In avascular necrosis, the blood supply to a bone is cut off or reduced, causing the bone tissue to die. This can cause pain, stiffness, and eventually collapse.
An injury, such as a broken bone or a dislocated joint, damages the blood vessels near a bone, leading to traumatic avascular necrosis. There are two types of avascular necrosis: traumatic and nontraumatic. Avascular necrosis occurs when the blood flow to the bone is affected by an underlying condition, such as:
Long-term use of high-dose steroids, which can increase the fat levels in the blood and block the blood vessels.
Excessive alcohol consumption, which can also cause fatty deposits in the blood vessels.
Certain diseases that affect the blood cells or the blood vessels, such as sickle cell anemia, Gaucher’s disease, lupus, or diabetes.
Radiation therapy or chemotherapy, which can weaken the bone and harm the blood vessels.
Avascular necrosis can affect any bone, but it is most common in the hip, shoulder, knee, ankle, and jaw. Sometimes, it can affect more than one bone or both sides of the body.
Avascular necrosis may not cause any symptoms in the early stages, but as the condition progresses, you may experience:
Joint pain that worsens with movement or weight-bearing.
Joint stiffness and reduced range of motion.
Difficulty walking or performing daily activities.
Swelling or tenderness around the affected joint.
Depending on the location and severity of the damage to the bone, avascular necrosis can cause pain and disability. If the bone collapses, it can cause arthritis and joint failure.
Your doctor will ask you about your medical history, symptoms, and risk factors to diagnose avascular necrosis. They will also examine your joint and look for signs of pain, swelling, or reduced mobility. Your doctor may order one or more of the following tests to confirm the diagnosis:
X-rays, which can show changes in the bone structure and density.
Magnetic resonance imaging (MRI), which can provide detailed images of the bone and the blood vessels.
Bone scan, which can detect areas of reduced blood flow to the bone.
Computed tomography (CT) scan, which can show the shape and size of the bone and the joint.
The treatment of avascular necrosis depends on the stage of the condition, the location and size of the bone damage, and your overall health and preferences. The main goals of treatment are to:
Relieve pain and inflammation.
Restore blood flow to the bone.
Prevent further bone loss and joint damage.
Improve joint function and mobility.
The treatment options for avascular necrosis include:
Medications, such as pain relievers, anti-inflammatory drugs, blood thinners, or cholesterol-lowering drugs, to ease the symptoms and address the underlying causes of reduced blood flow.
Physical therapy, such as exercises, stretches, massage, or heat and cold therapy, to improve the joint movement and strength, and reduce the stress on the bone.
Assistive devices, such as crutches, braces, or walkers, to reduce the weight-bearing on the affected joint and prevent further damage.
Surgery, which may be recommended if the bone damage is severe or the joint function is impaired. There are different types of surgery for avascular necrosis, such as:
Core decompression, which involves drilling a hole in the bone to relieve the pressure and stimulate the blood flow.
Bone graft, which involves transplanting healthy bone tissue from another part of the body to replace the damaged bone.
Osteotomy, which involves cutting and reshaping the bone to improve the alignment and stability of the joint.
Joint replacement, which involves removing the damaged bone and joint and replacing them with artificial implants.
Avascular necrosis may not be preventable in some cases, especially if it is caused by trauma or genetic factors. However, you can reduce your risk of developing or worsening the condition by:
Avoiding or limiting alcohol consumption, which can affect the blood flow to the bone.
Quitting smoking, which can also impair the blood circulation and the bone health.
Following your doctor’s advice on the use of steroids, which can increase the risk of avascular necrosis if taken for a long time or in high doses.
Managing your chronic conditions, such as diabetes, high blood pressure, or high cholesterol, which can affect the blood vessels and the bone health.
Eating a balanced diet, rich in calcium and vitamin D, which can support the bone health and strength.
Exercising regularly, with low-impact activities, such as walking, swimming, or cycling, which can improve the blood flow and the joint function.
Protecting your joints from injury, by wearing protective gear, following safety precautions, and seeking medical attention if you have a fracture or a dislocation.
The health and function of your bones and joints can be adversely affected by avascular necrosis. The condition occurs when a bone's blood supply is cut off or reduced, causing it to die. Trauma, disease, medication, or alcohol may cause avascular necrosis, causing pain, stiffness, and eventually collapse of the bone. It can affect any bone, but is most common in the hip, shoulder, knee, ankle, and jaw. Avascular necrosis can be diagnosed by your doctor using physical examination and imaging tests. Depending on the stage, location, and size of the bone damage and your overall health and preferences, medications, physical therapy, assistive devices, and surgery are all options for treating avascular necrosis. Although some cases of avascular necrosis cannot be prevented, you can reduce your risk by avoiding or limiting alcohol, quitting smoking, following your doctor's advice regarding steroids, managing your chronic conditions, eating a balanced diet, exercising regularly, and protecting your joints. Talk to your doctor about the best treatment plan if you have avascular necrosis.
