16. Aseptic necrosis

Essay 16- Aseptic necrosis

Definition

• Condition in which bone tissue becomes ischemic and begins to suffer pathological decomposition
• Also called osteonecrosis!
• Develop mainly during childhood/accelerated growth

Etiology

• Trauma- causes obliteration of blood vessels
• Medications- corticosteroids
• Others- endocrine, congenital, metabolic, mycotic, embolic diseases
• Cellular toxicity- chemotherapy, thermal injury, smoking
• Intraosseous compression- hemorrhage, elevated BM pressure
• Susceptible joints- kip, knee, shoulder, wrist, ankle

Pathogenesis

• Factors have impact on blood vessels and cause ischemia
• Leads to trophic changes and necrosis of cartilage and bone tissue
• Stage 1- ischemia and necrosis
• Stage 2- impression fractures and fragmentation
• Stage 3- resorption and sucking of bone fragments
• Stage 4- revascularisation/recovery
• Stage 5- residual phenomena

Symptoms

• Generally, there are no complaints from the patients
• Early stages are asymptomatic!
• When symptoms appear, there may be pain at a specific site which is worse on exertion!
• May be bilateral
• Limited range of motion
• Joint swelling
• Joint instability (in later stages)
• Diagnosis
• Physical exam
• MRI without contrast- gold standard
• X-ray- to rule out acute fracture
• Bone scan
• CT
• EMG to rule out muscular problems
• Treatment
• Main goal is to improve tropics of the specific area by continuous decompression
• Non-operative- for early stages
• Surgical- stimulate vascularisation by means of bone/muscle graft
• Core decompression!
• Osteotomy
• Joint replacement surgery