The blood flow to a section of bone can be obstructed if the bone joint become dislocated or fractured. Avascular necrosis is related to the longer-term use of high-dose steroid medications and excessive alcohol intake.
Anyone can be affected by avascular necrosis. However, it is most common in people between the ages of 30 and 60 years. Since this is relatively young age range, avascular necrosis can have significant long-term consequences,
Many individuals have no symptoms in the early stages of avascular necrosis. As the condition worsens, affected joints may hurt only when you put weight on it. Eventually, the joint can cause chronic pain even when you’re lying down.
Pain can be mild or severe and usually develops gradually. Pain related with avascular necrosis of the hip can be focused in the groin, thigh or buttock. In addition to the hip bone, the areas possible to be affected are the shoulder, knee, hand and foot
Some people form avascular necrosis bilaterally – for example, in both hips or both knees.
When Should You See A Doctor
See your doctor if you have constant pain in any joint. Seek immediate medical attention if you believe you have a broken bone or a dislocated joint.
Cause of Avascular Necrosis
Avascular necrosis transpires when blood flow to a bone is obstructed or reduced. Reduced blood supply can be triggered by:
- Bone or joint trauma. An injury, such as a discounted joint, might damage nearby blood vessels, Disease treatments involving radiation also can lessen bone mass and harm blood vessels.
- Fatty deposits in blood vessels. The fat (lipids) can obstruct small blood vessels, reducing the blood flow that feeds bones.
- Certain diseases- Medical conditions, such as sickle cell anemia and Gaucher’s disease can also cause diminished blood flow to the bone.For about 25 percent of individuals with avascular necrosis, the trigger of interrupted blood flow is unknown.
- Trauma, injuries, such as hip displacement or fracture, can damage nearby blood vessels and decrease blood flow to bones.
- Steroid use- High dose use of corticosteroids, including prednisone, is the most prevalent cause of avascular necrosis that isn’t related to trauma. The exact purpose is unknown, but one theory is that corticosteroids can enhance lipid levels in your blood, diminishing blood flow and leading to avascular necrosis.
- Excessive alcohol use. Drinking several alcoholic beverages a day for several years also can cause fatty deposits to be created in your blood vessels.
- Bisphosphonate use. Long-term use of medicines to increase bone density may be a risk factor producing osteonecrosis of the jaw. This complication has happened in some individuals treated with these medications for cancers, such a multiple myelomas, and metastatic breast cancer. The danger appears to be lower for women treated with bisphosphonates for osteoporosis.
- Certain medical treatments. Radiation therapy for cancer can weaken bone. Organ transplantation, specifically kidney transplant, also is associated with avascular necrosis.
Medication conditions that are related to avascular necrosis include:
- Gaucher’s disease
- Sickle Cell Anemia
- Systemic lupus erythematosus
Untreated, avascular necrosis worse with time. Over time eventually, the bone may become so weakened that it collapses. Avascular necrosis also triggered bone to lose it’s smooth shape potentially leading to severe arthritis
Test and Diagnosis
During a physical exam, your physician will likely press throughout your joints, looking for tenderness. Your doctor may also move the joints through a variety of positions to see if your range of motion has been reduced.
Many disorder can cause joint pain; an Imaging test can help pinpoint the source of pain. The options include the following:
X-rays –They can show bone changes that happen with later stages of avascular necrosis. Within the conditions early stages, X-rays may appear normally.
MRI and CT scan – These tests produce accurate images that can show early changes in bone that may designate avascular necrosis.
Bone scan – A small quantity of radioactive material is injected into the vein. This tracer material travels into all the parts of the bones that are injured or healing and shows up as light localities on the imaging plate.
Treatments and Medications for Avascular Necrosis
The goal of treatment is to prevent the further erosion and bone loss. Specifically, treatment typically depends on the amount of bone loss and the damage you already have.
In the earlier stages of avascular necrosis, symptoms can be decreased with medication and therapy. Your doctor might recommend:
- Nonsteroidal anti-inflammatory drugs. Medications, such as ibuprofen (Advil, Motrin IB, etc.) or naproxen sodium ( Aleve) may help relieve the pain and inflammation linked with avascular necrosis.
- Osteoporosis drugs. Medications, including alendronate ( Binosto, Fosamax) may slow the growth of avascular necrosis, but currently, there is not clear evidence to prove this for certain.
- Cholesterol-lowering drugs, Reducing the quantity of cholesterol and fat in the blood can help stop the vessel blockages and obstructions that can cause avascular necrosis.
- Blood thinners may help if you have clotting disorders, blood-thinners, such as warfarin (Jantoven, Coumadin) can be suggested to prevent clots in the vessels feeding your bones.
- Rest, Lessening the weight and strain on your affected bone can slow the damage. Your might need to restrict your physical activity or use crutches to keep weight off your joint for several months.
- Exercise, you may be referred to a physical therapist to learn exercises to help maintain or improve your range of motion in your joint.
- Electrical stimulation. Electrical currents might encourage your body to grow new bone to replace the area damaged by avascular necrosis. Electrical stimulation can be utilized during surgery and applied directly to the damaged area. Or it can be administered through electrodes attached to your skin.
Surgical and other Procedures
Because most people do not start having symptoms of avascular necrosis until it is fairly advanced, your doctor may recommend surgery. These options include:
- Core decompression – a surgeon removes a portion 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 method can help restore 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). IN this procured, a wedge of bone is removed above or below a wight-bearing joint. To help change your weight off the damaged bone. Bone reshaping may enable you to postpone joint replacement.
- Joint replacement. If your diseased bone has already collapsed or other treatment options are not helping, you may need surgery to replace the injured parts of your joint with plates or metal parts. An estimated 10 percent of hip replacements in the United States are performed to treat avascular necrosis of the hip
- Regenerative medication treatment – Bone marrow aspirate and concentration are a different procedure that eventuality may be suited for early stage avascular necrosis of the help. Stem cells are harvested from your bone marrow. During surgery, a core of deceased hip bone is extracted and stem cells injected in its place, possibly allowing for growth of new bone.
To reduce risk of avascular necrosis and approve your general health:
Limit alcohol – heavy drinking is one of the top risk factors for developing avascular necrosis
Maintain low cholesterol levels – tiny bits of fat are the most common substances in blocking blood supply to bones.
Monitor steroid use- Make sure your physician is aware of any past or present use of high dose steroids. Steroids-linked bone damage appears to worsen with repeated course of high dose steroids.