Written By: Bhavyajyoti Chilukoti | Published : November 24, 2017 5:51 PM IST
Avascular necrosis (AVN), also called osteonecrosis, aseptic necrosis, or ischemic bone necrosis, is a condition that occurs when there is a loss of blood to the bone. As bone is a living tissue, it requires blood and an interruption to the blood supply causes the bone to die. If not treated, this process eventually causes the bone to collapse. It most often occurs in the ball of the hip (head of the femur bone), shoulders, the ankle, wrist or the jaw. Dr Ameet Pispati, Consultant Orthopaedic Surgeon, Jaslok Hospital, Mumbai explains in detail about the causes, symptoms and treatment of avascular necrosis in India. Also read about causes of pain in the hip.
What are the causes of avascular necrosis?
About half the people who get AVN have no identifiable cause. The commonest cause is excess alcohol intake, steroids, smoking, injury, conditions where there is damage to the blood vessels, autoimmune diseases, radiation therapy and due to deposition of fat in the blood vessels. What is important is that the affected age group is usually between 18 years to 45 years, hence affecting peoples livelihood.
The male-to-female ratio depends on the underlying cause, although primary AVN is more prevalent in men. The overall male-to-female ratio is 8:1. The age at onset depends on the underlying cause. Primary AVN most often occurs at 40 years or 50 years and is bilateral in 40-80% of cases. Also read about 15 causes of joint pains, other than arthritis.
What are the symptoms of avascular necrosis?
In the very early stages, there may be no symptoms at all. Pain is the cardinal feature though and can be unbearable. There may be limp while walking and hip movements may be restricted. Often the affected person does not feel like attending work or getting out of bed. The affected part (usually the hip) tends to be sore and stiff. Eventually, arthritis sets in.
How is it treated (in India)?
In the very early stages, one uses painkillers, rest, crutches, calcium, vitamin D, and bone strengthening agents called bisphosphonates. If there is no response to the above, one needs to drill holes into the affected bone to let the pressure out and let the repair process start this is called Core decompression surgery . This procedure needs to be performed in good time before the ball of the femur is damaged/flattened, for best results.
Once the head (ball) of the hip bone is damaged, a hip replacement can help relieve pain and restore mobility.
Hip replacements done with modern technology, minimally invasive methods and using ceramics material in younger people allow rapid recovery and return to sport and normal activity. Here's more on hip replacement surgery questions you should ask your surgeon before the procedure.
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