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Avascular Necrosis : Cause, Diagnosis and Treatment

Avascular necrosis is a condition of bone tissue that dies due to lack of blood supply. In the early stages, avascular necrosis generally shows no symptoms. But over time, affected joints will feel pain when moving. Then the joint will feel painful, even if the sufferer is just lying down. Pain that feels can be mild or severe, pain will feel heavier in the joints that hold body weight, such as joints in the groin area or buttocks. In addition, pain can also be felt in the shoulders, knees, hands and feet.

Pain that can feel increased due to the presence of microfractures or small cracks in the bone. This condition can cause bone death and damage to joints that develop into arthritis, and will limit movement. Keep in mind, the distance from the first time the symptoms appear until the patient is difficult to move, varies in each patient, can be in a matter of months or more than one year. Symptoms can also appear on both sides of the body, such as in both thighs or both knees.

Causes of Avascular Necrosis

The cause of Avascular necrosis (AVN) is an injury that causes a disruption or cessation of blood circulation to the bone. Other risk factors that are also related to AVN are:

  • consume too much alcohol
  • smoke
  • taking high doses of corticosteroids for a long time
  • diseases like Legg-Calve Perthes

There are also several other causes of AVN which, although rare, can also be found, such as:

  • side effects of undergoing chemotherapy or radiotherapy
  • high cholesterol or triglycerides or both
  • Gaucher disease
  • HIV infection
  • lupus
  • undergo organ transplants such as kidneys
  • pancreatitis
  • blood disorders such as sickle cell anemia

However, the cause of avascular necrosis is not always certain, because this disease can occur in healthy individuals without having the above risk factors. Avascular necrosis is more susceptible to attacking men than women. However, women with lupus are also at risk for this disease. Although avascular necrosis can occur at any age, but generally this disease afflicts people aged 30-60 years.

Diagnosis of Avascular Necrosis

After asking for a history of symptoms and a physical examination, the orthopedic doctor will carry out a number of examinations. An X-ray will be performed to see bone changes that occur in avascular necrosis. In addition, imaging with an MRI or CT scan can also be done to see the condition of the bone in more detail.

If the X-ray imaging results show no problems and the patient also does not have a risk factor for this disease, the doctor will recommend a bone scan examination. This examination begins with injecting radioactive substances into the blood vessels. The substance will go to the area of the bone that is experiencing interference and will be caught when carried out photos with a gamma camera.




If the doctor still suspects that the patient has avascular necrosis even though all the results of the imaging test do not indicate the presence of this disease, the patient may be advised to undergo a surgical test to measure the pressure on the diseased bone. This test is called the functional bone test.

Treatment and Prevention of Avascular Necrosis

Treatment for people with avascular necrosis depends on age, the cause of the disease, the part of the bone that is damaged, and the extent of the damage. To treat avascular necrosis in the initial stages, therapies and treatments recommended by doctors include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Medications such as ibuprofen or diclofenac can reduce signs of inflammation, such as pain due to avascular necrosis.
  • Cholesterol-lowering drugs. Decreased levels of fat in the blood can help prevent blockages in blood vessels that can trigger avascular necrosis.
  • Types of anticoagulant drugs such as warfarin, will be recommended to prevent blood clots.
  • Bisphosphonate drugs. In some cases, bisphosphonate drugs such as alendronate can slow the progression of avascular necrosis. However, there are reports that even bisphosphonates make avascular necrosis in the jawbone.

If you have avascular necrosis, you should not do a lot of activities that can burden the affected part of the bone. At the same time, you can also do physiotherapy to help maintain and improve the function of damaged joints.

If the pain is already in a severe condition, the doctor will recommend surgery, such as:

  • Bone transplant. This procedure aims to strengthen damaged bones, by taking healthy parts of bones from other areas of the patient's body.
  • Joint replacement. If the affected part is no longer possible to repair, the patient can undergo a surgical operation to replace the damaged joint with a metal imitation joint.
  • Part of the damaged bone will be removed, and the part that is still healthy is expected to reshape the bone structure to strengthen the support in the joint, so that it can be used better.
  • Bone core decompression. The procedure that is carried out is to remove the inside of the bone to reduce the burden on the joint, and to form new blood vessels.

This disease can be prevented by avoiding alcohol consumption and keeping cholesterol at normal values. If the patient is a corticosteroid user, be sure to consult a doctor to monitor their use. Bone damage can get worse if accompanied by corticosteroid use.

Whereas to prevent avascular necrosis in the jaw, it is recommended to routinely clean teeth and visit a dentist for dental examination and treatment, especially for those undergoing treatment with bisphosphonates.



References

References

1. McDowell, S. Healthline (2017). Everything You Should Know about Avascular Necrosis (Osteonecrosis).

2. Orthoinfo (2018). Osteonecrosis of The Hip.

3. Narayanan, et al. (2017). Avascular Necrosis of Femoral Head: A Metabolomic, Biophysical, Biochemical, Electron Microscopic and Histopathological Characterization. 


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Is a health and wellness enthusiast. In him free time, she loves to travel and taste different types of teas.

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