Subchondral avascular necrosis: a common cause of arthritis

Article Abstract:

The term arthritis refers to joint dysfunction, characterized by pain, instability, and loss of motion. It can result from any process that alters joint components, including the contour of the interior surfaces that form the joint, or that affects the mechanical or structural properties of the joint materials (bone, cartilage, or connecting tissues), or from alteration of the neuromuscular control of the joint. Necrosis (death) of bone tissue directly beneath the cartilage surface leads to changes in the joint surface, and is thought to be a common cause of arthritis. Four types of injury, physical, thermal, toxic, or circulatory, can cause necrosis. Avascular necrosis refers to disruption of circulation to the bone, but it cannot always be demonstrated. The incidence, demographics, and history of bone necrosis are discussed. The disease progresses through four stages, and the anatomical changes associated with each stage are described. A combination of imaging techniques, including X-rays, radioisotope imaging, CT scans and MRI, may be needed to fully demonstrate the presence of subchondral necrosis, and the advantages and disadvantages of each technique are described. Several mechanisms and diseases are associated with avascular necrosis. Anatomical factors render the ends of bones susceptible to loss of circulation, and physical injury and fat embolisms (blockage of vessel) or disturbances in fat metabolism (overactive adrenal gland or steroid treatment, and alcoholism) may also play a role. Increased pressure within bone, dysbarism (the bends, or decompression illness), Gaucher's disease (in which storage of abnormal fats and other compounds occurs), and sickle cell disease are associated with these factors. The symptoms associated with subchondral avascular necrosis are described, and sudden onset of acute pain distinguishes this from osteoarthritis. Treatment may be by analgesics and limited weight-bearing, by limited surgical decompression or by grafting with electrical stimulation. Total joint replacement should be used with care, as high failure rates may result within certain groups of patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Bones, Arthritis, Osteonecrosis

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Avascular necrosis of the femoral head presenting as trochanteric bursitis

Article Abstract:

Hip pain is a common complaint of patients seeking medical care. This symptom may be due to trochanteric bursitis, the inflammation of the bursa. The bursa is a sac-like structure found in connective tissue near the joints, such as the hip joint. Trochanteric bursitis can develop in healthy, active young and old patients, as well as patients with joint diseases such as rheumatoid arthritis and osteoarthritis. Treatment of trochanteric bursitis involves one or several local injections of corticosteroids, which are anti-inflammatory agents, but rarely includes surgery. This disorder can be diagnosed by physical examination of the joint and by noting the presence of pain. However, because trochanteric bursitis may resemble other bone and joint disorders, the patient's history must be carefully assessed. The ability of corticosteroids to relieve the pain helps to confirm the diagnosis of trochanteric bursitis. The cases are described of five patients with avascular necrosis of the femoral head, which is tissue death of the head portion of the thigh bone without involvement of blood vessels. These patients were initially thought to have trochanteric bursitis without hip joint disease. The diagnosis of avascular necrosis was later made using magnetic resonance imaging, a diagnostic method in which electromagnetic energy creates images of internal structures. In these cases, the pain associated with trochanteric bursitis was not relieved by corticosteroid treatment, which suggests that trochanteric bursitis that does not respond to corticosteroid treatment may be an early sign of hip disease. Patients who may be at risk for avascular necrosis should be assessed by magnetic resonance imaging to obtain the correct diagnosis quickly, thereby averting further deterioration of the joint and the need for a total hip replacement. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hip joint, Femur, Necrosis, Bursitis

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Thermal stability and structure of cancellous bone mineral from the femoral head of patients with osteoarthritis or osteoporosis

Article Abstract:

The thermal stability and mineral structure of cancellous bone from femoral head of patients with osteoarthritis or osteoporosis is examined.

United Kingdom, Abnormalities, Osteoarthritis, Trabecular bone

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