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Osteonecrosis and Intravascular Coagulation Revisited

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Osteonecrosis

Abstract

The primary pathophysiologic feature of advanced osteonecrosis is a zone of necrotic bone containing trabeculae with dead osteocytes associated with marrow necrosis and fibrosis [1]. This pathognomonic feature led to the use of the expression “avascular necrosis,” although the international society for the study of the circulation to bone and its disorders, ARCO International (Association Internationale pour la Recherche sur la Circulation Osseuse), recommends using the term “osteonecrosis.” There are several theories regarding the pathogenesis of osteonecrosis [ON], as discussed in several outstanding review articles [2–6]. These can be categorized as (1) extraosseous, (2) intraosseous, or (3) direct cellular. There are many other theories as well, such as intravascular or extravascular pathologies. John Paul Jones, Jr., suggested that multiple etiologies may lead to a final common pathway of intravascular coagulation. He hypothesized that intravascular coagulation is an “intermediary mechanism” in the development of ON [7]. The evidence that intravascular coagulation plays an integral role in the pathogenesis of ON is both direct and indirect and will be the focus of this chapter.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Center for Osteonecrosis Research and Education, Center for Metabolism and Obesity Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Lynne C. Jones

  2. Johns Hopkins Orthopaedics, 601 N. Caroline St., JHOC 5255, Baltimore, MD, 21287, USA

    Lynne C. Jones

  3. Department of Plastic Surgery, Lifespan Academic Medical Center, The Warren Alpert Medical School of Brown, 239 Multiphasic Building, 593 Eddy St., Providence, RI, 02903, USA

    Deborah McK. Ciombor

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Correspondence to Lynne C. Jones .

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Editors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Kyonggi-do, Korea, Republic of (South Korea)

    Kyung-Hoi Koo

  2. Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland, USA

    Michael A. Mont

  3. Department of Orthopaedic Surgery, Department of Orthopaedic Surgery, Center for Metabolism and Obesity Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    Lynne C. Jones

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Jones, L.C., Ciombor, D.M. (2014). Osteonecrosis and Intravascular Coagulation Revisited. In: Koo, KH., Mont, M., Jones, L. (eds) Osteonecrosis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-35767-1_10

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