Nontraumatic Necrosis of Bone (Osteonecrosis)

ALTHOUGH osteonecrosis, the in situ death of a segment of bone, has been recognized since the early part of this century, it still presents challenges to the biologist, the physician in the applied sciences, and especially the clinician. Since the first descriptions,1 2 3 we have learned what to call it; at least for lesions of the hip, how to classify it4 , 5; and through advanced radiologic imaging, how to diagnose it with certainty.6 , 7 The pathogenesis of osteonecrosis has been partially elucidated,8 , 9 but its natural history and the effective management of it remain in some ways as confusing and shrouded in mystery . . .