Aseptic necrosis

Definition

Aseptic necrosis is bone death caused by poor blood supply to the area. It is most common in the hip, knee, and shoulder.

Alternative Names

Avascular necrosis; Osteonecrosis; Ischemic bone necrosis; AVN

Causes

Aseptic necrosis occurs when part of the bone does not get blood and dies. After a while part of the bone breaks off. If this condition is not treated, bone damage gets worse. Eventually, the healthy part of the bone may collapse.

Aseptic necrosis can be caused by disease, or a severe trauma, such as a break or dislocation, that affects the blood supply to the bone. Many times, no trauma or disease is present. This is called "idiopathic aseptic necrosis" -- aseptic necrosis without any known cause.

The following can cause aseptic necrosis:

• Long-term treatments with steroids
• Excessive alcohol use
• Sickle cell disease
• Radiation therapy
• Gaucher disease
• Decompression sickness

Some diseases that may be associated with the development of aseptic necrosis include:

• Gout
• Atherosclerosis
• Diabetes

Aseptic necrosis is most common in people between ages 30 and 60. Most aseptic necrosis cases in adults occur at the hip joint. The condition can also occur due to childhood cancer therapy.

Legg-Calvé-Perthes disease is a similar condition seen in children and adolescents.

References

Canale ST (ed). Campbell's Operative Orthopaedics. 10th ed. Philadelphia, Pa: Mosby; 2003.

Lackner H, Benesch M, Moser A, Smolle-Juttner F, Linhart W, Raith J, Urban C.  Aseptic osteonecrosis in children and adolescents treated for hemato-oncologic diseases: a 13-year longitudinal observational study. J Pediatr Hematol Oncol. 2005 May;27(5):259-63.

Powars DR, Chan LS, Hiti A, Ramicone E, Johnson C. Outcome of Sickle Cell Anemia: A 4-Decade Observational Study of 1056 Patients. Medicine (Baltimore). 2005 Nov;84(6):363-376.