Avascular Necrosis: Causes and Management Options

Avascular necrosis of the femoral head?

Hello Dr.
Shi,
I have a troubling issue that has persisted for nearly 10 years, and I would like to seek your advice.
Ten years ago, I was diagnosed with idiopathic thrombocytopenic purpura (ITP) and underwent treatment with corticosteroids for about three months, followed by a splenectomy.
Approximately two years later, I required bilateral hip arthroplasty due to avascular necrosis.
I initially thought that would be the end of my problems, but I later discovered that the joints in my shoulders and knees are also continuing to deteriorate (the shoulder has already collapsed).
I have asked my attending physician about the reasons for the ongoing joint degeneration, but I was told there is no solution.
Therefore, I would like to ask for your professional opinion on whether there are any other good recommendations or specialists you could suggest (I live in Kaohsiung).
Thank you for your response.

Megan, 30~39 year old female. Ask Date: 2006/06/23

Dr. Shi Guozheng reply Orthopedics

If the shoulder and knee joints have similar conditions with a relatively small area of damage, bone grafting can be used to repair the necrotic bone.
However, if the area of damage is too large, this approach may not be feasible.
Typically, after discontinuing corticosteroids, there will be no further progressive bone necrosis after a certain period.
Is there continued alcohol use? Stopping the habit of drinking alcohol should lead to improvement.

Reply Date: 2006/06/23

More Info

Avascular necrosis (AVN), also known as osteonecrosis, is a condition that occurs when there is a loss of blood supply to the bone, leading to bone death and subsequent joint dysfunction. This condition can affect various joints, but it is most commonly seen in the hip, knee, and shoulder. Understanding the causes and management options for AVN is crucial for patients experiencing this debilitating condition.

Causes of Avascular Necrosis
1. Steroid Use: One of the most common causes of AVN is the prolonged use of corticosteroids. As you mentioned, you were treated with steroids for your condition, which can lead to fat deposition in blood vessels, causing obstruction and reducing blood flow to the bone.

2. Trauma: Fractures or dislocations can damage blood vessels, leading to AVN. In your case, the surgical removal of the spleen may also have contributed to changes in blood flow.

3. Alcohol Consumption: Excessive alcohol intake can lead to fatty deposits in blood vessels, similarly obstructing blood flow.

4. Medical Conditions: Certain medical conditions, such as lupus, sickle cell disease, and Gaucher's disease, can increase the risk of AVN due to their effects on blood flow or bone health.

5. Radiation Therapy: Previous radiation treatment can damage blood vessels and lead to AVN.

6. Other Factors: Conditions like obesity, high cholesterol, and certain medications can also contribute to the development of AVN.

Management Options
1. Medications: While there is no specific medication to reverse AVN, certain drugs may help manage pain and inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used for pain relief. Bisphosphonates and other medications that promote bone health may also be considered.

2. Physical Therapy: Engaging in physical therapy can help maintain joint function and improve mobility. A physical therapist can design a program tailored to your specific needs.

3. Surgical Options: If conservative treatments fail, surgical options may be necessary. These can include:
- Core Decompression: This procedure involves removing a portion of the inner bone to reduce pressure and allow for new blood vessels to form.

- Bone Grafting: This involves transplanting healthy bone tissue to replace the necrotic bone.

- Joint Replacement: In cases where the joint is severely damaged, total joint replacement may be necessary, as you have already experienced with your hip joints.

4. Lifestyle Modifications: Reducing alcohol intake, maintaining a healthy weight, and managing underlying health conditions can help slow the progression of AVN.

5. Regular Monitoring: Regular follow-ups with your healthcare provider are essential to monitor the progression of the disease and adjust treatment plans as necessary.

Seeking Further Help
Given your history of AVN and the ongoing issues with your shoulder and knee joints, it is advisable to consult with a specialist in orthopedic surgery or a rheumatologist who has experience in managing AVN. They can provide a comprehensive evaluation and discuss advanced treatment options tailored to your situation.

In conclusion, while AVN can be a challenging condition to manage, understanding its causes and exploring various treatment options can help improve your quality of life. It is essential to work closely with your healthcare team to develop a personalized management plan that addresses your specific needs and concerns.

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