Multi-joint Avascular necrosis
Multi-joint Avascular necrosis After Chemotherapy a Significant Problem. Avascular necrosis (AVN) occurs when the blood supply to a region of bone becomes disrupted leading to ischemia and bone cell death or necrosis. The extent of necrosis is significant for both the prognosis and treatment recommendations.
Avascular necrosis (AVN) may result from many causative factors. Trauma is the leading cause. However several other mechanisms exist related to disease states and after chemotherapy. AVN following chemotherapy much like corticosteroid induced AVN may often have multiple joint involvements. The hip is most commonly afflicted, however in these cases it often is present in both hips. AVN that affects I both hips is more complicated as if both hips fail, bilateral hip replacement is needed.
These patients with AVN may have other joint involvement. Therefore when a patient complains of pain in another area or unusual symptoms, a high index of suspicion must be used to not miss the development of AVN at a new site. This may be the knee or ankle. It may involve the entire limb. Hip, knee, and ankle. This makes multiple joint AVN not only difficult to treat but important to treat early and important if stem cell therapy may provide improvement.
Preventing joint collapse of multiple joints on the same limb or opposite limb is of immense importance for future high-level functioning especially in younger patients. Young patients with multi-joint AVN desire to avoid eye joint replacement surgery due to their young age and success with stem cell therapy in these settings can be very critical. Replacing a joint in a young patient is fraught with difficulties.
Most troubling is at a young age the joint replacement will not last a lifetime. Typical joint prostheses lifespan are 10-15 years. A revision would be necessary at still a young age. If the revision fails, then the only option is usually joint fusion. Fusing multiple joints is a very undesirable prospect for any patient. The younger diagnosed muti-joint AVN patient is especially concerned with this prospect.
This makes procedures such as stem cell therapy for the treatment of AVN so exciting as an option. Previous treatments often were the passive wait and see strategies, with no proactive measures. Incorporating stem cell therapy into the management of AVN takes a more proactive role. This can make all the difference in long-term outcomes of multi-joint AVN patients.
