DR. ADITYA R. BOTHRA

Avascular Necrosis (AVN), also known as osteonecrosis, is a condition where the blood flow to a bone is disrupted, leading to the death of bone tissue. AVN most commonly affects the hip joint but can also impact the knees, shoulders, and other bones. If left untreated, AVN can lead to joint collapse and severe disability.

AVN progresses in stages

1. Stage 1 (Early): No visible changes on X-ray, but MRI shows reduced blood supply to the bone.
2. Stage 2 (Intermediate): Bone structure starts to weaken but is still intact. Some changes may be visible on X-ray.
3. Stage 3 (Late): The bone starts to collapse. X-rays show significant bone damage, and the joint may begin to deteriorate.
4. Chronic Medical Conditions: Conditions like sickle cell disease, lupus, or gout can increase the risk of AVN.
5. Stage 4 (End-stage): Complete collapse of the bone structure, resulting in joint arthritis.

AVN can be caused by several factors

1. Trauma: Fractures or dislocations of joints can damage blood vessels, leading to decreased blood flow to the bone.
2. Steroid Use: Long-term or high-dose corticosteroid use can interfere with blood flow to the bones.
3. Excessive Alcohol Use: Alcohol can affect the blood vessels, leading to AVN.
4. Chronic Medical Conditions: Conditions like sickle cell disease, lupus, or gout can increase the risk of AVN.
5. Prolonged Use of Bisphosphonates: These are drugs used to treat osteoporosis and may sometimes cause AVN.
6. Smoking: Smoking restricts blood flow and can increase the risk.
7. Idiopathic (No Known Cause): Sometimes, AVN can develop without an identifiable cause.

1. Pain: Usually the first symptom, which often starts as mild and gradually worsens over time.
• In the early stages, pain may be felt only during activity (e.g., walking or weight-bearing).
• As the condition progresses, pain may be felt even at rest and can become severe.
2. Limited Range of Motion: Joint movement becomes restricted as the bone deteriorates.
3. Joint Stiffness: Over time, stiffness can develop in the affected joint.
4. Limping: Due to pain and limited motion, people may develop an abnormal gait.

1. Physical Examination: A doctor may check for pain or stiffness in the joint, and assess range of motion.
2. Imaging:
• X-ray: Initial imaging tool. In the early stages, AVN might not be visible, but as the condition progresses, changes like bone collapse can be seen.
• MRI (Magnetic Resonance Imaging): The most sensitive tool for detecting AVN in its early stages, even before any visible changes appear on an X-ray.
• CT Scan: Sometimes used to assess the extent of bone damage.
• Bone Scintigraphy (Bone Scan): Can be used to detect changes in blood flow to the bones.

1. Non-Surgical Treatment
• Medication: Pain management using NSAIDs or stronger pain relievers
• Physical Therapy: To improve joint function and prevent stiffness.
• Lifestyle Changes: Reducing weight-bearing activities to decrease joint stress
2. Surgical Treatment
• Core Decompression: Removing part of the bone to reduce pressure and allow better blood flow.
• Bone Grafting: Replacing the damaged bone with healthy bone tissue.
• Joint Replacement: In advanced cases, hip or knee replacement might be necessary.

1. Avoid Excessive Alcohol Consumption: Limit alcohol intake, as it can contribute to AVN.
2. Avoid Smoking: Smoking reduces blood flow, which can lead to AVN.
3. Cautious Use of Steroids: Use corticosteroids only under the guidance of a doctor, especially for long-term treatment.

The outlook for AVN depends on several factors:

1. Stage of Diagnosis: Early-stage AVN has a better prognosis than advanced stages where joint collapse has occurred.
2. Treatment Type: Non-surgical treatments can help manage early-stage AVN, but surgery may be necessary if the condition worsens.
3. Age and Activity Level: Younger, more active individuals may require more aggressive treatments like joint replacement.

Post-surgical rehabilitation is important to regain joint function:

1. Physical Therapy: Focuses on restoring mobility and strength in the affected joint.
2. Weight-Bearing Restrictions: Initially, the joint will need time to heal, and patients may need crutches or a walker.
3. Gradual Return to Activity: Over several months, activity levels can be gradually increased, depending on the surgery and recovery progress.