Merck Manual

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The Manual's Editorial Staff

Reviewed/Revised Dec 2022
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What is osteonecrosis?

Osteonecrosis is the death of bone cells.

  • Osteonecrosis happens when something, such as a bone injury, interferes with blood supply to a bone

  • Osteonecrosis most often happens after a bone injury, but it can happen on its own

  • It's most common in the hip, knee, and shoulder

  • Osteonecrosis near a joint can cause arthritis in that joint

  • Symptoms include pain and trouble moving the nearby joint

  • Doctors do x-rays or MRI (magnetic resonance imaging)

  • Doctors treat osteonecrosis with pain medicine and physical therapy and sometimes do surgery

  • Early diagnosis may prevent the need for surgery

What causes osteonecrosis?

Osteonecrosis happens when there is:

  • Decreased blood flow to part of a bone

Because bones are living tissue, they need a blood supply to deliver oxygen and nutrition. Without enough blood, bones die.

Decreased blood flow to a bone can:

  • Be caused by an injury

  • Just happen on its own

Injuries that break a bone or dislocate a joint sometimes tear blood vessels that feed the bone. If the blood vessels don't heal properly, your bone won't get enough blood.

Sometimes you get osteonecrosis without having an injury. This is more likely if you:

  • Take high doses of corticosteroids for a long time

  • Drink too much alcohol for a long time

What are the symptoms of osteonecrosis?

Symptoms of osteonecrosis include:

  • Pain that’s worse when moving and better with rest

  • Later, pain, achiness, and stiffness in your joints

Other symptoms depend on where the problem is. If you have osteonecrosis in your hip, for example, you’ll have pain down your thigh or in your buttocks. If you have osteonecrosis in a leg bone, you’ll limp and have pain while standing or walking.

How can doctors tell if I have osteonecrosis?

Doctors may suspect osteonecrosis if you broke a bone but keep having pain after the bone should have healed. They also suspect it if you have bone or joint pain for a long time for no apparent reason, particularly if you've been taking corticosteroids or drinking too much alcohol.

To see if you have osteonecrosis, doctors will do imaging tests, such as:

How do doctors treat osteonecrosis?

There is no specific treatment for osteonecrosis. Doctors try to make you feel better by having you:

If the osteonecrosis is caught early and is in just a small area, the bone may heal on its own with time.

Sometimes you'll need surgery. There are different types of surgery:

  • Core decompression (doctors make holes in your bone to lower pressure inside your bone)

  • Bone graft (doctors remove the dead bone and replace it with normal bone from another part of your body)

  • Osteotomy (doctors cut and reshape your bone so weight is shifted from damaged bone to healthy bone)

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