosis of the femoral head. Clin Orthop Relat Res. 1997;334:85–90.

    Article  PubMed  Google Scholar 

  28. Goetz JE, Robinson DA, Pedersen DR, Conzemius MG, Brown TD. Cryoinsult parameter effects on the histologically apparent volume of experimentally induced osteonecrotic lesions. J Orthop Res. 2011;29(6):931–7. doi:10.1002/jor.21342.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Tucker FR. Arterial supply to the femoral head and its clinical importance. J Bone Joint Surg Br. 1949;31B(1):82–93.

    CAS  PubMed  Google Scholar 

  30. Torvik A. The pathogenesis of watershed infarcts in the brain. Stroke. 1984;15(2):221–3.

    Article  CAS  PubMed  Google Scholar 

  31. Chandler FA. Coronary disease of the hip. J Int Coll Surg. 1948;11(1):34–6.

    CAS  PubMed  Google Scholar 

  32. Miyanishi K, Yamamoto T, Irisa T, Yamashita A, Jingushi S, Noguchi Y, et al. Bone marrow fat cell enlargement and a rise in intraosseous pressure in steroid-treated rabbits with osteonecrosis. Bone. 2003;30(1):185–90. http://dx.doi.org/10.1016/S8756-3282(01)00663-9.

    Article  Google Scholar 

  33. Koo KH, Dussault R, Kaplan P, Kim R, Ahn IO, Christopher J, et al. Age-related marrow conversion in the proximal metaphysis of the femur: evaluation with T1-weighted MR imaging. Radiology. 1998;206(3):745–8.

    Article  CAS  PubMed  Google Scholar 

  34. Kricun ME. Red-yellow marrow conversion: its effect on the location of some solitary bone lesions. Skeletal Radiol. 1985;14(1):10–9.

    Article  CAS  PubMed  Google Scholar 

  35. Amstutz HC, Carey EJ. Skeletal manifestations and treatment of Gaucher’s disease. Review of twenty cases. J Bone Joint Surg Am. 1966;48(4):670–701.

    CAS  PubMed  Google Scholar 

  36. Humphreys S, Spencer JD, Tighe JR, Cumming RR. The femoral head in osteonecrosis. A quantitative study of osteocyte population. J Bone Joint Surg Br. 1989;71(2):205–8.

    CAS  PubMed  Google Scholar 

  37. James J, Steijn-Myagkaya GL. Death of osteocytes. Electron microscopy after in vitro ischaemia. J Bone Joint Surg Br. 1986;68(4):620–4.

    CAS  PubMed  Google Scholar 

  38. Nadel SN, Debatin JF, Richardson WJ, Hedlund LW, Senft C, Rizk WS, et al. Detection of acute avascular necrosis of the femoral head in dogs: dynamic contrast-enhanced MR imaging vs spin-echo and STIR sequences. AJR Am J Roentgenol. 1992;159(6):1255–61. doi:10.2214/ajr.159.6.1442396.

    Article  CAS  PubMed  Google Scholar 

  39. Fondi C, Franchi A. Definition of bone necrosis by the pathologist. Clinical Cases Miner Bone Metab. 2007;4(1):21–6.

    Google Scholar 

  40. Catto M. Pathology of aseptic bone necrosis. In: Davidson JK, editor. Aseptic necrosis of bone. Amsterdam: Excepta Medica; 1976. p. 3–100.

    Google Scholar 

  41. Glueck CJ, Freiberg R, Tracy T, Stroop D, Wang P. Thrombophilia and hypofibrinolysis: pathophysiologies of osteonecrosis. Clin Orthop Relat Res. 1997;334:43–56.

    Article  PubMed  Google Scholar 

  42. Jones LC, Mont MA, Le TB, Petri M, Hungerford DS, Wang P, et al. Procoagulants and osteonecrosis. J Rheumatol. 2003;30(4):783–91.

    CAS  PubMed  Google Scholar 

  43. Pierre-Jacques H, Glueck CJ, Mont MA, Hungerford DS. Familial heterozygous protein-S deficiency in a patient who had multifocal osteonecrosis. A case report. J Bone Joint Surg Am. 1997;79(7):1079–84.

    CAS  PubMed  Google Scholar 

  44. Zalavras CG, Vartholomatos G, Dokou E, Malizos KN. Genetic background of osteonecrosis: associated with thrombophilic mutations? Clin Orthop Relat Res. 2004;422:251–5. 00003086-200405000-00040 [pii].

    Article  PubMed  Google Scholar 

  45. Bjorkman A, Svensson PJ, Hillarp A, Burtscher IM, Runow A, Benoni G. Factor V leiden and prothrombin gene mutation: risk factors for osteonecrosis of the femoral head in adults. Clin Orthop Relat Res. 2004;425:168–72. 00003086-200408000-00023 [pii].

    Article  PubMed  Google Scholar 

  46. Glueck CJ, Fontaine RN, Gruppo R, Stroop D, Sieve-Smith L, Tracy T, et al. The plasminogen activator inhibitor-1 gene, hypofibrinolysis, and osteonecrosis. Clin Orthop Relat Res. 1999;366:133–46.

    Article  PubMed  Google Scholar 

  47. Glueck CJ, Freiberg RA, Fontaine RN, Tracy T, Wang P. Hypofibrinolysis, thrombophilia, osteonecrosis. Clin Orthop Relat Res. 2001;386:19–33.

    Article  PubMed  Google Scholar 

  48. Seleznick MJ, Silveira LH, Espinoza LR. Avascular necrosis associated with anticardiolipin antibodies. J Rheumatol. 1991;18(9):1416–7.

    CAS  PubMed  Google Scholar 

  49. Korompilias AV, Gilkeson GS, Ortel TL, Seaber AV, Urbaniak JR. Anticardiolipin antibodies and osteonecrosis of the femoral head. Clin Orthop Relat Res. 1997;345:174–80.

    Article  PubMed  Google Scholar 

  50. Golding JS. Conditions of the hip associated with hemoglobinopathies. Clin Orthop Relat Res. 1973;90:22–8.

    PubMed  Google Scholar 

  51. Hernigou P, Galacteros F, Bachir D, Goutallier D. Deformities of the hip in adults who have sickle-cell disease and had avascular necrosis in childhood. A natural history of fifty-two patients. J Bone Joint Surg Am. 1991;73(1):81–92.

    CAS  PubMed  Google Scholar 

  52. Vakil N, Sparberg M. Steroid-related osteonecrosis in inflammatory bowel disease. Gastroenterology. 1989;96(1):62–7. S0016508589000302 [pii].

    CAS  PubMed  Google Scholar 

  53. Hauzeur JP, Malaise M, Gangji V. Osteonecrosis in inflammatory bowel diseases: a review of the literature. Acta Gastroenterol Belg. 2009;72(3):327–34.

    PubMed  Google Scholar 

  54. Kabata T, Matsumoto T, Yagishita S, Wakayama T, Iseki S, Tomita K. Vascular endothelial growth factor in rabbits during development of corticosteroid-induced osteonecrosis: a controlled experiment. J Rheumatol. 2008;35(12):2383–90. doi:10.3899/jrheum.070838.

    Article  PubMed  Google Scholar 

  55. Frost HM. In vivo osteocyte death. J Bone Joint Surg Am. 1960;42-A:138–43.

    CAS  PubMed  Google Scholar 

  56. Catto M. A histological study of avascular necrosis of the femoral head after transcervical fracture. J Bone Joint Surg Br. 1965;47(4):749–76.

    CAS  PubMed  Google Scholar 

  57. Young MH. Epiphysial infarction in a growing long bone. An experimental study in the rabbit. J Bone Joint Surg Br. 1966;48(4):826–40.

    CAS  PubMed  Google Scholar 

  58. McCarthy EF. Aseptic necrosis of bone. An historic perspective. Clin Orthop Relat Res. 1982;168:216–21.

    PubMed  Google Scholar 

  59. Day SM, Ostrum RF, Chao EYS, Rubin CT, Aro HT, Einhorn TA. Bone injury. Regeneration and Repair In: Buckwalter JA, Ein-horn T, Simon S, eds. Orthopaedic Basic Science - The Biology and Biomechanics of the Musculoskeletal System. Rosemont IL: America Academy of Orthopaedic Surgeons. 2000:371–400.

    Google Scholar 

  60. Koo KH, Ahn IO, Kim R, Song HR, Jeong ST, Na JB, et al. Bone marrow edema and associated pain in early stage osteonecrosis of the femoral head: prospective study with serial MR images. Radiology. 1999;213(3):715–22.

    Article  CAS  PubMed  Google Scholar 

  61. Atsumi T, Kuroki Y, Yamano K. A microangiographic study of idiopathic osteonecrosis of the femoral head. Clin Orthop Relat Res. 1989;246:186–94.

    PubMed  Google Scholar 

  62. Glimcher MJ, Kenzora JE. The biology of osteonecrosis of the human femoral head and its clinical implications: II. The pathological changes in the femoral head as an organ and in the hip joint. Clin Orthop Relat Res. 1979;139:283–312.

    PubMed  Google Scholar 

  63. Glimcher MJ, Kenzora JE. Nicolas Andry award. The biology of osteonecrosis of the human femoral head and its clinical implications: 1. Tissue biology. Clin Orthop Relat Res. 1979;138:284–309.

    PubMed  Google Scholar 

  64. Glimcher MJ, Kenzora JE. The biology of osteonecrosis of the human femoral head and its clinical implications. III. Discussion of the etiology and genesis of the pathological sequelae; comments on treatment. Clin Orthop Relat Res. 1979;140:273–312.

    PubMed  Google Scholar 

  65. Mitchell DG, Rao VM, Dalinka MK, Spritzer CE, Alavi A, Steinberg ME, et al. Femoral head avascular necrosis: correlation of MR imaging, radiographic staging, radionuclide imaging, and clinical findings. Radiology. 1987;162(3):709–15.

    Article  CAS  PubMed  Google Scholar 

  66. Curtiss Jr PH, Kincaid WE. Transitory demineralization of the hip in pregnancy. A report of three cases. J Bone Joint Surg Am. 1959;41-A:1327–33.

    PubMed  Google Scholar 

  67. Hayes CW, Conway WF, Daniel WW. MR imaging of bone marrow edema pattern: transient osteoporosis, transient bone marrow edema syndrome, or osteonecrosis. Radiographics. 1993;13(5):1001–11; discussion 12.

    Article  CAS  PubMed  Google Scholar 

  68. Kim SY, Koo KH, Suh KT, Kim YS, Cho YJ, Min BW, et al. Fatty marrow conversion of the proximal femoral metaphysis in transient bone marrow edema syndrome. Arch Orthop Trauma Surg. 2005;125(6):390–5. doi:10.1007/s00402-005-0824-4.

    Article  PubMed  Google Scholar 

  69. Willis-Owen CA, Daurka JS, Chen A, Lewis A. Bilateral femoral neck fractures due to transient osteoporosis of pregnancy: a case report. Cases J. 2008;1(1):120. doi:10.1186/1757-1626-1-120.

    Article  PubMed Central  PubMed  Google Scholar 

  70. Van Veldhuizen PJ, Neff J, Murphey MD, Bodensteiner D, Skikne BS. Decreased fibrinolytic potential in patients with idiopathic avascular necrosis and transient osteoporosis of the hip. Am J Hematol. 1993;44(4):243–8.

    Article  PubMed  Google Scholar 

  71. Berger CE, Kluger R, Urban M, Kowalski J, Haas OA, Engel A. Elevated levels of lipoprotein(a) in familial bone marrow edema syndrome of the hip. Clin Orthop Relat Res. 2000;377:126–31.

    Article  PubMed  Google Scholar 

  72. Koo KH, Ahn IO, Song HR, Kim SY, Jones Jr JP. Increased perfusion of the femoral head in transient bone marrow edema syndrome. Clin Orthop Relat Res. 2002;402:171–5.

    Article  PubMed  Google Scholar 

  73. Wilson AJ, Murphy WA, Hardy DC, Totty WG. Transient osteoporosis: transient bone marrow edema? Radiology. 1988;167(3):757–60.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kyung-Hoi Koo .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Koo, KH., Lee, YK., Lee, Y.J. (2014). Pathophysiology of Ischemic Diseases of the Hip: Osteonecrosis, Borderline Necrosis, and Bone Marrow Edema Syndrome. In: Koo, KH., Mont, M., Jones, L. (eds) Osteonecrosis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-35767-1_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-35767-1_18

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-35766-4

  • Online ISBN: 978-3-642-35767-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics