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Is Your Hip Pain The Sign of a Rare Condition?

Your hips are largest and most powerful of muscle groups—the glutes, quads, and hamstrings—all connect at the hips, and they allow you to walk, run, climb. The hip joint is crucial to all movement, in sports and day-to-day life, which is why persistent hip pain can be such a pain in the ass literally and often debilitating.

hip

 

Wear and tear on your hip joint can worsen with age. According to the Centers for Disease Control and Prevention, 7 percent of adults in the U.S. suffer from hip pain, the third most common joint pain behind shoulder pain, at 9 percent, and knee pain, at 18 percent. There’s also a growing prevalence of young athletes with hip injuries, especially young women, due to repetitive overuse and acute trauma.

Trauma can sometimes lead to osteonecrosis  in any joint but we are focusing on the hip , and some of the medications given to help inflammation and strengthen bones can also be a cause of osteonecrosis aka avascular necrosis.

Your Hip Pain May be the Sign of a Rare Condition

If you have hip pain don’t always brush it off as arthritis, if it persists, get it checked out to be safe

Persistent or worsening hip pain warrants a visit to your health care provider and possibly a sports medicine specialist or ortho. Some problems, particularly hip stress fractures, are commonly misdiagnosed due to the confusing presentation of symptoms.

 

A thorough evaluation is necessary and often includes X-rays and other studies, such as an MRI or bone scan. As with all injuries, the absence of pain does not mean that all is well. Strength and flexibility deficits must be addressed to allow a healthy return to helping your quality of life.

 

 

Although a person may not initially experience symptoms, hip pain is usually the first indicator. The earlier the diagnosis is achieved, the better the patient’s potential outcome. AVN has four stages that can progress over a period of several months to more than a year. In Stage I, the hip is healthy; in Stage II, the patient experiences mild to moderate pain in direct proportion to the deterioration of the head of the femur (or ball of the hip joint). By Stage III, usually the patient will find it difficult to stand and bear weight on the hip, and joint movement will be painful. During this stage, the ball of the hip has deteriorated to what is called a subchondral fracture and early collapse. Stage IV is a full collapse of the femoral head and degenerative joint disease (DJD).

 

Treatment for AVN is recommended based on the stage of the disease coupled with the age of the patient. In Stage I, medication and crutches may be prescribed to provide relief and enable the bone to heal on its own. This treatment may require the patient to be non-weight-bearing for up to six months. It also has a failure rate greater than 80-percent.

On the horizon treatments are stem cell.

 

Surgical treatment is recommended with a Stage II diagnosis, or very early in a Stage III diagnosis. A procedure, known as a core decompression, typically involves drilling one large hole in the core of the effected bone, with or without a bone graft, to reduced pressure and improve blood circulation in the hip. Another surgical option is the vascularized fibular graft, which takes a healthy piece of bone from the fibula, along with the artery or vein, and transplants and reattaches it into the hip, to help healthy bone grow. Recovery can take several months.

 

Because most patients are diagnosed in late Stage III or IV of the disease, when the bone quality of the femoral head is poor (subchondral fracture) or has collapsed, total hip replacement is the most successful treatment for AVN. This procedure replaces the damaged bone with artificial parts. Recovery takes about eight to twelve weeks. If left untreated, AVN progresses and results in pain and severe debilitating osteoarthritis.

Treatment decisions for AVN are ultimately up to the patient and are based on his or her lifestyle and goals. If you are suffering with hip pain, talk with your primary care doctor about a referral to an orthopedic surgeon

Hip Osteonecrosis -Stages- Info

Osteonecrosis of the Hip

Osteonecrosis of the hip is a painful condition that occurs when the blood supply to the head of the femur (thighbone) is disrupted. Because bone cells need a steady supply of blood to stay healthy, osteonecrosis can ultimately lead to destruction of the hip joint and severe arthritis.

Osteonecrosis is also called avascular necrosis (AVN) or aseptic necrosis. Although it can occur in any bone, osteonecrosis most often affects the hip. More than 20,000 people each year enter hospitals for treatment of osteonecrosis of the hip. In many cases, both hips are affected by the disease. 

Doctor Examination

After discussing your symptoms and medical history, your doctor will examine your hip to discover which specific motions cause your pain.

Patients with osteonecrosis often have severe pain in the hip joint but relatively good range of motion. This is because only the femoral head is involved in the earlier stages of the disease. Later, as the surface of the femoral head collapses, the entire joint becomes arthritic. Loss of motion and stiffness can then develop.

Osteonecrosis is typically seen as a wedge-shaped area with a dense whitish sclerotic border in the superior lateral portion of the femoral head. On lateral view, a lucent line called a “crescent sign” can often be seen just below the surface of the femoral head. 

Magnetic resonance imaging (MRI) scans.Early changes in the bone that may not show up on an x-ray can be detected with an MRI scan. These scans are used to evaluate how much of the bone is affected by the disease. An MRI may also show early osteonecrosis that has yet to cause symptoms (for example — osteonecrosis that may be developing in the opposite hip joint). 

Stages of Avascular Necrosis-Osteonecrosis Hip

photo credit AAOS American Academy of Orthopaedic Surgeons

Video Link of Stages of Avascular Necrosis-Osteonecrosis Hip

Dr Nabil Ebraheim Shows Info on Hip Avascular Necrosis

You can have Avascular Necrosis in one hip or both , if in both hips it’s called bilateral which means both sides.

And if you have Avascular Necrosis- osteonecrosis in more that 3 different joints

Multifocal osteonecrosis is defined as disease involving three or more anatomic sites.

Example

Hips

Knees

Shoulder

That is called multi focal Avascular Necrosis- Osteonecrosis

Read more

Multifocal osteonecrosis Article in The Journal of Rheumatology 25(10):1968-74 · November 1998

Multifocal ON, which ON involves three or more distinct anatomical sites [5], is rare, being seen in only approximately 3% of all ON patients [5]. Corticosteroid use is a known risk factor for multifocal ON [5,6], as are certain comorbidities, including systemic lupus erythematosus (SLE), renal failure, leukemia, and lymphoma [5,7,8]. However, almost all studies of multifocal ON are case reports and case series, so the inci- dence and clinical characteristics of the condition remain poorly defined [5,[8][9][10][11][12][13]. …

Non-operative Treatment

There is no known pharmaceutical cure for osteonecrosis. Several non-operative treatments have been studied including hyperbaric oxygen therapy, shock wave therapy, electrical stimulation, pharmaceuticals (anticoagulants, bisphosphonates, vasodilators, lipid lowering agents), physiotherapy and muscle strengthening exercises, and combinations thereof. There are conflicting results for some of these treatments, therefore, rigorous, randomized controlled trials with large numbers of patients are still needed to determine the effectiveness of these treatments. Non-operative treatment may be part of a wait-and-see approach based on the size of the area of dead bone. Non-operative treatments cannot be labeled as conservative, since many of them do not slow the progression of the disease or lead to avoidance of a total hip arthroplasty. Most are simply pain-relieving at best.

Reduced weight bearing does not alter the course of the disease and is not a treatment. It may be used to simply permit the patient to better cope with pain until appropriate treatment is instituted. 

Surgical Treatment

Core decompression – This surgical procedure removes or drills a tunnel into the area of the affected bone, which reduces pressure within the bone. Core decompression works best in people who are in the earliest stages of osteonecrosis, before the collapse of the dead bone. This procedure sometimes can reduce pain and slow the progression of bone and joint destruction in these patients.

Osteotomy – This surgical procedure reshapes the bone to reduce stress on the affected area. There is a lengthy recovery period, and the patient’s activities are very limited for 3 to 12 months after an osteotomy. This procedure is most effective for patients with advanced osteonecrosis and those with a small area of affected bone.

Bone graft – Bone grafts can be used as part of the surgical treatment for osteonecrosis. Bone grafts can use bone from the same patient or donor bone. Bone graft or synthetic bone graft can be inserted into the hole created by the core decompression procedure. A specialized procedure, called vascularized bone grafting, involves moving a piece of bone from another site (often the fibula, one of the bones of the calf, or the iliac crest, a portion of the pelvic bone) with a vascular attachment. This allows for support of the diseased area as well as a new source of blood supply. This is a complex procedure and is performed by surgeons that are specially trained. Another type of bone grafting, involves scraping out all of the dead bone and replacing it with healthier bone graft, often from other portions of the patient’s skeleton. 

A unique type of bone graft involves the use of a patient’s own cells that are capable of making new bone. Often these cells are a type of stem cell from the bone marrow or other bodily tissues. There has been increasing interest in the potential of stem cell therapy. This is also being studied for the treatment of osteonecrosis. Mesenchymal stem cells, which are a type of ‘adult’ stem cell, can grow and develop into many different cell types in the body. Physicians take the patient’s own mesenchymal stem cells (autologous transplant) and place them into the affected bone to stimulate bone repair and regeneration.

Arthroplasty/total joint replacement – Total joint replacement is the treatment of choice in late-stage osteonecrosis when the joint is destroyed. In this surgery, the diseased joint is replaced with artificial parts. It may be recommended for people who are not good candidates for other treatments, such as patients who do not do well with repeated attempts to preserve the joint. Various types of replacements are available, and people should discuss specific needs with their doctor.

For most people with osteonecrosis, treatment is an ongoing process. Doctors may first recommend the least complex and invasive procedure, such as protecting the joint by limiting high impact activities, and watch the effect on the patient’s condition.

Other treatments then may be used to prevent further bone destruction and reduce pain such as core decompression with bone graft/stem cell therapy. Eventually patients may need joint replacement if the disease has progressed to collapse of the bone. It is important that patients carefully follow instructions about activity limitations and work closely with their doctor to ensure that appropriate treatments are used.

Investigational Therapies

Scientists, researchers, and physicians continue to pursue a better understanding of how this disease occurs as well as compare the effectiveness of current and newly developed therapies. Often, this requires a clinical trial to answer questions and gain additional knowledge.

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site. 

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Toll-free: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today? A Ten-Year Update.

By Dr. Michal Mont MD

There is hope

Treatment

The goal is to prevent further bone loss.

Medications and therapy

In the early stages of avascular necrosis, symptoms might be eased with medication and therapy. Your doctor might recommend:

  • Nonsteroidal anti-inflammatory drugs.Medications, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) might help relieve the pain associated with avascular necrosis.
  • Osteoporosis drugs. Medications, such as alendronate (Fosamax, Binosto), might slow the progression of avascular necrosis, but the evidence is mixed.
  • Cholesterol-lowering drugs. Reducing the amount of cholesterol and fat in your blood might help prevent the vessel blockages that can cause avascular necrosis.
  • Blood thinners. If you have a clotting disorder, blood thinners, such as warfarin (Coumadin, Jantoven), might be recommended to prevent clots in the vessels feeding your bones.
  • Rest. Reducing the weight and stress on your affected bone can slow the damage. You might need to restrict your physical activity or use crutches to keep weight off your joint for several months.
  • Exercises. A physical therapist can teach you exercises to help maintain or improve the range of motion in your joint.
  • Electrical stimulation. Electrical currents might encourage your body to grow new bone to replace the damaged bone. Electrical stimulation can be used during surgery and applied directly to the damaged area. Or it can be administered through electrodes attached to your skin.

Surgical and other procedures

Because most people don’t develop symptoms until avascular necrosis is fairly advanced, your doctor might recommend surgery. The options include:

  • Core decompression. The surgeon removes part of the inner layer of your bone. Besides reducing your pain, the extra space within your bone stimulates the production of healthy bone tissue and new blood vessels.
  • Bone transplant (graft). This procedure can help strengthen the area of bone affected by avascular necrosis. The graft is a section of healthy bone taken from another part of your body.
  • Bone reshaping (osteotomy). A wedge of bone is removed above or below a weight-bearing joint, to help shift your weight off the damaged bone. Bone reshaping might enable you to postpone joint replacement.
  • Joint replacement. If your diseased bone has collapsed or other treatments aren’t helping, you might need surgery to replace the damaged parts of your joint with plastic or metal parts.
  • Regenerative medicine treatment. Bone marrow aspirate and concentration is a newer procedure that might be appropriate for early stage avascular necrosis of the hip. Stem cells are harvested from your bone marrow. During surgery, a core of dead hipbone is removed and stem cells inserted in its place, potentially allowing for growth of new bone. More study is needed.

Talk to your doctor about treatment options and the stage of your Avascular Necrosis of the Hip.

If this helped you please like comment or share this.

Thank You

Wishing you a pain free day

Debbie

Rare Disease Day 28 February 2019

We are #rare!!

Celebrate You’re Rare

Facts

Osteonecrosis – Avascular Necrosis -Aseptic Necrosis-Ischemic Necrosis-Bone Infarction- has many different names and causes.In children its Legg Calves Perthes.

They all mean – A Loss of blood supply to the bone  which may lead to bone cell death and can be caused by an injury (meniscal tear -bone fracture or joint dislocation; called traumatic osteonecrosis).

There may be no history of injury (non-traumatic osteonecrosis); however, other risk factors are associated with the disease such as some medications (steroids, also known as corticosteroids), alcohol usage or blood coagulation disorders. Increased pressure within the bone also is associated with osteonecrosis.

One theory is that the pressure within the bone causes the blood vessels to narrow, making it difficult for blood to circulate through the bone. Osteonecrosis can also be associated with other disorders. The exact reason osteonecrosis develops is not fully understood for some risk factors.

rareday2019avn

Sometimes, osteonecrosis occurs in people with no risk factors (idiopathic). Some people have multiple risk factors. Osteonecrosis most likely develops because of the combination of factors, possibly including genetic, metabolic, self-imposed (alcohol, smoking), and other diseases that you may have and their treatment.

Injury:

When a joint any joint hip,knee, shoulder, ankle, elbow is injured, as in a fracture or dislocation, meniscus tear the blood vessels may be damaged.

This can interfere with the blood circulation to the bone and lead to trauma-related osteonecrosis.

Studies suggest that this type of osteonecrosis may develop in more than 20% of people who dislocate their hip joint.

Corticosteroid Medications:

Corticosteroids, such as prednisone, are commonly used to treat diseases in which there is inflammation, such as systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, and vasculitis. Studies suggest that long-term, high dose systemic (oral or intravenous) corticosteroid use is a major risk factor for non-traumatic osteonecrosis with reports of up to 35 percent of all people with non-traumatic osteonecrosis.

And corticosteroids come in many versions – inhaled and ingested corticosteroids for asthma-cold-sinus problems or steroid injections into joints, topical for skin-

Patients should discuss concerns about corticosteroid use with their doctor.

Doctors aren’t sure exactly why the use of corticosteroids sometimes is associated with osteonecrosis. They may have negative effects on different organs and tissues within the body. For example, they may interfere with the body’s ability to build new bones and to break down fatty substances.

These substances would then build up in and clog the blood vessels, causing them to narrow. This then would reduce the ability of blood to flow inside a bone.

Alcohol Use:

Excessive alcohol use is another major risk factor for non-traumatic osteonecrosis. Studies have reported that alcohol accounts for about 30% of all people with non-traumatic osteonecrosis. While alcohol can slow down bone remodeling (the balance between forming new bone and removing bone), it is not known why or how alcohol can trigger osteonecrosis.

Other Risk Factors:

Other risk factors or conditions associated with non-traumatic osteonecrosis include Gaucher disease, pancreatitis, autoimmune disease, cancer, HIV infection, decompression disease (Caisson disease), and blood disorders such as sickle cell disease. Certain medical treatments including radiation treatments and chemotherapy can cause osteonecrosis. People who have received a kidney or other organ transplant may also have an increased risk.

Affected Populations

Osteonecrosis usually affects people between 30 and 50 years of age; about 10,000 to 20,000 people develop osteonecrosis each year in the United States.

Osteonecrosis affects both men and women and affects people of all ages. It is most common among people in their thirties and forties.

Depending on a person’s risk factors and whether the underlying cause is trauma, it also can affect younger or older people.

Related Disorders

Some Symptoms of the disorders listed below may be similar to those of osteonecrosis. Comparisons may be useful for a differential diagnosis:

Osteopetrosis is a combination of several rare genetically caused symptoms grouped together as one disorder. It can be inherited and is marked by increased bone density, brittle bones, and, in some people, skeletal abnormalities. Although symptoms may not initially be apparent to people with mild forms of this disorder, trivial injuries may cause bone fractures due to abnormalities of the bone. The dominantly transmitted form is milder than the recessive form and may not be diagnosed until adolescence or adulthood when symptoms first appear. More serious complications occur in the recessive form which may be diagnosed from examination of skeletal x-rays during infancy or childhood. (For more information on this disorder, choose “Osteopetrosis” as your search term in the Rare Disease Database.)

Reflex sympathetic dystrophy syndrome (RSDS), also known as complex regional pain syndrome, is a rare disorder of the sympathetic nervous system that is characterized by chronic and severe pain. The sympathetic nervous system is that part of the autonomic nervous system that regulates involuntary functions of the body such as increasing heart rate, constricting blood vessels, and increasing blood pressure. Excessive or abnormal responses of portions of the sympathetic nervous system are thought to be responsible for the pain associated with reflex sympathetic dystrophy syndrome. The symptoms of RSDS typically begin with burning pain, especially in an arm, finger(s), palm of the hand(s), and/or shoulder(s). In some individuals, RSDS may occur in one or both legs or it may be localized to one knee or hip. Frequently, RSDS may be misdiagnosed as a painful nerve injury. The skin over the affected area(s) may become swollen (edema) and inflamed. Affected skin may be extremely sensitive to touch and to hot or cold temperatures (cutaneous hypersensitivity). The affected limb(s) may perspire excessively and be warm to the touch (vasomotor instability). The exact cause of RSDS is not fully understood, although it may be associated with injury to the nerves, trauma, surgery, atherosclerotic cardiovascular disease, infection, or radiation therapy. (For more information on this disorder, choose “reflex sympathetic dystrophy” as your search term in the Rare Disease Database.)

Legg-Calvé-Perthes disease (LCPD) is one of a group of disorders known as the osteochondroses. The osteochondroses typically are characterized by degeneration and subsequent regeneration of the growing end of a bone (epiphyses). In LCPD, the growing end of the upper portion of the thigh bone (femur) is affected. The upper section of the thigh bone is known as the head or “the ball” and connects to the hip in a depression or “socket”. This is the hip joint, which is a ball and socket joint. The disorder results from an unexplained interruption of the blood supply (ischemia) to the head of the femur, which causes degeneration and deformity of the femoral head. Symptoms may include a limp with or without pain in the hip, knee, thigh, and/or groin; muscle spasms; and/or limited or restricted movement of the affected hip. The disease process seems to be self-limiting as new blood supplies are established (revascularization) and new healthy bone forms (re-ossifies) in the affected area. The exact cause for the temporary interruption of blood flow to the femoral epiphysis is not fully understood. Most times the disorder appears to occur randomly for no apparent reason (sporadically).

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Osteonecrosis-Avascular Necrosis -Broken Down

Osteonecrosis is the death of a segment of bone caused by an impaired blood supply. We all need an adequate blood supply to the bone other wise the bone can collapse and die. The blood supply to bone is delivered to the endosteal cavity by nutrient arteries, then flows through marrow sinusoids before exiting via numerous small vessels that ramify through the cortex. Reductions in vascular supply are associated with bone loss. Bones in our body are living tissue. They have their own blood vessels and are made of living cells, which help them to grow and to repair themselves. As well, proteins, minerals and vitamins make up the bone when you get to little blood flow the bone breaksdown much faster than it can repair and generate new bone.

This disorder can be caused by an injury or can occur spontaneously.

Typical symptoms include pain, limited range of motion of the affected joint, and, when the leg is affected, a limp.

The diagnosis is based on symptoms, the person’s risk of osteonecrosis, and the results of x-rays and magnetic resonance imaging.

Stopping smoking, stopping excessive alcohol use, and minimizing the use of or lowering the dose of corticosteroids reduce the risk of developing the disorder.

Various surgical procedures can be done if nonsurgical measures (such as rest, physical therapy, and pain relievers) do not relieve symptoms. Eat a healthy diet

Each year in the United States, about 20,000 people develop osteonecrosis. The hip is most commonly affected, followed by the knee and shoulder. The wrist and ankle are affected less often. Osteonecrosis does not usually affect the shoulder or other less commonly affected sites unless the hip is also affected. However, osteonecrosis of the jaw (ONJ) is a disorder involving only the jaw bone.
Causes

Osteonecrosis is not a specific disease but a condition in which death of the bone is confined to one or more specific (localized) areas. There are two general categories of osteonecrosis:Making it a rare disorder.

Traumatic (following an injury)

Nontraumatic

Traumatic osteonecrosis is the most common. The most frequent cause of traumatic osteonecrosis is a displaced fracture. In a displaced fracture, a bone breaks into two or more parts and moves so that the fractured ends are not lined up. The type of displaced fracture that causes osteonecrosis most often affects the hip (see Hip Fractures) and most commonly occurs in older people.

Another cause of traumatic osteonecrosis is a dislocation. A dislocation occurs when the ends of bones in joints become completely separated from each other, as in a hip dislocation.

A displaced fracture or a dislocation may damage the blood vessels supplying the upper end of the thighbone (the femoral head, part of the hip joint), resulting in death of this part of the bone. This death of bone occurs less often in other areas of the body.
Some Risk Factors for Osteonecrosis

Traumatic osteonecrosis- injury to bone or joint like meniscal tear -broken bones-dislocations etc…

Fractures (breaks in bones) and dislocations (when the ends of bones in joints become completely separated from each other)

Nontraumatic osteonecrosis

Excessive alcohol

Blood clotting (coagulation) disorders

Bone Marrow Edema

Chemotherapy

Corticosteroids

Cushing syndrome

Decompression sickness

Gaucher disease

High level of lipids in the blood (hyperlipidemia)

HIV infection

Liver disease

Lupus and other autoimmune connective tissue disorders

Miscellaneous conditions (such as chronic kidney disease and rare genetic mutations)

Organ transplantation

Pancreatitis

Radiation

Sickle cell disease

Smoking

Tumors

Vasculitis
Nontraumatic osteonecrosis occurs without direct trauma or injury. This type may be caused by a disease or condition that results in the blockage of small blood vessels that supply certain areas of the bone. The areas most commonly affected are the femoral head (which is part of the hip joint), the knee, and the upper arm at the shoulder. This disorder occurs most commonly among men and people between the ages of 30 and 50 and often affects both hips or both shoulders. The most common causes are

Corticosteroids (when given at high doses, for long periods of time, or both)

Chronic, excessive alcohol use (more than 3 drinks a day for several years)

A number of other causes have been identified, but these occur much less often. These other causes include certain blood-clotting disorders, sickle cell disease, liver disease, tumors, Gaucher disease, radiation therapy, and decompression sickness (which occurs in divers who surface too quickly). A number of disorders that are treated with high doses of corticosteroids (such as lupus) also may be associated with osteonecrosis. In these cases, it may not be clear whether the cause is the disorder or the corticosteroids.

In about 20% of people with osteonecrosis, the cause is unknown.

If one bone has nontraumatic osteonecrosis, the same bone on the opposite side of the body sometimes has it also, even if there are no symptoms. For example, if one hip is affected, about 60% of the time the other hip is affected.

Spontaneous osteonecrosis of the knee (SPONK or SONK) can occur in older women (occasionally men) who have no specific risk factors for the disorder. SPONK differs from other forms of osteonecrosis. SPONK is thought to be caused by an insufficiency fracture. An insufficiency fracture is caused by normal wear and tear on bone that has been affected by osteoporosis. SPONK occurs without direct trauma or injury.
Symptoms

As osteonecrosis progresses, more and more tiny fractures may occur, particularly in bones that support weight, such as the hip. As a result, the bone usually collapses weeks or months after the blood supply is cut off. Most often pain develops gradually when the bone begins to collapse. At times, however, pain may begin suddenly and could be related to increased pressure that develops in and around the affected area of bone. Regardless of how sudden, pain is increased by moving the affected bone and typically is alleviated with rest. The person avoids moving the joint to minimize pain.

If the affected bone is in the leg, standing or walking worsens the pain and a limp develops.

In osteonecrosis of the hip, pain is usually present in the groin and may extend down the thigh or into the buttocks.

Spontaneous osteonecrosis of the knee causes sudden pain along the inner part of the knee. There may be tenderness in this area, and the joint often becomes swollen with excess fluid. Bending the knee may be painful, and people may have a limp.

Osteonecrosis of the shoulder often causes fewer symptoms than osteonecrosis that occurs in the hip or knee.

Osteoarthritis (damage to the cartilage covering the joint surfaces) develops over time, often after a large part of the bone collapses.
Diagnosis

X-rays

Magnetic resonance imaging

Because osteonecrosis is often painless at first, it may not be diagnosed in its earliest stages. Doctors suspect osteonecrosis in people who do not improve satisfactorily after having certain fractures. They also suspect the disorder in people who develop unexplained pain in the hip, knee, or shoulder, particularly if these people have risk factors for osteonecrosis.

X-rays of the affected area usually show osteonecrosis unless the disorder is in its earliest stages. If x-rays appear normal, however, magnetic resonance imaging (MRI) is usually done because it is the best test for detecting osteonecrosis early, before changes appear on ordinary x-rays. The x-rays and MRI also show whether the bone has collapsed, how advanced the disorder is, and whether the joint is affected by osteoarthritis. If doctors discover nontraumatic osteonecrosis in one hip, they also examine the other hip with an x-ray or MRI.

Blood tests may be done to detect an underlying disorder (such as a blood-clotting disorder).
Prevention

To minimize the risk of osteonecrosis caused by corticosteroids, doctors use these drugs only when essential, prescribe them in as low a dose as needed, and prescribe them for as short a duration as possible.

To prevent osteonecrosis caused by decompression sickness, people should follow accepted rules for decompression during diving and when working in pressurized environments (see prevention of decompression sickness and see Diving Safety Precautions and Prevention of Diving Injuries).

Excessive alcohol use and smoking should be avoided.

Various drugs (such as those that prevent blood clots, dilate blood vessels, or lower lipid levels) are being evaluated for prevention of osteonecrosis in people at high risk.
Treatment

Nonsurgical measures to relieve symptoms

Surgical procedures

Hip replacement

blood supply long bones

Some areas affected by osteonecrosis need only nonsurgical measures to relieve symptoms. Other areas need to be treated with a surgical procedure.
Nonsurgical measures

Several nonsurgical measures are available for treating the symptoms caused by osteonecrosis. Taking anti-inflammatory drugs or other pain relievers, minimizing activity and stress (such as weight bearing for osteonecrosis of the hip and knee), and undergoing physical therapy are ways to relieve symptoms but not cure the disorder or change its course. These measures, however, may be adequate for treatment of the shoulder, the knee, spontaneous osteonecrosis of the knee, and small areas of osteonecrosis of the hip, which may spontaneously heal without treatment. Osteonecrosis heals without treatment in about 80% of people if the disorder is diagnosed early and if the affected area is small.

Spontaneous osteonecrosis of the knee is usually treated without surgery, and pain usually resolves.
Surgical procedures

There are a number of surgical procedures that slow or possibly prevent progression of the disorder. These procedures are done to preserve the joint and are most effective for treating early osteonecrosis, particularly of the hip, that has not yet progressed to bone collapse. If bone collapse has occurred, a type of joint replacement procedure may be done to decrease pain and improve function.

Core decompression, the simplest and most common of these procedures, involves drilling one or many small tracks or holes (perforations) into the area in an attempt to decrease pressure inside the bone. Core decompression often relieves pain and stimulates healing. In about 65% of people, the procedure can delay or prevent the need for total hip replacement. In younger people, core decompression may also be used even if a small amount of collapse already has taken place. The procedure is relatively simple, has a low rate of complications, and requires the use of crutches for about 6 weeks. Most people have satisfactory or good results overall. However, results for any particular person can be hard to predict. About 20 to 35% of people require a total hip replacement.

During core decompression, surgeons may inject a person’s own bone cells into the small hole or holes. This enhancement to the core decompression procedure may help heal the femoral head (which is part of the hip joint).

Bone grafting (transplanting bone from one site to another) is another procedure. For osteonecrosis of the hip, this can involve removing the dead area of bone and replacing it with more normal bone from elsewhere in the body. This graft supports the weakened area of bone and stimulates the body to form new, living bone in the affected area.

An osteotomy is another procedure designed to save the affected joint. This procedure is done particularly in the region of the hip and may be suitable for younger people in whom some degree of collapse already has occurred, which makes them poor candidates for core decompression or other procedures. Usually the osteonecrosis is in the weight-bearing area of the femoral head. An osteotomy changes the position of the bone so that the weight of the body is now supported by a normal area of the femoral head and not by the collapsed area.

Bone grafting and osteotomy are difficult procedures, however, and are not often done in the United States. They require a person to spend up to 6 months on crutches. These procedures are done only at selected centers that have the surgical experience and facilities to achieve the best results.

A total joint replacement is an effective procedure to relieve pain and restore motion if osteonecrosis has caused significant joint collapse and osteoarthritis. About 95% of people benefit from total replacement of the hip or knee (see Hip replacement). With modern techniques and devices, most daily activities can be resumed within 3 months and most joints should last more than 15 to 20 years.

In younger people with osteonecrosis, a total joint replacement may have to be revised (called revision surgery) or replaced at some later time. However, with modern devices, revision surgery has become much less common. Because total joint replacement is now so successful, there is much less need to do other procedures that replace part of the joint or remove the surface cartilage and place a cap on each bone end.

Occasionally, a partial or total replacement of an extremely painful knee or shoulder may be needed for advanced osteonecrosis that is not alleviated by nonsurgical treatment.
More Information

National Institute of Arthritis and Musculoskeletal and Skin Diseases

 

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The first image at top of page I was given special permission to tweak  it for rare disease awareness day

You are what you eat©

Finding delicious, wholesome  food is not always easy when you’re eating out at a restaurant, but it’s totally possible when you make it at home I’m Debbie a flexitarian that eats mostly plant based and I am changing my weight and improving my health.I changed my lifestyle to help lower my inflammation and control pain but i will eat fish, chicken etc….just not everyday

Not all my recipes posted are healthy I do like a good old fashioned dinner or snack now and then but its rare.

I am a patient leader advocate and home cook

I have

Avascular Necrosis-Osteonecrosis From Injury

Osteoarthritis

Inherited Blood Clot Disorder

Hashimoto Thyroiditis

http://avascularnecrosiseducation.com

https://flexitarianforlife.wordpress.com/author/chronicallygratefuldebla/

www.ChronicallyGratefulDebla.com

 

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