What is Avascular Necrosis?

WHAT IS AVASCULAR NECROSIS?

Avascular necrosis, also referred to as osteonecrosis, occurs when the blood flow to a section of bone is interrupted (as with a fracture or joint dislocation), creating a lack of blood supply and the eventual death of bone tissue. The joint most commonly affected by avascular necrosis is the hip, and although anyone can develop this condition, avascular necrosis is especially prevalent among men between the ages of 30 and 60. If left untreated, avascular necrosis will worsen over time, potentially leading to the development of tiny breaks in the bone, and weakening the bone’s structure until it eventually collapses. The bones of patients with avascular necrosis tend to lose their smooth shape as the disease progresses, which may trigger the concurrent development of severe arthritis.

AVASCULAR NECROSIS CAUSES AND RISK FACTORS

The primary source of avascular necrosis is the interruption or reduction of blood flow to a bone, which can be caused by increased pressure inside the bone, or a traumatic injury to the joint or bone. Factors that increase a patient’s predisposition to the development of avascular necrosis include:

  • Medications
    • Corticosteroids (i.e. prednisone)
    • Biphosphonates (often prescribed for patients with osteoporosis)
  • Lifestyle factors (excessive consumption of alcohol, which can cause the formation of fatty deposits in the blood vessels, thereby restricting blood flow to the bones)
  • Medical procedures (cancer treatments/radiation, organ transplants, kidney dialysis)
  • Medical conditions (Lupus, Diabetes, HIV/AIDS, Sickle cell anemia, Gaucher’s disease)
  • Injury to the joint or bone (i.e. dislocated joint)

AVASCULAR NECROSIS SYMPTOMS

Although many patients are asymptomatic during the early stages of avascular necrosis, as the disease progresses, the affected joint may begin to hurt when weight is placed on it, and patients may eventually experience joint pain even when they are at rest or lying down. The pain from avascular necrosis develops gradually, and may vary in degree (ranging from mild to severe). The joints that are most commonly affected are the knee, shoulder, hip, foot, and hand. Pain from avascular necrosis of the hip may also radiate into the buttock, thigh, and/or groin region. This condition can be experienced unilaterally (i.e. affecting the knee or hip of only one leg) or bilaterally (i.e. affecting the knees or hips of both legs).

To prevent further bone loss and effectively manage your avascular necrosis symptoms, you will need the experience and clinical skillset of a talented orthopaedic specialist, such as Dr. Brandon Gough, whose private orthopaedics practice is located within the prestigious Western Orthopaedic Institute in Phoenix, Arizona. During your initial consultation, Dr. Gough will conduct a thorough medical evaluation, pressing around your joint to check for tenderness, and moving your joints through a variety of positions to check for any restrictions in your range of motion. If he sees any concerning irregularities, he may then perform diagnostic imaging tests (x-rays, bone scan, magnetic resonance imaging—MRI) to confirm an avascular necrosis diagnosis.

AVASCULAR NECROSIS TREATMENT OPTIONS

When formulating your avascular necrosis treatment plan, Dr. Gough will take into consideration the amount of bone damage you have sustained, and the severity of your current symptoms. He may choose to incorporate one or more of the following treatment options:

  • Medications
    • Cholesterol medications
    • Nonsteroidal anti-inflammatory drugs (NSAIDs)
    • Blood thinners (i.e. Coumadin, Jantoven)
    • Osteoporosis medications (i.e. Alendronate)
  • Therapeutic Modalities
    • Exercises to maintain or improve range of motion
    • Limiting physical activity to reducethe amount of weight and stress on the affected bone(s)
    • Electrical stimulation to stimulate new bone growth
  • Surgery
    •  Bone Graft (bone transplant): a section of healthy bone taken from another area of the patient’s body is grafted onto the diseased bone
    • Osteotomy (bone reshaping): a wedge of bone above or below a weight-bearing joint is removed to shift the patient’s weight off the damaged bone
    • Core decompression: the inner layer of the diseased bone is removed, reducing the patient’s discomfort and stimulating the production of new blood vessels and healthy bone tissue
    • Joint replacement: necessary for patients whose bone has already collapsed, or who have not found relief from other treatment options, this procedure involves the replacement of the damaged areas of the joint with metal or plastic structures

CONTACT DR. GOUGH

Brandon Gough, M.D. is a widely-respected orthopaedic surgeon who specializes in the treatment of avascular necrosis and other orthopaedic disorders. Dr. Gough’s overarching treatment objective is to deliver high-quality patient care in a welcoming, compassionate environment. He employs cutting edge treatments that are designed to safeguard his patients’ health, reduce the risk of complications, minimize any discomfort, and expedite the post-procedural recovery period.

In addition to his private practice at the Western Orthopaedic Institute in Phoenix, Dr. Gough maintains operating privileges at St. Luke’s Hospital and Thompson Peak Hospital in the Phoenix/Scottsdale, Arizona area. If you would like additional information about treatment options for the management of avascular necrosis, please contact our office today. We look forward to speaking with you, and to scheduling your initial consultation with Dr. Gough.

BrandonGough MD