Abiding Avascular Necrosis
You are 68 years old. You have ongoing pain in both hips. You also have pain in the knee, shoulders and ankle. You could have avascular necrosis.
Avascular necrosis is also referred to as osteonecrosis and aseptic necrosis. All three terms indicate a blockage of blood flow to a section of bone. Without a blood supply, that section of bone dies and crumbles.
Avascular necrosis can be found in association with other illnesses, such as lupus, a disease that affects skin, joints and blood vessels. Prolonged use of cortisone drugs can lead to it. In a few, it appears to be a family trait. In no way does that mean your grandchildren are destined to have avascular necrosis.
Hips are the joints most frequently involved. It is common that both hips suffer from the process. Knees and shoulders are other targets.
Because blood supply from surrounding tissues is limited, the bone becomes dependent upon these small vessels to survive; if blood flow is interrupted, the bone nourished by a particular vessel will die. This damages the architecture of the bone and causes a loss of calcium, eventually causing the bone in that area to collapse.
Alcohol consumption is believed to be a risk factor in 31 percent of cases, with heavy use leading to fatty deposits within the vessels. The more one drinks chronically, the greater the risk of developing the disease.
Avascular necrosis is more likely in people with lupus, antiphospholipid syndrome, sickle cell disease, acute lymphoblastic leukemia or Gaucher disease and in people who have had a transplant. Many times, the cause is unknown.
Avascular necrosis of the hip—the most likely joint to be affected—is often the most disabling. The pain initially felt while walking can later occur at rest and, when the condition becomes severe, patients cannot walk at all due to the joint’s collapse.
Risk factors for avascular necrosis include trauma, high-dose corticosteroids, alcohol, sickle cell disease, HIV, a history of cancer requiring radiation to the joint, chemotherapy, blood-clotting disorders, rheumatologic conditions and COVID-19.
Patients of all ages may suffer from avascular necrosis, so it’s important to not ignore symptoms so that the bone can be treated before the joint collapses.
The main symptom of avascular necrosis is generally a chronic aching pain, which is most commonly referred to as a toothache-type pain. The pain is generally not exacerbated by activity, but occasionally may be worsened with activity. The pain is also typically described as unrelenting and may be severe.
If the condition is caught at an early stage before the joint collapses, efforts to preserve the joint can be successful. These efforts include surgical options such as core decompression, which involves drilling a hole in the bone that is affected. This treatment helps to relieve the pressure inside the bone and prevent the joint from collapsing. It can be very effective if the disease is caught early enough.
If the joint has collapsed and has become arthritic, then the best option is a joint replacement. Even if one joint has collapsed and requires replacement, another joint may be affected and may have not collapsed yet.
This less affected joint may be preserved if treated in time. Therefore, even in collapsed joints it is worthwhile to perform a detailed evaluation of the patient’s other joints to try to prevent them from collapsing.
For cases where the joint has not collapsed, patients can explore nonsurgical treatment options, such as a medication class of bone-building drugs known as bisphosphonates. Patients with a known blood-clotting disorder or vascular disease should take medications to address those conditions (blood thinners or cholesterol-lowering medication). Pain can be treated with over-the-counter medication such as acetaminophen or nonsteroidal anti-inflammatory drugs. However, these medications don’t cure avascular necrosis and joint collapse is still a risk.
