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Osteonecrosis and Osteochondritis Overview

This document summarizes osteonecrosis and osteochondritis, beginning with their etiology and pathogenesis, which involves disruption of local blood supply or vascular issues that lead to bone cell death. It then discusses clinical manifestations like pain, imaging tests, staging systems, treatment options that depend on the stage of disease, and systemic disorders that can be associated with osteonecrosis like sickle cell disease or radiation necrosis. Prevention, load reduction, and activity restriction are recommended for management.

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Francisco Gani
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6 views13 pages

Osteonecrosis and Osteochondritis Overview

This document summarizes osteonecrosis and osteochondritis, beginning with their etiology and pathogenesis, which involves disruption of local blood supply or vascular issues that lead to bone cell death. It then discusses clinical manifestations like pain, imaging tests, staging systems, treatment options that depend on the stage of disease, and systemic disorders that can be associated with osteonecrosis like sickle cell disease or radiation necrosis. Prevention, load reduction, and activity restriction are recommended for management.

Uploaded by

Francisco Gani
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Book Reading

dr. Francisco Gilbert Timothy


dr. Adam Moeljono, [Link] (K) Spine
Section 1
General Orthopaedics
Chapter 6
Osteonecrosis and
osteochondritis

2
Aetiology and pathogenesis

• Distant part of bone vascular territory, largely enclosed by


cartilage
• Vascular sinusoids have no adventitial layer
• Initiated by
• Disruption of the local
blood supply
• Venous stasis and retrograde
arteriolar stoppage
• Intravascular thrombosis
• Compression of capillaries and
sinusoids by marrow swelling

3
• Traumatic osteonecrosis
• Vascular anatomy
• Nontraumatic osteonecrosis
• Intravascular thrombosis
• Extravascular marrow
swelling

4
Pathology and natural history

• Bone cells die after 12-48


hours of anoxia yet gross
appearance unaltered for
days or weeks
• Repair tendency
• New bone is laid down
upon the dead
• Linear tangential fracture

5
Clinical Manifestation Imaging
• Asymptomatic • X-ray
• Pain, local tenderness, • Radioscintigraphy
restricted ROM • MRI
• CT scan

6
Test for haemodynamic
function
• Intramedullary pressure
• Venography
Staging the lesion
• Ficat and Arlet
• Association Research
Circulation Osseous (ARCO)
Diagnosis of the
underlying disease
• Trauma
• Occupation
• Family background
• Medication
7
Treatment

• Early osteonecrosis
• Watchful waiting
• ‘Unloading’ osteotomy
• Medullary decompression
• Intermediate stage
osteonecrosis
• Realignment osteotomy
• Arthrodesis
• Late stage osteonecrosis
• Non-operative
• Arthrodesis
• Arthroplasty

8
Systemic disorders associated with
osteonecrosis
• Drug induced necrosis
• Total intake, spread of the
intake, other risk factors
• Sickle cell disease
• Abnormal HbS that
precipitate at low oxygen
tension
• Adequate anaesthesia, fully
oxygenated, prevent infection

9
• Caisson disease and dysbaric osteonecrosis
• Deep sea divers, compressed air workers
• Pain near joint, breathing difficulty and vertigo
• Juxta-articular mottled calcifications or dense
sclerosis
• Prevention
• Gaucher’s disease
• Inherited deficiency of lysosomal enzyme
glucocerebrosidase
• Liver, spleen, bone marrow
• Pain, limited movements, anaemia, leucopenia,
thrombocytopenia
• X-ray: Erlenmeyer flask appearance
• Replacing the missing enzyme

Gaucher
10
• Radiation necrosis
• Ionizing radiation
• Pain, previous history of radiation
treatment, local signs of irradiation
• X-rays: areas of bone destruction &
patchy sclerosis
• Site of osteonecrosis, quality of the
surrounding bone, life expectancy.
• Osteochondrosis
(osteochondritis)
• Demarcation of small segment of
articular cartilage and bone
• Intermittent pain, swelling, small
effusion in the joint
• X-ray: radiolucent line of
demarcation
• Load reduction and activity
restriction

11
Bone marrow oedema syndrome

• Pain and transient osteoporosis


• Lasts for 6-12 months then subside

12
13

Thanks!

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