Avascular Necrosis-Osteonecrosis

The real term is Osteonecrosis

Synonyms of Osteonecrosis

  • aseptic necrosis
  • avascular necrosis of bone
  • ischemic necrosis of bone

What is avascular necrosis-osteonecrosis ?

AVN-ON is a disease that results from the temporary or permanent loss of blood supply to the bone.

When blood supply is cut off, the bone tissue dies and the bone collapses. If it happens near a joint, the joint surface may collapse.

This condition may happen in any bone. It most commonly happens in the ends of a long bone. It may affect one bone, several bones at one time, or different bones at different times.

What causes avascular necrosis?

Avascular necrosis – Osteonecrosis may be the result of the following:

• Injury

• Fracture

• Damage to blood vessels

• Long-term use of medicines, such as corticosteroids

•To many steroid injections

• Excessive, long-term use of alcohol

• Specific chronic medical conditions

What are the risk factors for avascular necrosis-osteonecrosis?

Risk factors include:

• Injury

• Steroid use

• Gaucher disease

• Caisson disease

• Alcohol use

• Blood disorders, such as sickle cell anemia, factor V, eNOS, mthfr, factor viii

• Radiation treatments

• Chemotherapy

• Pancreatitis

• Decompression disease

• Hypercoagulable state

• Hyperlipidemia

• Autoimmune disease

• HIV

• Vasculitis

• Bone Marrow Edema

• Legg Calves Perthes is avn in childhood

Vasculitis

Smoking

High cholesterol

What are the symptoms of avascular necrosis?

The following are the most common symptoms of avascular necrosis. However, each person may experience symptoms differently. Symptoms may include:

• Minimal early joint pain

• Increased joint pain as bone and joint begin to collapse

• Limited range of motion due to pain

The symptoms of avascular necrosis may look like other medical conditions or bone problems. Always talk with your healthcare provider for a diagnosis.

How is avascular necrosis treated?

Specific treatment for avascular necrosis will be determined by your healthcare provider based on:

• Your age, overall health, and medical history

• Extent of the disease

• Location and amount of bone affected

• Underlying cause of the disease

• Your tolerance for specific medicines, procedures, or therapies

• Expectations for the course of the disease

Key points about avascular necrosis

• Avascular necrosis is a disease that results from the temporary or permanent loss of blood supply to the bone. It happens most commonly in the ends of a long bone.

• Avascular necrosis may be the result of injury, use of specific medicines, or alcohol.

• Symptoms may include mild to severe joint pain and limited range of motion.

• Medications,assistive devices, new experimental treatments like Prp and stem cell injections have show great promise but usually not covered by insurance or you may need to have surgery to improve functionality or to stop further damage to the affected bone or joint.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions. You’re physician should always take a few minutes to talk to you and discuss concerns, treatments all treatments not just the ones they do.

If you don’t get good communication you may want to get another opinion and consider changing providers.

Learn to be your own advocate

Your worth it.

Osteonecrosis has many different causes. Loss of blood supply to the bone may lead to bone cell death and can be caused by an injury (bone fracture or joint dislocation; called traumatic osteonecrosis). At times, 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. 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 is injured, as in a meniscus tear, fracture or dislocation, 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. And 15 % of people who have trauma to knee.

Corticosteroid Medications:
Corticosteroids, such as prednisone, are commonly used to treat diseases in which there is inflammation, such as systemic lupus erythematosus, copd, 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.

However, there is still some risk of osteonecrosis associated with the infrequent use of corticosteroids, inhaled corticosteroids, or most steroid injections into joints.

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, factor v, mthfr, and more so always ask your doctor to check you for a clot disorder.

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 20 and 50 years of age; about 10,000 to 20,000 people develop osteonecrosis each year in the United States alone.

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.

Diagnosis

After performing a complete physical examination and asking about the patient’s medical history (for example, what health problems the patient has had and for how long), the doctor may use one or more imaging techniques to diagnose osteonecrosis. As with many other diseases, early diagnosis increases the chances of treatment success.

It is likely that the doctor first will recommend an x-ray. X-rays can help identify many causes of joint pain, such as a fracture or arthritis. If the x-ray is normal, the patient may need to have more tests.

Research studies have shown that magnetic resonance imaging (MRI) is currently the most sensitive method for diagnosing osteonecrosis in the early stages. The tests described below may be used to determine the amount of bone affected and how far the disease has progressed.

X-Ray
An x-ray is a common tool that the doctor may use to help diagnose the cause of joint pain. It is a simple way to produce pictures of bones. The x-ray of a person with early osteonecrosis is likely to be normal because x-rays are not sensitive enough to detect the bone changes in the early stages of the disease. X-rays can show bone damage in the later stages, and once the diagnosis is made, they are often used to monitor the course of the condition.

Magnetic Resonance Imaging (MRI)
MRI is a common method for diagnosing osteonecrosis. Unlike x-rays, bone scans, and CT (computed/computerized tomography) scans, MRI detects chemical changes in the bone marrow and can show osteonecrosis in its earliest stages before it is seen on an x-ray. MRI provides the doctor with a picture of the area affected and the bone rebuilding process. In addition, MRI may show diseased areas that are not yet causing any symptoms. An MRI uses a magnetic field and radio waves to produce cross-sectional images of organs and bodily tissues.

Bone Scan
Also known as bone scintigraphy, bone scans should not be used for the diagnosis of osteonecrosis because they may miss 20 to 40% of the bone locations affected.

Computed/Computerized Tomography (CT)
A CT scan is an imaging technique that provides the doctor with a three-dimensional picture of the bone. It also shows “slices” of the bone, making the picture much clearer than x-rays and bone scans. CT scans usually do not detect early osteonecrosis as early as MRI scans but are the best way to show a crack in the bone. Occasionally it may be useful in determining the extent of bone or joint surface collapse.

Biopsy
A biopsy is a surgical procedure in which tissue from the affected bone is removed and studied. It is rarely used for diagnosis, as the other imaging studies are usually sufficiently distinct to make the diagnosis with a high level of confidence.

Standard Therapies

Treatment
Appropriate treatment for osteonecrosis is necessary to keep joints from collapsing. If untreated, most patients will experience severe pain and limitation in movement within two years. There is no agreed upon optimal treatment for individuals with osteonecrosis.

Early intervention is essential to preserve the joints, but most people are diagnosed late in the disease process. 

Several treatments are available that can help prevent further bone and joint damage and reduce pain. To determine the most appropriate treatment, the doctor considers the following aspects of a patient’s disease: the age of the patient; the stage of the disease–early or late; the location and amount of bone affected–a small or large area. The underlying cause has not been shown to influence outcomes of treatment.

The goal in treating osteonecrosis is to improve the patient’s use of the affected joint, stop further damage to the bone, and ensure bone and joint survival. If osteonecrosis is diagnosed early enough, collapse and joint replacement can be prevented. To reach these goals, the doctor may use one or more of the following treatments.

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,Prp injections, A2m injection. But some of these new treatments may not be covered by your insurance.

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.

Information

Stem Cell

Alcohol and Osteonecrosis

Osteonecrosis Knee

Various Links Osteonecrosis

Kummel Disease

Avascular necrosis (AVN) develops when a bone loses its blood supply. AVN goes by several other names, including Kummel disease, osteonecrosis, aseptic necrosis, and ischemic bone necrosis. AVN typically affects bone in the hips, thighs, knees and shoulders—although it can develop in any bone in the body.

Kummel disease is a rarely occurring variation of avascular necrosis that can affect the spine’s vertebrae, usually the thoracic spine (mid back) region. There are many different spine-related disorders that can contribute to disrupting a vertebral body’s blood supply, such as infection, osteoporosis, radiation therapy, steroid use, and metastatic spine tumors. Like other organs in the body, bone needs a healthy blood supply to rebuild itself, stay strong and support the spinal column.

Though Kummell disease is rare, researchers believe it’s becoming more prevalent as the aging population grows. People with osteoporosis and older adults are at a greater risk for developing this disorder.

Kummel Disease: A Not-So-Rare Complication of Osteoporotic Vertebral Compression Fractures

As our population ages, the prevalence of osteoporosis, its most common fragility fracture (vertebral compression fracture), and Kummel disease will increase.

Also if younger and you are diagnosed with osteoporosis your chances are higher to possibly develop Kummel Disease.

Avascular Necrosis and Kummel Disease Share Some Similar Causes and Risk Factors

  • Injury: This is known as trauma-related avascular necrosis. A broken hip or vertebral fracture may lead to osteonecrosis.
  • Increased pressure within the bone: The pressure within the bone causes the blood vessels to narrow, making it hard for the vessels to deliver enough blood to the bone cells.
  • Certain risk factors: This is known as non-traumatic avascular necrosis. These risks include medical conditions and lifestyle choices that affect bone metabolism or bone remodeling.

AVN has several risk factors, including medical conditions and lifestyle choices that may increase your chances of developing the disorder:

  • Heavy alcohol use
  • Long-term corticosteroid use
  • Osteoporosis
  • Blood clots and arterial inflammation
  • Blood disorders (such as Sickle cell disease)
  • Radiation and chemotherapy
  • Pancreatitis
  • Gaucher disease (occurs when high amounts of fatty substances collect in the organs)
  • Decompression sickness (a condition causing gas bubbles in the blood)

How Doctors Diagnose Avascular Necrosis 

Diagnosing spinal AVN caused by trauma—also called Kummell disease—begins with a thorough review of your medical history and symptoms. This is all part of your physical exam.

After your physical exam, your doctor may order imaging scans to better see changes in your vertebrae.

Below are some of the tools your doctor may use to diagnose Kummell disease:

  • X-ray: This first-line imaging test can illuminate problems with your spinal bones. It’s not able to show early-stage bone problems, though.
  • Computed tomography (CT) scan: A CT scan provides a 3-dimensional picture of your bone. It also shows “slices” of bone, making the picture clearer than what x-rays and bone scans deliver.
  • Magnetic resonance imaging (MRI): This technology can produce very detailed images of your soft tissues and bones. The test is sensitive enough to see bone problems at their earliest onset, which x-ray is unable to do.
  • Bone scan: Also known as skeletal scintigraphy, bone scans are often used in people who have normal x-rays. A radioactive dye is injected into your affected bone and a picture of your bone is taken with a special camera. The picture shows how the dye travels through your bone and where normal bone formation is occurring.
  • Biopsy: A biopsy is a surgical procedure in which tissue from your affected bone is removed and studied. Although a biopsy is a conclusive way to diagnose AVN, it is rarely used because it requires surgery.
  • Functional evaluation of bone: Tests to measure the pressure inside a bone may be used when your doctor strongly suspects that you have AVN, despite normal x-ray, bone scan, and MRI results. These tests are very sensitive at detecting increased pressure within your bone, but they require surgery.

How Is Avascular Necrosis Treated?

The goals of treatment for AVN include improving your use of the affected joint, stopping further damage to the bone, and ensuring bone and joint survival.

If you have an early-stage form of Kummell disease, your doctor may prescribe medications to manage pain and/or inflammation. Physical therapy (PT) may be included in your treatment plan. A physical therapist can teach you how to exercise safely to protect your joints and bones while building strength, flexibility and endurance.

Though non-surgical treatments may help keep pain at bay, they are generally a temporary solution for people with Kummel disease. In many cases, spine surgery is necessary to prevent the condition from progressing to a point that it harms your quality of life.

Spine surgery for Kummel disease may have several purposes, depending on your specific symptoms. As such, your surgeon may use a single surgical approach or combine techniques to give you the best possible outcome. For example:

  • If you have developed abnormal kyphosis, your doctor may recommend osteotomy (surgical removal of bone) combined with spinal instrumentation and fusion. This combination of surgical procedures can reduce the size of the kyphotic curve, realign the spine and stabilize it.
  • Some patients with Kummel disease have pain and neurological symptoms, such as numbness or weakness. If symptoms are caused by nerve compression, a spinal decompression surgery (such as a foraminotomy) may be recommended to relief pressure on pinched nerves and prevent potentially permanent nerve damage.

Another surgical option for AVN is known as core decompression. This procedure involves removing the inner layer of bone, which reduces pressure within the bone, increases blood flow to the bone, and allows more blood vessels to form.

Core decompression works best in people who are in the earliest stages of avascular necrosis, often before the collapse of a joint. This procedure may reduce pain and slow progression of bone and joint destruction.

After core decompression, your surgeon may implant bone graft to help stimulate new bone growth and healing. Bone graft transplants healthy bone from a part of the body, such as the leg, to the diseased area. Several synthetic bone grafts are also available. Depending on the location and extent of the surgery, expect a lengthy recovery period, usually from 6 to 12 months.

As with all areas of medicine, researchers are continuously exploring treatments that may help people with AVN. One area of interest is therapies that increase the growth of new bone and blood vessels. These treatments have been used experimentally alone and in combination with other treatments, such as osteotomy and core decompression.

Your doctor will work with you to develop a custom treatment plan that addresses your symptoms and medical history.

Your Outlook with Avascular Necrosis (Kummel Disease)

For most people with avascular necrosis (also known as osteonecrosis, aseptic necrosis, and ischemic bone necrosis), treatment is an ongoing process. Your doctor may first recommend the least invasive approach and observe how you respond before progressing you to more substantial AVN therapies. If your condition affects your spinal vertebrae and was caused by trauma or injury (Kummell disease), several treatments may help prevent complications like spinal fracture, kyphosis deformity, and nerve pain from disrupting your life.

Joint Pain

 Congratulations !  If you’re like me you are one of the 30 million adults in the United States who suffer with joint pain, you know the pain often is debilitating. It can keep you from staying active and limits your mobility and it even makes daily chores seem impossible. What you might not know is that many doctors can treat joint pain with more than just pills or surgery. Beware though some doctors will tell you about one procedure and then change it once they know your insurance example Medicare I felt one doctor thought less of me as a patient because I am disabled so he changed or tried to change the procedure. It pissed me off because I was all set to get the procedure we discussed and then he changed it.

Both procedures were covered under Medicare so I felt betrayed as if I wasn’t good enough for the other injection.

Newsflash …..people on Medicare pay for the insurance they have. It’s not free , hell I pay more for insurance than when I was working.

But thankfully Medicare is good coverage. Low deductible.

It’s some doctors that treat you like a second class citizen.

Make sure this doesn’t happen to you.

 

Depending on the severity of your pain, injections can be another option for easing your joint pain and help to get you moving again.

Doctors use these injections to try to reduce inflammation and pain in your joints some come with side effects and some risks.

The injections range from corticosteroids, which have been around for decades, to newer ortho-biologic injections like platelet-rich plasma (PRP) , Stem Cell and placental tissue matrix (PTM)

 

You and your physician will decide which one is best based on your individual needs. The issue is finding doctors qualified to do these.

Not every injection is right for every patient, in my case I hate steroid injections, not only did it make my pain worse it also comes with the risk of developing osteonecrosis. Something I already have. I have noticed that it seems like doctors are quick to prescribe and inject steroids. I stand my ground and refuse. But that’s me.

 

So here are some facts to help you know more about the options.

Corticosteroid injections

 

Use: This injection is the first line of defense against osteoarthritis symptoms and other joint pain in shoulders, knees and hips. Corticosteroids can offer relief for two to three months, and reduce inflammatory cell activity in the joint. In some people.

Side effects and Risks : As with all injections, there’s a small chance of infection about one in 1,000 as well as Joint infection.

Nerve damage.

Thinning of skin and soft tissue around the injection site.

Temporary flare of pain and inflammation in the joint.

Tendon weakening or rupture.

Thinning of nearby bone (osteoporosis)

Osteonecrosis lack of blood supply to the bone

Raised blood sugar level

Whitening or lightening of the skin around the injection site

Cost: Most insurance covers the $100 -$200 usd cost of these injections. Your insurance provider may require that you try at least one corticosteroid injection first to see whether it works. If not, you may move on to a different therapy.

 

Hyaluronic acid injections

Use: Hyaluronic acid (HA) injections often are used when corticosteroid injections don’t work. But they usually are approved only for use in the knee.

In some instances, doctors consider an HA injection first if you don’t have obvious signs of inflammation. HA also is a better option if you have diabetes, as corticosteroids can raise blood sugar levels.

Also known as gel injections, HA injections are chemically similar to your natural joint fluid.

When you have osteoarthritis which is different than osteonecrosis lucky me I have both, the joint fluid becomes watery.

So, this injection helps to restore the fluid’s natural properties and works as a lubricant and a shock absorber.

HA is a cushion or a buffer against inflammatory cells in the joint.  In some cases, it can stimulate the knee to start producing more natural HA.” Some physicians also believe that HA helps reduce pain by coating nerve endings within the joint.

One treatment, which may consist of between one and three injections, usually offers symptom relief for four to five months, but sometimes up to one years. However, pain and stiffness will return. Most insurance companies only approve one HA injection every six months.

In knees with osteoarthritis, the joint fluid (called synovial fluid) can break down and not provide the cushioning your knee needs

Durolane

Euflexxa

Hyalgan

Orthovisc

Monovisc

Supartz

Synvisc, Synvisc-One

Depending on which type your doctor uses, you may get a single shot. Or you’ll get three to five injections spaced a week apart.

 

Side effects: There’s a 1-in-100 chance of an inflammatory reaction, The most common short-term side effects are minor pain at the injection site and minor buildup of joint fluid. These get better within a few days.

 

Cost: HA injections cost more — about $300 to $850 per injection, but most insurance companies cover the cost for knee injections.

 

 

Platelet-rich plasma (PRP) injections

Use: Platelet-rich plasma (PRP) injections can treat osteoarthritis joint pain, and are being thoroughly researched to understand their effects.

These injections use your own blood and platelets to promote healing. Platelets contain growth factors and proteins that aid healing in soft tissues. Research shows PRP injections can alter the immune response to help reduce inflammation,

Side effects: Side effects include a very low risk of infection and pain at the injection site. You must stop oral anti-inflammatory medications for a short amount of time if you get a PRP injection.

Cost: Insurance companies don’t generally cover PRP injections and you will pay between $400 and $1,300 per injection out-of-pocket.

 

Stem Cell Injections

The world’s most advanced regenerative injection treatments for treating knee pain due to arthritis, meniscus tears, traumatic ligament injuries, overuse conditions and other degenerative conditions.

 

Side effects : mild discomfort associated with the procedure. There is a very small risk of infection whenever aspirations and injections are performed. Nerve damage, vessel damage, and injury to other important structures are exceedingly rare

 

Placental tissue matrix (PTM) injections

 

Use: Placental Tissue Matrix (PTM) injections can very profoundly decrease the pain related to osteoarthritis.

 

These are injections of placental tissue, which is obtained after a healthy baby is delivered from a healthy mother. Research has discovered that there is a large number of growth factors in placental tissue that promote healing, Dr. Genin says.

Side effects: Side effects include a  low risk of infection and pain at the injection site. The placental tissue is “immune privileged,” which means the body would not have an adverse reaction to it.

Cost: Insurance companies don’t generally cover PTM injections; you will pay around $1,800 -$2500 per injection out-of-pocket.

 

Many of these injections often are effective in reducing or stopping your joint pain, but it’s important to remember that they may not keep the pain from returning, Dr. Schaefer says. In fact, they’re most effective when used with other therapies.

 

As a patient who has Osteonecrosis, Osteoarthritis, and other stuff I consider surgical options as a last resort only if other treatment options have failed. Unfortunately some treatments I cannot even afford to try. I wish the FDA would get a move on and approve some things so insurance companies can have this as a form of treatment.

 

 

 

 

Stem Cells

 

BONE MARROW AND FAT CELLS

The stem cells used in this point of care clinic are Autologous Cells that we take from your own body.  These cells are taken from your own Bone Marrow or Fat Cells.  The cells are your own Stem Cells and will not be rejected by your body.

Taking the Bone Marrow or Fat Cells from your body is relatively painless as a mild local anesthetic is used prior to harvesting.  These cells are processed to receive the most stem cell gain and then injected into the area of your body where you need the growth factors to go to work the quickest.  Your blood is also drawn and your platelet rich plasma is added to the Stem Cells taken from your Bone Marrow or Fat Cells to increase the activity of the growth factors.

It is important that these cells are used the day they are extracted from your body in order to insure they remain alive and active.  Our clinic does not grow extra stem cells from your Bone Marrow or Fat Cells to ensure that they are alive and active.  It is an FDA requirement that you receive your cells the same day they are harvested.

You get only the stem cells we extract from your body and there is no other manipulation used except extraction and preparation of the samples taken from your own body.  The cells are taken in a procedure that creates only mild discomfort or none at all.  Ninety nine percent of our patients experience no pain obtaining bone marrow or fat cells.

CORD STEM CELLS:

Embryo and Placenta stem cells can create certain types of cancers.  The cord blood Stem Cells should only be used if they are obtained from a healthy relative and you are a good match.  Cord Stem Cells that are used outside of the country or shipped to this country are illegal.  The FDA has found diseases in these grown cells and states that most of them are dead.  Even though the physicians supplying these Cord Cells claim they are safe to use, you should use extreme caution before considering these procedures.

ARE YOU A CANDIDATE FOR THESE STEM CELL PROCEDURES

REBUILDING JOINTS & SPINE: The Stem Cells that are obtained from your body are placed into all joints and spine to rebuild and regenerate new tissue growth as determined by the clinic physician.   There has been clinical evidence that new cartilage can be grown within your joint provided you are determined a candidate by the clinical physician.  Not all patients will be a candidate and may require joint replacement.

TORN TENDONS:  If the patients tendons are not completely torn this procedure will produce new tissue growth to regenerate torn tendons. Our clinic physician can only determine this with an initial visit and evaluation.

How Does PRP Therapy Work?

To prepare PRP, a small amount of blood is taken from the patient. The blood is then placed in a centrifuge. The centrifuge spins and through a multi-functional process separates the plasma from the blood producing the PRP. This increases the concentration of platelets and growth factors up to 500% also increasing hMSC (human stem cells) proliferation as a function of 8-day exposure to platelet released concentrations 10x. (x= increase above native levels)

When PRP is injected into the damaged area it stimulates the tendon or ligament causing mild inflammation that triggers the healing cascade. As a result new collagen begins to develop. As this collagen matures it begins to shrink causing the tightening and strengthening of the tendons and ligaments of the damaged area.

What is Platelet Rich Plasma?

Platelet Rich Plasma or PRP is blood plasma with concentrated platelets. The concentrated platelets found in PRP include growth factors among the huge reservoirs of bioactive proteins that are vital to initiate and accelerate tissue repair and regeneration. These bioactive proteins increase stem cell production to initiate connective tissue healing, bone regeneration and repair, promote development of new blood vessels and stimulate the wound healing process.

PRP Regenerates Tendons & Ligaments

Tendons connect the muscle to the bone making it possible for you to do many everyday physical activities. Overuse or damage to the tendon over a long period of time causes the collagen fibers in the tendons to form small tears, a condition called tendonitis. Damage to tendons most often occurs in the knees, ankles, hips, spine, elbows, shoulders, and wrists.

Ligaments are composed of collagen fibers that hold one bone to another, stabilizing the joint and controlling the range of motion. When a ligament is damaged, it is no longer able to support the bones in the joint, which often leads to pain symptoms. The instability causing the pain in your joints does not always show up on high tech imaging equipment. Through a thorough neurological and orthopedic evaluation Dr. Baum can determine which ligaments and tendons are unstable due to injury, wear or tear.

Tendons and ligaments have a poor blood supply and they do not usually heal from damage. Combined with the stress of day-to-day activities tendons and ligaments become inefficient causing degeneration of the joint which leads to chronic pain and weakness. Patients who experience chronic pain may not even remember when the injury occurred.

How Does PRP Compare With Cortisone Shots?

Studies have shown that cortisone injections may actually weaken tissue. Cortisone shots may provide temporary relief and stop inflammation, but may not provide long term healing. PRP therapy is healing and strengthening these tendons and ligaments and in some cases thickening the tissue up to 40%.

Treatment Plan

PRP injections with guided ultrasound can be performed on tendons and ligaments all over the body. Cervical, thoracic and lumbar spine, degenerative disc disease, arthritic joints shoulder pain, hip pain, and knee pain, even the smaller joints of the body can all be treated effectively with PRP. Dr. Baum will determine whether prolo solution, Platelet Rich Plasma or a combination of both will be the most effective form of treatment for you during his initial consult and evaluation.

Frequency Of Treatments

While responses to treatment vary, most people will require 3 to 6 sets of injections of PRP. Each set of treatments is spaced 4 to 6 weeks apart.

Is PRP Right For Me?

If you have degenerative spine or joint disease, a tendon or ligament injury, laxity or tear and traditional methods have not provided relief then PRP therapy may be the solution. It will heal tissue with minimal or no scarring and alleviates further degeneration and builds new tissues. There will be an initial evaluation with Dr. Baum to see if PRP therapy is right for you.

What Can Be Treated?

Platelet Rich Plasma injections helps regenerate all areas of the body including the cervical, thoracic and lumbar spine, wrists, elbows, shoulders, hips, knees and ankles as well as tendons and ligaments all over the body.  Dr. Baum is one of the few physicians performing PRP procedures to all areas of the spine.  Our clinic treats patients with sports injuries, arthritic and degenerative joints and degenerative disc disease. More specific injuries including tennis elbow, carpal tunnel syndrome, scoliosis, ACL tears, shin splints, rotator cuff tears, plantar faciitis and iliotibial band syndrome may all be effectively treated with PRP.

What Are The Potential Benefits?

Patients can see a significant improvement in symptoms as well as a remarkable return of function. This may eliminate the need for more aggressive treatments such as long-term medication or surgery.

Special Instructions

You are restricted from the use of non-steroid anti-inflammatory medications (NSAIDs) one week prior to the procedure and throughout the course of treatments.

Initially the procedure may cause some localized soreness and discomfort. Most patients only require some extra-strength Tylenol to help with the pain. Ice and heat may be applied to the area as needed.

How Soon Can I Go Back Regular Activities?

PRP therapy helps regenerate tendons and ligaments but it is not a quick fix. This therapy is stimulating the growth of new tissue requiring time and rehabilitation. Under Dr. Baum’s supervision patients will begin an exercise program immediately following the first procedure. During the treatment program most people are able to resume normal activities and exercise.

Platelet Rich Plasma (PRP) Matrix Graft by David Crane, MD and Peter A.M. Everts PhD

PRP application techniques in musculoskeletal medicine utilize the concentrated healing components of a patient’s own blood—reintroduced into a specific site—to regenerate tissue and speed the healing process

PRP INJECTION APPLICATION SITES

Spine

Cervical/Thoracic/Lumbar/Sacral

Shoulders & Elbows

Wrist & Hand

Hip/Pelvis

Knee & Lower Leg

Ankle & Foot

Fingers & Toes

Arthritic Joints

Osteoarthritis

Some Osteonecrosis

 

Information

http://www.prolotherapy.com/PPM_JanFeb2008_Crane_PRP.pdf

https://drjamesbaum.com/wp-content/uploads/stemcells2002-0109.pdf

 

Important Videos Everyone Should watch on Biologics

https://drjamesbaum.com/2013/07/the-science-of-mesenchymal-stem-cells-and-regenerative-medicine/

 

Scientific Papers on Research of Stem Cells

https://drjamesbaum.com/stem-cells/scientific-papers/

knnz

I will be posting this in my other blog section also

Tired of Doctors? I am also.

If you are like me,your sick of seeing doctors , some see so many my heart breaks for them, pcp, orthos, hematologist, cardiologists, pain management, endocrinologist dentists, optometrist whatever it just gets tiring. then you might get so nervous at your appointment you forget to ask specific questions.

Or maybe your anxiety has gotten you to a place where your heart is beating out of your chest, and your voice quivers or you just become blank.

Either way, having a list of things you mean to ask will help not only you but your doctor be able to better communicate.

So here we go:

1. What is the exact name of whatever is wrong with me? 1a if Osteonecrosis what stage is it? 1-2-3-4-5-5a-6

2. Is this something that is treatable and may possibly go away, or heal on its own or is this something that is chronic?

3. What are the short-term and long-term prognoses?

4. What are the short-term and long-term goals with treatment?

Example : Prp injections- physical therapy- hyperbaric oxygen-water therapy- stem cell treatments- joint replacement .

5. Is this something that genetically I can pass down to my child(ren)?

5a. Will you check me for underlying clot issue like Factor V Leiden-MTHFR-eNOS

6. What do you recommend as far as treatment?

7. What are the medications you recommend? I heard and read statins like Zocor and Lipitor can help lower lipids (fat) in the blood which can help blood flow better. I personally took simvastatin for 6 m and it helped me. I also during that time changed how I ate to consume less fatty meat cheeses etc

To lower my cholesterol on my own and I must say I am grateful I tried this.

Not only do I love eating REAL food but my blood work shows fantastic results and my pain is less.

So it’s good to talk to your doctor about this stuff also. Of course your doctor is not a specialist in nutrition which is kinda sad , you’d think they would teach that in medical school. But a good plant based diet was a great change for me.

 

8. How will this condition and/or medications affect my life?

9. Is there a specialist I can see? So I may try to avoid a joint replacement?

10. Will this condition or medications affect my ability to exercise? Walk-Bike- Swim.

Will this be temporary?

11. Is there a special diet that might ease symptoms or improve this condition?

For me personally it is plant based. I will eat meat (beef) rarely . Chicken or fish 1x a week but I am all about plant based.

My pain is lessened by over 60percent. I still have pain I’m not cured but I’m not in constant misery anymore. I rarely take a pain pill.

Never start or stop anything without talking to your doctor.

As always, if you have any concerns about your health, it’s always best to consult your primary care physician.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

 

Specific Questions To Ask Your Otho

What stage is osteonecrosis?
Will I be checked to make sure it also is not affecting other joints since I have pain in other bones/joints?
What is your treatment plan for Osteonecrosis ?
Why is this procedure being recommended? Are there alternatives?
What are the benefits of this procedure in terms of pain relief, functioning/mobility? How long will the benefit last?
What are the risks involved?
What is the success rate for this procedure?
What is the procedure called? How is it done?
How many patients with osteonecrosis do you see a year?
If Surgery Will this surgery solve the problem? Will any more surgery be required in the future?
How many of these procedures are annually performed at this hospital?
How many patients with osteonecrosis do you see a year?
What percentage of patients improve following the procedure?
What will happen if I don’t have the surgery now?
If I want a second opinion, whom can I consult?
Will I need any tests or medical evaluations prior to the surgery?
What kind of anesthesia will be used?
Are there possible after effects or risks?
Will I meet with the anesthesiologist in advance? Will her or she know my needs/allergies?
What kind of implant or prosthesis will be used? What are the outcomes using this device?
How long will it last?
Will I have pain following the procedure? What pain relief or pain control measures will I be given?
How long will the recovery take? What are my limitations during recovery?
Will I need assistance at home afterwards? For how long?
What will discharge instructions be?
Will I have any disability following surgery? Will I need physical therapy?
When can I return to work? When can I drive my car? When can I have sexual activity?
Are there any materials about this surgery that I can review?
What will I have for pain management?
Are their any patients I can ask about their experience?

 

Here is some info you may be interested in.

Clinical Trials

Atorvastatin to Prevent Avascular Necrosis of Bone in Steroid Treated Exacerbated Systemic Lupus Erythematosus

https://clinicaltrials.gov/ct2/show/NCT00412841

Statin therapy decreases the risk of osteonecrosis in patients receiving steroids.

https://www.ncbi.nlm.nih.gov/m/pubmed/11347831/

Aseptic osteonecrosis of the hip in the adult: current evidence on conservative treatment

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4832407/

Steinberg Stages Of Osteonecrosis-Avascular Necrosis

Steinberg Staging Of Avascular Necrosis/ Osteonecrosis

History and etymology

It is based on the radiographic appearance and location of lesion. It primarily differs from the other systems by quantifying the involvement of femoral head which allows direct comparison between series1. Seven stages of involvement are identified. Following staging, extent of involvement of femoral head is recorded as mild, moderate or severe.

Classification

stage 0: normal or non-diagnostic radiographs, MRI and bone scan of at risk hip (often contralateral hip involved, or patient has risk factors and hip pain)

stage I: normal radiograph, abnormal bone scan and/or MRI

stage II: cystic and sclerotic radiographic changes

stage III: subchondral lucency or crescent sign

stage IV: flattening of femoral head, with depression graded into

mild: <2 mm

moderate: 2-4 mm

severe: >4 mm

stage V: joint space narrowing with or without acetabular involvement

stage VI: advanced degenerative changes

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

B, moderate: 15% to 30%

C, severe: >30%

stage III

A, mild: subchondral collapse (crescent) beneath <15% of articular surface

B, moderate: crescent beneath 15% to 30%

C, severe: crescent beneath >30%

stage IV

A, mild: <15% of surface has collapsed and depression is <2mm

B, moderate: 15% to 30% collapsed or 2 to 4mm depression

C, severe: >30% collapsed or >4mm depression

stage V

A, B or C: average of femoral head involvement, as determined in stage IV, and estimated acetabular involvement.

Steinberg Staging Osteonecrosis

See also

Avascular Necrosis Of The Hip

Fixated and Arlet Staging

Legg-Calvé Perthes Disease

AVN CharityUK

References

1. Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg Br. 1995;77 (1): 34-41. Pubmed citation

Terminology

Medical Definition of Avascular necrosis

Avascular necrosis: A condition in which poor blood supply to an area of bone leads to bone death. Abbreviated AVN. Also known as aseptic necrosis and osteonecrosis.

 

 

avascular necrosis Death of a tissue, especially bone, as a result of deprivation of its blood supply. Avascular necrosis of bone is often referred to as osteonecrosis.

 

 

Medical Definition of avascular

: having few or no blood vessels the lens is a very avascular structure avascular necrosis

Necrosis is

The death of cells, tissues, or organs. Necrosis may be caused by insufficient blood supply, pathogenic microorganisms, physical agents such as trauma.

superficial necrosis

Necrosis affecting only the outer layers of bone or any tissue.

coagulation necrosis

Also found in: Dictionary, Thesaurus, Legal, Encyclopedia.

Related to coagulation necrosis: coagulative, liquefaction necrosis, Necrotic tissue

necrosis [nĕ-kro´sis, ne-kro´sis] (Gr.)

the morphological changes indicative of cell death caused by enzymatic degradation.

aseptic necrosis necrosis without infection or inflammation.

central necrosis necrosis affecting the central portion of an affected bone, cell, or lobule of the liver.

Links

 

Glossary of terms used in  Avascular Necrosis –Osteonecrosis

Acetabulum – In the pelvis the hip socket is called the acetabulum and forms a deep cup that surrounds the ball or femoral head of the upper thigh bone.

 

Acute pain – Pain that is rapid to develop, and for a shorter duration than Chronic pain.

Ref – Wikipedia

 

Analgesic – A member of a group of drugs to give relief from pain.

 

Arthroplasty – Surgical repair of  joint., also referred to as joint replacement. The affected bone is removed and replaced with an artificial joint. This treatment may be needed in the late stages of AVN, or when a joint has collapsed.

 

Articular cartilage – White smooth tissue that covers the ends of bones in joints. It enables bones in a joint to glide over one another with very little friction, allowing easy movement. See Cartilage

 

Aseptic Necrosis – Another name for Avascular Necrosis or Osteonecrosis.

 

Asymptomatic – A disease is considered Asymptomatic if a patent is a carrier for a disease or infection but experiences no symptoms. A condition might be considered Asymptomatic if it fails to show the noticeable symptoms of which it is usually associated. The term clinically silent is also used.

 

Atherosclerosis – Condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol.

Ref – Wikipedia

 

Avascular – Having few or no blood cells.

Ref – Encyclopaedia Britannica

 

Bone Marrow Edema – Only cited since 1988 after the introduction of MRI scans – is bruising of the bone or additional fluid (water) content in the bone marrow. This condition often accompanies avascular necrosis. On the MRI image it is shown as light areas of the bone which should be seen as dark.

 

Bone Infarct – Bone Infarct is another name for osteonecrosis . It’s a more descriptive term for what has happened, a blockage of blood circulation leading to the death of part of the bone.

 

Bilaterally –  avascular necrosis  in both sides -in both hips, or both knees etc.

 

BRONJ – Biphosphonate-Related OsteoNecrosis of the Jaw (BRONJ). This usually only occurs in people receiving high dose intravenous biphosphonate injections for bone cancers, and is often associated with a dental operation. If taking biphosphonates it is important to inform your dentist and to take extra care with dental hygiene.

 

Cartilage – Flexible tissue between the joint bones. It is not as hard and rigid as bone, but is stiffer and less flexible than muscle.

 

Caisson disease – Name given to a variety of symptoms suffered by a person exposed to a reduction in the pressure surrounding their body. Typically it occurs when a person subjected to great atmospheric pressure suddenly has that pressure removed – as when a scuba diver returns rapidly to the surface after a long submerged period.  Also known as Barotrauma.

 

Chronic pain – This is pain that has lasted for a long time, the distinction between acute and chronic pain has traditionally been determined as Acute pain lasts for 30 days while Chronic pain last much longer.

 

Condyle – Smooth surface area at the end of a bone forming part of a joint with another bone.

 

Corticosteroid – Corticosteroids, more often known as steroids, are an anti-inflammatory medicine prescribed for a wide range of conditions.

Diabetes – A group of diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of frequent urination, increased thirst and increased hunger.

 

Diaphysis – Shaft of the bone.

 

Distal – The more (or most) distant of two (or more) things. For example, the distal end of the femur (the thigh bone) is the end down by the knee; the end more distant from the torso.

 

Ellipsoidal – Joint that can move in two planes, example wrist and ankle.

 

Endothelial NOS (eNOS), also known as nitric oxide synthase 3 (NOS3) or constitutive NOS (cNOS), is an enzyme that in humans is encoded by the NOS3 gene located in the 7q35-7q36 region of chromosome 7.[5] This enzyme is one of three isoforms that synthesize nitric oxide (NO), a small gaseous and lipophilic molecule that participates in several biological processes.[6][7] The other isoforms include neuronal nitric oxide synthase (nNOS), which is constitutively expressed in specific neurons of the brain[8] and inducible nitric oxide synthase (iNOS), whose expression is typically induced in inflammatory diseases.[9] eNOS is primarily responsible for the generation of NO in the vascular endothelium,[10] a monolayer of flat cells lining the interior surface of blood vessels, at the interface between circulating blood in the lumen and the remainder of the vessel wall.[11] NO produced by eNOS in the vascular endothelium plays crucial roles in regulating vascular tone, cellular proliferation, leukocyte adhesion, and platelet aggregation.[12] Therefore, a functional eNOS is essential for a healthy cardiovascular system.

 

Epiphysis – Ends of the bone.

 

Factor V (pronounced factor five) is a protein of the coagulation system, rarely referred to as proaccelerin or labile factor. In contrast to most other coagulation factors, it is not enzymatically active but functions as a cofactor. Deficiency leads to predisposition for hemorrhage, while some mutations (most notably factor V Leiden) predispose for thrombosis.

Factor VIII (FVIII) is an essential blood-clotting protein, also known as anti-hemophilic factor (AHF). In humans, factor VIII is encoded by the F8 gene. Defects in this gene result in hemophilia A, a recessive X-linked coagulation disorder

 

Femoral head – The ball at the upper end of the thigh bone that sits inside the hip socket or acetabulum.

 

Gaucher’s disease – A disease in which a fatty substance accumulates in cells and certain organs. Symptoms may include enlarged spleen and liver, liver malfunction, skeletal disorders and bone lesions that may be painful, severe neurologic complications, swelling of lymph nodes and (occasionally) adjacent joints, distended abdomen, a brownish tint to the skin, anemia, low blood platelets and yellow fatty deposits on the white of the eye. Persons affected most seriously may also be more susceptible to infection.

 

Gout – Condition usually characterized by recurrent attacks of acute inflammatory arthritis – a red, tender, hot, swollen joint. The joint at the base of the big toe is the most commonly affected (approximately 50% of cases). It is caused by elevated levels of uric acid in the blood which crystallizes, and the crystals are deposited in joints, tendons, and surrounding tissues.

Idiopathic – An adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause.

In Greek; Idios translates to one’s own and Pathic translates to suffering or disease; so together becomes “a disease of it’s own” or “it comes from nothing” and medical jargon for “we don’t know what the cause is”.

 

Infarct – Bone infarct is another name for AVN. It’s a more descriptive term for what has happened, a blockage of blood circulation leading to the death of part of the bone.

 

Ischemic – Restriction in blood supply to tissue, causing a shortage of oxygen and glucose needed to keep tissue alive.

 

Legg Perthes disease – Avascular Necrosis in young children and can lead to Osteoarthritis in adults, also known as Calve Perthes or Perthes Disease

 

Lesions – Any abnormality in the tissue of an organism, for AVN we mean the bone structure at the joint site has started to break away. Usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.

 

Ligaments – Fibrous tissue that connects bones to other bones.

 

Medial Condyle – Inner side of the lower extremity of the femur (thigh), see Condyle.

 

MRI – Magnetic Resonance Imaging, is a medical imaging technique used in radiology to visualise internal structures of the body in detail. MRI makes the use of the property of nuclear magnetic resonance (NMR) to image nuclei of atoms inside the body.

 

MRI provides good contrast images between the different soft tissues inside the body, which makes it especially useful in imaging the brain, muscles, heart and cancers; compared with other medical imaging techniques such as computed tomography (CT) or X-rays. Unlike CT scans or traditional X-rays, MRI does not use ionizing radiation.

 

MTHFR is an enzyme that adds a methyl group to folic acid to make it usable by the body. The MTHFR gene produces this enzyme that is necessary for properly using vitamin B9. This enzyme is also important for converting homocysteine into methionine, which the body needs for proper metabolism and muscle growth and which is needed for glutathione creation . The process of methylation also involves the enzyme from the MTHFR gene, so those with a mutation may have trouble effectively eliminating toxins from the body.

 

 

Multifocal – Having many focal points. With regard to avascular necrosis AVN it means that it has affected many different joints in the body,. For example the hips, shoulders, knees and jaw.

 

Multilateral – Having many focal points. With regard to avascular necrosis AVN it means that it has affected many different joints in the body,. For example the hips, shoulders, knees and jaw.

 

Necrosis – Death of living tissue.

 

Oedema – also known as edema – Bone marrow oedema occurs when excess fluid build up in the bone marrow and causes swelling. Caused by the bodies reaction to a trauma or other condition. Symptoms are pain and/or swelling at the bone site.

 

Osteoarthritis –  degradation of a joint from partial loss of cartilage and damage to the bone joint surface.

 

Osteonecrosis – Another name for Avascular Necrosis.

 

Osteoradionecrosis ORN – Another name for Avascular Necrosis caused by radiotherapy.

 

Osteopenia – Condition where bone mineral density is lower than normal. It is considered by many doctors to be a precursor to osteoporosis. However, not every person diagnosed with osteopenia will develop osteoporosis.

 

Osteophytes – Commonly referred to as bone spurs, they are bony projections that form along the joint margins.

 

Osteoporosis – Condition of fragile bones.

 

Osteotomy – Osteotomy surgery involves cutting and re-aligning the bone (usually shin bone/tibia) in order to re-distribute the weight going through the knee. Re-alignement can be achieved by either taking a slice of bone out of the tibia (shin bone) or femur (thigh bone) close to the knee joint (closing wedge) or opening a gap in the bone (opening wedge).

A hip osteotomy is a surgical procedure in which the bones of the hip joint are cut, reoriented, and fixed in a new position. Healthy cartilage is placed in the weight-bearing area of the joint, followed by reconstruction of the joint in a more normal position.

 

Perthes disease – Avascular Necrosis (AVN) in young children and can lead to Osteoarthritis in adults also known as Legg Calve Perthes or Calve Perthes Disease.

 

Sacrum – Large triangular bone at the base of the spine and at the upper and back part of the pelvic cavity.

 

Sagittal – Imaginary line, used in MRI scans.

 

Sclerosis – Osteosclerosis, condition where bone density is significantly increased.

 

Sickle cell disease Sickle cell disease is a group of disorders that affects haemoglobin, the molecule in red blood cells that delivers oxygen to cells throughout the body. People with this disorder have atypical haemoglobin molecules called haemoglobin S, which can distort red blood cells into a sickle, or crescent, shape.

 

Signs and symptoms of sickle cell disease usually begin in early childhood. Characteristic features of this disorder include a low number of red blood cells (anaemia), repeated infections, and periodic episodes of pain. The severity of symptoms varies from person to person. Some people have mild symptoms, while others are frequently hospitalised for more serious complications.

 

SPONK – SPontaneous OsteoNecrosis of the Knee, a type of AVN or osteonecrosis specifically of the knee, either femur or tibia, and spontaneous means it occurred without an obvious cause

 

Subchondral – Below the cartilage.

 

Systemic lupus erythematosus – (SLE), often known just as lupus, is an autoimmune disease where your immune system produces antibodies that attack your body’s own tissues, causing inflammation. Lupus usually affects your skin and joints, but it may also involve your heart or kidneys, when the effects can be severe. SLE isn’t the same as discoid lupus, which only affects the skin.

 

Synovial – Synovial tissue is found around the tendons (bands of fibre that connect muscle to bone), and can form bursa (fluid filled cushioning pouches or sacs found in spaces between tendons, ligaments and bones) found in the area of joints.

 

Synovial fluid is the clear, viscid, lubricating fluid secreted by synovial membranes.

Ref – Synovial Sarcoma Survivors Network

 

Trabecular – The inner part of the bone. The spongy bone, as it is frequently called, is highly vascular and is responsible for blood cell production. The trabecula bone contains the red bone marrow that is responsible for this blood cell production.

Ref – Trabeclularbone.org

 

UKR – Unicompartmental Knee Replacement, or partial knee replacement.

 

Vertebrae – The Vertebral Column (Spinal Column) supports the head and encloses the spinal cord.

 

The spinal column is comprised of 26 individual bones, these bones are referred to as vertebrae. The spinal column is divided into five (5) different areas containing groups of vertebrae, and are grouped as follows:

 

Seven (7) Cervical vertebrae in the neck.

 

Twelve (12) Thoracic vertebrae in the upper back corresponding to each pair of ribs.

 

Five (5) Lumbar vertebrae in the lower back.

 

Five (5) Sacral vertebrae which are fused together to form 1 bone called the sacrum.

 

Four (4) Coccygeal vertebrae that are fused together to form the coccyx or tailbone.

 

 

X-Ray – A form of radiation that can pass through solid and semi-solid substances. In carefully controlled doses, they can be used to capture images of the body’s internal structures.X-ray is a safe and painless procedure often used to produce images of the inside of the body.

It is a very effective way of looking at fractured bones, such as a broken arm or wrist.

An X-ray can also be used to examine organs and identify problems. For example, an X-ray will show up an infection in your lungs, such as pneumonia.

X-rays are also often used during therapeutic procedures, such as a coronary angioplasty, to help the surgeon guide equipment to the area being treated.

AVN is not always seen on an Xray

 

 

term

 

 

Non -Surgical Treatment’s of Avascular Necrosis – Osteonecrosis

Non -Surgical Treatment s of Avascular Necrosis – Osteonecrosis

If osteonecrosis is diagnosed while damage is limited to a small area of bone sometimes doctors can try PRP injections, A2M injections, or Stem cell injections which is said to be the gold standard of injections.

I will get into those treatment options another day . And it may also be effective in up to stage 3 of AVN-ON but the faster you get it treated the better the outcome. It also depends on how you got your avn that will determine the outcome.

Let’s be real here

Avascular Necrosis –Osteonecrosis can be incredibly painful. And only those who have it understand the pain.

Medication to treat osteonecrosis may not be effective in people who have medical conditions that require treatment using corticosteroids, immunosuppressant medications, or chemotherapy. These medications may counteract osteonecrosis treatment.

During treatment with medication to stop the progression of osteonecrosis, your doctor monitors bone damage by taking periodic images of the affected bone for six months to a year or more. Some doctors may also recommend using crutches or a brace to remove stress from the affected bones.

As the bone starts to heal, physical therapy can help you maintain joint mobility, strengthen muscle groups that support the joint, and make changes to the way you walk to protect the affected bones.  If the disease does not progress and putting weight on the joint becomes less painful, nonsurgical treatment may be all that is needed to recover from osteonecrosis.

Bisphosphonates

Bisphosphonates are prescription medications that reduce bone loss by destroying cells that contribute to the degeneration of bone. This helps preserve healthy bone tissue.

Your doctor may recommend that you take this medication by mouth or injection for six months or more, depending on the size of the osteonecrosis lesion or lesions and whether symptoms improve during the first six months. If an injected form of medication is prescribed, your doctor may give the injection in his or her office or show you how to administer your injections at home. Some bisphosphonates are taken by mouth or injection once a week or once a month, others less frequently.

Your doctor will continue to evaluate the effectiveness of treatment, using periodic X-rays or MRI that can reveal changes in the bone’s health. The doctor also looks for signs of side effects from bisphosphonates, which may include bone fractures outside the affected joint, and conducts regular blood tests.

Long-term use of bisphosphonates should be monitored by your doctor.  And also may cause avn-on in jaw if you need on going dental work.

Nonsteroidal Anti-inflammatory Drugs

Bone loss due to osteonecrosis may be painful, especially in the hip and knee joints, which bear much of the body’s weight. Nonsteroidal anti-inflammatory drugs, or NSAIDs, sometimes work by reducing inflammation in the soft tissues surrounding the joint, relieving pain and swelling. These over-the-counter pain relievers include ibuprofen, naproxen, and aspirin. It may help in the short term but again talk to your doctor.

Long-term use of NSAIDs can cause side effects, including upset stomach or ulcers. If joint pain persists for more than a month, talk to your doctor before continuing use.

Statins

Statins are medications that lower cholesterol levels by reducing the amount of fatty substances called lipids in the bloodstream. If statin’s remove lipids from blood vessels leading to a diseased bone, more blood can reach the bone, allowing it to rebuild bone tissue. This may slow or stop the progression of osteonecrosis.

Statins can cause liver abnormalities and muscle damage, so your doctor takes your overall health and medical history into consideration before prescribing them for long-term use.

Medical Marijuana

No other pain relieving medication is less toxic than cannabis, even aspirin or Tylenol. This is why cannabis as medicine can be an excellent choice for pain.  A proper cannabis recommendation requires more than just a few minutes of a doctor’s time, and includes information on cannabinoid content, strain selection, and delivery methods. If you’re not getting this information from your doctor, you’re not getting a real cannabis consultation and are missing information on the full value and healing potential of the plant. Cannabidiol, a nonpsychotropic component of marijuana, may enhance the healing process of bone fissures, according to a new study.

CBD oil is an entirely different compound, and its effects are very complex. It is not psychoactive, meaning it does not produce a “high” or change a person’s state of mind. Instead, it influences the body to use its own endocannabinoids more effectively and can ease pain.

Pain medication  

Most pain medications for bone cancer are taken by mouth, in pill or liquid form. If swallowing is difficult, pain medication can also be delivered through a patch placed on the skin, an injection,talk to your doctor or see a pain management specialist if needed . No one needs to suffer in pain

Physical Therapy

When prescribed in addition to medication, physical therapy may slow down the progression of osteonecrosis and provide some pain relief. During the early stages of treatment, if the disease has affected the hip or knee, physical may suggest using crutches or a cane to help you move around without putting any weight on the affected joint.

You may use crutches or a cane for six weeks or more, depending on your age, the location of the lesion, and the severity of the disease. This gives the lesions time to heal and may prevent further joint damage.

Rehabilitation experts also offer heat and ice therapy, which may provide temporary pain relief deep within the joint, as well as acupuncture and acupressure, in which very thin needles or massage are used to stimulate blood flow and reduce inflammation.

After you can put weight on the affected joint without pain, physical therapists can customize a routine of simple, low-impact exercises to maintain range of motion in the affected joint as well as build strength in muscles that surround and support the joint. For example, stretching exercises and movements such as leg lifts or squats can prevent the joint from becoming stiff.

In addition, adding exercise such as tai chi or  or my favorite is  qi gong ,  or using a stationary  or recumbent bike  another favorite of mine or add swimming to your regular workout routine can help you maintain flexibility in the joints without putting too much stress on the bones. These exercises may prevent the disease from limiting your ability to walk and participate in everyday activities. They also improve blood flow throughout the body, which may help the bone heal more quickly.

A physical therapist can also help you alter the way you walk to avoid limping or putting too much stress on the affected joint. This helps ensure that you are able to use the joint without feeling pain for the long term.

The duration of physical therapy varies depending on the location of a lesion and how quickly your body responds to medication and physical therapy. After four to eight weeks, your therapist and physician assess your progress and determine whether additional treatment is required.

The most important thing you can do is have a good ortho , talk to him or her openly and honestly about your condition, your pain, your limitations etc…. together you can work together to find the best treatment plan for you . And also remember if you are unsatisfied you can always get a second opinion and or new ortho.

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