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Aseptic necrosis

• Overview
• Symptoms
• Treatment
• Prevention

Definition:

Aseptic necrosis is bone death caused from a disruption in the blood supply. It is most common in the hip, knee, and shoulder.

Alternative Names:

Avascular necrosis; Osteonecrosis; Ischemic bone necrosis; AVN

Causes, incidence, and risk factors:

Aseptic necrosis results when part of the bone does not receive blood and dies. After a while part of the bone breaks off. If this condition is not treated, bone damage gets worse. Eventually, the healthy part of the bone may collapse.

Aseptic necrosis can be caused by an underlying disease, or a severe trauma, such as a break or dislocation , that affects the blood supply to the bone. Many times, no trauma or disease is present. This is called "idiopathic aseptic necrosis" -- aseptic necrosis without any known cause.

The following may cause aseptic necrosis:

• Long-term treatments with steroids
• Excessive alcohol use
• Sickle cell disease
• Radiation therapy   
• Gaucher disease
• Decompression sickness

Some diseases that may be associated with the development of aseptic necrosis include:

• Gout
• Atherosclerosis
• Diabetes   

Up to 20,000 people in the United States are diagnosed with aseptic necrosis each year. The condition is most common in people between 30 and 60. As many as 90% of aseptic necrosis cases in adults occur at the hip joint. It can also occur as a result of childhood cancer therapy.

A similar condition seen in children and adolescents is Legg-Calvé-Perthes disease .

References:

Canale ST (ed). Campbell's Operative Orthopaedics . 10th ed. Philadelphia, Pa: Mosby; 2003.

Lackner H, Benesch M, Moser A, Smolle-Juttner F, Linhart W, Raith J, Urban C.  Aseptic osteonecrosis in children and adolescents treated for hemato-oncologic diseases: a 13-year longitudinal observational study. J Pediatr Hematol Oncol . 2005 May;27(5):259-63.

Powars DR, Chan LS, Hiti A, Ramicone E, Johnson C. Outcome of Sickle Cell Anemia: A 4-Decade Observational Study of 1056 Patients. Medicine (Baltimore) . 2005 Nov;84(6):363-376.

• Review Date: 11/4/2005
• Reviewed By: Ariel D. Teitel, M.D., Chief, Division of Rheumatology, St. Vincent's Hospital, New York, NY. Review provided by VeriMed Healthcare Network.

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