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Avascular Necrosis (AVN or Osteonecrosis)

Avascular Necrosis (AVN or Osteonecrosis) Treatment in Delhi, India

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Overview

Avascular necrosis, also known as osteonecrosis, is a degenerative bone condition in which the bone tissue becomes dead due to a lack of blood supply. It typically affects the ends of long bones at weight-bearing joints. 

A dislocated joint or fractured bone may compromise the blood supply to the bone cells, leading to osteonecrosis, a severe condition. If treatment is avoided, the bone may collapse. The age group between 37 and 50 is the most commonly affected. The most common sites of occurrence are the hip, knee, talus, femoral head, and humeral head.

Causes of Avascular Necrosis (AVN or Osteonecrosis)

Avascular necrosis occurs as a result of reduced or interrupted blood supply to the bone. However, there may be numerous risk factors and theories on the development of vascular impairment. A study explains a few factors responsible for reducing the blood supply to the bones:

  • Direct cellular toxicity occurs in the form of chemotherapy, radiotherapy, thermal injury, and smoking.
  • Bone fractures such as hip dislocation, femoral neck fracture, iatrogenic post-surgery, congenital arterial abnormalities.
  • Internal Bone compression such as haemorrhage, elevated bone marrow pressure, fatty infiltration of bone marrow due to prolonged use of high-dose corticosteroid, cellular hypertrophy and marrow infiltration (Gaucher's disease), bone marrow oedema, displaced fractures.
  • Medical conditions, such as coagulation disorders like thrombophilias and hypofibrinolysis, Sickle cell anaemia, hyperlipidemia.
  • Idiopathic osteonecrosis.
  • Repetitive trauma.
  • Other risk factors for AVN are alcohol misuse, blood dyscrasias, and autoimmune diseases.

Symptoms of Avascular Necrosis (AVN or Osteonecrosis)

Avascular Necrosis, or Osteonecrosis, is asymptomatic in the early stage. As the disease progresses, it may present the following symptoms:

  • Minimal early joint pain on weight-bearing.
  • Pain differs in intensity from person to person. May range from mild to severe.
  • Pain may radiate to the groyne, buttocks, and thigh.
  • The joint pain increases as bone and joint begin to collapse.
  • There is a limited range of motion due to pain.

The symptoms of avascular necrosis can be similar to the symptoms of other bone conditions, such as arthritis or joint pain. It is important to see a doctor to get a diagnosis and rule out other possible causes.

When should I see a doctor?

Avascular necrosis is a progressive condition that worsens with time. One should consult a doctor if they experience:

  • Joint pain that doesn't relieve with rest or pain relievers.
  • Inability to move or limited mobility.
  • Inexplicable limping.

Diagnosis of Avascular Necrosis (AVN or Osteonecrosis)

The doctor assesses the symptoms and conducts a physical exam to check the joints for pain and range of motion. The doctor may advise the following imaging tests:

  • Bone scans: Radioactive tracing to assess the exact spot of injury is done. The injured part appears as bright patches on the scan report.
  • X-rays of the affected bones: In the early stages, x-rays appear normal. Bone changes are evidently seen in the advanced stages of AVN.
  • MRI and CT scan: MRI and CT scan may be done to produce images that show the exact changes occurring in the affected bone.
  • Biopsy: Maybe done to rule out possibilities of malignancy or other abnormal cells or to remove tissue from the affected bone.
  • Functional evaluation of bone: Tests usually involve surgery to measure the pressure within the bone.

Treatment for Avascular Necrosis (AVN or Osteonecrosis)

Based on the patient's age, affected bones, the extent of damage, and overall health, the doctor will formulate a treatment plan:

Non-surgical Treatment 

It is the least effective in preventing the progression of Avascular necrosis. Crutches and canes can be used to aid in walking, and analgesics can be taken to deal with pain. Physiotherapy can help ease joint tenderness and increase the range of motion.

Surgical Approach

The main aim of surgery is to improve the blood supply to the bone. This may be achieved by:

  • Core decompression: Small holes may be drilled in the affected bone, or the inner layer of the bone can be removed to reduce internal pressure, enhance blood flow and prevent joint/bone destruction. Additionally, grafting procedures may be carried out to promote healing.
  • Joint replacement: The damaged joint can be replaced with an artificial counterpart. They allow significant pain reduction and help restore mobility.
  • Osteotomy: Osteotomy allows for reshaping the bone and lower stress in affected areas.
  • Other treatment modalities include electrical stimulation and a combination of multiple therapies to promote bone growth and healing.

Risk Factors of Avascular Necrosis (AVN or Osteonecrosis)

Risk factors responsible for developing avascular necrosis (AVN or osteonecrosis) are:

  • Smoking and consumption of alcohol.
  • Fracture of bones.
  • Excessive use of steroids.
  • Medical conditions such as Gaucher disease, sickle cell anaemia, autoimmune diseases.
  • Medical treatments such as radiation therapy, chemotherapy, organ transplants.
  • Bisphosphonate use: Bisphosphonate-related osteoporosis of Jaw or BRONJ is a common factor for developing AVN.

Preventing Avascular Necrosis (AVN or Osteonecrosis)

Avascular necrosis cannot be prevented. However, a few steps could be taken to reduce the risk of suffering from AVN:

  • Reduction in the consumption of alcohol and smoke.
  • Maintain a healthy lifestyle.
  • Regular exercise.
  • Keeping a watch on cholesterol levels.
  • Mindful use of steroids can prevent the development of AVN.

Complications & Prognosis of Avascular Necrosis

Untreated AVN may cause the bone to collapse. With time, the severity of AVN increases, and the bone might lose its smooth shape. Treatment can retard the progress of AVN, but this condition has no cure. Most patients eventually require surgery, inclusive of joint replacement. People who have avascular necrosis may also develop severe Avascular necrosis (osteoarthritis) with time.

Review

Reviewed By Dr L Tomar Senior Director & Unit Head Orthopaedics & Joint Replacement on 14 Aug 2024.

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