Treatment of osteonecrosis of the hip, knee and jaw

Avascular necrosis is a dangerous and unpredictable disease

The osteonecrosis is quite a dangerous disorder that occurs when a deficiency of blood circulation in bones. In the result, the process of programmed cell death.

If not stopped, it could lead to complete destruction of bone.

This files most often diagnosed avascular necrosis of the hip joint. In addition, violations can occur around the knees, arms, shoulders.

If time does not begin treatment, the consequences can be very unpredictable.

What is the pathology?

This term is understood as severe joint disease degenerative nature. It is accompanied by necrosis, which is associated with a deficiency of the blood supply.

As in the process do not participate pathogenic microorganisms, usually called aseptic osteonecrosis.

What joints are affects the disease?

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Depending on the localization of pathologic process there are distinguished such types of pathology:

  • necrosis of the hip joint;
  • necrosis of the knee;
  • necrosis of the shoulder joint.

In most cases, the pathology affects the femoral head. Often, however, diagnosed with osteonecrosis of the knee and shoulder joints, it can also be localized on the wrists and feet.

If the disease is non-traumatic origin, in 70% of cases it is characterized by bilateral in nature. Necrosis of the hip occurs in men more often than women.

The osteonecrosis of the knee is characteristic of older women.

It can be concluded that the pathological process affects the areas that are subject to the greatest load. In more rare cases diagnosed osteonecrosis of the jaw.

Depending on the degree of development there are the following types of violations:

  • Stage 1 – normal;
  • Stage 2 – cystic and sclerotic disorders;
  • Stage 3 – a symptom of a Crescent;
  • Stage 4 – the emergence of osteoarthritis and the growth of osteophytes.
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Causes and risk factors

To the development of osteonecrosis most often cite the following factors:

  1. Drinking large amounts of alcohol, which causes poor circulation in the bone.
  2. Administration of corticosteroid drugs. These drugs provoke the destruction of bone due to the blocking activity of osteoblasts. It is especially dangerous to take these drugs for a long time.
  3. Smoking.
  4. Sickle-cell anemia.
  5. Injuries to bones, accompanied by severe circulatory disorders.
  6. Systematic violation of the connective tissue, causing the lesion of the endothelium.
  7. Radiation therapy.

At risk for the development of osteonecrosis are the following categories of people:

  • young patients 25-40 years of age;
  • people with severe asthma, which requires prolonged use of corticosteroids;
  • receiving bisphosphonates who are not complemented by the use of vitamin D and calcium.

Another factor in the development of osteonecrosis is considered acceptance of desomorphine (methamphetamine), which is a makeshift drug of codeine drugs.

Doctors say that this substance increases the likelihood of osteonecrosis jaw, and every year the number of such people increases.

The development of this disease in the region of the jaw can be a consequence of periodontal disease, lack of oral hygiene, use of bisphosphonates, tooth extraction.

How to identify the disease?

At an early stage of the disease the symptoms.

With the progression of the disorders experience these symptoms:

  1. Pain in the joint which gradually increased. The destruction of bone pain syndrome can become unbearable.
  2. Pain at rest.
  3. Limitation of physical activity.

The development of the disease in stages may occur within a few months, or a year. It is very important to detect a violation as early as possible so that treatment would be most effective.

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To identify osteonecrosis and determine the stage of the disease, use these methods:

  • radiography of the joints;
  • bone scan;
  • magnetic resonance imaging;
  • measurement of the intraosseous pressure.

You need to consider that radiography in the initial stages of the disease makes it impossible to identify a violation. Therefore, be sure to perform an MRI or a CT scan.

These studies provide an opportunity to detect abnormalities at any stage of development.

Treatment should be timely and comprehensive

Treatment of osteonecrosis should be aimed at restoration of the damaged joint, prevent disease progression, reduce the pain.

The earlier you start treatment, the more effective results can be achieved. In some cases it is impossible to do without surgical intervention, which helps to reduce pain and prevent collapse of the head joint.

At the initial stage of treatment to relieve the affected area. To do this, use canes, crutches or completely restrict circulation.

Moreover, it is often prescribe painkillers. The use of oxygen at high pressure helps to eliminate the appearance of new sites of necrotic tissue.

Conservative therapy is effective only in the early stages of osteonecrosis. If the affected knee or hip joint, it is impossible to do without surgery.

Surgery is a necessary measure

The goal of surgery is preservation of bone – this allows you to avoid prosthetics. There are several types of operations:

  1. Decompression. In the head of the damaged bone perform the hole, which reduces pressure that prevents the development of collapse.
  2. Osteotomy. In this case, remove some unhealthy bone and perform artificial restoration.
  3. Autotransplantation. While taking part of the healthy bone and transplanted to the location of the affected area.
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In the later stages of disease development apply prosthetics. In this case, insert artificial elements that contribute to the recovery of the joints.

If a person is observed osteonecrosis of the jaw, apply antibiotics and special washes.

You also need to surgically remove necrotic tissue and to eliminate the inflammatory process.


The consequences are severe and unpredictable

The main complication is the occurrence of injuries of different localization.

This problem can provoke prolonged immobility of the patient, which is accompanied by the development of pressure sores, thromboembolism, hypostatic pneumonia.

To prevent the development of serious health consequences, need to engage in the prevention of osteonecrosis.

Preventive measures

It consists in implementing such measures:

  • avoiding harmful habits;
  • the use of minimal doses of corticosteroids;
  • observance of rules of personal hygiene when caring for the oral cavity;
  • discontinuation of bisphosphonates for two months before dental procedures.

The osteonecrosis is quite a dangerous disorder that is accompanied by unpleasant symptoms and may provoke serious complications.

To avoid this, it is very important to consult a doctor as early as possible. The treatment of the disease can be effective only in the initial stages of the disease.