RT Book, Section A1 Yazdany, Jinoos A1 Manno, Rebecca L. A2 Papadakis, Maxine A. A2 McPhee, Stephen J. A2 Rabow, Michael W. A2 McQuaid, Kenneth R. SR Print(0) ID 1184193699 T1 Osteonecrosis (Avascular Necrosis of Bone) T2 Current Medical Diagnosis & Treatment 2022 YR 2022 FD 2022 PB McGraw-Hill Education PP New York, NY SN 9781264269389 LK accessmedicine.mhmedical.com/content.aspx?aid=1184193699 RD 2024/03/29 AB Osteonecrosis is a complication of corticosteroid use, alcoholism, trauma, SLE, pancreatitis, gout, sickle cell disease, dysbaric syndromes (eg, “the bends”), knee menisectomy, and infiltrative diseases (eg, Gaucher disease). The most commonly affected sites are the proximal and distal femoral heads (eFigure 20–45), 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 for treating metastatic cancer or plasma cell myeloma rather than osteoporosis. Initially, radiographs are often normal; MRI, CT scan, and bone scan are more sensitive techniques. Treatment involves avoidance of weight bearing on the affected joint for at least several weeks. The value of surgical core decompression is controversial. For osteonecrosis of the hip, a variety of procedures designed to preserve the femoral head have been developed for early disease, including vascularized and nonvascularized bone grafting procedures. These procedures are most effective in avoiding or forestalling the need for total hip arthroplasty in young patients who do not have advanced disease. Without a successful intervention of this nature, the natural history of avascular necrosis is usually progression of the bony infarction to cortical collapse, resulting in significant joint dysfunction. Total hip replacement is the usual outcome for all patients who are candidates for that procedure.