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Avascular necrosis

Dr. Nadheer K M (AIIMS)MBBS

September 25, 2020

December 01, 2020

Avascular necrosis
Avascular necrosis

Avascular necrosis refers to the death of cells and tissues in the bone and marrow. This condition is also called bone infarction, osteonecrosis, osteoradionecrosis, aseptic necrosis and ischemic bone necrosis. Though some of these terms are used interchangeably, there's a slight difference:

  • A bone infarct refers to damage or death of tissues in specific parts of bones, such as the metaphysis (neck part of a bone, where the bone shaft or diaphysis meets the rounded ends or epiphysis) and diaphysis (the long, tubular part of a bone)
  • Avascular necrosis typically causes lesions in the epiphysis—or rounded ends of bones—of long bones

Avascular necrosis occurs when blood supply is reduced or stopped to specific bone tissues, which begin to die due to lack of nourishment. If not diagnosed and treated early, avascular necrosis could lead to the premature collapse of the affected bone.

Usually, avascular necrosis occurs in some of the primary joints in the body, including the hips, knees, ankles and shoulders. It is marked by pain in those sites as bone tissue grows weaker over time due to the condition. (Read more: Joint pain)

According to a study published in the journal Clinical Epidemiology and Global Health in 2019, osteonecrosis of the femoral head (the highest part of the thigh bone) is the most common cause of hip replacement procedures in India and many other Asian countries.

There is limited data on the prevalence of avascular necrosis and what causes it, though steroid administration has been found to be one of the common causes for this condition in northern India.

Avascular necrosis symptoms

Avascular necrosis may not present with symptoms early on, but symptoms may begin to show up as the disease progresses. While it is most commonly experienced in the hip joint, avascular necrosis can also develop in the shoulders, ankles, hands and wrists. The breaks or cracks in the bone may lead to significant pain which may lead to arthritis.

Some of the common signs of this condition are:

  • Pain ranging from mild to severe in the affected areas or joints in the body
  • Pain in the groin; the pain may travel down to either knee
  • Pain in the hip or knees, especially when directly applying some weight on them
  • Inability to move freely due to the pain

Avascular necrosis causes

The cause is not known in about one-fourth of all avascular necrosis cases. That said, there are several known reasons for reduced blood supply to the bone tissues. Here are some common factors behind the development of this condition:

  • Fractures and dislocations: A fractured bone or a dislocated joint, especially in the hip region, is associated with the development of this condition as these injuries can stop or limit blood supply to the bones for a period of time.
  • Prolonged corticosteroid use: Long-term use of anti-inflammatory steroids is linked with the increase of fat in the body, which may lead to a reduction in the flow of blood to the bones thus resulting in avascular necrosis.
  • Excessive use of alcohol: Alcoholism or consuming excess alcohol for a long time has also been linked to this condition as it also leads to fatty deposits in the blood vessels, which reduces blood supply to the bones.
  • Smoking: Smokers are considered to be at a higher risk of developing osteonecrosis or avascular necrosis, and this risk has also been found among people who were former smokers as well, according to a study. (Read more: Health effects of smoking)
  • Some treatments: Treatments such as radiation therapy and chemotherapy for cancers have been associated with the development of avascular necrosis as the intense treatments end up weakening the bones. Even organ transplants have been linked to the development of this condition.
  • Certain medicines: Bisphosphonates are medicines used to increase bone density in osteoporosis patients. They are also prescribed to strengthen bones and reduce pain in people with cancer or multiple myeloma. A rare complication of using bisphosphonates is the development of osteonecrosis, especially in the jaw.
  • Illnesses: Certain illnesses which affect the bone density are also risk factors for avascular necrosis. These conditions include sickle cell disease, Gaucher disease, diabetes, pancreatitis, HIV/AIDS and lupus. Blood clots, inflammation and high cholesterol.

Diagnosis of avascular necrosis

As mentioned earlier, pain of varying degrees, especially emanating from the joints, is enough for a person to visit a doctor to have it checked. The physician or specialist will ask questions about your medical history, besides performing a physical exam to check for tenderness around the affected area.

The doctor may also recommend further imaging tests such as X-raysMRI or CT scans to look for changes in the structure of the bone or joint. A bone scan may also be ordered which produces more details of the damage to the bone.

Avascular necrosis treatment

As avascular necrosis is a condition that causes slow degeneration of bones, the treatment depends on the stage at which the condition has been diagnosed. Ideally, the treatment would involve preserving the bone and preventing further loss of the bone. In the early stages, it can be managed with the use of medications, such as a combination of painkillers and other drugs.

Drugs to manage osteoporosis or those to control cholesterol (to improve blood flow to the bone by reducing plaque buildup in the walls of blood vessels) have often been used to manage this condition. Blood thinners are also used if the underlying cause for the condition is blood clots.

Medications, resting the affected part of the body and using crutches or assistance to avoid putting weight on the affected bone are also helpful in managing the condition. Depending on the condition, physical therapy may also be advised to restore the function of the bone or improve movement which has been affected by the disease.

Joint replacement surgery can be performed if the disease has progressed to the point where the affected bones are completely damaged. In this surgery, the damaged parts of the bone are replaced with metal plates and rods. Surgery, however, is an option when less invasive methods of treatment have not helped in restoring function or relieving the patient's symptoms.

Doctors for Avascular necrosis

Dr. Tushar Verma Dr. Tushar Verma Orthopedics
5 Years of Experience
Dr. Urmish Donga Dr. Urmish Donga Orthopedics
5 Years of Experience
Dr. Sunil Kumar Yadav Dr. Sunil Kumar Yadav Orthopedics
3 Years of Experience
Dr. Deep Chakraborty Dr. Deep Chakraborty Orthopedics
10 Years of Experience
Consult a Doctor

Medicines for Avascular necrosis

Medicines listed below are available for Avascular necrosis. Please note that you should not take any medicines without doctor consultation. Taking any medicine without doctor's consultation can cause serious problems.

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