Osteonecrosis
Osteonecrosis
A
progressive deterioration of the femoral
head or any other bone that is not
receiving adequate vascular nutrition.
Causes

The exact etiology is not known. The level of
unbound maternal cortisol gradually raises
towards the end of pregnancy to a level about
three times that in normal non-pregnant women. It
has been speculated that the rise in unbound
cortisol, estrogen and progesterone in late
pregnancy, the increased interosseous pressure
and a direct injury to the femoral joint by the
compression of the growing uterus or during a
difficult delivery may all act together to produce
insufficiency of blood supply to the femoral head.
Most of the cases are idiopathic.
Other Causes





Renal
transplantation
Alcoholism
Autoimmune
disorders (systemic
lupus erythematosus,
rheumatoid arthritis,
polyarteritis nodosa)
Gout
Cushing’s disease







Pancreatitis
Polycythaemia
Cryoglobulinaemia
Decompression
sickness
Sickle-cell anaemia
Liver disease
Infections
Signs and Symptoms









During the last trimester or at delivery (in relatively
older mothers)
Higher rate of involvement of the left hip
Increasing pain of variable severity
Usually unilateral
Deep pain in the groin
Pain radiates to the knee, thigh, or back
Pain exaggerated by standing and walking
Painful limitation of AROM or PROM of the hip
joint
Positive Trendelenburg gait on the affected side
PT Implications
 MRI
should distinguish between
osteonecrosis and TPO. Decrease weight
bearing, osteotomy, use of a nonvascularized structural graft, electrical
stimulation, core decompression and use
of a vascularised structural graft.
References



Goodman, Catherine Cavallaro and Snyder, Teresa
E. Kelly. Differential Diagnosis for Physical Therapists:
Screening for Referral. 2007 ed. Vol. 4th Edition. St.
Louis, Missouri: Saunders Elsevier, 2007. Print.
Keriakos, R, Bhatta, SR, Morris, F, Mason, S, and
Buckley, S. Pelvic Girdle Pain During Pregnancy and
Puerperium. J Obstet Gynaecol 31.7 (2011): 572-80.
Print.
Rosenthal, H. E., W. R. Slaunwhite, Jr., and A. A.
Sandberg. Transcortin: A Corticosteroid-Binding
Protein of Plasma. X. Cortisol and Progesterone
Interplay and Unbound Levels of These Steroids in
Pregnancy. J Clin Endocrinol Metab 29.3 (1969): 35267. Print.