Dead bone
Published Jul 19, 2020 11:09 pm
IF SYMPTOMS PERSIST
“Fill all thy bones with aches.”
DR. JOSE PUJALTE JR.
— William Shakespeare
(1564-1616), English dramatist
The Tempest. Act i. Sc 2.
Imagine something dying inside you and finding out only when it’s too late.
That is what happens in the orthopedic condition called osteonecrosis (osteo – bone and necrosis – death of tissue). The first surprise, for most people, is being told that bone is living tissue. This means that it grows, changes, and remodels ever so slowly that we hardly know. This also means that it needs a steady, robust blood supply. The second surprise is being told that it can die, ahead of the rest of the body, in places where they matter most. The hip and knee joints are primary targets of osteonecrosis. These are the major joints for weight bearing and movement. Irreversible changes leading to bone death will occur if its blood supply is cut off.
The mystery lies in why it happens to some people and not to others.
Who Gets It and Why. This brings us to risk factors — descriptions that make it more likely to get osteonecrosis. These include:
• Age between 20 and 50.
• Diabetes.
• Alchohol abuse.
• Abuse or chronic high doses of corticosteroids.
• Lupus erythematosus.
• Sickle cell anemia.
• Hyperlipidemia.
• Previous trauma such as fracture or dislocation.
• Decompression sickness (Caisson’s disease; scuba divers – the population most at risk).
It is easy to say that most of the risk factors are unavoidable. That is true if we mean misguided people who think steroids are vitamins and that you can never have too much of it. However, certain diseases rely on corticosteroids as mainstays of treatment. If you have asthma, lupus, or rheumatoid arthritis, prednisone (a steroid) is probably one of your life-saving drugs. Unfortunately, if you stay too long on it, osteonecrosis can develop. You must check with your doctor for the right dosage or if you need it at all.
In alcohol abuse, fatty substances are released into the bloodstream to such a volume that blood flow (even to bone) is compromised. All these lead to one inescapable pathway in which blood to bone is lost and cell death results. If the knees or hips are affected, there will be pain because dying bone eventually collapses. The strain from what used to be normal loads becomes unbearable.
Signs and Symptoms. The reason osteonecrosis is alarming is that it is painless in the beginning, even as bone begins to die. That is why, early on, the pain is felt only when putting weight on the joint. Resting makes the pain stop. However, as bone destruction continues, pain increases dramatically up to a point that it can no longer be masked by analgesic or anti-inflammatory drugs.
Tests. The doctor to visit is the family medicine practitioner, the rheumatologist, the rehabilitation medicine specialist (physiatrist), or the orthopedic surgeon. Each one will get to the bottom of that hip or knee pain. The first screening tool is a simple X-ray of the complained joint. Regrettably, X-rays are read as normal in the early stages of osteonecrosis. A more sensitive imaging test is magnetic resonance imaging. MRI is able to detect changes in the bone marrow that signal a decrease in bone blood supply.
Treatment Options. Once a diagnosis of osteonecrosis is made, the doctor will want to “stage” the process. From this point on, it’s a race against time. In the early stage, the bone may yet be saved by doing core decompression. The purpose of this surgical procedure is to release the pressure within the bone thus reducing pain and allowing blood supply to return. Bone may regenerate. Bone grafting is filling the gap where dead bone was removed. In the late stage, the joint is lost. Total joint replacement is currently the best option for the patient to get a normal life back. In this operation, the diseased joint is replaced with metal and plastic articulations. A new hip or knee is expected to take pain away and restore motion.
The tragedy of osteonecrosis is that it is silent and joint pain, its first warning symptom, is usually ignored. If in doubt about that painful hip or knee, it is best to see the doctor soon.
email [email protected]
“Fill all thy bones with aches.”
DR. JOSE PUJALTE JR.
— William Shakespeare
(1564-1616), English dramatist
The Tempest. Act i. Sc 2.
Imagine something dying inside you and finding out only when it’s too late.
That is what happens in the orthopedic condition called osteonecrosis (osteo – bone and necrosis – death of tissue). The first surprise, for most people, is being told that bone is living tissue. This means that it grows, changes, and remodels ever so slowly that we hardly know. This also means that it needs a steady, robust blood supply. The second surprise is being told that it can die, ahead of the rest of the body, in places where they matter most. The hip and knee joints are primary targets of osteonecrosis. These are the major joints for weight bearing and movement. Irreversible changes leading to bone death will occur if its blood supply is cut off.
The mystery lies in why it happens to some people and not to others.
Who Gets It and Why. This brings us to risk factors — descriptions that make it more likely to get osteonecrosis. These include:
• Age between 20 and 50.
• Diabetes.
• Alchohol abuse.
• Abuse or chronic high doses of corticosteroids.
• Lupus erythematosus.
• Sickle cell anemia.
• Hyperlipidemia.
• Previous trauma such as fracture or dislocation.
• Decompression sickness (Caisson’s disease; scuba divers – the population most at risk).
It is easy to say that most of the risk factors are unavoidable. That is true if we mean misguided people who think steroids are vitamins and that you can never have too much of it. However, certain diseases rely on corticosteroids as mainstays of treatment. If you have asthma, lupus, or rheumatoid arthritis, prednisone (a steroid) is probably one of your life-saving drugs. Unfortunately, if you stay too long on it, osteonecrosis can develop. You must check with your doctor for the right dosage or if you need it at all.
In alcohol abuse, fatty substances are released into the bloodstream to such a volume that blood flow (even to bone) is compromised. All these lead to one inescapable pathway in which blood to bone is lost and cell death results. If the knees or hips are affected, there will be pain because dying bone eventually collapses. The strain from what used to be normal loads becomes unbearable.
Signs and Symptoms. The reason osteonecrosis is alarming is that it is painless in the beginning, even as bone begins to die. That is why, early on, the pain is felt only when putting weight on the joint. Resting makes the pain stop. However, as bone destruction continues, pain increases dramatically up to a point that it can no longer be masked by analgesic or anti-inflammatory drugs.
Tests. The doctor to visit is the family medicine practitioner, the rheumatologist, the rehabilitation medicine specialist (physiatrist), or the orthopedic surgeon. Each one will get to the bottom of that hip or knee pain. The first screening tool is a simple X-ray of the complained joint. Regrettably, X-rays are read as normal in the early stages of osteonecrosis. A more sensitive imaging test is magnetic resonance imaging. MRI is able to detect changes in the bone marrow that signal a decrease in bone blood supply.
Treatment Options. Once a diagnosis of osteonecrosis is made, the doctor will want to “stage” the process. From this point on, it’s a race against time. In the early stage, the bone may yet be saved by doing core decompression. The purpose of this surgical procedure is to release the pressure within the bone thus reducing pain and allowing blood supply to return. Bone may regenerate. Bone grafting is filling the gap where dead bone was removed. In the late stage, the joint is lost. Total joint replacement is currently the best option for the patient to get a normal life back. In this operation, the diseased joint is replaced with metal and plastic articulations. A new hip or knee is expected to take pain away and restore motion.
The tragedy of osteonecrosis is that it is silent and joint pain, its first warning symptom, is usually ignored. If in doubt about that painful hip or knee, it is best to see the doctor soon.
email [email protected]