AvascularNecrosis

(Osteonecrosis)
Inthisarticle

WhoGetsAvascularNecrosisandWhatCausesIt?
SymptomsofAvascularNecrosis
TreatmentforAvascularNecrosis

Avascularnecrosis(AVN),alsocalledosteonecrosis,aseptic
necrosis,orischemicbonenecrosis,isaconditionthatoccurs
whenthereislossofbloodtothebone.Becauseboneisliving
tissuethatrequiresblood,aninterruptiontothebloodsupply
causesbonetodie.Ifnotstopped,thisprocesseventuallycauses
thebonetocollapse.
Avascularnecrosismostcommonlyoccursintheupperleg.
Othercommonsitesaretheupperarm,knees,shoulder,and
ankles.

WhoGetsAvascularNecrosisandWhat
CausesIt?
Asmanyas20,000peopledevelopAVNeachyear.Mostare
betweenages20and50.Forhealthypeople,theriskofAVNis
small.Mostcasesaretheresultofanunderlyinghealthproblem
orinjury.Possiblecausesinclude:
Dislocationorfractureofthethighbone(femur).Thistypeof
injurycanaffectthebloodsupplytothebone,leadingto
traumarelatedavascularnecrosis.AVNmaydevelopin20%or
moreofpeoplewhodislocateahip.
Chroniccorticosteroiduse.Longtermuseofthese
inflammationfightingdrugs,eitherorallyorintravenously,is
associatedwith35%ofallcasesofnontraumaticAVN.

Althoughthereasonforthisisnotcompletelyunderstood,
doctorssuspectthesedrugsmayinterferewiththebody'sability
tobreakdownfattysubstances.Thesesubstancescollectinthe
bloodvesselsmakingthemnarrowerandreducetheamount
ofbloodtothebone.
Excessivealcoholuse.Muchlikecorticosteroids,excessive
alcoholmaycausefattysubstancestobuildinthebloodvessels
anddecreasethebloodsupplytothebones.
Bloodclots,inflammation,anddamagetothearteries.Allof
thesecanblockbloodflowtothebones.
OtherconditionsassociatedwithnontraumaticAVNinclude:
Gaucher'sdisease,aninheritedmetabolicdisorderin
whichharmfulquantitiesofafattysubstanceaccumulateinthe
organs
Sicklecelldisease
Pancreatitis,inflammationofthepancreas
HIVinfection
Radiationtherapyorchemotherapy
Autoimmunediseases
Decompressionsickness,aconditionthatoccurswhenthe
bodyissubjectedtoasuddenreductioninsurroundingpressure,
causingtheformationofgasbubblesintheblood

SymptomsofAvascularNecrosis

Initsearlystages,AVNtypicallycausenosymptoms;however,
asthediseaseprogressesitbecomespainful.Atfirst,youmay
experiencepainwhenyouputpressureontheaffectedbone.
Then,painmaybecomemoreconstant.Ifthediseaseprogresses
andtheboneandsurroundingjointcollapse,youmay
experienceseverepainthatinterfereswithyourabilitytouse
yourjoint.Thetimebetweenthefirstsymptomsandcollapseof
thebonemayrangefromseveralmonthstomorethanayear.

TreatmentforAvascularNecrosis

ThegoalsoftreatmentforAVNaretoimproveorensure
functionoftheaffectedjoint,stoptheprogressionofbone
damage,andreducepain.
Thebesttreatmentwilldependonanumberoffactors,
including:
Yourage
Stageofthedisease
Locationandamountofbonedamage
CauseofAVN
Ifthecauseofyouravascularnecrosisisidentified,treatment
willincludeeffortstomanagetheunderlyingcondition.For
example,ifAVNiscausedbybloodclots,yourdoctorwill
prescribemedicationstodissolveclots.Ifinflammationofthe
arteriesisresponsible,yourdoctormayprescribeanti
inflammatorymedicines.
Ifavascularnecrosisiscaughtearly,treatmentmayinvolve
takingmedicationstorelievepainorlimitingtheuseofthe
affectedarea.Ifyourhip,knee,orankleisaffected,crutches
maybenecessarytotakeweightoffthedamagedjoint.Your
doctormayalsorecommendrangeofmotionexercisestohelp
keeptheaffectedjointmobile.
Whilethesenonsurgicaltreatmentsmayslowtheprogressionof
avascularnecrosis,mostpeoplewiththeconditioneventually
needsurgery.
Surgicaloptionsinclude:
Bonegrafts,whichinvolveremovinghealthybonefrom
onepartofthebodyandusingittoreplacethedamagedbone
Osteotomy,aprocedurethatinvolvescuttingtheboneand
changingitsalignmenttorelievestressontheboneorjoint
Totaljointreplacement,whichinvolvesremovingthe
damagedjointandreplacingitwithasyntheticjoint
Coredecompression,aprocedurethatinvolvesremoving
partoftheinsideofthebonetorelievepressureandallownew
bloodvesselstoform

Vascularizedbonegraft,aprocedurethatusesthe
patient'sowntissuetorebuilddiseasedordamagedhipjoints;
thesurgeonfirstremovesthebonewiththepoorbloodsupply
fromthehipandthenreplacesitwiththebloodvesselrichbone
fromanothersite,suchasthefibula,thesmallerbonelocatedin
thelowerleg.