27th February 2025

Osteonecrosis

Osteonecrosis, also known as aseptic or avascular necrosis, is an important differential to consider in any patient presenting with chronic and progressive musculoskeletal pain. Commonly affected areas include the humeral head, femoral head, patella and talus, with approximately half of atraumatic cases bilateral. While the aetiology of atraumatic osteonecrosis is unclear, risk factors include high-dose glucocorticoid therapy, alcohol excess, coagulopathies, sickle cell anaemia, SLE and radiotherapy. Only in advanced disease does physical examination reveal restriction of movement due to pain. Similarly, radiographs are normal in early disease, making MRI the investigation of choice.