Overview
Avascular Necrosis is a painful condition that occurs due to the death of bone cells and is caused by a lack of blood supply to the bone. It affects most commonly the hip joint, but it can also affect the knees, shoulder, and ankles.
Alternate names- Osteonecrosis is another name for Avascular Necrosis or AVN.
Symptoms of Avascular Necrosis
Initially, the patient may be asymptomatic which may be followed by mild to severe pain as the disease progresses. Finally, the collapse of the head of the femur occurs, resulting in painful arthritis of the hip.
Following symptoms appear in the case of Avascular Necrosis -
- Intermittent pain in hip, inguinal or gluteal region,
- Stiffness
- Decreased range of motion
- Painful Limp and shortening
Avascular Necrosis Causes
Trauma has been the most common cause of AVN, followed by excessive intake of alcohol. Steroid intake is another important cause of AVN. When the cause is unknown, it is called "Idiopathic."
Recently there has been an "epidemic of Corona" when millions of people suffered from the deadly virus "Covid-19". The disease has been managed with steroids as a life-saving drug, and there seems to be a tremendous rise in patients suffering from Osteonecrosis of the hip.
Fat deposition in blood vessels
Fat builds up in blood vessels, thus disrupting blood flow to the bone.
Steroids
Steroids are believed to cause lipid deposition in blood vessels, thus causing Avascular Necrosis.
Excessive intake of alcohol for a prolonged period
Too much alcohol intake can increase cholesterol levels blocking blood vessels. Moreover, fat deposition occurs in the bone marrow, which builds pressure inside the bone and decreases blood supply to the bone.
Other medical conditions
- Blood disorders like "sickle cell disease."
- Diabetes
- Radiation therapy
- HIV
- Lupus
- Organ transplants are other medical conditions causing Osteonecrosis of the hip
Diagnosis of Avascular Necrosis (AVN or Osteonecrosis)
Diagnosis is based on the history of symptoms, physical examination, and radiological investigations.
Physical examination
The treating doctor examines the joints for tenderness, range of movements, deformity and gait of the patient.
X-ray- Early stages show no changes. In later stages, an X-ray shows increased bone density, followed by collapse and arthritic changes in the joint.
MRI (Magnetic Resonance Imaging)
MRI is the most sensitive imaging technique and thus helps in the accurate staging of Avascular Necrosis.
CT Scan (Computed Tomography Scan)
CT scan does not detect stages 0 and 1 of Avascular Necrosis but can detect bone collapse.
Bone scan
A radioactive substance is injected into the vein to detect the injury or abnormality in the structure of the bone.
Avascular Necrosis Treatment
Treatment aims to arrest the disease process or induce vascularization of the dead bone.
Medications
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Helps relieve pain; however, stronger medications are available on prescription.
Cholesterol-lowering drugs
Helps lower blood cholesterol and help to remove blockages in blood vessels.
Blood thinners
These are prescribed if Osteonecrosis occur due to blood clots.
Other Conservative Treatment Modalities
Rest
You need to avoid putting weight on your joints that may require using crutches for several months.
Exercise
Physiotherapists help to increase the range of motion. They also teach exercises that help patients back to a routine lifestyle.
Electrical stimulation
Electrical stimulation helps in regenerating the bone. It can be used at the time of surgery directly over the joint or after surgery using electrodes on the skin.
Surgery
-
Core decompression
It helps relieve pressure by drilling and giving space for new blood vessels to grow and establish blood circulation locally.
-
Bone grafting
A bone graft is taken from the local or distant area to fill the space left out after removing dead bone. The procedure provides structural support and creates neo vascularization to create newer vascular channels.
-
Osteotomy
Osteotomy takes away damaged bone and allows the healthy bone to occupy the weight-bearing area of the hip joint.
Hence it relieves pain and initiates healing of the dead bone by offloading, debridement and bone grafting.
-
Joint Replacement
Joint replacement is the last option to treat the patient with a metal prosthesis. Patients should undergo timely treatment with biological methods to avoid the stage of joint replacement.
Possible complications
Avascular Necrosis Prevention
- Limit alcohol
- Limit steroid use
- Avoid smoking
- Maintain low levels of cholesterol
Prognosis
Last Update
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