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Aseptic necrosis

• Overview
• Symptoms
• Treatment
• Prevention

Alternative Names:

Avascular necrosis; Osteonecrosis; Ischemic bone necrosis; AVN

Treatment:

If the reason for the development of aseptic necrosis is known, part of the treatment will be aimed at the underlying condition. For example, if a blood clotting disorder is the reason, treatment will consist, in part, of clot-dissolving medicine.

If the condition is caught very early, treatment will consist of pain relievers and limiting use of the effected area. This may include use of crutches if the hip, knee, or ankle is affected. Range-of-motion exercises may be prescribed. Non-surgical treatment may delay the progression of aseptic necrosis, but in most cases surgical treatment will be necessary.

Surgical options include:

• A bone graft  
• Vascularized bone graft (this is the same as a bone graft, but the bone is grafted with its blood supply)
• Osteotomy (cutting the bone and changing its alignment, to relieve stress on the bone or joint)
• Total joint replacement, in very advanced cases

Core decompression is another procedure, but it is controversial. Results vary widely. It works best in people with very early stages of aseptic necrosis. Core decompression involves removing part of the inside of the bone, thereby relieving pressure and allowing new blood vessels to form.

Support Groups:

More information and support resources can found at the following organizations.

• National Osteonecrosis Foundation -- www.nonf.org
• ON/AVN Support Group Int’l Association -- http://osteonecrosisavnsupport.org
• The Arthritis Foundation -- www.arthritis.org
• Center for Osteonecrosis Research and Education (CORE) -- http://www.osteonecrosis.org

Expectations (prognosis):

Prognosis depends on the stage of the disease at the time it was diagnosed; the size of the area of bone involved; whether any underlying conditions contributed to the condition; and the age and general health of the person affected. The outcome may vary from complete healing to permanent damage in the affected bone.

Complications:

Advanced aseptic necrosis can lead to osteoarthritis and permanent decreased mobility. Severe cases of osteoarthritis may require joint replacement.

Calling your health care provider:

Call your healthcare provider if symptoms are present.

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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