Avascular Necrosis (AVN)


Osteonecrosis or avascular necrosis (AVN) is the death of bone tissue due to a lack of blood supply. Osteonecrosis or avascular necrosis can lead to tiny breaks in the bone and the bone's eventual collapse. Blood flow to a section of bone can be interrupted if the bone is fractured or the joint becomes dislocated. Avascular necrosis typically causes pain and reduced range of motion in the affected joint. 

The most common joints affected by avascular necrosis include:

  • Hip. In addition to pain in the hip joint itself, pain also may radiate into your groin or go down your thigh to your knee. The hip is the most common joint affected by AVN.
  • Knee. In avascular necrosis of the knee, the pain occurs most often on the inside of the knee and worsens with activity.
  • Shoulder. Several bones come together at the shoulder, but the one most commonly affected by avascular necrosis is the upper arm bone.
  • Other joints that are affected by avascular necrosis include:
    • Ankles
    • Feet
    • Hands
    • Jaw
    • Spine
    • Wrists

 

Signs and symptoms of osteonecrosis or avascular necrosis may appear suddenly if caused by an injury. In other cases, the pain and stiffness may build up slowly over several months. Some people with avascular necrosis experience no symptoms at all.

 

Avascular necrosis occurs when blood flow to a bone is interrupted or reduced, which may be caused by:

  • Joint injury. Trauma that results in a broken bone or a dislocated joint may also damage or destroy nearby blood vessels. Without a steady supply of oxygen and nutrients, bone cells die.
  • Narrowed blood vessels. Blood flow to a bone can be decreased if the passage through a vessel becomes narrowed or clogged, most commonly by a tiny bit of fat or — in the case of sickle cell anemia — by clumps of deformed blood cells.
  • Pressure inside the bone. Some medical treatments or conditions, such as Legg-Calve-Perthes disease or Gaucher's disease, can increase the pressure inside the bone, making it more difficult for fresh blood to enter.

 

The two most common risk factors of avascular necrosis are:

  1. Corticosteroids. People with chronic illnesses such as rheumatoid arthritis and lupus, and who receive high doses of corticosteroids, such as prednisone, for long periods of time, are more likely to experience avascular necrosis.
  2. Heavy drinking. Several alcoholic drinks a day for several years can cause fatty deposits to form in your blood vessels. This can restrict the flow of blood to your bones. The more alcoholic drinks you consume on a daily basis, the higher your risk of avascular necrosis.

 

People who take bisphosphonates — a type of medicine used to help strengthen bones weakened by osteoporosis — sometimes develop osteonecrosis of the jaw. This risk is higher for people who have received high doses of bisphosphonates intravenously to counteract the damage caused by cancer in the bones.

 

Several types of medical procedures can weaken bones, making it easier to develop avascular necrosis. Examples include:

  • Cancer treatments such as chemotherapy or radiation
  • Dialysis, a process to clean the blood after kidney failure
  • Kidney and other organ transplants
  • Conditions linked to bone death

Many underlying medical conditions increase the risk of developing avascular necrosis, including:

  • Diabetes
  • Gaucher's disease
  • HIV
  • Kienbock's disease
  • Legg-Calve-Perthes disease
  • Lupus
  • Sickle cell anemia

 

The treatment goal for avascular necrosis is to prevent further bone loss. Early stages of avascular necrosis may benefit from conservative treatment, while later stages may require surgery.

 

Treatment for Avascular Necrosis (AVN)

Conservative treatments include:

  • Nonsteroidal anti-inflammatory drugs, such as aspirin or ibuprofen (Advil, Motrin, others), may help relieve the pain and inflammation associated with avascular necrosis. Some studies indicate that osteoporosis medications, such as alendronate (Fosamax), may slow the progression of avascular necrosis.
  • Reducing the amount of weight and stress on the affected bone may slow the damage of avascular necrosis. So restricting the amount of physical activity engaged in, may slow the progression of avascular necrosis.
  • Certain exercises may help maintain or improve the range of motion in the affected joint. A physical therapist can choose exercises specifically for your condition and teach you how to do them.

 

An alternative treatment for avascular necrosis or AVN is platelet-rich plasma (PRP) and stem cell therapy. Both of these cutting-edge technologies capture the healing growth factors that are in a person’s own body. By injecting the platelet-rich plasma (PRP) and/or stem cells into the damaged area, it may help heal and regenerate the affected area, and diminish pain. In addition, there are indications for platelet-rich plasma in healing a variety of conditions, in much the same way that stem cells may be used to help regenerate different types of tissues.

 

 

If you continue to suffer with osteonecrosis or avascular necrosis (AVN) and your current treatment plan leaves you feeling hopeless, perhaps a fresh set of experienced eyes can change your outlook.  Since 1990, Dennis M. Lox, M.D has applied his personal interests in sports medicine, cutting-edge regenerative medicine and chronic pain management to helping patients increase their quality of life. Contact us for an appointment at 727-462-5582 or 800-301-5499.

 

All statements, information or opinions provided by this website are provided for educational purposes only. We do not diagnose nor treat through this website or by telephone. As you consider any treatment, discuss them with your physician.

 

Regarding platelet-rich plasma or stem cell therapy: Neither statements nor treatments have been evaluated by the FDA. We do not claim that these treatments work for any listed or unlisted condition. Patient testimonials offer only the patient’s impression of how a therapy worked for them – individual results will vary; results are not guaranteed nor warranteed. As you consider any treatment, discuss them with your physician.