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Avascular necrosis is a localized  death of bone as a result of local injury (trauma), drug side effects,  or disease. This is a serious condition because the dead areas of bone  do not function normally, are weakened, and can collapse. ... Avascular necrosis is also referred to as aseptic necrosis and osteonecrosis. 

about avascular necrosis

According to Wikipedia

 Avascular necrosis (AVN), also called osteonecrosis or bone infarction, is death of bone tissue due to interruption of the blood supply.   Early on there may be no symptoms.  Gradually joint pain may develop which may limit the ability to move.  Complications may include collapse of the bone or nearby joint surface.  Risk factors include bone fractures, joint dislocations, alcoholism, and the use of high dose steroids.  The condition may also occur without any clear reason.  The most commonly affected bone is the femur.   Other relatively common sites include the upper arm bone, knee, shoulder, and ankle.  Diagnosis is typically by medical imaging such as X-ray, CT-scan, or MRI.  Rarely biopsy may be used.  Treatments may include medication, not walking on the affected leg, stretching, and surgery.  Most of the time surgery is eventually required and may include core decompression, osteotomy, bone grafts, or joint replacement.  About 15,000 cases occur per year in the United States.People 30 to 50 years old are most commonly affected.  Males are more commonly affected than females. 

Signs and symptoms

 In many cases there is pain and discomfort in a joint which increases  over time. While it can affect any bone, about half of cases show  multiple sites of damage.  

Avascular necrosis primarily affects the joints at the shoulder, knee, and hip. The classical sites are: head of femur, neck of talus and waist of the scaphoid.  

Avascular necrosis most commonly affects the ends of long bones such as the femur (the bone extending from the knee joint to the hip joint). Other common sites include the humerus (the bone of the upper arm),  knees,  shoulders,  ankles and the jaw. 

Types

When AVN affects the scaphoid bone, it is known as Preiser disease. Another named form of AVN is Köhler disease, which affects the navicular bone of the foot,/ primarily in children.

Treatment

A variety of methods may be used to treat the most common being the total hip replacement  (THR). However, THRs have a number of downsides including long recovery  times and short life spans (of the hip joints). THRs are an effective  means of treatment in the older population; however, in younger people  they may wear out before the end of a person's life. Other techniques such as metal on metal resurfacing may not be  suitable in all cases of avascular necrosis; its suitability depends on  how much damage has occurred to the femoral head. Bisphosphonates which reduces the rate of bone breakdown may prevent collapse (specifically of the hip) due to AVN.


Core decompression

Other  treatments include core decompression, where internal bone pressure is  relieved by drilling a hole into the bone, and a living bone chip and an  electrical device to stimulate new vascular growth are implanted; and  the free vascular fibular graft (FVFG), in which a portion of the  fibula, along with its blood supply, is removed and transplanted into  the femoral head.  A 2012 Cochrane systematic review noted that no clear improvement can  be found between people who have had hip core decompression and  participate in physical therapy,  versus physical therapy alone. More research is need to look into the  effectiveness of hip core decompression for people with sickle cell  disease. Progression of the disease could possibly be halted by  transplanting nucleated cells from bone marrow into avascular necrosis  lesions after core decompression, although much further research is  needed to establish this technique. 

Prognosis

The amount of disability that results from avascular necrosis depends on  what part of the bone is affected, how large an area is involved, and  how effectively the bone rebuilds itself. The process of bone rebuilding  takes place after an injury as well as during normal growth.  Normally, bone continuously breaks down and rebuilds—old bone is  resorbed and replaced with new bone. The process keeps the skeleton  strong and helps it to maintain a balance of minerals.  In the course of avascular necrosis, however, the healing process is  usually ineffective and the bone tissues break down faster than the body  can repair them. If left untreated, the disease progresses, the bone  collapses, and the joint surface breaks down, leading to pain and arthritis. 

FAQs about Wikipedia

  • I do not own any of wikipedia's content and neither is this information mine.  This information is used to educate and learn only. I am not a doctor and I only share this information to inform only.  Please see your doctor and talk to him/her for professional treatment and further information.
  • This page was last edited on 15 November 2018, at 20:27 (UTC).  ext is available under the Creative Commons Attribution-ShareAlike License;   Wikipedia® is a registered trademark of the Wikimedia Foundation, Inc., a non-profit organization. 
  • See this link for AVN supplied and posts and updayes by Wikipedia.  https://en.wikipedia.org/wiki/Avascular_necrosis 
  • Photo of femur head credits to Wikipedia. I do not own the photos or any content of Wikipedia

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Stages of avn

1 - IV - AVN

(Photo shows stages III & IV)


Quantification of extent of involvement is necessary for stages I to V:

  • stage I and II. A, mild: <15% head involvement as seen on radiograph or MRI. ... 
  • stage III. A, mild: subchondral collapse (crescent) beneath <15% of articular surface. ... 
  • stage IV. A, mild: <15% of surface has collapsed and depression is <2 mm. ... 
  • stage V.

(I do not own the photo shown on this post pf stages neither any of its content.  this is only used for informational and educational purposes only.)


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