What is Avascular Necrosis – Osteonecrosis ?
Avascular necrosis is a disease that results from the temporary or permanent loss of blood supply to the bone. When blood supply is cut off, the bone tissue dies and the bone starts to collapse.
This condition can happen in any bone. It commonly happens in the ends of a long bone. But it can happen to any bone or joint. It may affect one or several bones at one time, or different bones at different times. If diagnosed with AVN its always best to get the other bone checked out as well .
Example AVN in Rt knee best to also get left knee check because often it can be bilateral (both sides)
What causes avascular necrosis?
Avascular necrosis may be the result of the following:
- Damage to blood vessels
- Long-term use of medicines, such as corticosteroids
- Excessive, long-term use of alcohol
- Specific chronic medical conditions
What are the risk factors for avascular necrosis?
Risk factors include:
- Steroid use
- Gaucher disease
- Caisson disease
- Alcohol use
- Blood disorders, such as factor v lieden, factor iii, mthfr, eNOS,sickle cell anemia
- Radiation treatments
- Decompression disease
- Hypercoagulable state
- Autoimmune disease
What are some of the symptoms of avascular necrosis?
The following are the most common symptoms of avascular necrosis. However, each person may experience symptoms differently.
- Minimal early joint pain
- Increased joint pain as disorder progresses
- Limited range of motion due to pain
- chronic pain
The symptoms of avascular necrosis may look like other medical conditions or other bone conditions. Always talk to your primary care provider for a diagnosis and make sure you seek an orthopedic who is knowledgeable in current treatments and has experience in treating patients with avascular necrosis-osteonecrosis.
How is avascular necrosis diagnosed?
Along with your complete medical history and physical exam, you may have one or more of the following tests:
- X-ray. This test uses invisible electromagnetic energy beams to make images of internal tissues, bones, and organs onto film. Its not accurate in diagnosing early stage avascular necrosis.
- Computed tomography scan (also called a CT or CAT scan). This is an imaging test that uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
- Magnetic resonance imaging (MRI). This test uses large magnets, radio frequencies, and a computer to make detailed images of organs and structures within the body.
- Radionuclide bone scan. This nuclear imaging technique uses a very small amount of radioactive material, which is injected into the blood to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.
- Biopsy. A procedure in which tissue samples are removed (with a needle or during surgery) from the body for exam under a microscope. It’s done to find cancer or other abnormal cells or remove tissue from the affected bone.
- Functional evaluation of bone. Tests that usually involve surgery to measure the pressure inside the bone.
How is avascular necrosis treated?
Specific treatment for avascular necrosis will be determined by your healthcare provider based on:
- Your age, overall health, and medical history
- Extent of the disease
- Location and amount of bone affected
- Underlying cause of the disease
- Your tolerance for specific medicines, procedures, or therapies
- Expectations for the course of the disease
- Your opinion or preference
The goal of treatment is to improve functionality and stop further damage to the bone or joint. Treatments are needed to keep joints from breaking down, and may include:
- Medicines. These are used to control pain.
- Assistive devices. These are used to reduce weight on the bone or joint.
- Core decompression. For this surgical procedure, the inner layer of bone is removed to reduce pressure, increase blood flow, and slow or stop bone and/or joint destruction.
- PRP platlett rich plasma. Platelet-rich plasma, or PRP, is a substance that’s thought to promote healing when injected. Plasma is a component of your blood that contains special “factors,” or proteins, that help your blood to clot. It also contains proteins that support cell growth. Researchers have produced PRP by isolating plasma from blood and concentrating it.
- Stem Cell Injections Stem cells live in all of us and they act as the repairmen of the body. However, as we age or get injuries, we sometimes can’t get enough of these critical repair cells to the injured area. Medical technology now has promising results in stem cell injections for stage 1-2 stage of avn. And often some surgeons will also use it with surgery or as a non surgical treatment on its own.
- Osteotomy. This procedure reshapes the bone and reduces stress on the affected area.
- Bone graft. In this procedure, healthy bone is transplanted from another part of the body into the affected area.
- Joint replacement. This surgical procedure removes and replaces an arthritic or damaged joint with an artificial joint. This may be considered only after other treatment options have failed to relieve from pain and/or disability.
Other treatments may include electrical stimulation and combination therapies to promote bone growth.
Tips to help you get the most from a visit to your healthcare provider:
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are. Example : Steroids can make avn worse
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- Ask about alternative treatments.
Avascular necrosis goes by many names -Osteonecrosis-Aseptic Necrosis-Bone infarction- ischemic necrosis
Ahlbacks Disease avn in knee due to meniscal tear
SPONK – Spontaneous osteonecrosis of the knee
Kienböck’s disease avn in wrist