4 Jaypee Brothers Medical Publishers (P) Ltd.

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© 2016, Jaypee Brothers Medical Publishers

All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission of the publisher.

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This book has been published in good faith that the contents provided by the author contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the author specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the author. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device.

I have had the privilege of being acquainted with Professor Sudhir Babhulkar since 1980. Over the last 30 years, we have met and interacted in various regional, national and international meetings. I have always been impressed by his scientific clinical work, excellent documentation and dedication to research activities. I am personally aware of his extensive clinical work on osteonecrosis carried out over a period of four decades. This particular monogram is a culmination of the vast experience and knowledge gained over such a long period.

The book is a comprehensive guide on the subject of osteonecrosis encompassing the entire spectrum from etiopathology to various surgical treatments. The importance of early diagnosis and timely intervention is aptly stressed upon in order to ensure a pain free and active life of young adults who are the victims commonly of this debilitating disease.

The association of sickle cell disease with osteonecrosis is well documented. Osteonecrosis of hip prevalent around the world is well known, knee, ankle, talus, shoulder, hands, feet and spine, are described in great details.

I am convinced that the book will serve as a complete guide on osteonecrosis to all my orthopedic colleagues.

Aseptic necrosis occurs when there is loss of blood supply to bone causing bone death. This disease attacks people in their late 30s and 40s, i.e. young adults; and if left untreated, results in total joint destruction with joint replacement remaining the only treatment option. It is an extremely debilitating condition though not life-threatening. The incidence of osteonecrosis is increasing globally mostly due to the use of high dose of steroids for certain medical conditions and increasing alcohol abuse. Sickle cell disease remains a common cause of osteonecrosis.

Since the beginning of my practice in 1970, we have managed a large number of patients with osteonecrosis. In 1994, our institute had the privilege of hosting an international symposium on osteonecrosis, which was attended by two giants in this field, Professor Y Sugioka from Japan and Dr JP Jones Jr from USA. Infact, these two pioneers in the field of osteonecrosis inspired me to maintain meticulous records of my patients, collect scientific data and focus my research on this topic. The book is a culmination of over four decades of dedicated clinical work, research and knowledge gained through various national and international meetings, especially on osteonecrosis.

The book covers the etiopathology of the disease including the research studies done on the different conditions associated with osteonecrosis. It will discuss in detail the various diagnostic tools including X-rays, CT scan, MRI and bone scan. Classification and staging are described at length with reference to importance in planning the treatment and correlation to prognosis. Various mimics of osteonecrosis are covered in the differential diagnosis. Association of sickle cell disease with osteonecrosis is covered in great details. Numerous illustrations have been included to ensure easy understanding of the disease. Surgical procedures are described with attention to details to ensure maximum benefit to the reader.

The book attempts to cover the entire spectrum of osteonecrosis with special emphasis on femoral head necrosis, this being the most common bone being affected.

I would like to thank my colleagues in the Department of Orthopedics, Indira Gandhi Medical College and Mayo General Hospital, Nagpur, Maharashtra, India, for their support, help and encouragement in bringing together the book. I would also like to thank our publisher, M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for the support and encouragement.

I sincerely wish that the book will serve as a concise guide to all the students and practicing orthopedic surgeons all over.