Avascular Necrosis
What is avascular necrosis?
Avascular
necrosis is a disease that results from the temporary or permanent loss of
blood supply to the bone. It is also called osteonecrosis, aseptic
necrosis, or ischemic bone necrosis. When blood supply is cut off, the bone
tissue dies and the bone collapses. If avascular necrosis occurs near a joint,
collapse of the joint surface may occur.
Avascular
necrosis may occur in any bone, but most commonly occurs in the ends of a long
bone. It may affect one bone, several bones at one time, or different bones at
different times.
What causes avascular necrosis?
Avascular
necrosis may be the result of the following:
·
Traumatic causes (including injury, fracture, or
damage to blood vessels)
·
Nontraumatic causes (including long-term use of
medications, such as corticosteroids, or excessive, long-term use of alcohol)
Other
theories and associations have been suggested as risk factors.
What are the risk factors for avascular necrosis?
Suggested risk
factors for avascular necrosis include the following:
·
Injury
·
Steroid use
·
Gaucher disease
·
Alcohol use
·
Blood disorders, such as sickle cell anemia
·
Radiation treatments
·
Chemotherapy
·
Pancreatitis
·
Decompression disease
What are the symptoms of avascular necrosis?
The following
are the most common symptoms for avascular necrosis. However, each individual
may experience symptoms differently. Symptoms may include:
·
Minimal early joint pain
·
Increased joint pain as bone and joint begin to
collapse
·
Limited range of motion due to pain
The symptoms of
avascular necrosis may resemble other medical conditions or bone problems.
Always consult your doctor for a diagnosis.
How is avascular necrosis diagnosed?
In addition to a
complete medical history and physical examination, diagnostic procedures for
avascular necrosis may include the following:
·
Imaging procedures,
such as:
·
X-ray. A
diagnostic test that uses invisible electromagnetic energy beams to produce
images of internal tissues, bones, and organs onto film; to determine bone
changes.
·
Computed tomography scan (also
called a CT or CAT scan). A diagnostic imaging procedure
that uses a combination of X-rays and computer technology to
produce horizontal, or axial, images (often called slices) of the body. A
CT scan shows detailed images of any part of the body, including the bones,
muscles, fat, and organs. CT scans are more detailed than general X-rays.
·
Magnetic resonance imaging
(MRI). A diagnostic procedure that uses a combination of
large magnets, radiofrequencies, and a computer to produce detailed images of
organs and structures within the body.
·
Radionuclide bone scan. A
nuclear imaging technique that uses a very small amount of radioactive
material, which is injected into the patient's bloodstream to be detected by a
scanner. This test shows blood flow to the bone and cell activity within the
bone.
·
Biopsy. A
procedure in which tissue samples are removed (with a needle or during surgery)
from the body for examination under a microscope; to determine if cancer or
other abnormal cells are present; to remove tissue from the affected bone.
·
Functional evaluation of bone. Tests, that usually involve surgery,
to measure the pressure inside the bone.
Treatment for avascular necrosis
Specific
treatment for avascular necrosis will be determined by your doctor based
on:
·
Your age, overall health, and medical history
·
Extent of the disease
·
Location and amount of bone affected
·
Underlying cause of the disease
·
Your tolerance for specific medications,
procedures, or therapies
·
Expectations for the course of the disease
·
Your opinion or preference
The goal of
treatment for avascular necrosis is to improve functionality or to stop further
damage to the affected bone or joint. Treatments are necessary to keep joints
from breaking down, and may include:
·
Medications. These are used to control pain.
·
Assistive devices. These are used to reduce weight on the
bone or joint.
·
Core decompression. A surgical procedure in which the
inner layer of bone is removed to reduce pressure, allow for increased blood
flow, and slow or stop bone and/or joint destruction.
·
Osteotomy. A surgical procedure to reshape the
bone and reduce stress on the affected area.
·
Bone graft. A surgical procedure in which healthy
bone is transplanted from another part of the patient's body into the affected
area.
·
Arthroplasty (total joint
replacement). A
surgical procedure to remove and replace an arthritic or damaged joint with an
artificial joint (called a prosthesis); may be considered only after other
treatment options have failed to provide adequate relief from pain and/or
disability.
Other treatments
for avascular necrosis may include electrical stimulation and combination
therapies to encourage the growth of new bone.
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