AVASCULAR NECROSIS

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Orthopaedics

Also known as Osteonecrosis, Aseptic necrosis, Ischemic bone necrosis.

ABOUT THE DISEASE

Avascular necrosis is a painful condition that occurs when the blood supply to the bone is disrupted. The bone tissue dies due to a reduced blood supply and eventually the bone collapses. It mostly affects the thighbone (femur) in the hip area, but it can affect other bones also such as the wrist, knee, and shoulder. Avascular necrosis gets worse with time.

SYMPTOMS

Osteonecrosis develops in stages. Pain in joints - Hip pain is typically the first symptom. This may lead to a dull ache or throbbing pain in the groin or buttock area, even while resting. As the disease progresses, it will become more difficult to stand and put weight on the affected hip. Range of motion becomes limited.

CAUSES

It might occur without any reason, however some of the risk factors that can lead to the development of avascular necrosis:
- A break or dislocation
- Continued usage of steroids
- Excess alcohol intake
- Cancer treatment like radiation and chemotherapy
- Sickle cell anemia
- Gaucher`s disease
- Systemic lupus erythematosus
- Crohn`s disease
- Arterial embolism

DIAGNOSIS

- Physical examination
- MRI or a nuclear bone scan
- CT Scan
- Bone biopsy and functional evaluation of the bone

TREATMENT METHODS

Treatments are based on various factors, including the patient’s age, the amount and location of bone that the condition affects, and the stage of the disease. The following are some of the treatment options:

- Reduced weight bearing — If the condition is diagnosed early. This may involve the use of crutches or the limitation of certain activities.

- Core decompression — This procedure involves drilling one larger hole or several smaller holes into the femoral head to relieve pressure in the bone and create channels for new blood vessels to nourish the affected areas This surgery is most effective for people in the earliest stages of the disease.

- Osteotomy — This surgery reshapes the bone in order to lessen stress on the area affected. The surgery is most effective for patients with advanced forms of the disease and when a larger area is affected.

- Bone graft — A bone graft is healthy bone tissue that is transplanted to an area of the body where it is needed.

- Arthroplasty/total joint replacement — This treatment is used in late-stage avascular necrosis and when the joint is destroyed. The diseased joint is replaced with artificial parts.