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Key Features

  • A complication of

    • Corticosteroid use

    • Trauma

    • Systemic lupus erythematosus (SLE)

    • Pancreatitis

    • Alcoholism

    • Gout

    • Sickle cell disease

    • Dysbaric syndromes

    • Knee menisectomy

    • Infiltrative diseases (eg, Gaucher disease)

  • The natural history is usually progression of the bony infarction to cortical collapse, resulting in significant joint dysfunction

Clinical Findings

  • Most commonly affected sites are the proximal and distal femoral heads, leading to hip or knee pain

  • Other commonly affected sites include the ankle, shoulder, and elbow

  • Osteonecrosis of the jaw has been associated with use of bisphosphonate therapy, usually when the bisphosphonate is used to treat metastatic cancer or plasma cell myeloma rather than osteoporosis

  • Hip or knee pain

    • Many patients with hip disease first present with pain referred to the knee; however, internal rotation of the hip—not movement of the knee—is painful

Diagnosis

  • Initially, radiographs are often normal

  • MRI, CT scan, and bone scan are all more sensitive techniques

  • Differential diagnosis

    • Osteoarthritis or rheumatoid arthritis

    • Fracture

    • Joint pain resulting from other cause

Treatment

  • Avoidance of weight bearing on the affected joint for at least several weeks

  • Surgical core decompression is controversial

  • Total hip replacement is the usual outcome for all patients who are suitable candidates

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