Avascular Necrosis: Causes, symptoms and treatment

From surgical and non-surgical treatment options of AVN to the probable causes of the diseases, here’s all that you need to know about Avascular Necrosis.

Avascular Necrosis, also known as Osteonecrosis (bone death syndrome) is a bone-related disease that occurs from the blood supply stopping at the bones. This further leads to tiny cracks in the bones. In ideal scenarios, the bones can rebuild the cracks of their own, but due to the stopped blood supply, they become ineffective, leading to temporary or permanent damage. In an interview with HT Lifestyle, Dr Amit Kumar Agarwal, Sr. Consultant, Orthopaedic Surgery, Indraprastha Apollo Hospitals Delhi said, “As AVN progresses, tiny fractures affect the structure of the bone and ultimately lead to a breakdown of the hip joint. The normal hip joint is a ball and socket joint. The bones are covered with a smooth glass-like material called cartilage. This smooth surface makes movement painless. In AVN, the normally smooth and round shape of the hip joint is lost and it becomes mushroom-shaped.”

Avascular Necrosis: Causes, symptoms and treatment(Unsplash)

Dr Amit Kumar Agarwal further noted down the causes, symptoms and the treatments and their effectiveness in curing AVN. Take a look:

Causes:

Even though the direct causes of AVN are yet to be defined, it is usually caused by hip fracture, excessive alcohol and tobacco consumption, chemotherapy and radiation, and certain medical conditions such as sickle cell disease, lymphoma, and leukemia. However, cases of AVN have increased since the onset of the covid-19 pandemic, and the most probable cause is said to be the usage of steroids. After covid-19, age group between 20 and 40 years is highly vulnerable to developing a severe type of AVN bone condition with fast progress to total destruction.

Symptoms:

“AVN is also known as a silent disease as the symptoms remain absent till a large part of the hip is involved. Any joint in the body can be affected but AVN mostly affects the hip joints. 80% of AVN cases occur in both hip joints (left and right). AVN of the hip develops stiffness reducing the mobility of the hip joint, there is a pain spot in the regions of the groin and buttocks that radiate to the knees. The common symptoms associated with AVN are difficulty in walking, bending, sitting on the ground, limping while walking, and a decrease in the movement of the hip,” said Dr Amit Kumar Agarwal.

Treatment:

Based on the stage and severity of the disease, treatments are recommended. There are a range of surgical and non-surgical treatments available for curing AVN. They are:

Non-surgical approach: In the first step of treatment, pain medication can be prescribed. However. They do not help in the form of bone formation. Physiotherapy and resting are also recommended for reducing joint pain. However, none of them can directly address AVN.

Surgical approach: There are a range of surgical approached available – further divided into hip preserving and hip replacement options.

(A) Core Decompression: In this case of surgery, the doctor drills a small hole in the damaged bone to increase blood supply. However, this surgical approach comes with a considerable risk of failure.

(B) Bone Cell Therapy: This treatment involves extraction of healthy stem cells from patients' bone marrow and culture of bone cells and then injecting the same into the patient's hip joint through a small keyhole procedure.

(C) Total Hip Replacement: “In this replacement surgery, the doctor cuts off the bone of the hip joint and replaces it with a metal ball and socket. This procedure is suitable in the advanced stages (stage4) of AVN when the shape of the ball has changed,” said Dr Amit Kumar Agarwal.