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Related Experiment Videos

Osteonecrosis: current perspectives on pathogenesis and treatment

C C Chang1, A Greenspan, M E Gershwin

  • 1Division of Rheumatology, Allergy, and Clinical Immunology, University of California, Davis.

Seminars in Arthritis and Rheumatism
|August 1, 1993
PubMed
Summary

Nontraumatic osteonecrosis, often affecting the femoral head, stems from impaired bone circulation due to various factors. Idiopathic avascular necrosis occurs without known risks, and hip replacement is common for advanced cases.

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Area of Science:

  • Orthopedics
  • Vascular Biology
  • Bone Metabolism

Background:

  • Nontraumatic osteonecrosis involves impaired blood supply to bone, frequently affecting the femoral head.
  • Causes are diverse, including steroid use, alcohol, pancreatitis, lipid disorders, and decompression syndrome.
  • Legg-Calvé-Perthes disease suggests systemic abnormalities may underlie osteonecrosis.

Purpose of the Study:

  • To review the varied etiologies and pathogenic factors contributing to nontraumatic osteonecrosis.
  • To discuss potential mechanisms, including fat emboli, gaseous emboli, and systemic abnormalities.
  • To highlight treatment options for advanced femoral head osteonecrosis.

Main Methods:

  • Literature review of nontraumatic osteonecrosis.

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  • Analysis of proposed pathogenic factors and underlying causes.
  • Discussion of clinical presentations and therapeutic modalities.

    • Main Results:

    • Osteonecrosis etiology is multifactorial, involving local and systemic factors.
    • Mechanisms include fat/gaseous emboli, increased intraosseous pressure, coagulation issues, and hyperviscosity.
    • Idiopathic avascular necrosis occurs without identifiable risk factors.

    Conclusions:

    • A single common etiology for all osteonecrosis cases remains elusive.
    • Advanced femoral head osteonecrosis management often involves total hip arthroplasty, especially in older patients.