What is Avascular Necrosis?

Avascular necrosis (AVN) refers to the death of bone tissue as a result of insufficient blood supply to an area of bone. Reduced or complete cessation of blood flow results in bone cells being unable to receive oxygen and nutrients, which leads to the gradual collapse of bone tissue and death. AVN can occur in any bone in the body, but is most common in the femoral head (hip joint), knee, shoulder and ankle.

Avascular necrosis is usually seen as a condition affecting bone tissue. Avascular necrosis of the femoral head is also called osteonecrosis. Osteonecrosis is a painful disease of the hip joint. Osteonecrosis is also called avascular necrosis or aseptic necrosis. This disease can occur in any bone in a person. However, it is most common in the hip joint. This problem can occur in only one hip joint or both hip joints of the patient can be affected.

Osteonecrosis (decay), which occurs when the blood supply to the hip joint is impaired, if there is no blood supply at all, the bone cells in the hip joint die and calcification of the hip joint occurs very quickly.

Table of Contents

• What is Avascular Necrosis?
• What are the Causes of Avascular Necrosis?
• What are the Symptoms of Avascular Necrosis?
• What are the Diagnostic Methods for Avascular Necrosis?
• What are the Treatment Options for Avascular Necrosis?
• How to Prevent Avascular Necrosis?

What is Avascular Necrosis?

Avascular necrosis is tissue death that occurs when the blood supply to a tissue is insufficient. This condition usually occurs in the bones, and when the blood supply to bone tissue is cut off, the bone cells cannot be nourished and die. This disease can especially affect large joints such as the hip, shoulder and knee.

What are the Causes of Avascular Necrosis?

Avascular necrosis may have several causes. One of the most common causes is blockage of blood vessels. This blockage can occur due to factors such as trauma, steroid use, alcohol abuse and certain medical conditions. In addition, genetic factors that affect the blood supply of bone tissue can also increase the risk of avascular necrosis. In addition to these, we can also add the following causes of avascular necrosis;

• Injury
• Hip dislocation
• Long-term use of corticosteroids
• Kashan disease
• Vasculitis
• Sickle cell anemia

Avascular necrosis (decay) is a condition usually seen in the hip. Although hip decay does not have a specific age, it affects people of all ages. However, if we look at the most common age range, we can say that it occurs between the ages of 40 and 60. Hip decay is a disease seen in both men and women. However, the rate we see in men is calculated to be higher than the rate seen in women.

What are the Symptoms of Avascular Necrosis?

There are various stages of avascular necrosis and the symptoms can often be mild initially and worsen over time. Pain is often the first symptom felt in the affected area. Other symptoms such as loss of movement, swelling and stiffness in the joints are also observed. However, every patient is different and symptoms vary from person to person. It takes approximately 3 months to 1 year for the disease to progress seriously. As with any other condition, recognizing the symptoms of avascular necrosis early, seeing a specialist doctor and starting the treatment process after an early diagnosis can lead to good results for the patient.

What are the Diagnostic Methods for Avascular Necrosis?

For an accurate diagnosis of avascular necrosis, doctors often use imaging tests. Methods such as X-rays, magnetic resonance imaging (MRI) and computed tomography (CT) can provide the diagnosis by examining the affected bone tissue in detail.

X-ray X-ray evaluates the patient’s bone structure in detail. It provides enough information about the patient’s discomfort by providing a complete examination of the amount and degree of collapse in the hip knob.

MRI X-rays may not show early stage osteonecrosis. But an MRI does not. It shows detailed information about the bone structure or the femoral knob of a person’s early-stage condition.

What are the Treatment Options for Avascular Necrosis?

The treatment of avascular necrosis usually varies depending on the stage and severity of the condition. In the early stages, conservative methods such as rest, pain management and physical therapy can be applied and the patient can be treated in a short time. However, surgical intervention may be required in advanced cases where the disease is not recognized in the early stages or the person ignores the situation and waits for the pain to go away on their own without being examined by a specialist doctor. Surgical options include bone transplantation, bone grafting and joint replacement. The treatment methods that can be applied to patients according to their condition can be listed as follows;

• Medicine
• Rest
• Physical therapy
• Pain management
• No load on the area with crutches
• Ozone treatments

It is possible to get good and successful results by slowing down the progression of the disease and reducing pain during the number of sessions that your doctor deems appropriate according to your discomfort stage.

The treatment methods mentioned above are shown as methods that do not require surgical intervention. If the disease has progressed beyond the first stage, some surgical methods that your doctor will find appropriate are also available for treatment. We can list them as follows;

Core Decompression

Core decompression is a surgical procedure used to treat avascular necrosis, particularly in the hip (femoral head) region. Avascular necrosis is a condition that occurs when bone tissue has insufficient blood supply and usually affects large joints such as the femoral head. Core decompression aims to preserve bone tissue by regulating pressure and blood flow in this area.

During the procedure, the surgeon makes a small hole in the affected area and removes part of it to reduce pressure inside the bone. This aims to provide better nutrition to the bone tissue by increasing blood flow and reducing stress on the affected area. Core decompression can be more effective when used in the early stages of avascular necrosis.

This surgical procedure is designed to improve circulation in the bone and stop the progression of necrosis. However, like any surgical procedure, core decompression can have certain risks and complications.

Core decompression is an option for the treatment of avascular necrosis, but it is not suitable for all patients. Therefore, when considering this type of surgery, it is important to have a thorough evaluation and consultation with an orthopaedic surgeon or specialist.

Vascular fibula grafting

Vascular fibula grafting is a surgical procedure usually used in the fields of orthopedic surgery and reconstructive surgery. This method is applied especially in cases where bone tissue needs to be improved, grown or salvaged.

The procedure is based on removing a vascularized graft on the leg bone called fibula and transplanting this graft to another area where it is needed. The fibula is a long bone found in the leg together with the tibia bone. Vessels in this bone can be used to transplant a live bone graft to another area.

Fibula grafting with vessels is a preferred method for the treatment of avascular necrosis, bone tumors, large bone defects or other serious bone problems. The vessels of the graft are removed together with the leg bone from which it is taken and can be surgically transferred to the targeted area.

Vascular fibula grafting is used depending on factors such as the patient’s general state of health, the type and severity of the bone problem. It is a reconstructive surgical procedure designed to improve the patient’s quality of life and restore mobility. However, as with any surgical intervention, this procedure can have certain risks and complications. Therefore, when considering this type of surgery, it is important to act in line with the recommendations and assessments of a specialist surgeon.

Hip Prosthesis

Hip replacement is a surgical treatment used when the hip joint is severely damaged or degenerative. The procedure aims to replace the damaged natural hip joint with a prosthesis.

Hip replacement surgery is usually performed for pain and restriction of movement caused by conditions such as osteoarthritis, rheumatoid arthritis, hip fractures, avascular necrosis and other serious hip problems.

During surgery, the surgeon removes the damaged femoral head and hip bone and replaces these areas with a hip prosthesis. The prosthesis most often contains a metal head, a metal or ceramic shell and usually a polyethylene body. This prosthesis is specially designed to mimic natural hip movement.

Hip replacement surgery usually relieves patients’ pain, increases their mobility and improves their overall quality of life. However, hip replacement surgery also involves certain risks and the recovery process can take some time. Therefore, when considering this type of surgery, the surgeon’s recommendations and the patient’s general state of health should be taken into account.

Hip replacement surgery can usually be performed by a specialized orthopedic surgeon. Post-operative rehabilitation and physical therapy are important to ensure the patient’s optimal recovery with the prosthesis.

How to Prevent Avascular Necrosis?

Orthopedics and Traumatology Diseases Specialist Op. Dr. As ÖzgürOktay Nar points out, it is important to take some precautions to prevent avascular necrosis. Individuals, especially those at risk, should not neglect regular health checks. And take measures to reduce risk factors. These measures can include adopting a healthy lifestyle, avoiding excessive alcohol use

Avascular necrosis is a condition in which bone tissue has insufficient blood supply. It can also lead to serious consequences if not treated in time. Therefore, when symptoms are noticed, it is important to contact a health professional immediately. In any case, with the right diagnosis and treatment, the effects of avascular necrosis can be minimized.