Avascular Necrosis Treatment And Management

Avascular necrosis (AVN) is a bone disorder characterized by cell death. This condition is also known by various names such as osteonecrosis, aseptic necrosis, ischemic bone necrosis, and bone infarction. 

It has been verified through data that each year, tens of thousands of patients in India receive a diagnosis of Avascular Necrosis (AVN). Additionally, 50% of all Total Hip Replacement Surgeries in India are conducted as a result of the deterioration of the hip joint caused by AVN. 

AVN primarily affects the Hip Joint of males aged between 21 and 50 years. However, the majority, more than 70%, of AVN patients fall within the age range of 20 to 40 years. If left untreated, Avascular Necrosis (AVN) leads to the collapse of the joint within a span of 2 years, necessitating the requirement for Total Joint Replacement Surgery. This blog will specifically focus on Avascular Necrosis of The Hip Joint, as the hip joint plays a crucial role in supporting the body weight and is highly susceptible to AVN.

What is The Cause of Avascular Necrosis?

Avascular Necrosis can occur when specific risk factors disrupt the blood flow to the bones. The primary causes of this condition include:

• Fracture
• Injury to blood vessels
• Accidents or Trauma 
• Prolonged use of medications, like corticosteroids
• Excessive, prolonged consumption of alcohol
• Particular chronic health conditions.

What Are The Symptoms of Avascular Necrosis?

The most frequent signs of avascular necrosis are outlined below. Nevertheless, symptoms can vary from person to person. Common symptoms may include the following:

• Inflammation and infection are present in the impacted joint.
• Rigidity experienced at the impacted joint.
• Discomfort felt at the impacted joint.
• Gait affected by a limp when walking.
• Extreme lack of mobility.
• Incapacity to flex to tie a shoelace or put on a sock.

What Are The Different Types of Diagnosis Done For Avascular Necrosis?

Generally, individuals who experience the aforementioned symptoms often attempt to alleviate their discomfort by taking medications like a painkiller or seeking assistance from their primary care doctor, who may prescribe oral medication to temporarily address the pain. However, this approach can hinder the timely identification of hip pain and contribute to the advancements of undiagnosed AVN in the hip joint. The precise and early diagnosis of AVN is crucial in both the treatment and prevention of the need for hip replacement surgery. In addition to a comprehensive medical history and physical examination, you may undergo one or multiple tests from the following options:

• X-ray
• CT Scan or CAT Scan
• MRI
• Radionuclide Bone Scan
• Biopsy
• Functional Evaluation of Bone.

What Are The Different Stages of Avascular Necrosis?

Avascular Necrosis, also known as AVN, is categorized into four different stages: Stage I, Stage II, Stage III, and Stage IV. The early stages of AVN are Stage I and Stage II, while the mid and advanced stages are Stage III and Stage IV, respectively. In the early stages of AVN, it is possible to preserve the hip joint; however, in the advanced stage, the only option is Hip Replacement Surgery or the respective Joint Replacement Surgery. Depending on the diagnosis and investigation from X-ray scans, MRI, and other tests and with that, the doctor will recommend either Surgical or Non-Surgical treatment for Avascular Necrosis.

Different Types of Procedures for Avascular Necrosis Treatment

Different procedures will be recommended according to the diagnosis done by the healthcare professional. Your healthcare provider will determine the specific treatment for avascular necrosis based on various factors such as:

• Your age, general well-being, and past medical background
• Extent of the illness
• Site and extent of bone involvement
• Root cause of the illness
• Your response to particular medications, treatments, or therapies
• Anticipations for the progression of the illness
• Your personal viewpoint or choice.

The objective of the treatment is to enhance functionality and prevent additional harm to the bone or joint. Following are the different types of procedures that is performed for treating AVN.

Total Hip Replacement Surgery or Partial Replacement Surgery: The patients in this advanced stage are frequently advised to undergo Total or Partial Joint Replacement Surgery by the treating spaecialist. During this procedure, the surgeon removes the infected or deceased bone and replaces it with an artificial joint. However, both Total Hip Replacement Surgery and Partial Replacement Surgery impose certain limitations on movement. Consequently, patients are unable to fully engage in their previous daily activities that were once possible with a natural hip joint. A major drawback of Joint Replacement Surgery is its limited lifespan, requiring patients to replace the artificial joint every 10-12 years, depending on their daily activities.

Core Decompression Surgery: The prevailing treatment option nowadays is Core Decompression, a procedure that involves drilling into the hip to eliminate necrotic bone and alleviate pressure, thus restoring blood supply. Nevertheless, a significant number of Orthopedic Surgeons, approximately 60%, hold the belief that the success rate of Core Decompression Surgery is limited to a mere 50%.

Osteotomy: An osteotomy involves cutting bone to correct the alignment and shape of bones and joints. Common areas for this procedure include the jaw, elbow, spine, shoulder, hips, knees, legs, toes, and feet. Various surgical techniques and modifications are available.

Bone Cell Therapy: AVN, or Avascular Necrosis, can be effectively treated with Bone Cell Therapy. This advanced and scientifically validated treatment has shown an efficacy rate of over 90%. The procedure involves two steps. Firstly, the doctor extracts a sample of the patient’s bone marrow, which is then sent to the laboratory. Here, tissue engineers separate the bone-forming cells, known as osteoblasts, from the marrow sample and cultivate them through a process called cell culture. Once the bone-forming cells are successfully cultured, they are sent back to the doctor. In the second step, the doctor utilizes the Core Decompression method to remove the dead bone cells and subsequently injects the cultured bone-forming cells. This innovative therapy offers a promising solution for AVN patients.

Know More:- Avascular Necrosis Treatment Cost in India

Prevention

In order to decrease the chances of avascular necrosis and enhance overall well-being:

• Restrict alcohol intake: Excessive drinking is a major risk factor for the development of avascular necrosis.
• Maintain low cholesterol levels: Small fat particles are the primary substance that obstruct blood flow to the bones.
• Supervise steroid consumption: Inform your healthcare provider about any history or current use of high-dose steroids. Damage to bones caused by steroids seems to escalate with repeated courses of high doses.
• Avoid smoking: Smoking constricts blood vessels, leading to reduced blood circulation.