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What is Avascular Necrosis?

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  • Written By: Mary McMahon
  • Edited By: Bronwyn Harris
  • Last Modified Date: 16 November 2016
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Avascular necrosis is a medical condition which is caused by a restriction of blood supply to the bones of the body. As a bone is deprived of blood, it starts to weaken and crack, and it will ultimately collapse, potentially causing serious problems. The condition strikes people in all ages and physical conditions, and it requires prompt medical treatment for the best chance at recovery. In some cases, it can become a life long problem which will require extensive monitoring to ensure that the patient's bones stay in good health.

Three leading causes for avascular necrosis are trauma, heavy alcohol consumption, and the use of corticosteroids. The condition can also be caused by sudden decompression, radiation damage, sickle cell anemia, and hypertension, among other things. Sometimes there is no clear explanation for avascular necrosis, in which case it may be known as idiopathic necrosis. Some doctors call the condition osteonecrosis, aseptic necrosis, or ischemic bone necrosis as well.

Joints are common victims of avascular necrosis, especially the hip joints. The condition can also strike the shoulders, knees, and jaw. Typically, the condition is diagnosed after a patient complains of persistent joint pain; if you experience recurrent or persistent pain, it is very important to see a doctor to get to the root cause. The longer avascular necrosis is left untreated, the more damage to the bone the condition can cause; if left for too long, it can result in permanent disability.

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To diagnose avascular necrosis, doctors use x-rays, imaging studies, and bone scans to investigate the area in question. Patients can be treated in a variety of ways; there are some medications which can reduce pain and promote bone regrowth, and patients are also encouraged to rest and to use special exercises to gently support the affected area. Surgical treatments include grafts of healthy bone and joint replacement. Doctors also generally like to find and treat the cause of the problem to ensure that it does not recur.

Blood supply to the bones is very important, as is prompt treatment of any interruption of this blood supply. The prognosis for avascular necrosis varies immensely, depending on the patient's physical condition, where the necrosis strikes, and what stage the condition was at when it was diagnosed. If left for too long, avascular necrosis can cause total bone collapse, which would require extensive surgical treatment. Patients who are fortunate enough to identify problems early may be able to treat the condition with rest, medication, and specialized exercise treatments to promote bone growth and blood flow.

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CarolD
Post 4

I was diagnosed with avascular necrosis in the spring of 2012 after undergoing a heavy course of prednisone (100 mg/day for almost 6 months). I had been diagnosed with idiopathic orbital inflammatory syndrome, which creates a pseudo-tumor in the eye. After a surgery, a biopsy proved that the tumor kernel was benign, so I came off the prednisone.

I then had a cancer scare in which I had to undergo every test in the book, and they diagnosed avascular necrosis at that time. I went on a walker in March, 2013 and am still on one. I had surgery in April 2013 to remove a cancerous eye and surgery in June 2013 for a core depression on my right hip.

It is now the end of September and both my hips still bother me, I am still on the walker, and am on hydrocodone for pain. I am allergic to most anti-inflammatories (Mobic, Relafan, Neurotin) which, for some reason make the pain worse. I am seriously considering *not* having the surgery on the left hip, considering all I have been through with the right hip. I almost wish they would do hip replacements.

bear78
Post 3

@burcidi-- I think in some advanced cases, stem cell treatment is possible. Doctors can take stem cells from the person and inject it into the tissues that have necrosis. I'm not sure how successful or common this treatment is though. My coworker who suffers from avascular necrosis of the hip was talking about it once.

Avascular necrosis is very painful. Most of the time, medications are not enough for the pain. My coworker is on a bunch of medications for it and she still has so much pain. She's thinking about applying for disability retirement because of it.

SteamLouis
Post 2

@burcidi-- Many people who have avascular necrosis have surgery, that's true. But it would be wrong to say that everyone who has the condition will need surgery.

Like the article said, sometimes medications that stop or slow down avascular necrosis symptoms may be enough. If the necrosis was not caught early however and there is considerable damage done, surgery will probably be necessary.

The type and seriousness of the surgery also depends on where the avascular necrosis is found.

For example, those with AV of the hips may have to have hip replacement surgery. But those with AV of the knees may require a much minor surgery where the dead bone tissue is cleaned up.

burcidi
Post 1

I've heard that almost every case of avascular necrosis will require surgery at some point. Is this true?

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