Avascular Necrosis

Avascular necrosis is bone tissue that dies from a lack of blood supply. Initially avascular necrosis was asymptomatic. However, the joints will feel painful when moving or lying down.

Severe pain will be felt in the joints that hold body weight, such as joints in the groin area or buttocks. In addition, pain can also be felt in :

• Shoulder.
• Knee.
• Hand.
• Feet.

The pain may increase due to microfractures or small cracks in the bone. This condition causes bone death and joint damage that develops into arthritis.

Cause.

Avascular necrosis occurs due to disorders resulting in a lack of blood supply to the bones. Disorders that can reduce the blood supply to bones include :

Joint or bone injuries ➡ Injuries such as joint dislocations result in :

• The blood vessels around the bone are damaged.
• Fat accumulates in the blood vessels, thus closing small blood vessels and blocking blood supply to the bones.

Corticosteroid use ➡ This condition can occur in people who use long-term corticosteroids or people who are addicted to alcohol.

Disease ➡ sickle cell anemia or Gaucher's disease, pancreatitis, diabetes, lupus and HIV / AIDS.

Medical measures ➡ Medical measures, such as radiotherapy, kidney transplant can weaken bones and damage blood vessels.

Avascular necrosis can occur at any age, but generally this disease attacks people aged 30-60 years.

Diagnosis.

• History of symptoms and physical examination.
• X-rays to see bone changes.
• MRI.
• CT-scan.
• Bone scan.
• Functional bone test to measure the pressure on the diseased bone.

Treatment.

Treatment for avascular necrosis depends on :

• Age.
• Causes of disease.
• The part of the bone that is damaged.
• The degree of bone damage.

Early stage treatment :

• Nonsteroidal anti-inflammatory drugs (NSAIDs) for inflammation and pain due to avascular necrosis.
• Cholesterol-lowering drugs. Decreasing levels of fat in the blood can prevent blockage of blood vessels.
• Anti-coagulant (warfarin) to prevent blood clots.
• Bisphosphonates (alendronate) drugs to slow the progression of avascular necrosis. In some cases, bisphosphonates can cause avascular necrosis of the jawbone.

If the pain is very severe, you will do :

• Bone transplant to strengthen damaged bone: remove healthy bone from another area in the patient's body.
• Replace joints with imitation joints made of metal. The damaged bone will be removed and healthy bone is expected to reshape the bone structure to strengthen the joint support.
• Decompression of the bone core: removing the inside of the bone to reduce the burden on the joint to form new blood vessels.

Prevention.

• Stop drinking alcohol.
• Keep cholesterol at normal values.
• Consult with a doctor for the use of corticosteroids, bone damage can get worse if you take corticosteroids for a long time.
• To prevent avascular necrosis of the jaw, regularly clean teeth and treat teeth, especially for people who are undergoing bisphosphonate treatment.