Dr. Abhinav Kesarkar | Orthopedic Surgeon In Nagpur
AVN Injury in Nagpur: A Comprehensive Guide
AVN Injury in Nagpur: A Comprehensive Guide
Avascular necrosis refers to the death of bone tissue resulting from insufficient blood supply. Commonly known as osteonecrosis, this condition can result in small fractures within the bone, ultimately leading to its collapse. The progression of this process typically spans several months to years.
Injuries such as fractures or dislocated joints can impede blood circulation to specific areas of bone. Additionally, avascular necrosis is linked to prolonged use of high-dose steroid medications and excessive alcohol consumption.
Causes of Avascular necrosis
Avascular necrosis arises when the blood supply to a bone is either interrupted or diminished. This reduction in blood flow may result from:
- Joint or bone injuries. An injury, such as a dislocated joint, may result in damage to adjacent blood vessels. Additionally, cancer therapies that utilize radiation can compromise bone integrity and adversely affect blood vessels.
- Lipid accumulation in blood vessels. The presence of fat (lipids) can obstruct smaller blood vessels, leading to diminished blood circulation to the bones.
- Specific medical conditions. Diseases like sickle cell anemia and Gaucher’s disease can also impair blood flow to the bones.
Avascular necrosis that is not induced by trauma can occasionally have an unclear etiology. It is probable that a combination of genetic factors, excessive alcohol consumption, specific medications, and other medical conditions contribute to its development.
Symptoms
In the initial phases of avascular necrosis, some individuals may exhibit no symptoms. As the condition progresses, discomfort in the affected joints may occur primarily during weight-bearing activities. Ultimately, pain may be experienced even while at rest. The intensity of the pain can range from mild to severe and typically increases gradually over time. In cases of avascular necrosis affecting the hip, the pain is often localized in the groin, thigh, or buttock regions. Additionally, other joints such as the shoulder, knee, hand, and foot may also be involved. It is noteworthy that some individuals may experience avascular necrosis bilaterally, affecting both hips or both knees simultaneously.
Risk factors
Risk factors associated with the development of avascular necrosis encompass:
- Trauma. Injuries such as hip dislocation or fractures can compromise adjacent blood vessels, leading to diminished blood circulation to the bones.
- Corticosteroid use. The administration of high-dose corticosteroids, including prednisone, is frequently linked to avascular necrosis. Although the exact mechanism remains unclear, some specialists suggest that corticosteroids may elevate lipid levels in the bloodstream, thereby impairing blood flow.
- Excessive alcohol consumption. Consuming multiple alcoholic beverages daily over an extended period can lead to the accumulation of fatty deposits within blood vessels.
- Bisphosphonate therapy. Prolonged use of medications aimed at enhancing bone density may be associated with the onset of osteonecrosis of the jaw. This uncommon complication has been observed in individuals receiving high doses of these drugs for conditions such as multiple myeloma and metastatic breast cancer.
- Specific medical interventions. Radiation therapy utilized in cancer treatment can weaken bone structure. Additionally, organ transplants, particularly kidney transplants, have been linked to avascular necrosis.
Medical conditions associated with avascular necrosis include:
- Pancreatitis
- Gaucher’s disease
- HIV/AIDS
- Systemic lupus erythematosus
- Sickle cell anemia
- Decompression sickness, commonly referred to as divers’ disease or the bends
- Specific forms of cancer, including leukemia.
Diagnosis
A health care provider will assess your joints during a physical examination by applying pressure to check for any tenderness. Additionally, they may manipulate the joints into various positions to evaluate whether there is a reduction in the range of motion.
Imaging tests
Numerous factors can lead to joint discomfort. Imaging examinations can assist in identifying the origin of the pain. These tests may encompass:
- X-rays are capable of detecting alterations in bone structure that manifest during the advanced phases of avascular necrosis. However, in the initial stages of this condition, X-rays typically do not reveal any abnormalities.
- MRI and CT scans offer high-resolution images that can identify early bone changes potentially associated with avascular necrosis.
- A bone scan involves the injection of a small quantity of radioactive material into a vein. This tracer migrates to the areas of the bones that are either damaged or in the process of healing, appearing as bright spots on the imaging plate. Treatment of Avascular Necrosis
Treatment for Avascular Necrosis
The primary goal is to prevent further bone loss. Early-stage management includes medications like NSAIDs for pain relief, osteoporosis drugs to slow progression (mixed evidence), cholesterol-lowering drugs to avoid blockages of vessel, and blood thinners for clotting disorders. Iloprost may improve blood flow. Therapy options include rest, exercises to maintain joint motion, and electrical stimulation to promote bone growth. Surgical options include core decompression, bone grafts, osteotomy (bone reshaping), or joint replacement for severe cases. Regenerative treatments like stem cell therapy are being explored for early stages but require more research.