Avascular necrosis of bone: A review

Abstract

The development of new investigative techniques designed to detect the very early changes of avascular necrosis of bone has stimulated interest in biologically orientated joint-sparing surgical procedures. Without surgical intervention in the very early stages of the disease, it seems that the joint is destined to collapse and then develop secondary degenerative osteoarthritis. The initial results of pedicle grafting, trochanteric osteotomy and decompression procedures, when performed in the early stages of necrosis, appear promising. Some patients will still go on to require total joint replacement at a later stage, or may present too late for a conservative surgical approach to be adopted. What remains unclear, however, is the sequence of events which lead ultimately to bone death in a wide variety of differing medical conditions; and it is only when these biochemical and cellular processes are better understood that it may be possible to adopt non-surgical measures to protect the joint.