Avascular Necrosis And Your Joint Injury

Avascular necrosis is a disease that can develop as the result of trauma,  a side effect of certain medications, or from an unknown source. We offer an overview of the causes and symptoms of this condition.

Avascular necrosis, also called osteonecrosis, is a debilitating disease caused by loss of blood flow to a joint or bone. When blood can’t reach the bone, the bone cells begin to die. The literal meaning of osteonecrosis is bone death. This condition is usually found at the head of long bones like the femur and humerus bones, but small bones can also be affected. The most common site of avascular necrosis is the hip. Other locations include joints in the shoulder, hands, feet, and jaw. Left untreated, this disease can cause the bone structure to collapse, resulting in joint osteoarthritis, bone destruction, pain, and loss of joint function.

This bone disease has a number of causes, including joint trauma that damages blood supply to the bones. Other causes include cortico-steroid medications and chemotherapy drugs. Not everyone who takes these medications develops bone necrosis; research continues to better understand how this disease develops. Avascular necrosis can also be idiopathic (of unknown cause).

An estimated 10,000 to 20,000 new cases of avascular necrosis are diagnosed in the United States every year. Although patients can be affected by this disease regardless of age, gender, or ethnic background, it is more common in men than in women. Eight men are affected for every woman who develops necrosis. The disease appears most often in patients who are in their 40s and 50s. This bone condition is responsible for 5 to 18 percent of the more than 500,000 annual total hip replacement surgeries in our country.

Because it can be asymptomatic, diagnosis is challenging. Symptoms vary, depending on the joint affected. Pain is the most common symptom. Pain may be mild at first, and gradually increase over time and with use. Eventually, patients will experience joint pain even when they are at rest. Other indications include the following:

  • Tenderness around the affected bone.
  • Restricted and painful joint movements.
  • Neurologic problems may develop as affected bones become deformed and compress nerves in the joint.
  • Joint deformity and muscle wasting can develop as the condition advances.

Every case is unique, and not all patients respond the same way to treatments for this disease. However, there is good news for patients who are diagnosed early by an experienced orthopedic physician. When the disease is advanced, a total joint replacement may be necessary. However, medical advances now provide nonsurgical treatments for pain and restoration of joint function when the disease is in early stages.

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