Osteonecrosis: What It Is, What Causes It, What It Feels Like, and How to Treat It

Bones are living tissues that get new blood all the time, which keeps them healthy. When this blood supply stops, though, bone tissue can start to die, which can cause a painful and possibly crippling condition called osteonecrosis, or avascular necrosis (AVN).

Osteonecrosis can happen to anyone; however, it happens more often to adults between the ages of 30 and 60. Early diagnosis and treatment are crucial for preventing joint collapse and maintaining mobility.

In this blog, we'll talk about what osteonecrosis is, what causes it, how to tell if you have it, how to diagnose it, and the different ways to treat it to improve your bone health and quality of life.

What does osteonecrosis mean?

The word "osteonecrosis" implies "death of bone." When a part of the bone loses its blood supply, the bone tissue weakens, collapses, and eventually breaks down.

If this happens near a joint, the smooth cartilage that covers the bone surface may also break down, which can cause arthritis and render the joint ineffective.

The disorder can affect any bone; however, it most often affects the:

• Hip (femoral head) - the place that is hurt the most
• Knee
• Shoulder
• Ankle
• Jaw (less common, often linked to some drugs)

What causes osteonecrosis

When blood flow to a bone is cut off or slowed, osteonecrosis occurs. There are several things that can get in the way of this circulation:

• Injury or trauma

A fracture or dislocation may damage the blood vessels that supply blood to the bone. This is a common reason why people develop osteonecrosis of the hip after a hip fracture.

• Using corticosteroids for a long time

Taking a lot of corticosteroid drugs (like prednisone) for a long time can cause fat to build up in blood vessels, which makes it harder for blood to flow to the bone.

• Too Much Drinking

Alcohol can cause fat to build up in the blood arteries, which can make it harder for blood to flow to the bones.

• Health Issues
• Some disorders raise the chance of osteonecrosis, such as:
• Sickle cell disease
• Lupus
• HIV and AIDS
• Pancreatitis
• Diving-related decompression sickness
• Chemotherapy or radiation

These cancer treatments can hurt blood arteries, which makes bone necrosis more likely.

• Idiopathic (Cause Unknown)

Idiopathic osteonecrosis occurs when no definite etiology can be found.

Who Is in Danger?

Osteonecrosis can affect everyone; however, some groups are more likely to get it than others, such as:

• Individuals aged 30 to 60 years
• People who have been taking corticosteroids or drinking alcohol for a long time
• People who have chronic illnesses like lupus or sickle cell disease
• Individuals who have received organ transplants or radiation therapy

Osteonecrosis: Signs and Symptoms

Osteonecrosis typically begins with mild symptoms that worsen over time. As the condition gets worse, the symptoms can become very bad and make it hard to do everyday things.

In the Early Stages (Before the Bone Breaks):

• Mild, on-and-off soreness in the joint that hurts
• Only hurts when you move or carry something heavy.

Progressive Stages: Pain that doesn't go away and gets worse even when you're not moving

• The joint is swollen and stiff.
• Limited movement
• Problems with standing, walking, or utilizing the hurt limb
• Pain associated with hip osteonecrosis typically begins in the buttocks, groin, or thigh.
• Shoulder osteonecrosis commonly causes pain in the shoulder joint or upper arm.
• If not addressed, the bone and joint could break down, leading to severe arthritis and loss of movement.

Finding it early is crucial to prevent damage to the joints. To determine if someone has osteonecrosis, doctors review their medical history, perform imaging tests, and conduct a clinical examination.

1. A physical exam and a history

Your doctor will look at your symptoms, medical history, and any risk factors you may have, such as using steroids, drinking alcohol, or having had injuries in the past.

2. Imaging Tests X-rays: Changes may not show up in the early stages, but later pictures can show bone collapse or joint deformity.

MRI (Magnetic Resonance Imaging): The most accurate test for finding problems early on. It can detect osteonecrosis before the symptoms worsen.

CT scans provide detailed images of your bones and joints, allowing you to assess the extent of the damage.

Bone scans may help find changes in blood flow and bone activity.

3. Tests on blood

Even though they don't tell you what's wrong, they might help you find out if you have lupus or sickle cell disease.

Osteonecrosis Stages

Depending on how bad the bone degeneration is, doctors usually divide osteonecrosis into four stages:

Stage I: X-rays are normal, but the MRI reveals reduced blood flow.

Stage II: X-rays show early alterations in the bones, but the joint surface is still fine.

Stage III: The bone begins to break down, resulting in joint problems

Stage IV: There is a lot of arthritis and joint deformities.

Early diagnosis provides the best opportunity for recovery without surgery.

Treatment Choices

The goal of treatment is to prevent further bone breakdown and maintain joint function. The stage of the disease, the affected bone, and the patient's overall condition all play a role in determining a treatment.

1. Non-Surgical Treatments (Early Stages) Medications:

• Alendronate and other bisphosphonates may help slow down the deterioration of bones.
• Anti-inflammatory medicines help with pain and swelling.
• Medicines that lower cholesterol can help stop fat from building up in blood arteries.
• Less Weight Bearing: Using crutches or reducing weight on the affected joint may help lessen pressure and slow the disease's progression.
• Physical Therapy: Making the muscles around the joint stronger and increasing the joint's range of motion can make it more stable and functional.

Some therapies utilize electrical currents to aid in bone development and healing.

2. Surgery (for advanced stages)

If the bone has already broken or conservative techniques are not effective, surgery may be necessary to restore joint function.

Some common types of surgery are:

Core Decompression: A small piece of bone is removed to ease pressure, enhance blood flow, and accelerate healing. Frequently employed in the initial phase of hip osteonecrosis.

Bone Grafting: To repair damaged bone, healthy bone tissue is transferred from another part of the body or from a donor.

Osteotomy: The bone is manipulated to shift weight away from the injured location, which can help delay the need for joint replacement.

Arthroplasty, or joint replacement, involves the placement of an artificial implant in a damaged joint to restore movement and alleviate pain. The most prevalent types of replacements are for the hips and knees.

Problems that can happen if osteonecrosis isn't treated

Osteonecrosis can cause: Complete bone collapse if not addressed

• Severe osteoarthritis
• Long-term pain and stiffness
• Loss of movement for good
• Quick diagnosis and treatment can significantly reduce the likelihood of these problems and help maintain proper joint function.

Tips for Avoiding

Even though osteonecrosis can't always be stopped, you can lower your risk by doing specific things:

• Drink less alcohol.
• Avoid using corticosteroids for an extended period or when not necessary.
• Maintain a healthy weight and stay physically active.
• Get medical help to manage underlying diseases like lupus or diabetes.
• Seek help immediately if you injure your bones or joints.

When to Go to the Doctor

If you have joint pain, stiffness, or trouble walking that you can't explain, especially after an injury or while using corticosteroid medicine, you should see an orthopedic specialist right away. The best way to avoid permanent bone damage is to receive treatment as soon as possible.

Conclusion

Osteonecrosis is a dangerous disorder, but it can be treated. Patients can often regain their mobility and live pain-free lives if they are diagnosed and treated promptly, with the right medications, lifestyle adjustments, and even modern surgical interventions when necessary.

Our orthopedic surgeons, rehabilitation specialists, and radiologists at [Hospital Name] collaborate to treat a wide range of bone and joint conditions, including osteonecrosis. We help patients recover faster and feel better about returning to their daily activities by utilizing modern imaging, minimally invasive surgery, and individualized rehabilitation programs.

Call today to schedule a consultation if you have joint discomfort that won't go away or if you are at risk for osteonecrosis. Getting help early can make a significant difference in maintaining your joint health and maintaining a high quality of life.