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Osteonecrosis

Vicki R. Nelson, MD, PhD Reviewed 06/2019
 


BASICS

  • Cellular bone death due to vascular insufficiency

    • Can be either traumatic or nontraumatic

  • Also known as:

    • Avascular necrosis (AVN)

    • Ischemic necrosis

    • Idiopathic osteonecrosis

    • Lunatomalacia/Kienböck...

DIAGNOSIS

HISTORY

Consider osteonecrosis in individuals presenting with bone pain who have a history of trauma or other risk factors. 
  • Hip/femoral head: dull, aching groin/hip pain that is progressive a...

TREATMENT

  • Early diagnosis is important.

  • Treatment depends on the age, location, stage of the disease, and overall health of the patient.

  • The goal of therapy is to preserve the native joint.

GENERAL MEASURES

ONGOING CARE

Physical therapy and occupational therapy as adjuncts 

PATIENT EDUCATION

  • Physicians prescribing bisphosphonates should alert patients to potential oral complications, and advise patients to...

REFERENCES

1
Lafforgue P. Pathophysiology and natural history of avascular necrosis of bone. Joint Bone Spine.  2006;73(5):500–507. [View Abstract on OvidMedline]
2
Kaushik AP, Das A, Cui Q. Osteone...

ADDITIONAL READING

  • American College of Radiology (ACR) Appropriateness Criteria for avascular necrosis of the hip. National Guideline Clearinghouse.  2010;31:15734. [View Abstract on OvidMedline]

  • ...

SEE ALSO

Avascular Necrosis; Legg-Calvé-Perthes Disease; Osteoarthritis 

CODES

ICD10

  • M87.9 Osteonecrosis, unspecified

  • M87.20 Osteonecrosis due to previous trauma, unspecified bone

  • M87.00 Idiopathic aseptic necrosis of unspecified bone

  • M87.059 Idiopathic aseptic necrosis of uns...

CLINICAL PEARLS

  • Trauma, alcohol abuse, and prolonged glucocorticoid use are the most common risk factors for developing osteonecrosis.

  • Suspect osteonecrosis in high-risk patients presenting with dull b...

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