Avascular necrosis; Bone infarction; Ischemic bone necrosis; AVN; Aseptic necrosis
Osteonecrosis is bone death caused by poor blood supply. It is most common in the hip and shoulder but can affect other large joints such as the knee, elbow, wrist, and ankle.
Osteonecrosis occurs when part of the bone does not get blood flow and dies. After a while, the bone can collapse. If osteonecrosis is not treated, the joint deteriorates, leading to severe arthritis.
Osteonecrosis can be caused by disease or by severe trauma, such as a fracture or dislocation, that affects the blood supply to the bone. Osteonecrosis can also occur without trauma or disease. This is called idiopathic -- meaning it occurs without any known cause.
The following are possible causes:
When osteonecrosis occurs in the shoulder joint, it is usually due to long-term treatment with steroids, a history of trauma to the shoulder, or the person has sickle cell disease or any abnormal blood clotting conditions.
There are no symptoms in the early stages. As bone damage worsens, you may have the following symptoms:
Your health care provider will do a physical exam to find out if you have any diseases or conditions that may affect your bones. You will be asked about your symptoms and medical history.
Be sure to let your provider know about any medicines or vitamin supplements you are taking, even over-the-counter medicine.
After the exam, your provider will order one or more of the following tests:
If your provider knows the cause of your osteonecrosis, part of the treatment will be aimed at the underlying condition. For example, if a blood disorder is the cause, treatment will consist, in part, medicine to treat it.
If the condition is caught early, you will take pain relievers and limit use of the affected area. This may include using crutches if your hip, knee, or ankle is affected. You may need to do range-of-motion exercises. Nonsurgical treatment can often slow the progression of osteonecrosis, but most people will need surgery.
Surgical options include:
More information and support for people with osteonecrosis and their families can be found at:
How well you do depends on the following:
Outcome may vary from complete healing to permanent damage in the affected bone.
Advanced osteonecrosis can lead to osteoarthritis and permanent decreased mobility. Severe cases may require joint replacement.
Contact your provider if you have symptoms.
Many cases of osteonecrosis do not have a known cause, so prevention may not be possible. In some cases, you can reduce your risk by doing the following:
McAlindon T, Carrino JA. Osteonecrosis. In: Hochberg MC, Gravallese EM, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 208.
Whyte MP. Osteonecrosis, osteosclerosis/hyperostosis, and other disorders of the bone. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 234.BACK TO TOP
Review Date: 4/24/2023
Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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