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2015 ; 8
(3
): 201-9
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Pathophysiology and risk factors for osteonecrosis
#MMPMID26142896
Shah KN
; Racine J
; Jones LC
; Aaron RK
Curr Rev Musculoskelet Med
2015[Sep]; 8
(3
): 201-9
PMID26142896
show ga
Osteonecrosis, also known as avascular necrosis or AVN, is characterized by a
stereotypical pattern of cell death and a complex repair process of bone
resorption and formation. It is not the necrosis itself but rather the resorptive
component of the repair process that results in loss of structural integrity and
subchondral fracture. Most likely, a common pathophysiological pathway exists
involving compromised subchondral microcirculation. Decreased femoral head blood
flow can occur through three mechanisms: vascular interruption by fractures or
dislocation, intravascular occlusion from thrombi or embolic fat, or intraosseous
extravascular compression from lipocyte hypertrophy or Gaucher cells. In this
review, we emphasize etiologic relationships derived mostly from longitudinal
cohort studies or meta-analyses whose causal relationships to osteonecrosis can
be estimated with confidence. Understanding risk factors and pathophysiology has
therapeutic implications since several treatment regimens are available to
optimize femoral head circulation, interrupt bone resorption, and preserve the
subchondral bone.