What Constitutes A Diagnosis of Osteonecrosis of Bone?
While everyone agrees that a positive biopsy showing dead trabeculae devoid of lacunae remains “the gold standard” for the diagnosis of osteonecrosis, to insist that it be the “sine qua non” for the diagnosis simply impedes progress and condemns the physician to never making an early diagnosis. It also ignores the possibility of sampling error if one has anything less than the whole femoral head available for sectioning. Moreover, such insistence ignores the marrow element of bone as an integral part of the organ system and denies the fundamental landmark work of Rutishauer, Rohner and Held (1960) who showed that the bone trabecular death was the last item on a well defined pathophysiological cascade of home ischemia and necrosis. The initial stages of ischemia are evidenced only in morphological changes in the marrow. The error of insisting that only the finding of dead trabeculae in the biopsy justified the diagnosis of osteonecrosis is demonstrated in the publication of Camp and Col
