Brief Overview: According to Johns Hopkins Medicine, “avascular necrosis is a disease that results from the temporary or permanent loss of blood supply to the bone. When blood supply is cut off, the bone tissue dies and the bone collapses. If avascular necrosis happens near a joint, the joint surface may collapse. This condition may happen in any bone. It most commonly happens in the ends of a long bone. It may affect one bone, several bones at one time, or different bones at different times.”
Prevalence: The exact incidence and prevalence of osteonecrosis are unknown.
Etiology: Avascular necrosis can be idiopathic, traumatic (caused by fracture, dislocation), or non-traumatic (related to an illness or medical condition that prevents blood flow to bone tissue).
Risk Factors:
- Injury
- Long-term, high-dose corticosteroid use
- Excessive alcohol consumption
- Tobacco use
- Sickle cell disease
- Cancer, like leukemia
- Gout
- HIV
- Pancreatitis
- Rheumatoid arthritis
- Lupus
Commonly Associated Conditions:
- Osteoarthritis (secondary)
- Sickle cell disease
- Systemic lupus erythematosus (SLE)
- Chronic steroid use (asthma, autoimmune disease, transplant patients)
- Alcohol use disorder
Common Medications:
- NSAIDs
- Corticosteroid injections
Common Labs, Imaging, and Tests:
- X-ray, MRI, CT
Common Symptoms:
- Pain
- Stiffness
Common Treatments:
- Physical therapy
- Cane, crutches
- Surgery, if indicated – core decompression surgery, osteotomy, bone graft, total joint replacement
Physical Findings:
- Decreased range of motion or limp may be present
Potential Complications and Contraindications:
- Complications:
- Joint collapse → severe osteoarthritis
- Chronic disability, reduced mobility
- Need for joint replacement
- Pain-related depression or deconditioning
- Contraindications:
- High-impact activities (worsen collapse)
- Prolonged corticosteroid use if avoidable
- Opioids as long-term sole therapy (limited efficacy, high risk)
General Health and Lifestyle Guidance:
- Work with your healthcare provider to manage weight to reduce joint stress
- Limit alcohol and avoid smoking
- Discuss steroid alternatives with provider if on chronic therapy
- Use assistive devices as directed by your healthcare provider (cane, crutch) if weight-bearing pain
- Low-impact exercise (swimming, cycling) to maintain mobility – discuss what exercises are recommended and safe for you
- Ask your healthcare provider if you need vitamin D and calcium supplementation
- Fall prevention strategies if hip/knee pain are severe
Suggested Questions to Ask Patients:
- Which joint is affected, and how long have you had pain?
- Does pain worsen with activity/weight-bearing?
- Do you take or have you taken long-term steroids?
- Do you drink alcohol regularly?
- Any history of sickle cell, lupus, clotting disorders, or trauma?
- How is pain affecting your daily activities, mobility, or sleep?
- Have you had imaging (x-ray, MRI) of the joint?
- Have you discussed surgical options with your doctor?
Suggested Talking Points:
- Avascular necrosis can progress over time and cause the joint to collapse if untreated.
- Treatments range from lifestyle changes and physical therapy in early stages, to surgery in advanced cases.
- Weight control, avoiding alcohol and smoking, and staying active with low-impact exercise can help preserve joint function.
- Joint replacement can restore mobility and relieve pain if collapse occurs.
Sources:
- https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-osteonecrosis-avascular-necrosis-of-bone?search=avascular%20necrosis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
- https://www.niams.nih.gov/health-topics/osteonecrosis
- https://my.clevelandclinic.org/health/diseases/14205-avascular-necrosis-osteonecrosis
- https://www.hopkinsmedicine.org/health/conditions-and-diseases/avascular-necrosis
This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.