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Avascular Necrosis (AVN or osteonecrosis) is a disease that occurs from temporary or permanent loss of blood supply to the bones, leading to death of bone cells. This process can make tiny breaks in the affected bone and lead to eventual collapse. Avascular necrosis can happen at any site in the body, but it’s commonly seen at the hip, knees, shoulders and ankles. [1] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source If avascular necrosis afflicts you or someone you know, see Step 1 to start treating this disease effectively.
Steps
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Rest. Minimizing physical activity and keeping weight off the affected joint may help slow the bone damage. [2] X Trustworthy Source Mayo Clinic Educational website from one of the world's leading hospitals Go to source Apart from physical therapy, make efforts to restrict your daily activities to resolve pain and swelling. [3] X Research source
- You may need crutches if the affected joint is your hip, knee, or ankle. [4] X Research source However, talk to your healthcare provider for the best treatment options.
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Exercise. You should see a physiotherapist to show you certain exercises to maintain or improve the range of motion in the affected joint. [5] X Trustworthy Source Mayo Clinic Educational website from one of the world's leading hospitals Go to source The physiotherapist can help you change the way you walk to avoid limping or putting too much stress on the joint. [6] X Research source Once you have improved, they may teach you stretching exercises that you can do in the clinic or at home. [7] X Research source
- The exercise bike is helpful because the forward and backward moves produce synovial fluid to lubricate the joints, and build muscles in your legs and core. [8] X Trustworthy Source Arthritis Foundation Main organization devoted to arthritis support and education Go to source
- Your range of motion and strength will help the physiotherapist choose the proper exercises for you, plus teach you how to perform them on your own. [9] X Research source
- Alternatively, performing gentle yoga every day may improve bone mineral density, plus help you relax and avoid stress. [10] X Trustworthy Source Johns Hopkins Medicine Official resource database of the world-leading Johns Hopkins Hospital Go to source The more relaxed you are, the better you'll feel.
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Limit your alcohol intake. Drinking excessive amounts of alcohol is one of the risk factors of developing avascular necrosis (AVN). [11] X Research source Studies show that heavy drinking causes lower bone mineral density, which makes the bone more prone to fractures and may eventually lead to avascular necrosis. [12] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source
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Maintain low cholesterol levels. Stick to a healthy, low-fat diet by avoiding hydrogenated oils and fried foods, and by reducing your intake of whole milk dairy products, which you can replace with low- or non-fat alternatives. [14] X Trustworthy Source MedlinePlus Collection of medical information sourced from the US National Library of Medicine Go to source Doing this will keep your cholesterol levels to a minimum, helping your blood and heart. [15] X Trustworthy Source Cleveland Clinic Educational website from one of the world's leading hospitals Go to source
- Before cooking meat, make sure to trim off any visible fat. [16] X Trustworthy Source University of California San Francisco Health Center Research hospital associated with UCSF, a leading medical university, providing innovative patient care and public health resources Go to source
- Consume food rich in omega-3 fatty acids, such as fish (mackerel, salmon, herring, tuna), walnuts, flaxseeds, and soybean oil. [17] X Trustworthy Source Cleveland Clinic Educational website from one of the world's leading hospitals Go to source
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Avoid or minimize the intake of high-fat condiments, like butter and mayonnaise. Get your fats from healthy sources, such as raw nuts, vegetable oils (like olive oil), and cold water fish (like salmon and mackerel). [18] X Research source Eat lots of green leafy vegetables, fruits, and whole grains, and avoid foods with butter, whole-milk cheese, and cream sauces. [19] X Trustworthy Source Mayo Clinic Educational website from one of the world's leading hospitals Go to source
- If you’re diabetic, make sure to keep your blood sugar levels in a normal state. Consult your doctor immediately if you notice any sudden high or low sugar concentrations, since diabetes is considered one of the risk factors that may lead to AVN. [20] X Trustworthy Source Cleveland Clinic Educational website from one of the world's leading hospitals Go to source Monitoring your glucose level should be one of your top priorities, which you can do by paying attention to your food and medicines. [21] X Trustworthy Source Cleveland Clinic Educational website from one of the world's leading hospitals Go to source
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Consider acupressure therapy. Your physical therapist may recommend acupressure, which involves massaging areas on your body to stimulate blood flow and reduce inflammation. [22] X Research source Talk to your physical therapist or healthcare provider if this could be an effective treatment for you.
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Ask your doctor about medication. Here's the knowledge you should be armed with: [23] X Trustworthy Source Cleveland Clinic Educational website from one of the world's leading hospitals Go to source
- Nonsteroidal anti-inflammatory drugs (NSAIDs): These work to relieve pain and swelling around the affected joint, reducing inflammation. Popular over-the-counter NSAIDs include ibuprofen, naproxen, and aspirin. [24] X Research source
- Osteoporosis drugs: These may slow the progression of AVN, but evidence is mixed. [25] X Trustworthy Source Mayo Clinic Educational website from one of the world's leading hospitals Go to source Alendronate (Fosamax) is prescribed to treat and prevent AVN in women who have undergone menopause and to treat AVN in men. [26] X Trustworthy Source MedlinePlus Collection of medical information sourced from the US National Library of Medicine Go to source
- Cholesterol-lowering drugs: These are used to decrease the amount of fat and cholesterol in the blood in the blood circulation (due to corticosteroid intake); this prevents blood vessel blockage that leads to AVN. [27] X Trustworthy Source Mayo Clinic Educational website from one of the world's leading hospitals Go to source
- Blood thinners: For patients with clotting disorders, blood thinners (like Warfarin) prevent clots from forming in the vessels feeding the bones. [28] X Research source
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Talk to your doctor about electrical stimulation. This is a process that encourages the body to grow new bone to replace the damaged bone. It can be performed during surgery by applying electrical currents directly to the affected bones, or by attaching electrodes to your skin. [29] X Trustworthy Source Mayo Clinic Educational website from one of the world's leading hospitals Go to source It's not surgery, but it is generally used in conjunction with surgery. [30] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source
- If surgery puts your bones in line, electrical stimulation sets the ball in motion. However, it's not right for everyone, so ask your doctor if it's a feasible option.
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Consider surgery. Most people with avascular necrosis eventually have surgery, with more than 50% of patients with AVN of the femoral head needing major surgical intervention within 3 years of diagnosis. [31] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source Your doctor will determine which type of procedure or therapy you may need. Here are the details: [32] X Trustworthy Source Mayo Clinic Educational website from one of the world's leading hospitals Go to source
- Core decompression: The surgeon drills holes in the dead bone near the affected joint. The aim of this is to decrease the pressure inside, increase blood flow, and slow or stop bone and/or joint destruction. [33] X Research source
- Bone transplant (graft): This procedure involves transplanting healthy bone from one part of your body into the affected area. The bone graft may be inserted into the holes drilled for a core decompression procedure. [34] X Research source
- Bone reshaping (osteotomy): This is where the surgeon removes a section of the affected bone above or below a weight-bearing joint to reshape it and decrease stress on the affected area. It may help postpone joint replacement. [35] X Trustworthy Source Mayo Clinic Educational website from one of the world's leading hospitals Go to source
- Joint replacement: When the affected bone has collapsed or other treatment options have failed, the damaged joint is replaced with an artificial one, usually made from plastic or metal parts. [36] X Trustworthy Source Mayo Clinic Educational website from one of the world's leading hospitals Go to source
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Get physical therapy and stick to it. After surgery, it is absolutely imperative that your bones: A) heal and B) heal correctly. Regular physical therapy will ensure that both of these things happen. [37] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source Here's how it may be beneficial:
- Your physical therapist will hook you up with crutches, a cane, or some device to reduce weight on the joint. This will greatly speed up the healing process. [38] X Research source
- Your physical therapist will work on exercises with you to prevent joint damage and improve joint flexibility and mobility. [39] X Research source
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Know what avascular necrosis really is. Avascular necrosis (AVN or osteonecrosis) is defined as the death of bone tissue due to lack and loss of blood supply. [40] X Research source This may cause tiny breaks in the affected bone and lead to bone collapse. [41] X Trustworthy Source Mayo Clinic Educational website from one of the world's leading hospitals Go to source If AVN affects bones near a joint, the joint surface may collapse. [42] X Trustworthy Source Johns Hopkins Medicine Official resource database of the world-leading Johns Hopkins Hospital Go to source Usually, the affected bone or joint area in AVN is the hip. [43] X Trustworthy Source Cleveland Clinic Educational website from one of the world's leading hospitals Go to source
- AVN occurs in bones with a terminal blood supply (meaning there is a limited blood supply), such as the femoral (hip) and humeral (shoulder) heads. Closure or interruption of this terminal blood supply will lead to death of bone tissue and, later, bone collapse. [44] X Trustworthy Source Science Direct Online archive of peer-reviewed research on scientific, technical and medical topics Go to source
- Although bone tissue regenerates or grows back again, the rate of bone destruction is faster than bone regeneration. If the bone collapses, the joint structure breaks down and leads to pain. Corticosteroids and radiation therapy may contribute to AVN. [45] X Trustworthy Source Cleveland Clinic Educational website from one of the world's leading hospitals Go to source
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Know the risk factors and causes. Several causes can increase your risk of developing AVN. Any of the following can lead to AVN: [46] X Trustworthy Source Cleveland Clinic Educational website from one of the world's leading hospitals Go to source
- Osteoporosis
- A bone fracture or joint dislocation, which can interrupt blood flow
- Radiation during cancer treatment, which weakens the bone and affects the blood vessels
- Elevated pressure inside the bone that narrows the blood vessels and makes it difficult for fresh blood to enter
- Excessive alcohol consumption, which causes fats to block small blood vessels and reduce blood flow to bones
- Prolonged corticosteroid (Prednisolone) use
- Prolonged biphosphate (a treatment for osteoporosis) use [47] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source
- Diseases such as diabetes, HIV/AIDS, sickle cell anemia, organ transplantation, and decompression sickness
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Know what the symptoms are. AVN may be missed because there are no symptoms in the early stages of the disorder. [48] X Research source One of the first symptoms is pain in the affected bone/joint, such as groin pain in AVN of the femoral head. [49] X Research source Here are the symptoms: [50] X Trustworthy Source Cleveland Clinic Educational website from one of the world's leading hospitals Go to source
- Intermittent pain that gets worse when you apply weight or pressure on the bone
- Walking with a limp if you have AVN in your hips or knees
- Joint movements that are limited and painful. The affected joint may be deformed or disfigured through time.
- Difficulty climbing stairs, standing, or walking
- Usually, signs and symptoms occur late in the course of the disease and patients consult doctors when the disease is advanced. Without treatment, the affected joint will be destroyed, leading to severe arthritis. [51] X Research source
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Know how AVN gets diagnosed. During a physical examination, your doctor will press around the pain site to check for tenderness. They may need you to move the joint in different positions to see if the pain increases or decreases, or if your range of movement is reduced. [52] X Trustworthy Source Mayo Clinic Educational website from one of the world's leading hospitals Go to source To determine if surgery is necessary, your doctor may require the following: [53] X Research source
- X-rays: They usually appear normal in the early stages of AVN, but can reveal clear bone change in the later stages. [54] X Trustworthy Source Mayo Clinic Educational website from one of the world's leading hospitals Go to source
- Bone scan: Via an intravenous line, a safe radioactive material is slowly injected in your vein. The material flows with your blood until it reaches its destination; a picture on a special camera will show the affected sites as clear bright spots. [55] X Trustworthy Source National Cancer Institute An agency in the National Institutes of Health focused on cancer research and patient support Go to source
- Magnetic resonance imaging (MRI): This is known as the most sensitive method for the early stages of AVN because it reveals any chemical change in the bone marrow and bone rebuilding process. This is done by radio waves and a strong magnetic field. [56] X Research source
- Computerized tomography (CT scan): This is more clear than x-rays and bone scans; it determines the extent of bone damage by taking a three dimensional picture of the bone. [57] X Trustworthy Source Johns Hopkins Medicine Official resource database of the world-leading Johns Hopkins Hospital Go to source
- Bone biopsy: This is a procedure where a small amount of bone tissue is taken and examined under a microscope to check for the appearance of AVN. [58] X Research source
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Tips
- Consult your doctor before taking NSAIDs, and always take them with food to reduce your risk of stomach ulcers. Common side effects include: vomiting, irritation, and stomach pain. Patients with a history of stomach ulcers or gastrointestinal bleeding, kidney disease, and liver disease should avoid taking NSAIDs. [59] X Trustworthy Source Cleveland Clinic Educational website from one of the world's leading hospitals Go to sourceThanks
- Sometimes, a splint or cast is used to immobilize the affected joint. [60] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source This is done upon consulting your doctor or bone specialist.Thanks
- Studies show that short-term, low-dose corticosteroids may raise plasma lipid levels. [61] X Research source This may lead to plaque growth, which can block the blood vessels. [62] X Trustworthy Source Cleveland Clinic Educational website from one of the world's leading hospitals Go to sourceThanks
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Warnings
- If you experience pain that doesn’t improve with rest or pain relievers, pain that makes walking or moving difficult, or unexplained limping, visit your healthcare provider immediately. [63] X Trustworthy Source Cleveland Clinic Educational website from one of the world's leading hospitals Go to sourceThanks
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References
- ↑ https://www.ncbi.nlm.nih.gov/books/NBK537007/
- ↑ https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/diagnosis-treatment/drc-20369863
- ↑ https://www.chop.edu/conditions-diseases/avascular-necrosis
- ↑ https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/osteonecrosis
- ↑ https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/diagnosis-treatment/drc-20369863
- ↑ https://nyulangone.org/conditions/osteonecrosis/treatments/nonsurgical-treatment-for-osteonecrosis
- ↑ https://centralorthopedicgroup.com/wp-content/themes/central-14/pdf/hip/hip_hip_avascular_necrosis.pdf
- ↑ https://www.arthritis.org/health-wellness/healthy-living/physical-activity/other-activities/benefits-of-stationary-biking
- ↑ https://nyulangone.org/conditions/osteonecrosis/treatments/nonsurgical-treatment-for-osteonecrosis
- ↑ https://www.hopkinsmedicine.org/health/wellness-and-prevention/9-benefits-of-yoga
- ↑ https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/osteonecrosis
- ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10340773/
- ↑ https://health.umms.org/2023/07/05/10-great-reasons-to-stop-drinking-alcohol/
- ↑ https://medlineplus.gov/howtolowercholesterolwithdiet.html
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- ↑ https://my.clevelandclinic.org/health/articles/17290-omega-3-fatty-acids
- ↑ https://nutritionsource.hsph.harvard.edu/what-should-you-eat/fats-and-cholesterol/
- ↑ https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/fat/art-20045550
- ↑ https://my.clevelandclinic.org/health/diseases/14205-avascular-necrosis-osteonecrosis
- ↑ https://my.clevelandclinic.org/health/diseases/7104-diabetes
- ↑ https://nyulangone.org/conditions/osteonecrosis/treatments/nonsurgical-treatment-for-osteonecrosis
- ↑ https://my.clevelandclinic.org/health/diseases/14205-avascular-necrosis-osteonecrosis
- ↑ https://nyulangone.org/conditions/osteonecrosis/treatments/nonsurgical-treatment-for-osteonecrosis
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- ↑ https://www.stoptheclot.org/about-clots/blood-clot-treatment/warfarin/
- ↑ https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/diagnosis-treatment/drc-20369863
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- ↑ https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/diagnosis-treatment/drc-20369863
- ↑ https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/avascular-necrosis/treatments/core-decompression.html
- ↑ https://www.yalemedicine.org/conditions/avascular-necrosis-of-the-hip
- ↑ https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/diagnosis-treatment/drc-20369863
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- ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9902054/
- ↑ https://nyulangone.org/conditions/osteonecrosis/treatments/nonsurgical-treatment-for-osteonecrosis
- ↑ https://nyulangone.org/conditions/osteonecrosis/treatments/nonsurgical-treatment-for-osteonecrosis
- ↑ https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/osteonecrosis
- ↑ https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/symptoms-causes/syc-20369859
- ↑ https://www.hopkinsmedicine.org/health/conditions-and-diseases/avascular-necrosis
- ↑ https://my.clevelandclinic.org/health/diseases/14205-avascular-necrosis-osteonecrosi
- ↑ https://www.sciencedirect.com/topics/nursing-and-health-professions/avascular-necrosis
- ↑ https://my.clevelandclinic.org/health/diseases/14205-avascular-necrosis-osteonecrosis
- ↑ https://my.clevelandclinic.org/health/diseases/14205-avascular-necrosis-osteonecrosis
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- ↑ https://rheumatology.org/patients/osteonecrosis
- ↑ https://my.clevelandclinic.org/health/diseases/14205-avascular-necrosis-osteonecrosis
- ↑ https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/osteonecrosis
- ↑ https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/diagnosis-treatment/drc-20369863
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About This Article
Article Summary
X
Avascular Necrosis is a disease that's triggered by poor blood supply to the bones, leading to the death of the bone tissue. If you have AVN, minimize your daily physical activity to help relieve your pain and slow down the damage to your bones so your body can heal. Another way to treat AVN is to limit your alcohol intake, which can worsen your condition. You'll also want to keep your cholesterol levels as low as possible, which will help strengthen your heart and blood. Acupressure therapy can also help treat AVN by pressing on certain areas of the body to help you relax. While you can do acupressure yourself, you can also see a professional for a fully relaxing experience. If possible, see a physiotherapist, who can show you certain exercises to maintain or enhance your joint movement. To learn how to use medication to treat AVN, keep reading!
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Reader Success Stories
- "My cousin called me from Florida as he was recently diagnosed with AVN of the knee. He is quite uncomfortable and worried as his wife has MS. He is concerned that he may not be able to care for her and himself with his condition. I could tell he was quite overwhelmed by the sound of his voice. The doctors did not do a very good job in explaining the condition and prognosis. I feel your presentation here will help alleviate his anxiety and give him some sense of control with a tough diagnosis." ..." more
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"My cousin called me from Florida as he was recently diagnosed with AVN of the knee. He is quite uncomfortable and worried as his wife has MS. He is concerned that he may not be able to care for her and himself with his condition. I could tell he was quite overwhelmed by the sound of his voice. The doctors did not do a very good job in explaining the condition and prognosis. I feel your presentation here will help alleviate his anxiety and give him some sense of control with a tough diagnosis."
..."
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"I am in the final stages of AVN, and reading this article helped me to understand the blood flow issue and the different stages of the disease. Currently I cannot walk, and at times, the pain is absolutely unbearable."
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"Overall everything in the article helped me a lot. I have just been diagnosed with dead bone tissue and wanted to know more about it. Article was very helpful in everything I needed to know."
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"My granddaughter, who has a form of leukemia, had to have chemo plus steroids. She has now developed AVN. This as helped me to understand about AVN and understand the condition. Thanks."
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"It's 3 AM and my shoulder pain is excruciating. This article explains the different conditions of arthritis that I expected I have. I plan to visit my doctor asap to get an evaluation."
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