By definition, avascular necrosis is “death of bone tissue due to lack of blood supply.” This can lead to small breaks in the bone, eventually causing the bone to collapse. This condition most often affects the top of the thigh bone, the femur, resulting in hip pain. However, it can affect other bones as well.
How is the blood supply to the bone impaired? There are a number of reasons, such as injuries sustained, long-term use of steroid medications, and excessive alcohol intake. Other terms that are synonymous with avascular necrosis are osteonecrosis, aseptic necrosis or ischemic bone necrosis. This is a progressive disease and will most likely worsen over time. Managing it is a lifelong process.
Sometimes, avascular necrosis will not present any symptoms. Some patients, however, may notice pain or a loss of range of motion in the affected joint. If this condition is in the hip, it may cause pain in the groin. The pain may radiate down the leg to the knee. The pain tends to intensify when one is standing or walking. If avascular necrosis is in the wrist, the patient may notice pain in the wrist and weakness in the fingers. The more the hand is moved, the more intense the pain can become. When this condition is in the femur, more than likely the patient will experience knee pain. When in the shoulder, pain and stiffness in that area are evident.
The most common cause of avascular necrosis is some sort of injury to the bone, such as a fracture or a dislocated joint. As a result of the trauma, the blood vessels that deliver blood to the bone can be damaged. The bone is then left without a means to obtain oxygen or nutrients. Eventually, the bone cells die, which in turn weaken the bone.
Other reasons cited include long-term use of steroids. While it is uncertain as to how these anti-inflammatory medications cause avascular necrosis, it can be a contributing factor. Also, individuals who drink heavily are at risk of suffering from avascular necrosis. If one were to consume several alcoholic drinks per day for many years, that can cause fatty deposits to form in the blood vessels, thereby restricting the flow of blood to the bones.
It is important to seek medical advice if you are experiencing persistent pain in any joint. Your doctor should ask you about your medical history and any current signs or symptoms you may be exhibiting or experiencing. Common diagnostic tests for avascular necrosis include x-rays and MRIs. In rare cases, your doctor may opt to surgically remove a small piece of bone for a biopsy. If you were to let this disease go untreated, it could lead to severe pain and possibly the loss of movement within two to five years due to the significant weakness and deterioration of the bone.
Among the treatment measures are medications to relive the pain, such as aspirin and ibuprofen. Bisphosphonate medications, such as Fosamax, may aid in treatment of the disease. Some studies have shown that those patients experiencing avascular necrosis of the ball portion of the hip noticed reduced pain and a slower progression of the disease when taking bisphosphonate medications.
Additionally, rest and reducing the amount of weight and stress you put upon the affected bone may help to stall the disease. In some instances involving the hip or knee, you may have to use crutches for a period of time to completely keep the weight off of it.
Certain forms of exercise may be prescribed that will help you to maintain or improve your range of motion in your affected joint. A physical therapist with an understanding of this disease can design some exercises specifically tailored for you.
Again, in rare cases, surgical intervention may be necessary. The overall goal, however, is to recognize the disease early and learn to treat it in a life-long manner. Because this is a progressive disease, your doctor will most likely opt for a more conservative approach initially. Should those measures become ineffective, you may wish to consider any surgical options.
(Information for this article was obtained at www.mayoclinic.com/health/avascular-necrosis/DS00650SECTION=symptoms)