Avascular necrosis
Definition:
Avascular necrosis is the death of bone tissue due to a lack of blood supply. Also called osteonecrosis, avascular necrosis can lead to tiny breaks in the bone and the bone's eventual collapse.
The blood flow to a section of bone can be interrupted if the bone is fractured or the joint becomes dislocated. Avascular necrosis of bone is also associated with long-term use of high-dose steroid medications and excessive alcohol intake.
The hip is the joint most commonly affected by avascular necrosis. While avascular necrosis of bone can happen to anyone, it usually occurs in men between the ages of 30 and 60.
Symptoms:
Many people have no symptoms in the early stages of avascular necrosis of bone. As the disease worsens, your affected joint may hurt only when you put weight on it. Eventually, the joint may hurt even when you're lying down.
Pain can be mild or severe and usually develops gradually. Joints most likely to be affected are the hip, shoulder, knee, hand and foot. Pain associated with avascular necrosis of the hip may be focused in the groin, thigh or buttock. Some people experience avascular necrosis bilaterally — for example, in both hips or in both knees.
When to see a doctor
See your doctor if you experience persistent pain in any joint. Seek immediate medical attention if you believe you have a broken bone or a dislocated joint.
Causes:
Avascular necrosis occurs when blood flow to a bone is interrupted or reduced, which may be caused by:
Avascular necrosis that goes untreated will worsen with time. Eventually the bone may become weakened enough that it collapses. When the bone loses its smooth shape, severe arthritis can result.
Treatments and drugs:
The treatment goal for avascular necrosis is to prevent further bone loss. What treatment you receive depends on the amount of bone damage you already have.
Medications
In some people, avascular necrosis symptoms may be reduced with medications such as:
In the early stages of avascular necrosis, your doctor might suggest:
Because most people don't start having symptoms until the disease is fairly advanced, you may need to consider surgeries such as:
Definition:
Avascular necrosis is the death of bone tissue due to a lack of blood supply. Also called osteonecrosis, avascular necrosis can lead to tiny breaks in the bone and the bone's eventual collapse.
The blood flow to a section of bone can be interrupted if the bone is fractured or the joint becomes dislocated. Avascular necrosis of bone is also associated with long-term use of high-dose steroid medications and excessive alcohol intake.
The hip is the joint most commonly affected by avascular necrosis. While avascular necrosis of bone can happen to anyone, it usually occurs in men between the ages of 30 and 60.
Symptoms:
Many people have no symptoms in the early stages of avascular necrosis of bone. As the disease worsens, your affected joint may hurt only when you put weight on it. Eventually, the joint may hurt even when you're lying down.
Pain can be mild or severe and usually develops gradually. Joints most likely to be affected are the hip, shoulder, knee, hand and foot. Pain associated with avascular necrosis of the hip may be focused in the groin, thigh or buttock. Some people experience avascular necrosis bilaterally — for example, in both hips or in both knees.
When to see a doctor
See your doctor if you experience persistent pain in any joint. Seek immediate medical attention if you believe you have a broken bone or a dislocated joint.
Causes:
Avascular necrosis occurs when blood flow to a bone is interrupted or reduced, which may be caused by:
- Joint or bone injury. A traumatic injury, such as a
dislocated joint, may reduce the blood supply to a section of bone,
leading to bone death. Cancer treatments involving radiation also can
weaken bone and harm blood vessels.
- Pressure inside the bone. Some medical conditions, such as sickle cell anemia or Gaucher's disease, can increase the pressure inside the bone — making it more difficult for fresh blood to enter.
Avascular necrosis that goes untreated will worsen with time. Eventually the bone may become weakened enough that it collapses. When the bone loses its smooth shape, severe arthritis can result.
Treatments and drugs:
The treatment goal for avascular necrosis is to prevent further bone loss. What treatment you receive depends on the amount of bone damage you already have.
Medications
In some people, avascular necrosis symptoms may be reduced with medications such as:
- Nonsteroidal anti-inflammatory drugs (NSAIDs).
Medications such as ibuprofen (Advil, Motrin, others) or naproxen
(Aleve) may help relieve the pain and inflammation associated with
avascular necrosis.
- Osteoporosis drugs. Some studies indicate that
osteoporosis medications, such as alendronate (Fosamax, Binosto), may
slow the progression of avascular necrosis.
- Cholesterol drugs. Reducing the amount of fat (lipids) in your blood may help prevent the vessel blockages that often cause avascular necrosis.
- Blood thinners. If you have a clotting disorder, blood thinners such as warfarin (Coumadin, Jantoven) may be prescribed to prevent clots in the vessels feeding your bones.
In the early stages of avascular necrosis, your doctor might suggest:
- Rest. Reducing the amount of weight and stress on
your affected bone may slow the damage of avascular necrosis. You may
need to restrict the amount of physical activity you engage in. In the
case of hip or knee avascular necrosis, you may need to use crutches to
keep weight off your joint for several months.
- Exercises. Certain exercises may help you maintain
or improve the range of motion in your joint. A physical therapist can
choose exercises specifically for your condition and teach you how to do
them.
- Electrical stimulation. Electrical currents may encourage your body to grow new bone to replace the area damaged by avascular necrosis. Electrical stimulation can be used during surgery and applied directly to the damaged area. Or it can be administered through electrodes attached to your skin.
Because most people don't start having symptoms until the disease is fairly advanced, you may need to consider surgeries such as:
- Core decompression. In this operation, your surgeon
removes part of the inner layer of your bone. In addition to reducing
your pain, the extra space within your bone stimulates the production of
healthy bone tissue and new blood vessels.
- Bone transplant (graft). This procedure can help
strengthen the area of bone affected by avascular necrosis The graft is a
section of healthy bone taken from another part of your body.
- Bone reshaping (osteotomy). This procedure removes a
wedge of bone above or below a weight-bearing joint to help shift your
weight off the damaged bone. Bone reshaping may allow you to postpone
joint replacement.
- Joint replacement. If your diseased bone has already collapsed or other treatment options aren't helping, you may need surgery to replace the damaged parts of your joint with plastic or metal parts.
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