What Is Osteonecrosis?

Fast Facts On Osteonecrosis:

• Age Group: Most common in adults ages 30 to 50
• Gender: Affects both men and women
• Cause: Injury, excessive alcohol use, corticosteroid use
• Primary Symptoms: Joint pain, stiffness and loss of range of motion
• Prognosis: In many cases, multiple treatment methods are used as damage progresses

What Is Osteonecrosis?

Osteonecrosis — also known as avascular necrosis — is a disease that causes bone tissue death due to lack of adequate blood supply. Osteonecrosis often occurs at the ends of bone and affects the nearby joint. Left untreated, the disease causes progressive bone damage that leads to bone and joint collapse. When collapse occurs, it causes pain and loss of joint functionality. 

Osteonecrosis typically develops in localized areas. Some people develop one area of damage, multiple areas of damage on the same bone or multiple areas of damage on different bones. It most commonly affects the shoulder, hip, knee and ankle. In many cases, the stress and pressure placed on the affected joint causes arthritis to develop.

Medical researchers are still studying why and how this disease occurs and there remains a lot of uncertainty in the field. It’s estimated that approximately 10,000 – 20,000 people develop osteonecrosis in the U.S. per year.

Causes and Risk Factors

Osteonecrosis develops when blood vessels become damaged, narrowed or blocked and prevent adequate blood flow to the affected bone. Medical researchers are still studying exactly what leads to loss of blood supply in the bone, but several risk factors have been identified:

• Traumatic bone or joint injury, like a fracture or dislocation
• Long-term corticosteroid use
• Long-term bisphosphonate use
• Excessive alcohol use
• Radiation and chemotherapy therapies
• Organ transplants
• Medical conditions, including decompression disease, blood clotting disorders, Gaucher disease, autoimmune diseases, HIV and cancer 

While most people with osteonecrosis present with one or more of the above risk factors, some cases develop in people with no known risk factors. 

Signs and Symptoms

In the early stages, many people feel no pain or symptoms. Symptoms may appear gradually and worsen over time as damage progresses. It can take months to years for the disease to progress to the point of significant damage and pain. When symptoms do occur, they typically affect the nearby joint and include:

• Joint pain
• Joint pain during movement and weight bearing
• Groin, thigh or buttock pain (for osteonecrosis of the hip)
• Stiffness
• Loss of joint range of motion

If damage progresses to the point where the bone and joint surface collapse, you may experience more severe pain and an inability to move the joint. If the collapse affects a weight bearing joint like the hip or knee, you may be unable to walk.

Diagnosis

See your doctor if you experience any of the symptoms listed above. To make a diagnosis, your doctor will ask you about your symptoms and take down a medical history. He or she will perform a physical exam to check your joints for pain and loss of mobility. Imaging tests can help your doctor pinpoint the origin of pain and reveal bone changes. X-rays may not show osteonecrosis in the early stages. An MRI is the imaging study of choice to make a diagnosis. 

Treatment Options

Early and aggressive treatment is necessary to maintain joint functionality, slow the progression of damage, preserve bone and prevent joint collapse. Treatment options depend on the size and location of damage, the stage of the disease and the age of the patient. 

Currently, there is no consensus over the optimal course of treatment for patients with osteonecrosis. Catching and treating the condition in the early stages, before the damage causes bones loss and joint collapse, has shown to be the most effective way to preserve the bone and joint. Unfortunately, because many people don’t experience pain or symptoms in the early stages and early osteonecrosis is less likely to appear on X-rays, the disease often isn’t diagnosed until later stages, when the damage is more significant. 

Conservative and surgical treatment options are available.

Conservative Treatment

Conservative treatments can help reduce the symptoms of osteonecrosis, but they can’t repair damaged bone or prevent progression of the disease. Over-the-counter NSAIDs, pain relievers, activity modifications, rest and physical therapy exercises and stretches to improve joint range of motion may be recommended. If the area of damage is small, diagnosed early and doesn’t affect major weight bearing joints, conservative treatments may be enough. However, this is not often the case. 

Core Decompression

During a core decompression procedure, your surgeon will drill several small holes into the damaged bone and remove an inner layer to ease pressure on the bone, allow for the growth of new blood vessels and increase blood flow to the area. Core decompression is most effective for people in the early stages of disease, before bone loss or joint collapse has occurred. The procedure is relatively simple, has few risks and reduces pain for many people.

The possible downside is that core decompression may only slow or delay further bone and joint damage, instead of treating it completely. 

Osteotomy

During an osteotomy procedure, your surgeon will remove dead or damaged bone and reshape the remaining health bone to support the joint. The procedure reduces stress and pressure on the affected joint to prevent it from collapsing. An osteotomy is most effective for people in more advanced stages of the disease and in cases where the area of damage is small. 

However, there can be some significant downsides. An osteotomy is a difficult procedure that has a long recovery period — you may have to use crutches for anywhere from 6-12 months. Additionally, like a core decompression, an osteotomy may only slow or delay further damage, but not treat it completely.  

Bone Graft

During a bone graft procedure, your surgeon will remove dead or damaged bone and replace it with healthy bone, either from somewhere else in your body or from a donor. The procedure relieves stress on the affected joint and promotes the growth of new, healthy bone in the area. A bone graft is most effective for people with medium or large areas of damage. 

However, there can be some significant downsides. Like an osteotomy, a bone graft is a difficult procedure that has a long recovery period. Additionally, a bone graft may only slow or delay further damage, but not treat it completely.

Total Joint Replacement

During a total joint replacement procedure, your surgeon will remove the damaged joint and replace it with an artificial joint. The procedure reduces pain and restores mobility to many patients. A joint replacement is the final treatment option for patients who have bone and joint collapse, or for patients who haven’t responded well to other treatments. 

The possible downside is that an invasive surgery has multiple risks and may require several months of post-op recovery and rehabilitation. Additionally, an artificial joint wears out after several years of use, and a second surgery may become necessary to replace it. 

Prevention and Lifestyle Changes

Because so much is still unknown about what causes osteonecrosis, there are very few prevention guidelines. You can lower your risk of developing osteonecrosis by:

• Limiting excessive alcohol intake and smoking
• Limiting long-term use of corticosteroids

If you’ve been diagnosed with arthritis or joint damage and you suffer from pain, stiffness and difficulty walking, climbing stairs or performing daily activities, then the iO-Core™ procedure may be a viable treatment option for you. iO-Core combines orthopedics and biologics to treat degenerating cartilage and underlying bone and tissue damage caused by arthritis and other joint injuries. Treating the underlying damage and not just the surface layer of cartilage has shown better results in decreasing pain and improving mobility for many patients. Contact us today to see if you qualify for the iO-Core procedure.