Avascular Necrosis
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3/1/20XX
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 Avascular
necrosis is defined as the cellular death of bone
components due to interruption of the blood supply.
 The
bone structures then collapse, resulting in pain, loss of
joint function and long-term joint damage.
• Avascular necrosis is also
termed as ischemic bone
necrosis, aseptic necrosis,
osteo-necrosis
or
bone
infarction
Most cases of bone necrosis
are due to fracture or occur
after corticosteroid use, but
in many instances the
etiology is unknown.
Femoral head
Femoral condyls
Humeral head
Capitulum of humerus
Scaphoid (proximal part)
Talus (body)
Lunate
f
a
c
t
o
r
Injury
Steroid use
Gaucher disease
Caisson disease
Alcohol use
Blood disorders,
such as sickle
cell anemia
Radiation
treatments
Chemotherapy
Pancreatitis
Decompression
disease
Hypercoagulable
state
Hyperlipidemia
Autoimmune
disease
HIV
Mechanisms contributing to Osteonecrosis
•
Vascular compression or disruption
commonly after a fracture
•
Steroid administration
•
Thromboembolic disease (e.g.,
nitrogen bubbles in caisson disease)
•
Primary vessel disease (Vasculitis)
•
Sickle cell crisis
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Complete Medical history

Physical examination
•
Radiographic imaging as X-ray of the
affected site, CT Scan and MRI for
the assessment internal tissues,
bones, and organs onto film.
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•
Radionuclide bone scan shows blood
flow to the bone and cell activity within
the bone. It is a more sensitive technique
for the diagnosis of Avascular Necrosis.
•
Affected Bone Biopsy of the bone tissue
samples obtained (with a needle or
during surgery) from the affected site for
examination under a microscope.

Functional evaluation of bone. Tests that
usually involve surgery to measure the
pressure inside the bone.
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Section of a trauma induced
AVN sample showing a large
number of cement lines in the
trabeculae reflecting sites of
excessive bone-remodelling
3/1/20XX
Section of AVNFH bone
showing necrosis of the
marrow associated with
affected area
Section of AVNFH bone
showing the presence of
calcified
marrow
associated with adjacent
non-diseased areas of the
bone
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Section of AVNFH bone
showing the presence of
poorly
vascularized
fibrous marrow in the
necrotic areas
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