Osteonecrosis refers to the death (necrosis) of bones or bone sections as a result of a bone infarction. Bone necrosis can occur at any age. Depending on the location of the disorder, the prognosis for osteonecrosis ranges from complete healing to complete destruction of the respective bones.
What is osteonecrosis?
Osteonecrosis is characterized by severe pain at the affected site. There are three forms of osteonecrosis. See theinternetfaqs for Hyperphosphatemia Basics.
These include the aseptic, septic and post-traumatic forms. While septic osteonecrosis is triggered by an infection, the aseptic form is a collective term for all bone necrosis that is not caused by an infection.
Post-traumatic osteonecrosis occurs after an injury or fracture of the bone and can be triggered by infection or other post-traumatic processes. Every form of osteonecrosis is directly caused by the occlusion of a blood vessel that supplies the respective bone.
Causes
If the supply of nutrients to a bone or a section of bone is interrupted, it will die, or in other words osteonecrosis.
The only direct cause of this undersupply is to be found in the disturbance of the blood flow to the affected area. However, how the occlusion of the blood vessel comes about must be clarified in each individual case. This event can be preceded by both infectious and non-infectious processes. Furthermore, the triggering factor can be an injury at the corresponding site. However, the occlusion of the blood vessel can also occur as a result of other diseases, e.g. B. by hemoglobinopathies (blood diseases).
Furthermore, biophosphonates, which are used as drugs to treat osteoporosis, are a risk factor for osteonecrosis in the area of the jawbone. Among other things, they inhibit the formation of new blood vessels in the bone tissue, so that the jawbones become particularly susceptible to osteonecrosis if they are subjected to further stress.
Symptoms, Ailments & Signs
Osteonecrosis is initially manifested by pain, which can vary depending on the severity and localization of the necrosis. This can lead to bone pain and joint pain, but also to tension pain and nerve pain as a result. The pain initially only occurs during physical exertion before it develops into a chronic complication.
Joint effusion occurs in some patients as a result of necrosis. This is associated with throbbing pain and sensitivity to touch in the affected area. The skin initially feels overheated before the body temperature drops as a result of reduced blood flow. Then the necrosis occasionally appears externally, mostly in the form of dark swellings.
Small defects often heal by themselves. Large areas of necrosis usually affect other parts of the body and destroy bones and joints in the process. The condition is often accompanied by sleep problems, personality changes, and depression. In most cases, the patient can also no longer move as fluently as before.
Bone necrosis takes a progressive course and increases in intensity. If it is treated early, late effects can be avoided. If left untreated, the disease can result in serious physical and psychological problems, such as paralysis or depression.
Diagnosis & History
The course of osteonecrosis depends on the size and location of the affected area. Spontaneous healing has been observed in cases where the focus of necrosis is small and distant from the joints.
If the destructive process is close to a joint or the bone loss occupies a large area, then spontaneous healing is unlikely. In order to prevent complete joint destruction, immediate action must be taken. Diagnosing osteonecrosis can be difficult because sometimes the infarct event begins painlessly at first, with pain slowly developing over weeks or months.
However, there are also courses with sudden onset of pain. Restricted movement occurs less frequently and indicates extensive damage to the bones or joints. In very rare cases, joint effusion can occur. If osteonecrosis is suspected, a medical history is first taken. This is followed by functional tests on the corresponding bones and joints.
Imaging methods such as magnetic resonance imaging, ultrasound or an X-ray examination confirm the diagnosis of osteonecrosis, with MRI (magnetic resonance imaging) being the most reliable diagnostic method.
Complications
The prognosis of the individual osteonecrosis can be completely different. Both spontaneous healing and severe complications occur. Osteonecrosis is almost always associated with severe pain, which, however, can only occur some time after the actual bone infarction. In more severe cases, movement restrictions are observed in addition to the pain. The severity of these limitations and the chances of recovery often depend on the location and severity of the bone infarction.
In particularly severe cases, the corresponding joint can be completely destroyed. Joint effusion may also occur. With a joint effusion, fluid accumulates in the joint. The fluid can be bloody or purulent, among other things. A joint effusion often indicates a degenerative process of the bones. In the case of severe osteonecrosis, surgical treatment is usually unavoidable. If the joint is completely destroyed, often only the use of an artificial joint can help.
Chronically painful courses of the disease with severe movement restrictions impair the quality of life of the patients. As a result, mental illnesses up to and including depression can occur. Persistent pain can also lead to chronic insomnia, which is a common cause of irritability and aggressive behavior. The same symptoms often develop as a result of the artificial joint as well, when the patient has difficulty accepting their permanent disability.
When should you go to the doctor?
If bone pain or restricted movement is noticed, a doctor should be consulted. The symptoms mentioned point to osteonecrosis, which if left untreated can lead to chronic pain and other complications. In the event of unusual symptoms, those affected should consult a doctor who can diagnose bone necrosis using an ultrasound examination and other examination methods. People who have already suffered from osteomyelitis belong to the risk groups for the development of osteonecrosis.
The condition can occur in middle-aged men, older women, and other groups of people, depending on the type. Due to the large number of possible osteonecrosis, the symptoms must be considered with regard to any risk factors. Metabolic disorders, vascular occlusion and trauma are factors that need to be evaluated when signs of osteonecrosis appear.
The same applies to alcoholism and cortisone medication as well as angio- and coagulopathies. Osteonecrosis is treated by an orthopedist. Other contact points are physiotherapists and sports physicians. If the disease occurs in the context of cancer, a psycho-oncologist should be consulted.
Treatment & Therapy
Therapy for osteonecrosis depends on its severity and location. In many milder cases, sparing the affected parts of the body is sufficient. These should then be immobilized and not loaded with weights.
It is not uncommon for spontaneous healing to take place as a result of this resting phase. In the case of more severe disease progression, treatment without surgery is often no longer possible. In the case of smaller necroses, healing can be achieved by drilling into the bone (Pridie procedure). However, if the disease process is already far advanced, a bone transplant with or without cartilage or the use of an artificial joint is sometimes necessary.
In recent years, more innovative procedures have expanded the therapeutic options. In some cases, vasodilating drugs (iloprost) or electrostimulating methods are also used to increase bone growth. Which therapy should ultimately be used to treat osteonecrosis, the doctor must decide separately in each individual case due to the diverse course of the disease.
Outlook & Forecast
The prognosis of osteonecrosis depends on the size and location of the affected bone area. The prognosis is positive if the necrotizing area is small and in an easily accessible place. Necrosis in the area of the joints is much more difficult to treat, especially if it is a large-area necrosis. However, spontaneous healing is possible in all forms of osteonecrosis. Depending on the course, the disease can heal without consequences or lead to the complete destruction of the joint.
The causative disease is also decisive for the prognosis. If osteonecrosis is caused by Ahlbäck’s disease, the chances of recovery are relatively good. If it is a septic bone necrosis, the prognosis is significantly worse, since the necrosis is sometimes accompanied by inflammation and blood poisoning. The disease is associated with severe pain and restricted mobility. Rarely, osteonecrosis can result in joint effusion, which entails further risks. The prospect of a symptom-free life is only given again after recovery. The specialist responsible makes the prognosis. This is usually an orthopedist or osteopath.
Prevention
A general recommendation for the prevention of osteonecrosis cannot be given. The disease is dependent on many unknown factors. However, certain underlying diseases that can lead to osteonecrosis may require long-term treatment.
Aftercare
In the case of osteonecrosis, the aftercare measures are relatively severely limited in most cases, so that those affected by this disease are primarily dependent on a quick and, above all, early diagnosis of the disease. An early diagnosis of the disease always has a very positive effect on the further course and can prevent the occurrence of complications and other symptoms.
Most patients require surgery to relieve the symptoms. After such an operation, the person concerned should definitely rest and rest, avoiding exertion or stressful and physical activities. In many cases, the help and support of one’s own family is also very important.
Psychological support is also necessary and useful in many cases and can prevent the development of depression and other mental disorders. As a rule, osteonecrosis does not reduce the life expectancy of the affected person, although a general prediction about the further course cannot usually be made.
You can do that yourself
This condition must be treated by a doctor, otherwise it will get worse. However, if treatment is started early, osteonecrosis can heal completely. Of course, it is important to protect the affected body regions and to keep them still.
Since osteonecrosis is associated with very severe pain, it often leads to various accompanying symptoms. These include, for example, sleep disorders. Before the patients resort to sleeping pills, simple remedies can also help here. Naturopaths recommend, for example, the administration of zinc, magnesium and vitamin B6 before going to bed. This combination is said to make it easier to fall asleep. Melatonin has a similar effect. Naturopaths and doctors trained in naturopathic medicine will be happy to advise you.
The pain of osteonecrosis may also lead to a depressive mood or even to a change in personality. Then a psychotherapeutic accompanying treatment is absolutely advisable. Relaxation techniques can also help patients. In addition to Reiki, yoga and meditation, this also includes progressive muscle relaxation according to Jacobson. It is easy to learn and can often be found in the courses offered by adult education centres.
Electrical muscle stimulation (EMS) has also proven effective in healing osteonecrosis completely. Various doctors and physiotherapists offer these so-called TENS/EMS therapies. But there are also EMS devices for home use, which can then be used several times a day.