Topics

Intro
Cigarette Smoke
Nicotine
Carbon Monoxide
Other Substances
Smoke and Bone
Bone Healing
Wound Healing
Osteonecrosis
Lower Back Pain
Arthritis
Dupuytrens
RSD (CRPS)
Summary
Bibliography

Osteonecrosis

Since the human femoral head is entirely intrascapular, its blood supply is fragile. A variety of conditions can interrupt the flow of blood and result in ischemia and eventual osteonecrosis. These conditions include trauma with tearing of the epiphyseal arteries, arterial thrombosis or arterial embolism due to fat or sickled cells, and obstruction of venous outflow.

Hirota had demonstrated a four-fold increase in the risk of osteonecrosis of the femoral head among smokers.43 Matsuo also found an increase in risk of osteonecrosis among current smokers.68 An additional correlation between inhalation of passive smoke and the development of Legg-Calve-Perthes disease has been noted.78

The hematologic effects produced by nicotine and carbon monoxide are the probable reason for this condition. These substances result in narrowing of the epiphyseal vessels due to vasospasm and the development of a prothrombotic state with platelet aggregation,94 increased plasma viscosity, and elevated fibrinogen levels.69 This hypercoagulable state, in conjunction with vascular stasis and endothelial damage leads to microvascular sludging, clotting and eventual interruption of the vascular supply to the femoral head.