Also called osteonecrosis or aseptic necrosis, this disease is the death of bone cells due to reduced blood flow. It can cause pain and collapse of bone areas. This collapse of bones can lead to degenerative arthritis (also called osteoarthritis) of nearby joints, most often the hips and knees. Less affected areas are the shoulders, hands and feet. You can find more information below.

What is avascular necrosis?

Avascular necrosis , also known as osteonecrosis , is the death of bone tissue due to a lack of blood flow. It can lead to minor fractures of the bone and eventual collapse of the bone. A broken bone or dislocated joint can cut off blood flow to part of the bone. Avascular necrosis is also associated with long-term use of high-dose steroid drugs and excessive alcohol intake. Anyone can be affected by this condition, but it is most common in people between the ages of 30 and 50.

What causes avascular necrosis?

Avascular necrosis occurs when blood flow to a bone is interrupted or reduced. Reduced blood flow can be caused by:

  • Joint or bone trauma: An injury, such as a dislocated joint, can damage nearby blood vessels. Cancer treatments that involve radiation can also weaken bone and damage blood vessels.
  • Fat deposits in blood vessels: Fat (lipids) can block small blood vessels, reducing blood flow to nourish bones.
  • Certain diseases: Medical conditions such as sickle cell anemia and Gaucher disease can also cause decreased blood flow to the bone.
Read More  What Causes Right Shoulder and Arm Pain?

For about 25 percent of people with avascular necrosis, the cause of the interrupted blood flow is unknown.

Who is at risk?

Risk factors for osteonecrosis include:

  • Trauma: Injuries such as a hip dislocation or fracture can damage nearby blood vessels and reduce blood flow to bones.
  • Steroid use: The use of high-dose corticosteroids such as prednisone is a common cause of avascular necrosis. Although the cause is unknown, one hypothesis is that corticosteroids may decrease blood flow by increasing blood lipid levels.
  • Excessive alcohol use: Consuming several alcoholic beverages per day for several years can also cause fatty deposits in the blood vessels.
  • Bisphosphonate use: Long-term use of drugs to increase bone density may contribute to the development of osteonecrosis of the jaw. This rare complication can occur in people taking medications for cancers such as multiple myeloma and metastatic breast cancer.
  • Some medical treatments: Radiation therapy for cancer can weaken bone. Organ transplantation, especially kidney transplantation, is also associated with avascular necrosis.

Medical conditions associated with avascular necrosis include:

  • Pancreatitis
  • Diabetes
  • Gaucher’s disease
  • HIV / AIDS
  • lupus disease
  • sickle cell anemia

What are the symptoms of avascular necrosis?

Many people have no symptoms in the early stages of osteonecrosis. As the condition worsens, the affected joint may only hurt when weight is placed on it. Eventually, the pain becomes palpable even when lying down.

The pain can be mild or severe and usually develops gradually. Pain associated with avascular necrosis of the hip may focus on the groin, thigh, or hip. Besides the hip, areas likely to be affected are the shoulders, knees, hands and feet.

Some people develop avascular necrosis on both sides – such as in both hips or both knees.

When should you see a doctor?

If there is persistent pain in any joint, the doctor should be consulted. See a doctor immediately if a broken bone or dislocated joint is suspected.

Read More  What Causes Wrist Pain?

How is avascular necrosis diagnosed?

During the physical exam, the doctor will likely check for tenderness by putting pressure around the joints. The doctor may also move the joints in various positions to see if the range of motion has decreased.

Imaging tests

Many disorders can cause joint pain. Imaging tests can help identify the source of the pain. Options include:

  • X-rays (X-ray): X-rays can reveal bone changes that occur in the later stages of osteonecrosis. In the early stages of the condition, the x-ray often appears normal.
  • Magnetic resonance imaging and computed tomography scan: These tests produce detailed images that can show early bone changes that may indicate avascular necrosis.
  • Bone scan: A small amount of radioactive material is injected into the vein. This tracer travels to the injured or healing parts of the bones and appears as bright spots on the imaging plate.

How is avascular necrosis treated?

The aim of the treatment of osteonecrosis is to prevent further bone loss.

Medications and therapy

In the early stages of osteonecrosis, symptoms can be alleviated with medications and some therapy options. The doctor may recommend:

  • Non-steroidal anti-inflammatory drugs: Medications such as ibuprofen or naproxen sodium can help relieve pain associated with avascular necrosis.
  • Osteoporosis drugs: Bone resorption drugs such as alendronate can slow the progression of avascular necrosis.
  • Cholesterol-lowering drugs: Reducing the amount of cholesterol and fat in the blood can help prevent atherosclerosis that can cause avascular necrosis.
  • Blood thinners: If you have a clotting disorder, blood thinners such as warfarin may be recommended to prevent clots in the vessels that feed the bones.
  • Rest: Reducing the weight and stress of the affected bone can slow the damage. It may be necessary to restrict physical activity or use crutches for several months.
  • Exercises: A physical therapist can teach exercises to help maintain or improve range of motion in the joint.
  • Electrical stimulation: Electrical currents can stimulate the body to grow new bone to replace damaged bone. Electrical stimulation can be used during surgery and applied directly to the damaged area or applied with electrodes attached to your skin.
Read More  Scapula Pain: Causes and Treatment

Remember, your doctor will decide which medicine to take and how.

Surgery and other procedures

Since most people do not develop symptoms until osteonecrosis is quite advanced, a doctor may recommend surgery. Options include:

  • Core decompression: The surgeon removes part of the inner layer of bone. In addition to reducing pain, the extra space in the 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. A graft is a section of healthy bone taken from another part of the body.
  • Bone remodeling (osteotomy): A wedge of bone is removed and weight is redirected above or below a weight-bearing joint to help shift weight from damaged bone.
  • Joint replacement: If the diseased bone has collapsed or other treatments aren’t helping, surgery may be needed to replace the damaged parts of the joint with plastic or metal parts.
  • Regenerative drug therapy: Bone marrow aspirate and concentration is a newer procedure that may be suitable for early-stage avascular necrosis of the hip. Stem cells are collected from the bone marrow. During surgery, the dead hip bone core is removed and replaced with stem cells, potentially allowing new bone to grow.

Can avascular necrosis be prevented?

To reduce the risk of osteonecrosis and improve overall health, the following can be done:

  • Limiting alcohol: Heavy drinking is one of the most important risk factors for the development of avascular necrosis.
  • Keeping cholesterol levels low: Small pieces of fat are the most common substance that blocks blood flow to bones.
  • Monitoring the use of steroids: The use of steroids should be monitored by the physician of the person concerned. Steroid-related bone damage is exacerbated by repeated high-dose steroid courses.
  • Not smoking: Smoking significantly reduces the risk.

Related Posts

Leave a Reply

Your email address will not be published.