Osteonecrosis

Disease class: Bone diseases

Also known as 

• Avascular necrosis 
• AVN

 

Pathophysiology

• Disruption of the normal vascular supply to bones can cause ischaemia and necrosis.

 

Causes

• Trauma (particularly bone fracture)
• Cancer
• Lupus
• Sickle cell disease
• HIV infection
• Gaucher’s disease
• Decompression sickness
• Heavy metal poisoning (e.g. lead and cadmium)
• Adverse drug reactions (e.g. corticosteroids, bevacizumab)

Types

• Osteonecrosis of the Jaw (associated with bisphosphonate treatment)
• Avascular necrosis of the femoral head
• Avascular necrosis of the knee
• Avascular necrosis of the ankle
• Avascular necrosis of the humeral head
• Avascular necrosis of the shoulder
• Avascular necrosis of the scaphoid
• Preiser's Disease: Avascular necrosis of the scaphoid without fracture
• Avascular necrosis of the spine 

Management 

• Arthroplasty
• Arthrodesis
• Revascularisation procedures (emerging field)