Pine
The long-term intake of bisphosphonates can lead to the death of bone tissue in all bony structures. While this phenomenon is quite rare in the knee area, bisphosphonate-induced osteonecrosis in the jaw is more common. Furthermore, drugs from the steroid group are also suspected of provoking osteonecrosis of the jaw and knee.
Patients suffering from osteonecrosis of the jaw usually show significant instability of the bone. Depending on the location of the dead bone parts, osteonecrosis can even lead to the loss of completely healthy teeth. In most cases, the treatment of affected patients is carried out by inserting the body’s own bone, which is obtained from the jaw ridge. If osteonecrosis is less severe, simply immobilising the patient can also help to stimulate bone regeneration and restore jaw stability. Especially in children, immobilization of the jaw is considered the therapy of choice.
Hip
Osteonecrosis of the hip is also primarily caused by a disturbance in the blood flow to the bony structures. In the area of the hip joint, this circulatory disorder is usually provoked by high blood lipid values or a disorder of the lipid metabolism. In addition, the regular consumption of tobacco products and/or alcohol is considered a risk factor for the development of osteonecrosis of the hip.
Affected patients usually complain of pain in the groin region at the beginning. Classically, this pain increases significantly under stress (when walking) and decreases again in resting phases. In order to avoid severe damage to the hip, comprehensive diagnostics should be initiated as soon as possible if osteonecrosis of the hip is suspected.
The therapy is divided into non-operative and surgical measures. First and foremost, the diseased hip should be relieved with orthopedic aids. In addition, the use of blood circulation-enhancing drugs appears to be advisable in patients with osteonecrosis of the hip. In pronounced cases, surgical treatment of the dead bone may be necessary.
Wrist (Moonbone/scaphoid)
Osteonecrosis of the lunate bone (Os lunatum) is also called Kienböck’s disease or lunatum malacia. It is an aseptic bone necrosis of the lunate bone, which is located in the middle of the posterior (proximal) row of carpal bones. The lunar bone, together with the two other proximal carpal bones, the scaphoid bone (Os scaphoideum) and the triangular bone (Os triquetum), and the radius of the forearm, form the wrist (Articulatio radiocarpalis).
Predisposing factors for osteonecrosis of the lunar bone are mechanical stress (e.g., operating a pneumatic hammer) or an anatomical variant in which the ulna is shortened. Osteonecrosis manifests itself through pain and restricted movement. The doctor also examines the affected bone for pressure pain.Typical changes such as cysts, contour changes or signs of osteoarthritis only become apparent in conventional X-rays in later stages, which is why magnetic resonance imaging should be performed if osteonecrosis of the lunar bone is suspected.
In the early stages, the affected person is prescribed painkillers and physical therapy is performed. In later stages, surgical joint stiffening (arthrodesis) or shortening of the radius is indicated. In rare cases, the lunar bone must be surgically removed and replaced with silicone.
Just like the lunate bone (Os lunatum), the scaphoid bone (Os scaphoideum) can also be affected by osteonecrosis. Those affected complain of load-dependent pain with projection onto the anatomical tabatière and the radial (thumb-side) wrist region. Furthermore, it can lead to restricted movement, overheating, swelling and loss of strength.
Clinical examination is performed to check for pressure pain over the scaphoid. Depending on the stage of the disease, the therapy is also carried out conservatively or surgically. Diagnosis of suspected osteonecrosis begins with a medical history (anamnesis) and a physical examination.
During this examination, both the affected bone and the corresponding joint are subjected to functional tests. Imaging procedures are then used. Conventional methods such as ultrasound (sonography) and X-rays usually show typical changes in the bone only in the later stages. Earlier and more reliable diagnosis of “osteonecrosis” can be made with the help of magnetic resonance imaging (MRI), which is best performed with a contrast medium.
