OsteonecrosisSymptoms, Doctors, Treatments, Advances & More
Learn About Osteonecrosis
Osteonecrosis is bone death caused by poor blood supply. It is most common in the hip and shoulder but can affect other large joints such as the knee, elbow, wrist, and ankle.
Avascular necrosis; Bone infarction; Ischemic bone necrosis; AVN; Aseptic necrosis
Osteonecrosis occurs when part of the bone does not get blood flow and dies. After a while, the bone can collapse. If osteonecrosis is not treated, the nearby joint deteriorates, leading to severe arthritis.
Osteonecrosis can be caused by disease or by severe trauma, such as a fracture or dislocation, that affects the blood supply to the bone. Osteonecrosis can also occur without trauma or disease. This is called idiopathic -- meaning it occurs without any known cause.
The following are possible causes:
- Using oral or intravenous steroids
- Excessive alcohol use
- Sickle cell disease or any blood condition that causes abnormal blood clotting
- Dislocation or fractures around a joint
- Clotting disorders
- HIV or taking HIV drugs
- Radiation therapy or chemotherapy
- Gaucher disease (disease in which harmful substances build-up in certain organs and the bones)
- Systemic lupus erythematosus (an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue such as the skin, joints, and certain organs)
- Legg-Calve-Perthes disease (childhood disease in which the thigh bone in the hip doesn't get enough blood, causing the bone to die)
- Decompression sickness from a lot of deep sea diving
When osteonecrosis occurs in the shoulder joint, it is usually due to long-term treatment with steroids, a history of trauma to the shoulder, or the person has sickle cell disease or any abnormal blood clotting conditions.
There are no symptoms in the early stages. As bone damage worsens, you may have the following symptoms:
- Pain in the joint that may increase over time and becomes severe if the bone collapses
- Pain that occurs even at rest
- Limited range of motion when the joint collapses
- Groin pain, if the hip joint is affected
- Limping, if the condition occurs in the leg
- Difficulty with overhead movement, if the shoulder joint is affected
- Worsening arthritic symptoms in the joint when the condition deteriorates
If your provider knows the cause of your osteonecrosis, part of the treatment will be aimed at the underlying condition. For example, if a blood disorder is the cause, treatment will consist, in part, of medicine to treat it.
If the condition is caught early, you will take pain relievers and limit use of the affected area. This may include using crutches if your hip, knee, or ankle is affected. You may need to do range-of-motion exercises. Nonsurgical treatment can often slow the progression of osteonecrosis, but most people will eventually need surgery.
Surgical options include:
- A bone graft
- A bone graft along with its blood supply (vascularized bone graft)
- Removing part of the inside of the bone (core decompression) to relieve pressure and allow new blood vessels to form
- Cutting the bone and changing its alignment to relieve stress on the bone or joint (osteotomy)
- Replacing the deteriorated part with a donor osteochondral allograft
- Partial or total joint replacement
Northwest Hospital, Orthopedic Suite (DR. Mont)
Michael Mont is an Orthopedics provider practicing medicine in Randallstown, Maryland. Dr. Mont is rated as an Elite provider by MediFind in the treatment of Osteonecrosis. He is also highly rated in 19 other conditions, according to our data. His clinical expertise encompasses Osteonecrosis, Osteoarthritis, Osteolysis Syndrome Recessive, Knee Replacement, and Hip Replacement.
Cleveland Clinic Main Campus
Nicolas Piuzzi is an Orthopedics provider practicing medicine in Cleveland, Ohio. Dr. Piuzzi is rated as an Elite provider by MediFind in the treatment of Osteonecrosis. He is also highly rated in 20 other conditions, according to our data. His clinical expertise encompasses Osteoarthritis, Osteonecrosis, Arthritis, Hip Replacement, and Knee Replacement. Dr. Piuzzi is board certified in American Board Of Orthopaedic Surgery. Dr. Piuzzi is currently accepting new patients.
JH Health Care & Surgery Center – White Marsh
Paul Khanuja is an Orthopedics provider practicing medicine in Nottingham, Maryland. Dr. Khanuja is rated as an Elite provider by MediFind in the treatment of Osteonecrosis. He is also highly rated in 6 other conditions, according to our data. His clinical expertise encompasses Osteonecrosis, Osteoarthritis, Knock Knees, Knee Replacement, and Hip Replacement. Dr. Khanuja is board certified in American Board Of Orthopaedic Surgery. Dr. Khanuja is currently accepting new patients.
More information and support for people with osteonecrosis and their families can be found at:
- National Institute of Arthritis and Musculoskeletal and Skin Diseases -- www.niams.nih.gov/health-topics/osteonecrosis
- Arthritis Foundation -- www.arthritis.org
How well you do depends on the following:
- The cause of the osteonecrosis
- How severe the disease is when diagnosed
- The amount of bone involved
- Your age and overall health
Outcome may vary from complete healing to permanent damage in the affected bone.
Advanced osteonecrosis can lead to osteoarthritis and permanent decreased mobility. Severe cases may require joint replacement.
Contact your provider if you have symptoms.
Many cases of osteonecrosis do not have a known cause, so prevention may not be possible. In some cases, you can reduce your risk by doing the following:
- Avoid drinking excessive amounts of alcohol.
- When possible, avoid high doses and long-term use of corticosteroids.
- Follow safety measures when diving to avoid decompression sickness.
Objectives: * Primary objective : * To investigate the predisposing factors for femoral neck fractures, including age, sex, and associated comorbidities. * To investigate the complications associated with intracapsular femoral neck fractures, particularly in young patients. * To evaluate the effectiveness of autologous bone marrow injection at the femoral neck fracture site and its effect on: * Achieving comp...
Summary: Main indications for total hip arthroplasty (THA) are degenerative osteoarthritis of the coxofemoral joint, osteonecrosis of the hip, congenital disorders such as dysplasia and inflammatory arthritis. More recently, surgery using the direct anterior approach is getting popularity: this method, in fact, granting a significant sparing of the hip muscles, is associated with favorable results compared...
Published Date: June 04, 2025
Published By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
McAlindon T, Carrino JA. Osteonecrosis. In: Hochberg MC, Gravallese EM, Smolen JS, van der Heijde D, Weinblatt ME, Weisman MH, eds. Rheumatology. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 208.
Whyte MP, Dahir KM. Osteonecrosis, osteosclerosis/hyperostosis, and other disorders of the bone. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 229.