Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 20-51: Osteonecrosis (Avascular Necrosis of Bone) + Key Features Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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 is 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 Download Section PDF Listen +++ ++ Initially, radiographs are often normal MRI, CT scan, and bone scan are more sensitive techniques Differential diagnosis Osteoarthritis or rheumatoid arthritis Fracture Joint pain resulting from other cause + Treatment Download Section PDF Listen +++ ++ 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