At a Glance:
What is avascular necrosis or osteonecrosis?
What are the symptoms of avascular necrosis?
What are the causes of avascular necrosis?
What are the risk factors for developing avascular necrosis?
What are the investigations needed for diagnosis?
What are the stages of avascular necrosis?
What are the treatment options for avascular necrosis?
What are the risk factors for developing avascular necrosis?
A lack of blood supply to the tissue within the bone leads to its death, a condition called as avascular necrosis or osteonecrosis. It can sometimes lead to tiny breaks within the structure of the bone which is responsible for its eventual collapse. The hip is the most commonly affected area with osteonecrosis. Other than the hip, commonly affected areas are the knee, shoulder, hand and foot.
The early stages of avascular necrosis may not be associated with any symptoms. However, the affected joint may begin to hurt as the condition progresses and the person puts weight on the affected area. The primary symptom of avascular necrosis is pain which develops gradually and can be mild or severe in nature. Sometimes pain may persist even on lying down. The pain is located at the centre of the groin or radiates to the area of the thigh or buttock. In certain persons, (4 to 5 out of 10) avascular necrosis may be bilateral, i.e., it develops on both hip joints.
Even though anyone can be affected, osteonecrosis usually affects people between the ages of 25 and 50. The primary cause of avascular necrosis is an interruption of blood supply within the bone which can be caused by:
There are many factors that increase the likelihood of avascular necrosis like:
Some of the medical conditions that increase an individual’s susceptibility to avascular necrosis include:
The diagnosis of avascular necrosis is done by an orthopaedic surgeon on the basis of medical history, physical examination and tests. Tenderness and movements may be assessed by pressing around the joints and moving them during a physical examination.
Imaging tests: Advised to determine the source of pain
X-rays: Determine the bone changes in the later stages of avascular necrosis.
MRI: Assess the presence of early changes in bone indicative of avascular necrosis.
There are usually four stages of avascular necrosis.
FICAT classification of avascular necrosis
(Federative Committee on Anatomical Terminology)
The goal of treatment in avascular necrosis is to manage the symptoms and prevent further bone loss. Sometimes, the condition may be self-limiting and can be managed conservatively. The treatment is a combination of conservative and surgical management when required.
Surgical approaches: Since the symptoms of osteonecrosis develop mostly when the condition has progressed far, the orthopaedic surgeon might recommend surgery. The surgical options include:
Regenerative medicine treatment: This is the latest advancement in the management of avascular necrosis in the early stages. The stem cells from the bone marrow of the affected individual are harvested and inserted in place of the dead bone allowing for potential growth of new bone. However, the results of this procedure still need more study.
Avascular necrosis is progressive in nature. If left untreated, it deteriorates with time and eventually, the bone may collapse. Progressive avascular necrosis also leads to loss of the smooth surfaces thereby causing severe arthritis.
Treatment for avascular necrosis should be preferably done at a tertiary care hospital setup or a specialty orthopaedic hospital that have all the facilities as well as resources to perform these surgeries.
Yashoda Center for Orthopaedics is led by a team of qualified orthopaedic surgeons trained in advanced orthopaedic surgeries with sufficient experience to carry out these procedures with a multi-disciplinary team of doctors, anaesthetists and physiotherapists for preoperative, operative and postoperative care as well as for rehabilitation.
The center also possesses modern facilities like a state of the art operation theatre, necessary arthroscopy instruments, diagnostic facilities like MRI, CT, X-Ray, DEXA scans, etc. and an excellent physiotherapy unit for rehabilitation.
Read more about Avascular Necrosis symptoms, causes and treatment
If you find any of the above mentioned symptoms of Avascular Necrosis then
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About Author –
Dr. Praveen Mereddy, Consultant joint Replacement & Trauma Surgeon, Yashoda Hospitals – Hyderabad
MS (Ortho), DNB (Ortho), MRCS (Ed), M.Ch (Ortho), FRCS (Ortho)
Complex Primary Hip and Knee Replacement Surgery, Partial Knee Replacement Surgery, Treatment of Painful/Unstable/Failed (Loosening/infection) Primary Joint Replacements, Complex, complicated fractures and Pelvi-acetabular trauma
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I have AVN in left hip I don’t know whether I need hip replacement surgery or no ? I have latest xrays if you can guide me .
Thank you, Sanjiv Panchal. We are happy that the information we provide is useful for you. Please write to us at query@yashodamail.com