Avascular necrosis (AVN) is the death of bone tissue due to a loss of blood supply. It is also called
• aseptic necrosis
• ischemic bone necrosis
• bone infarction
It can lead to tiny breaks in the bone and the bone eventually collapses.
A broken bone or dislocated joint can interrupt the blood flow to a section of bone. Avascular necrosis is also associated with long-term use of high-dose steroid medications and excessive alcohol intake.
If it is not treated, eventually the space between joints can cause collapse and the bones can lose their smooth shape. Some people with AVN will need joint replacement surgery.
AVN most often affects your hip. Other common site is the knees. Less often, AVN affects bones in these areas –
In its early stages, AVN usually doesn’t have symptoms. As the blood cells die and the disease gets worse progressively, symptoms may occur in roughly this order –
• Mild or severe pain in or around the affected joint.
• Groin pain that spreads down to the knee.
• Pain that occurs when putting weight on the hip or knee.
• Joint pain severe enough to limit movement.
Pain may dramatically increase in intensity because of tiny breaks in the bone, called microfractures. There can cause the bone to collapse. Ultimately, the joint may break down and develop arthritis.
The time between the first symptom and bone collapse can range from several months to more than a year. Symptoms may appear bilaterally.
Avascular necrosis occurs when blood flow to a bone is interrupted or reduced. Reduced blood supply can be caused by –
• Joint or bone trauma
An injury, such as a dislocated joint, might damage nearby blood vessels. Cancer treatments involving radiation also can weaken the bone and harm blood vessels.
• Fatty deposits in blood vessels
The fat can block small blood vessels, reducing the blood flow that feeds bones.
• Certain diseases
Medical conditions, such as sickle cell anemia and Gaucher’s disease, also can cause diminished blood flow to the bone.
For about 25% of people with avascular necrosis, the cause of interrupted blood flow is unknown.
Risk Factors –
Risk factors for developing avascular necrosis include –
Injuries, such as hip dislocation or fracture
• Steroid use
Use of high-dose corticosteroids, such as prednisone.
• Excessive alcohol use
Consuming several alcoholic drinks a day for several years.
• Bisphosphonate use
High doses of such medications for cancers, such as multiple myeloma and metastatic breast cancer.
• Certain medical treatments
Radiation therapy for cancer can weaken bone. Organ transplantation, especially kidney transplants, is also associated with AVN.
Medical conditions associated with avascular necrosis include –
• Sickle cell anemia
• Gaucher’s disease
• Systemic lupus erythematosus
Untreated, avascular necrosis worsens with time. Eventually, the bone can collapse. Avascular necrosis also causes the bone to lose its smooth shape, potentially leading to severe arthritis.
During a physical exam, the doctor will likely press around your joints, checking for tenderness. The doctor might also move the joints through a variety of positions to see if your range of motion has been reduced.
Imaging tests can help pinpoint the source of pain. Options of imaging tests are –
• MRI and CT scan
• Bones scan
The goal of treatment is to prevent further bone loss as reverse loss is not possible.
Medications and therapy
• Nonsteroidal anti-inflammatory drugs – Medications, such as ibuprofen or naproxen sodium might help relieve the pain associated with AVN.
• Osteoporosis drugs – Medications, such as alendronate (Fosamax), might slow the progression of AVN, but the evidence is mixed.
• Cholesterol-lowering drugs – Reducing the amount of cholesterol and fat in your blood might help prevent the vessel blockages that can cause AVN.
• Blood thinners – If you have a clotting disorder, blood thinners, such as warfarin might be recommended.
• Rest – Reducing the weight and stress on your affected bone can slow the damage. You might need to restrict your physical activity or use crutches to keep weight off your joint for several months.
• Exercises – A physical therapist can teach you exercises to help maintain or improve the range of motion in your joint.
• Electrical stimulation – Electrical currents might encourage your body to grow new bone to replace the damaged bone.
Surgical and other procedures
As most people don’t develop symptoms until AVN is fairly advanced, your doctor might recommend surgery. The options of surgery include –
• Core decompression
• Bone transplant(Graft)
• Bone reshaping (Osteotomy)
• Joint replacement
• Regenerative medicine treatment
Ayurvedic Perspective –
According to Ayurveda, AVN resembles Dhatu pagina am dusty, Vatarakta, Asthi Kshaya, and Kati Graha. Eventually, in Ayurveda AVN is Dhatu Kshaya janya Vata vriddhi.
Depletion of any tissue leads to an increase of Vata at the site of depletion of tissue. This rule holds well with depletion of bone tissue too. When due to lack of blood supply to the bone, bone tissue gets depleted due to the death of its cells, Vata will increase in those regions of the bone tissue.
This increase in Vata will increase in those regions of the bone tissue. This increase in Vata will lead to an increase of Vata qualities in the bone like dryness, roughness, lightness, minuteness, etc. which will eventually lead to damage and breakage of a bone.
Panchkarma therapies like Snehana, Virechana, Vasti plays important role in AVN treatment. Other local therapies such as Dhanyamla Dhara, Udwarthana, Sneha Dhara, Patra pinda sweda, Swastika shali pinda Sweden, Lepa, Upnaha also plays an effective role in AVN treatment.
Effective medications –
• Dashamula Kashaya
• Ashtavarga Kashaya
• Mahayograj Guggulu
• Kaishore Guggulu
• Lakshadi Guggulu
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