Avascular Necrosis

What is Avascular Necrosis?

Avascular necrosis is a disease resulting from the temporary or permanent loss of the blood supply to a bone. Without blood, the bone tissue dies and the bone collapses. If avascular necrosis involves the bones near a joint, the joint surface will probably collapse.

Avascular necrosis usually affects the ends of long bones such as the femur. It may affect just one bone, more than one bone at the same time, or more than one bone at different times.

Avascular necrosis is also called osteonecrosis, aseptic necrosis, and ischemic bone necrosis.

Symptoms of Avascular Necrosis

In the early stages of avascular necrosis, symptoms may not be present. However, as avascular necrosis advances, symptoms are present.

When symptoms are present, the most common symptoms are:

• Joint pain--at first, only when putting weight on the affected joint, and then even when resting. Pain usually develops gradually and may be mild or severe.
• Disabling osteoarthritis.

The period of time between the first symptoms and loss of joint function is different for each patient, ranging from several months to more than a year.

What Causes Avascular Necrosis?

Avascular necrosis has several causes. Some of the common causes are:

• Injury to the bone
  • When a joint is injured, as in a fracture or dislocation, the blood vessels may be damaged. This can interfere with the blood circulation to the bone and lead to trauma-related avascular necrosis. Studies suggest that this type of avascular necrosis may develop in more than 20 percent of people who dislocate their hip joint.
• Steroid medication.
  • Corticosteroids such as prednisone are commonly used to treat diseases in which there is inflammation, such as systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, and vasculitis.
• Blood coagulation disorders
• Excessive alcohol use
  • Excessive alcohol use and corticosteroid use are two of the most common causes of nontraumatic avascular necrosis. In people who drink an excessive amount of alcohol, fatty substances may block blood vessels, causing a decreased blood supply to the bones that results in avascular necrosis.
• Increased pressure within the bone

Risks of Developing Avascular Necrosis

Some diseases will increase your chance of developing avascular necrosis. If you have Gaucher's disease, pancreatitis, radiation treatments and chemotherapy, decompression disease, and blood disorders such as sickle cell disease, your chances of developing avascular necrosis increases.

Can Avascular Necrosis be Treated?

Yes. Treatment is necessary to keep joints from breaking down. If left untreated, most patients will experience severe pain and limitation in movement within 2 years.

Treatments will depend on the age of the patient, state of avascular necrosis, the location of the bone that is affected, and the cause.

Some common treatments are:

• medicines to reduce pain, fatty substances, and blood clotting
• removal of weight from the affected bone or joint
• range of motion exercises
• bone decompression
• electrical stimulation
• surgery
• bone graft
  

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