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Excessive Cortisone Use for Hip Pain Leads to Hip AVN in Crohn’s Disease

Hip AVN as a Result of Excessive Corticosteroids or Cortisone

A patient in their 50’s presented to Dennis M. Lox M.D., for avascular necrosis AVN of both hips, it was presumed to be due to excessive corticosteroid (Cortisone) use. This is a commonly seen etiology for AVN by Dr. Lox. Dennis M. Lox M.D. is an expert in Sports and Regenerative Medicine, with special expertise in the treatment of AVN. In fact, Dr. Lox has treated patients from around the world with all types of avascular necrosis or AVN.
Trauma is the leading cause of AVN. This is usually seen in one joint where the trauma occurred, such as the hip. Bo Jackson, the incredible Professional Baseball and Football Player developed AVN of the hip, after an unusual tackle where his hip dislocated, then popped back into the socket as he hit the ground. Whereas trauma involves one joint, systemic causes of AVN such as excessive corticosteroid use may involve more than one joint. Most frequently, multi-joint AVN occurs in both hips. This is exactly what this patient had. The excessive use of corticosteroids occurred over several years as the result of Crohn’s disease, a disorder of the gastrointestinal that results in chronic inflammation, colitis, pain, and can be very disrupting to a patients quality of life. Often parts of the intestine or colon requires surgery to remove severely damaged areas. This is why very strong medications with often bad side effects are used to treat Crohn’s disease.

What is AVN?

Avascular necrosis or AVN occurs when the blood supply to a region of bone becomes impaired or disrupted, this leads to bone cell death or necrosis. There are many potential causes for the blood supply to become impaired. The trauma the leading cause can shear or tear a blood vessel. Clots from disorders such as Sickle Cell disease, hyper-coagulated states, thrombosis, and vasculitis are some examples. Excessive corticosteroids or Cortisone, and excessive alcohol consumption are more problematic. As overall AVN is not common, and only a small fraction of those given corticosteroids, or consume excessive alcohol develop AVN. This remains a mystery, as to why some people get AVN and others do not. When AVN occurs it is such a serious problem, that with a risk factor of excessive alcohol or corticosteroids the development of hip or joint pain without obvious causes, should alert the astute physician to the possibility of AVN.
AVN sometimes referred to as osteonecrosis can be an incidental finding on x-ray or MRI, or may present as severe pain. The most serious consequence of AVN is the collapse of the necrotic region of the bone, this leads to rapid destruction of the joint. Often, left with little alternative orthopedic surgeons, recommend total hip replacement surgery.

Excessive use of Corticosteroids is a Frequent Cause of AVN

The use of excessive corticosteroids is common in Rheumatologic diseases, Crohn’s disease, and chronic respiratory diseases.
Severe Asthma, and emphysema patients, often are given frequent and large corticosteroid doses to aid trouble breathing. The higher the dosages, the more frequent, and intravenous administration are often highly correlated with AVN. However, AVN has been seen with even infrequent use of corticosteroids. Part of the perplexing puzzle of excessive corticosteroid and excessive alcohol use. Both are common, yet overall AVN is infrequent so it is hard to often pinpoint, and thus diagnosis early. Rheumatologic conditions such as Rheumatoid Arthritis are often manifested by painful joints. Thus if treatment has consisted of regular corticosteroids for flare-ups of the condition due to pain, recognizing the development of AVN in someone who regularly has joint pain is difficult.
There lies the difficulty of recognizing and treating AVN.
This is where a specialist such as Dennis M. Lox M.D., can be very helpful, as Dr. Lox has treated many AVN patients from all around the world, with all types of AVN, involving nearly every joint or multi-joint AVN.

What Joints are Most Commonly Affected?

The hip is most commonly affected, followed by the shoulder, then the knee. However, AVN may occur in the foot, hand, and even the jaw.
Avascular necrosis or Osteonecrosis may also be involved in more than one joint. This is known as multi-joint AVN.
Multi-joint AVN most commonly is seen in both hips. But multi-joint AVN may be seen in a Hip and a knee, or hip, knee, and ankle. It may be on both sides, or in the legs and arms. Systemic factors that predispose to multi-joint AVN such as excessive corticosteroid use, excessive alcohol, radiation therapy or chemotherapy can occur diffusely making treatment difficult.

What Can Regenerative Medicine and Stem Cell Therapy Do?

Dennis M. Lox MD. has lectured around the world at Regenerative Medicine, Tissue Engineering, and Stem Cell Therapy Medical Symposiums on AVN, Degenerative Arthritis, and Sports Injuries. Understanding the science of AVN, how it progresses towards severe degenerative arthritis of the joint, and Regenerative Medicine and Stem Cell Therapy Treatments are advantageous. Having treated all types of AVN causative factors and joints is helpful for athletes and non-athletes to understand their treatment options, realistic goals. Dr. Lox has helped many patients achieve tremendous success, without surgery is often very important to patients. Especially those who are dismayed that little treatment options have been offered. Dr. Lox has been featured on several news stories for this. Regenerative Medicine utilizes your own bodies stem cells to try and help heal yourself without surgery, or the long painful recovery process. More importantly, Regenerative Medicine and Stem Cell Therapy, does not prevent future surgery, whereas hip replacement surgery or other joint replacement surgery, and joint fusion are irreversible. Often joint replacement surgery is the end of an athlete’s career. Dr. Lox has helped several teen athletes avoid joint replacement surgery or joint fusion, with Regenerative Medicine and Stem Cell Therapy, and go on with high school athletics, and then obtain college scholarships. Truly rewarding Medicine that is never forgotten by the patient, their family, or Dr. Lox.


About Dennis M. Lox, M.D.

Whether you are a professional athlete, weekend warrior, or have arthritis from aging, Dr. Lox can help.

Dennis M. Lox, M.D. is an internationally renown Sports and Regenerative Medicine specialist. Dr. Lox incorporates Regenerative Medicine techniques such as cell science applications, Platelet Rich Plasma (PRP), and Tissue Engineering aspects, to help patients from around the world with a vast array of problems. Dr. Lox is board certified in Physical Medicine and Rehabilitation. Dr. Lox lectures extensively and has edited two PM&R textbooks, the prestigious A State of the Art Review (Star) on Low Back Pain, and Soft Tissue Injuries: Diagnosis and Treatment.

Dennis M. Lox, M.D. maintains an active practice in the Tampa Bay, Florida area, and in Beverly Hills, California.

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