Los Angeles Patient with Ankle Avascular Necrosis (AVN)

A Los Angeles, California man with Ankle AVN consulted Dennis M. Lox M.D in his Beverly Hills, California office for avascular necrosis of the Ankle.

Dr. Lox an expert in Sports and Regenerative Medicine, has a special expertise in the treatment of avascular necrosis (AVN). Dr. Lox has treated a great number of patients with ankle AVN.

AVN, sometimes referred to as osteonecrosis, occurs when the blood supply to a region of bone is disrupted. This blood flow disruption or avascularity, results in bone cell death. Bone cell or cellular death is termed necrosis.

Simplistically, AVN is like a heart attack or myocardial infarction. The loss of blood flow to heart muscle leads to a heart attack, and cardiac muscle cell death. Heart attacks can be small or affect large amounts of tissue. The same is true for avascular necrosis. If a large amount of blood flow is disrupted to the bone, there is a larger amount of bone cell death. Many potential causes of AVN or Osteonecrosis can occur. The leading cause of AVN is trauma.

Causes Of Avascular Necrosis

There are several associated names for avascular necrosis (AVN) all of which mean the same medical thing. Osteonecrosis is often used. Osteo- refers to bone. Necrosis again, refers to cellular death.

Other terms used to describe AVN are:

• Aseptic Necrosis
• Bone Infarction

There are numerous names to describe specific regions of the body where AVN occurs.

For instance Legg Calves Perthes disease is AVN of the Hips in newborns to 2 years of age. Kohlers disease refers to avascular necrosis of the tarsal bone of the foot in 6-9 year olds.

These terms were often named after physicians who first described the condition. Alban Kohler was a German radiologist (1874-1947). Often these additional terms named for doctors add no value to the understanding of AVN, and when there are so many of these terms for different body parts, it is just more confusion.

The leading cause of AVN is trauma.

The next leading cause of AVN is idiopathic or unknown. Because of this other causes must be excluded, to address the potential for perpetuating the AVN. An example of this is excessive corticosteroids. It is not appropriate to assign the diagnosis of idiopathic AVN, without a review of other potential causes of AVN.

Known associated AVN factors:

• Excessive Corticosteroids (Cortisone)
• Excessive Alcohol consumption

Both alcohol and corticosteroids have variable dosages which may precipitate the development of AVN, and certainly not everyone who takes excessive corticosteroids or alcohol develop avascular necrosis. This implies possibly multi-factorial issues.

Radiation and Chemotherapy are known associated factors with AVN
Rheumatologic Diseases such as Rheumatoid Arthritis and Lupus have an Associated risk of developing AVN. In addition these Rheumatologic diseases are often treated with higher doses of corticosteroids, which also increase the risk of AVN development.

There are many other associated factors for the development of AVN, such as sickle cell disease, lipid storage diseases, and even decompression sickness.

Ankle AVN

The ankle joint proper is composed of the talus bone which rocks in the tibia and fibular boney articulations. This allows foot movement upwards and downwards. All may be involved in ankle AVN, however the talus is most frequently affected. Additional, the subtalar joint is often also included as part of the ankle. This is the talus and navicular bone. This joint allows the foot to move inward and outward.

The navicular bone is frequently involved in sports trauma, and thus is seen with resulting AVN.

Regenerative Medicine and Stem Cell Therapy Options

The ankle mortise and subtalar joint bear weight bearing stress. Therefore damage to the talus and navicular bone with avascular necrosis is extremely difficult. The weight bearing increases the stress on the necrotic area, and tends to lead to further degeneration of the joint. Joint collapses the most feared complication of AVN. Since ankle replacement surgery is typically not as successful as knee replacement surgery, patients are left with little options except live with the pain, or ankle fusion.

Ankle fusion is irreversible, will end most sports careers, and due to the abnormal motion that follows ankle fusion, limping leads to adjacent joint degenerative arthritis.

This is why so many patients have explored Regenerative Medicine treatment options, and Stem Cell Therapy applications as alternatives to ankle surgery.

Dr. Lox has had some tremendous success stories with teenage athletes, who were told their only option was ankle fusion for their AVN, they declined surgery and had Stem Cell Therapy with Dr. Lox and resumed their athletic careers. Even going on to get collegiate scholarships.

These types of success stories have given hope to many others to seek out Regenerative Medicine treatment options with Dr. Lox. Not only in the metropolitan Los Angeles, California area, and his Tampa Bay, Florida office, but travel from all over the world to seek out his consultation.