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 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:
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.
There are no symptoms in the early stages. As bone damage worsens, you may have the following symptoms:
If your provider knows the cause of osteonecrosis, part of the treatment will be aimed at the underlying condition. For example, if a blood clotting disorder is the cause, treatment will consist, in part, of clot-dissolving medicine.
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 need surgery.
Surgical options include:
Michael Mont is an Orthopedics doctor in New York, New York. Dr. Mont has been practicing medicine for over 38 years and is rated as an Elite doctor by MediFind in the treatment of Osteonecrosis. He is also highly rated in 19 other conditions, according to our data. His top areas of expertise are Osteonecrosis, Osteoarthritis, Arthritis, and Acute Pain. He is board certified in Orthopedic Surgery and licensed to treat patients in Ohio. Dr. Mont is currently accepting new patients.
Murray Urowitz is in Canada. Urowitz is rated as an Elite expert by MediFind in the treatment of Osteonecrosis. He is also highly rated in 15 other conditions, according to our data. His top areas of expertise are Systemic Lupus Erythematosus, Lupus Nephritis, Osteonecrosis, and Glomerulonephritis.
Philippe Hernigou is in Creteil, France. Hernigou is rated as an Elite expert by MediFind in the treatment of Osteonecrosis. They are also highly rated in 15 other conditions, according to our data. Their top areas of expertise are Osteonecrosis, Necrosis, Osteolysis Syndrome Recessive, and Thrombophlebitis.
More information and support for people with osteonecrosis and their families can be found at:
How well you do depends on the following:
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.
Call 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:
McAlindon T, Ward RJ. Osteonecrosis. In: Hochberg MC, Gravallese EM, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 206.
Whyte MP. Osteonecrosis, osteosclerosis/hyperostosis, and other disorders of the bone. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 234.