Related articles: Osteonecrosis
Definition
Osteonecrosis is a focal infarction of bone tissue. This condition can be caused by specific factors or prove to be idiopathic; osteonecrosis, for example, can be triggered by local mechanisms of ischemia, embolization by blood or lipid clots, intravascular thrombosis or extravascular compression.
The result is the death of osteocytes and bone marrow.
Osteonecrosis is more frequently of traumatic origin, so it may be due to fractures or dislocations. Instead, the chronic use of corticosteroids and excessive alcohol consumption contribute to the appearance of non-traumatic osteonecrosis. Other risk factors include various pathological conditions, such as vasculitis, coagulation disorders, sickle cell disease, gout, connective tissue diseases, decompression sickness, Cushing's syndrome, diabetes, hemoglobinopathies, Gaucher disease, hyperlipidemia, tumors, chronic pancreatitis, liver diseases and chronic kidney diseases . The risk of osteonecrosis also increases in the case of treatments involving the use of bisphosphonates, chemo- and radiotherapy.
Most common symptoms and signs *
- Intermittent claudication
- coxalgia
- Knee pain
- Hip pain
- Groin pain
- Jaw pain
- Bone pain
- Articolar pains
- Bone fractures
- Sore legs
- Joint swelling
- Osteopenia
- Rheumatism
- Joint stiffness
Further indications
The symptoms of osteonecrosis depend on the extent and location of the vascular insult. At the beginning, the affected areas can remain asymptomatic for weeks or months. Subsequently, osteonecrosis causes pain, limitation to movement and progressive collapse of the joint (ie the incongruity of the joint surfaces). Everything predisposes to the appearance of a serious secondary arthrosis and to the hypotrophy of the muscles.
Pain associated with osteonecrosis is usually gradual and is aggravated by movement and load, while relieved by rest; with joint collapse, this symptom increases and becomes continuous.
Other disorders can arise when specific joints are affected. Osteonecrosis of the hip, for example, causes pain in the groin that can radiate along the thigh or buttock and generally leads to a limping gait.
The diagnosis of osteonecrosis is confirmed with radiographic investigations (showing localized areas of sclerosis and transparency) and magnetic resonance (more sensitive and more specific than standard X-rays). Occasionally, bone scintigraphy and CT can be used. Laboratory tests can help identify the underlying cause of osteonecrosis (eg bleeding defects, hemoglobinopathies, dyslipidemia, etc.).
Treatment in the early stages of the disease involves the adoption of surgical procedures. This approach helps to stimulate healing and slow down the progression of the pathological process. In later stages, a prosthetic joint replacement may be needed to relieve pain and maintain its function. In support, symptomatic measures can be adopted such as rest, physical and pharmacological therapy (eg NSAIDs and bisphosphonates).
