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Spine Surgery Guide

Avascular Necrosis (Osteonecrosis)

What is Avascular Necrosis?

Avascular necrosis is bone death that occurs when the blood supply to the bones is decreased or stopped. Without an adequate blood supply, the bone breaks down and dies and collapses. If the bone affected is near a joint, the joint may also collapse. Although any bone can be affected, avascular necrosis most often affects ends of the long bones, such as the upper leg bone at the hip.

Avascular necrosis is also called osteonecrosis, aseptic necrosis, or ischemic bone necrosis.


Avascular necrosis may cause no signs or symptoms. But some people experience pain or a loss of range of motion in the affected joint. Where you experience pain depends on where the avascular necrosis occurs. For instance:
  • Avascular necrosis of the hip may cause pain in your groin. Pain may radiate down your thigh to your knee. Pain is usually worse when standing or walking.
  • Avascular necrosis of the wrist may cause wrist pain and finger weakness. You might feel less pain when you keep your hand still. The wrist bones most commonly associated with avascular necrosis include the lunate (Kienbock disease) and the scaphoid (Preiser disease).
  • Avascular necrosis of the knee causes knee pain. The bone most commonly affected is the lower end of the thighbone (femur).
  • Avascular necrosis of the shoulder usually involves the head of your upper arm bone (humerus). Pain and stiffness are common.
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Most cases of avascular necrosis follow trauma to the bone — for instance, a broken bone (fracture) or dislocated joint. The trauma can damage the blood vessels that deliver blood to the bone, leaving the bone without a source of oxygen and nutrients. As a result, the bone cells die, weakening the bone.

Other common causes of avascular necrosis include:
  • Corticosteroids. It isn't clear how these anti-inflammatory medications, such as prednisone, cause avascular necrosis. People who take high doses of corticosteroids for long periods of time — for instance, people with chronic illnesses such as rheumatoid arthritis and lupus — are more likely to experience avascular necrosis. Avascular necrosis is rare in people who take lower doses of corticosteroids for a short time. Corticosteroid injections — for instance, into an inflamed or arthritic joint — don't cause avascular necrosis.
  • Heavy drinking. People who drink large amounts of alcohol may be more likely to experience avascular necrosis than do those who drink less. Several alcoholic drinks a day for several years can cause fatty deposits to form in your blood vessels. This can restrict the flow of blood to your bones. The more alcoholic drinks you consume on a daily basis, the higher your risk of avascular necrosis.
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