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What is Osteonecrosis?

shutterstock 63226825 282x300 - What is Osteonecrosis?Osteonecrosis, also known as avascular necrosis or aseptic necrosis, refers to the death of bone cells due to the reduced blood supply. This condition can cause pain and collapse of areas of bone. 

Bone collapse can further lead to degenerative arthritis (osteoarthritis) of the surrounding joints, most commonly the hips and knees. Osteonecrosis also affects the hands, shoulder, and feet albeit less often. In rare cases, osteonecrosis may develop in the jaw. This can lead to sores (ulcers) in gum tissue, pain, and exposed jaw bone.

Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides orthopedic surgery to patients in Los Angeles, Century City, CA, and surrounding locations.


Key Facts

  • Similar to arthritis, osteonecrosis can also lead to severe pain and disability. The outcome may improve with early diagnosis and treatment.
  • Glucocorticoid (corticosteroid) or the consumption of excessive amounts of alcohol may lead to osteonecrosis.
  • Osteonecrosis can develop in nearly any bone of the body. But the sites that it most often affects are the hips, shoulders, and knees.
  • Osteonecrosis of the jaw involves a different cause and treatment in comparison to osteonecrosis found in other areas of the body.


What causes Osteonecrosis?

  • Serious injury (trauma) which leads to interruptions in the blood supply to a bone
  • Corticosteroid drugs (such as cortisone, prednisone, or methylprednisolone), especially when a high dose is used for an extended duration
  • Consumption of excessive amounts of alcohol
  • Systemic lupus erythematosus

Osteonecrosis affects between 10,000 and 20,000 Americans each year, and a majority of these patients are aged between 20 and 50 years. These patients usually have a history of serious injury, corticosteroid use, excess alcohol consumption or one of the other risk factors.



Early treatment

In general, the treatment commences with pain meds and by limiting weight bearing, such as walking, on the impacted areas. For patients with osteonecrosis in small areas of the bone, this type of conservative treatment may be effective.

However, it is not a suitable treatment option for patients with knee or hip osteonecrosis who are experiencing worsening disease and collapse of bone. In such cases, the patient may require surgical intervention for pain relief and bone collapse prevention.



Patients with worsening osteonecrosis may require a procedure known as core decompression. It eliminates a fragment (core) of bone from the impacted area aiming to enhance blood supply.

Patients facing an advanced stage of osteonecrosis may require a procedure called osteotomy. In this procedure, the surgeon will eliminate dead bone and re-position the remaining bone to allow the healthy bone to offer support to the weight-bearing joint surface.

If there has already been bone collapse at the joint, the patient will usually require total joint replacement (arthroplasty) of the knee or hip. This procedure should offer pain relief and improved function to the patient.

Bone grafting is another surgery for advanced osteonecrosis cases. In this procedure, the surgeon takes a tiny piece of the patient’s own healthy leg bone and transplants (grafts) it to the site of dead bone. Bone grafting enhances blood supply and support of the surrounding bone.



For osteonecrosis management, there is no proven medical treatment. Certain studies indicate that short-term bisphosphonate treatment may slow, improve, or even prevent the collapse of bone in the knee and hip.


Treatment of Jaw Osteonecrosis

Conservative treatment can help improve most cases of osteonecrosis of the jaw. This treatment includes limited removal of dead tissue (debridement) and the use of medicated mouthwash and antibiotics.

Board certified orthopedic surgeon Dr. Tigran Garabekyan receives patients from Los Angeles, Century City, CA, and nearby areas for orthopedic surgery.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

Century City / Los Angeles: 310.595.1030

Serving patients in Los Angeles, Beverly Hills, Santa Monica, Century City, West Hollywood, North Hollywood Encino, Sherman Oaks, Van Nuys, Burbank, Glendale and other neighboring cities in the greater Los Angeles, California area.

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Contact Us

Century City

2080 Century Park East Suite 1204
Los Angeles, CA 90067
Tel: 310.595.1030 Fax: 310.582.5619