Maintaining Angiogenesis Can Prevent Glucocorticoid Induced Osteonecrosis

Angiogenesis is a key component of bone repair. … Angiogenesis is regulated by a variety of growth factors, notably vascular endothelial growth factor (VEGF), which are produced by inflammatory cells and stromal cells to induce blood vessel in-growth.

Wouldn’t it be great if there wa a way many could keep their blood vessels healthy and avoid or lower risk of developing Osteonecrosis?

Research and links below discuss just that.

#angiogenesis and bone repair in steroid-induced osteonecrosis

#Osteonecrosis #AvascularNecrosis

Links

Angiogenesis in Bone Regeneration What It Is

Angiogenesis and Bone Repair For Osteonecrosis Info and Links

Maintaining Angiogenesis Prevents Glucocorticoid Induced Osteonecrosis

Genetic association of angiogenesis- and hypoxia-related gene polymorphisms with osteonecrosis of the femoral head

How people can develop Osteonecrosis in Jaw.

Link below.

Osteonecrosis of the Jaw and Angiogenesis inhibitors: A Revival of a Rare but Serous Side Effect.

Photo credit and website listed below.

Bringing new life to damaged bone: The importance of angiogenesis in bone repair and regeneration photo linked to this site

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

You won’t keep me down

Osteonecrosis can be painful you never know when the pain will come or go.

But I do know it’s already taken my job away from me.

I love the optical field. But the pain was too intense.

Well I’m back in school learning something new.

#YourNeverToOldToLearn

Avascular Necrosis Doctors Listed By State for USA

Avascular Necrosis Doctors Listed By State for USA
Copyright©Debla by Deborah Andio 2015

Alabama.

Alabama Orthopaedic Surgeons
F. Spain Hodges, M.D.
Jason D. Cobb, M.D.
Donald H. Slappey, Jr., M.D.
52 Medical Park East Drive
Suite 220, Birmingham, AL 35235
Phone: 205-838-4747
Fax: 205-838-2712 | 205-838-4510

Jeffrey Wade, M.D.
Kenneth Jaffe, M.D
Robert Sorrell, M.D
3525 Independence Dr
Homewood, AL 35209
Tel 205.802.6700
Fax 205.802.6701

Andrews Sports Medicine & Orthopaedic Center Physicians
James R. Andrews, M.D.
E. Lyle Cain, Jr., M.D.
Emily Bell Casey, M.D.
Andrew M. Cordover, M.D., MS
Ricardo E. Colberg, M.D.
Jeffrey C. Davis, M.D.
Jeffrey R. Dugas, M.D.
Benton Allen Emblom, M.D.
James Adam Flanagan Jr., M.D.,FAAOS
Samuel R. Goldstein M.D., FAAOS
B. Wayne McGough, Jr., M.D.
Kathleen E. McKeon, M.D.
Cherie B. Miner, M.D.
Steven R. Nichols, M.D.
Jose (Jody) O. Ortega, M.D.
Norman E. Waldrop, III, M.D.
805 St. Vincent’s Drive, Suite 100 – Birmingham, AL 35205
2217 Decatur Highway, Suite 101 – Gardendale, AL 35071
201 Doug Baker Boulevard – Hoover, AL 35242
3143 Pelham Parkway – Pelham, AL 35124
(205) 939-3699

Dr K.David Moore
UAB Hospital – Highlands
1201 11th Avenue South
Birmingham, AL 35205
205-934-9999
205-975-BONE (2663)

Alaska

Denali Orthopedic Surgery

Dr Gardner, Dr, Pace, Dr Ellison,Dr Clyde

Mat-Su Regional Medical Plaza
2490 S. Woodworth Loop
Suite 350
Palmer, Alaska 99645
All work with AVN
Tel: 907-745-2663
Fax: 907-745-2600

Denali Orthopedic Surgery specializes in orthopedic surgery. This includes such treatments as Total Joint Replacement, Arthroscopic surgery, and fractures. They treat all areas of the body, including hand, foot, knee, and shoulder, including the back, neck and spine.

Arizona

Phillip Bennion, M.D.
Brandon Gough, M.D
Jimmy Chow, M.D
Hedley Orthopaedic Institute & Mountain Vista Surgical Specialists
2122 E. Highland Ave. Suite 300
Phoenix, AZ 85016
Mountain Vista Surgical Specialists
10238 E. Hampton Ave. Suite 406
Mesa, AZ 85209

For Patient Appointments Call: (602) 553-3113

Arkansas

Arkansas Specialty Orthopaedics
600 S. McKinley
Little Rock, AR 72205
501.663.3647

Arkansas Specialty Orthopaedics
1525 Country Club Road
Sherwood, AR 72120
501.663.3647

California

Southern California Orthopedic Institute
2400 Bahamas Dr
Bakersfield, CA
(661) 328-5565
http://www.scoi.com/

Amir A. Jamali, MD, FACS
Sacramento Office
2825 J Street,#440
Sacramento, CA 95816
(916) 492-2110
Walnut Creek Office
130 La Casa Via, Bldg 3, Suite 111
Walnut Creek, CA 94598
(925) 322-2908
Fremont Office
39180 Farwell Dr.
Fremont, CA 94538
(510) 404-3727
http://www.jointpreservationinstitute.com/

Mauro Giordani, MD
4860 Y St #3800, Sacramento, CA 95817
(916) 734-2700

Mark Jo MD
10 Congress St.
#103
Pasadena, CA 91105
(626) 795-0281

Colorado

ROGER MURKEN
303-233-1223
TOPDOC2015
660 Golden Ridge Road, Suite 250
Golden, CO 80401
HONORED IN THESE SPECIALTIES:
2015 Orthopedic Surgery
HOSPITAL AFFILIATIONS:
Ortho Colorado, Littleton

ANDREW W. PARKER
303-321-6600
TOPDOC2015
4700 E. Hale Parkway, Suite 550
Denver, CO 80220
HONORED IN THESE SPECIALTIES:
2015 Orthopedic Sports Medicine
2015 Orthopedic Surgery
2014 Orthopedic Surgery
2014 Orthopedic Sports Medicine
2013 Orthopedic Sports Medicine
2013 Orthopedic Surgery

AMIT AGARWALA MD
303-233-1223
660 Golden Ridge Road, Suite 250
Golden, CO 80401
2008 Orthopedic Surgery
HOSPITAL AFFILIATIONS:
Lutheran, St. Anthony, 84th Avenue

Amer Mei-Dan MD
Assistant Professor Orthopedics
Clinic Phone: 303-441-2219 (Phone)
303-441-2230 (Fax)
Specialty: Orthopedic Sports Medicine
Location: Boulder – CU Sports Medicine – Specialty Clinic
311 Mapleton Avenue
Boulder, CO 80304
Cynthia Kelly, MD
1601 E 19th Avenue , Suite 3300
Denver, CO 80218
Phone: (303) 837-0072
Fax: (303) 837-0075

Connecticut

Dr. John Keggi
Dr. Robert Edward Kennon
3 Locations
Orthopaedics New England
Middlebury Office: 1579 Straits Turnpike
Middlebury, CT 06762
For Patient Appointments Call: 203-598-0700

Orthopaedics New England
New Milford Office: 11 Old Park Ln.
New Milford, CT 06776
For Patient Appointments Call: 203-598-0700

Orthopaedics New England
Orthopaedics New England – Hartford Office 399 Farmington, Ave.
Lower level-1 Farmington, CT 06032 Hartford Area Office
For Patient Appointments Call: 203-598-0700

Hip, Joint Replacement, Knee, Shoulder

Delaware

Andrew J. Gelman, MD
1096 Old Churchmans Road
Newark, DE 19713

For Patient Appointments Call: 302-655-9494

Specialties: Foot & Ankle, Fracture Care, Hand & Elbow, Hip, Joint Replacement, Knee, Shoulder, Sports Medicine, Forensic Orthopaedics

Florida
Orlando Orthopedic center
Orlando, Oviedo,Winter Park Florida
4072542500
3 locations
Hip Dr Jeffery Rosen MD

Knee Dr Jeffery Rosen MD

Talus Dr Joseph D. Funk, D.P.M.

Steven J Lalliss MD
5 Locations
1
Chimney Lakes
9560 Crosshill Blvd
Ste 110
Jacksonville, FL 32222
904-635-1901
2
Northeast Florida Orthopedics
7855 Argyle Forest Blvd
Suite 503
Jacksonville, FL 32244
904-635-1901
3
Northeast Florida Orthopedics
1679 Eagle Harbor Pkwy
Ste C
Fleming Island, FL 32003
904-635-1901
4
800 W Central Texas Expy
Suite 175
Harker Heights, TX 76548
254-618-1095
5
Riverside
2627 Riverside Ave
Jacksonville, FL 32204
904-634-0640

Jewett Orthopaedics 1285 Orange Ave Winter Park, FL 32789 Winter Park Fl 32789 United States

http://www.jewettortho.com/contact-us/

Harry Steinman MD
2 Locations
Ptak Ortho-Neuro Science Pavilion
430 Morton Plant St
Ste 301
Clearwater, FL 33756
727-461-6026
1526 Lakeview Rd
Clear water, FL 33756

David D Dore MD
Celebration Village
410 Celebration Pl
Ste 106
Kissimmee, FL 34747
407-303-4270
and
South Orange
Orlando Orthopedic Center
100 W Gore St
Ste 500
Orlando, FL 32806
407-254-2500

Orthopaedics and Sports Medicine Institute,
University of Florida
Dr Gray
Dr Scott Myers
3450 Hull Rd, Gainesville, FL 32607
Phone:(352) 273-7001

Dr Dennie
Sacred Heart Health System –
5151 N. Ninth Avenue – Pensacola, FL 32504 –
(850)-434-5770

Anthony Noble MD
4Locations
Botanica
Palm Beach Orthopedic Institute
2055 Military Trl
Ste 200
Jupiter, FL 33458
561-694-7776
2
Palm Beach Orthopedic Institute
1411 N Flagler Dr
Ste 9800
West Palm Beach, FL 33401
561-694-7776
3
Palm Beach Orthopedic Institute
10111 Forest Hill Blvd
Rm 231
Wellington, FL 33414
561-694-7776
4
Palm Beach Orthopedic Institute
4215 Burns Rd
Palm Beach Gardens, FL 33410
561-694-7776

Georgia

Nathan A. Jove, M.D
2801 N Decatur Rd Ste 200
Decatur, GA 30033
7705643393

Muariec Jove, M.D
2801 N Decatur Rd Ste 200
Decatur, GA 30033
7705643393

Hawaii

Peter Matsuura, MD
670 Ponahawai St. Suite 214
Hilo, Hawaii 96720

For Patient Appointments Call: 808-969-3331

shoulder, knee, hip, elbow, wrist, hand, ankle, foot, including: bones, joints, muscles, tendons and ligaments.

Robert Medoff, M.D
Stuart Wakatsuki, M.D
Linda Rasmussen, M.D
Kevin H. Higashigawa, MDWindward Orthopedics
Kailua Professional Center
30 Aulike Street
Suite 201
Kailua, HI 96734

For Patient Appointments Call: 808-261-4658
shoulder, knee, hip, elbow, wrist, hand, ankle, foot, including: bones, joints, muscles, tendons and ligaments.

Idaho

Joseph Bowen, MD
Coeur d alene – Bowen Orthopedic Clinic, 1296 E. Polston Avenue, Suite B
Post Falls, ID 83854

For Patient Appointments Call: 208-457-7075
shoulder, knee, hip, elbow, wrist, hand, ankle, foot, including: bones, joints, muscles, tendons and ligaments.

Illinois
 
Rush University Medical Center
1653 W. Congress Pkwy.
Chicago, IL 60612
Phone: (888) 352-7874

Genesis Orthopedics & Sports Medicine
2900 Foxfield Rd. Suite 102
St. Charles, IL 60174
Phone: (630) 377-1188
Fax: (630) 377-7360

Genesis on Facebook Genesis on Twitter Genesis on Google+ E-Mail Genesis

Dr. Shadid’s Office Hours

MON: 8:45 a.m.-5:00 p.m.
WED: 8:45 a.m.-12:00 p.m.
THU: 8:45 a.m.-5:00 p.m.

General Office Hours

MON: 8:45 a.m.-5:00 p.m.
TUE: 9:00 a.m.-3:00 p.m.
WED: 8:45 a.m.-3:00 p.m.
THU: 8:45 a.m.-5:00 p.m.
FRI: 9:00 a.m.-3:00 p.m.
Oakbrook Terrace Office

1 TransAm Plaza Dr. Suite 460
Oakbrook Terrace, IL 60183
Phone: (630) 377-1188
Fax: (630) 377-7360

Dr. Shadid’s Office Hours

WED: 1:30 p.m.-5:00 p.m.

Genesis Orthopedics & Sports Medicine
2900 Foxfield Rd. Suite 102
St. Charles, IL 60174
Phone: (630) 377-1188
Fax: (630) 377-7360

Oakbrook Terrace Office
1 TransAm Plaza Dr. Suite 460
Oakbrook Terrace, IL 60183
Phone: (630) 377-1188
Fax: (630) 377-7360
http://genesisortho.com

Richard A. Berger, M.D Hip & Knee Reconstruction and Replacement
John J. Fernandez, M.D. Hand ,Wrist & Elbow
George Holmes Jr M.D Foot & Ankle
Orthopedic Building at Rush University Medical Center
1611 West Harrison Street
Chicago, IL 60612
Toll free: 877 MD BONES (877.632.6637)
Phone: 312.243.4244
Fax: 708.409.5179

Rush Oak Park Hospital
610 South Maple Avenue, Suite 1550
Oak Park, IL 60304
Toll free: 877 MD BONES (877.632.6637)
Phone: 312.243.4244     Fax: 708.409.5179

Hand-Wrist -Elbow Shoulder- -Foot -Ankle
Central DuPage Hospital – Outpatient Services
Outpatient Services Building
Suite #505
25 North Winfield Road
Winfield, IL 60190
Toll free: 877 MD BONES (877.632.6637)
Phone: 630.682.5653
Fax: 708.409.5179

Prairie Medical Center of Westchester
2450 S. Wolf Road, Suite F, 2nd Floor
Westchester, IL 60154
Toll free: 877 MD BONES (877.632.6637)
Fax: 708.409.5179

Occupational Health Clinic
2450 S. Wolf Road, Suite I, 2nd floor
Westchester, IL 60154
Phone: 708.273.8400

Indiana Office
9200 Calumet Avenue
Munster, IN 46321
Toll free: 877 MD BONES (877.632.6637)
Opening October 2015!

Indiana

Joseph Koscielniak, MD
Orthopaedics Inc. of Indiana 5587 Broadway
Merrillville, IN 46410

For Patient Appointments Call: 219-884-3761

oint Replacement, Arthroscopic Joint Reconstruction, Sports Medicine, Upper Extremities, Joint Replacement, Spine Surgery, Hand Surgery, Arthroscopic Surgery

Iowa

Dr. Christopher E. Scott, MD
Dr. John C. Langland, MD
Dr. Brian P. Wills, MD
2751 Northgate Drive
Iowa City, IA 52245
(319) 338-3606 (Office)
(319) 338-0522 (Fax)

Dr. Lisa Coester, MD
202 10th St SE
Cedar Rapids, IA 52403
319-398-1500

Dr. Michael Hendricks
600 N Main St, Burlington, IA 52601 Show More
903 Oak St, Burlington, IA 5260
319-758-9133

Dr. Jeffrey Davick
6001 Westown Pkwy
West des Moines, IA 50266
515-224-1414

Kansas

Dr. Paul C. Pappademos, MD
2778 N Webb Rd
Wichita, KS 67226

(316) 247-6484
Dr. Mark C. Whitaker, MD
9300 E 29th St N Ste 205
Wichita, KS 67226 (316) 247-6484

Kentucky

Peter J Buecker MD

9 Locations
Poplar Level
3 Audubon Plaza Dr
Ste 430
Louisville, KY 40217
502-636-4900
2
Smoketown
Louisville Oncology
315 E Broadway
Louisville, KY 40202
502-629-2500
3
241 Atwood St
Suite 50
Corydon, IN 47112
812-738-4054
4
Jeffersonville
207 Sparks Ave
Ste 402
Jeffersonville, IN 47130
812-288-9969
5
Charlestown
2100 Market St
Ste 200
Charlestown, IN 47111
812-256-6351
6
115 Huston Dr
Suite 4
Shepherdsville, KY 40165
502-636-4900
7
East Louisville
3991 Dutchmans Ln
Ste 405
Louisville, KY 40207
502-899-3366
8
131 Stonecrest Rd
Shelbyville, KY 40065
502-633-7093
9
300 W John Fitch Ave
Suite 110
Bardstown, KY 40004
502-349-4617

Louisiana

Dr. Milan G. Mody, MD
7925 Youree Dr Ste 220
Shreveport, LA 71105
(318) 798-6700 (Office)

Dr. Jorge E. Isaza, MD
8080 Bluebonnet Blvd Ste 1000
Baton Rouge, LA 70810
(225) 341-7193

Dr. Peter C. Krause, MD
200 W Esplanade Ave Ste 500
Kenner, LA 7006
(504) 222-2717

Maine

Dr Adam Rana
Maine Medical Partners – Orthopedics & Sports Medicine
For Appointments Call:
(207) 781-1551
5 Bucknam Road, Suite 1D Falmouth, ME 04105

Maryland

Marc Hungerford, M.D. also was on Board of Directors of CORE
CENTER FOR OSTEONECROSIS RESEARCH & EDUCATION
Orthopedics and Joint Replacement
Board Certified: Orthopedic Surgery Specialties: Orthopedics and Joint Replacement, Orthopedics Areas of Interest: MAKOplasty, Anterior Hip Replacement, Hip and Knee Preservation, Reconstruction, and Revisions, Arthroscopy, Arthritis, Avascular Necrosis, Minimally Invasive Joint Replacement Languages Spoken: English Phone: 410-539-2227 Locations:

Mercy Downtown – McAuley Plaza
301 St. Paul Place
Baltimore, MD 21202
Lutherville Personal Physicians
1734 York Road
Lutherville, MD 21093
Personal Assistant is : Erica

Michael A. Mont, M.D.
10 Locations in MD
410-601-8500
http://www.lifebridgehealth.org/riao/riao.aspx#specialists

Harpal Paul Khanuja, M.D.
Chief, Adult Reconstruction – Hip and Knee Replacement
Associate Professor of Orthopaedic Surgery Specialty Osteonecrosis
Johns Hopkins at Green Spring Station
Appointment Phone: 443-997-2663
10755 Falls Road
Lutherville, MD 21093
Johns Hopkins Medicine – White Marsh
Appointment Phone: 443-997-2663

4924 Campbell Boulevard
Nottingham, MD 21236
Johns Hopkins Bayview Medical Center

Appointment Phone: 443-997-2663

4940 Eastern Avenue
Baltimore, MD 21224
The Johns Hopkins Hospital

Appointment Phone: 443-997-2663

600 N. Wolfe Street
Sheikh Zayed Tower
Baltimore, MD 21287

Dawn LaPorte, M.D Hand and wrist AVN
Johns Hopkins Outpatient Center
Appointment Phone: 443-997-2663
601 N. Caroline Street
Baltimore, MD 21287 map
Phone: 410-955-9663
Fax: 410-502-6816
Johns Hopkins Medicine – Green Spring Station
Appointment Phone: 443-997-2663

10753 Falls Road
Pavilion II
Baltimore, MD 21093 map
Phone: 410-955-3134
Fax: 410-502-6816

HAL S. CRANE MD
410-553-8170
now relocated to Maryland
HONORED IN THESE SPECIALTIES:
2007 Orthopedic Surgery
2006 Orthopedic Surgery
2005 Orthopedic Surgery
2004 Orthopedic Surgery

Massachusetts
Dr. Laurence D. Higgins
Orthopedic Surgeon
75 Francis St
Boston, MA, United States
02108
Brigham And Women’s Hospital
75 Francis Street
Boston, MA, United States
02115
phone 6177325500

Michigan

Advanced Orthopedic Specialists

Laith Farjo, MD: Specializing in sports medicine, shoulder and knee surgery, arthroscopy and general orthopedics.
Edward Loniewski, DO: Specializing in joint replacement, avascular necrosis, osteoporosis and general orthopedics.
Robert Mihalich, MD: Specializing in foot and ankle surgery and general orthopedics.

2305 Genoa Business Park, Suite 170
Brighton, Michigan
(810) 299-8550

DMC Orthopaedic Specialists offer the most advanced treatment for joint pain.

Specializes in in Osteonecrosis

DMC Huron Valley-Sinai
1 William Carls Drive
Commerce, MI 48382
DMC Detroit Receiving Hospital/University Health Center
4201 St. Antoine Blvd
Detroit, MI 48201
DMC Sinai-Grace Hospital
6071 W. Outer Drive
Detroit, MI 48235

Charles Christopher Sherry DO
Primary Office:
SHMG Musculoskeletal Orthopaedics/Sports Medicine
Suite 300, 4100 Lake Dr SE
Grand Rapids, MI 49546
Phone: (616) 267-8860
Fax: (616) 267-8442

Julian Kuz MD
1111 Leffingwell
Grand Rapids, MI 49525
616-459-7101

John Anderson MD Foot and Ankle

Donald Bohay MD, FACS

John Maskill MD
John Tanner, III MD
1111 Leffingwell Ave NE

Grand Rapids, MI 49525
616.459.7101

Minnesota

Jay F. Kruse, MD
Peter D. Holmberg, MD
Robin C. Crandall, MD
Jason A. Barry, MD
8290 University Ave NE, #200
MN
55432
Phone
763-786-9543
Fax
763-786-3320
****Jay F. Kruse, MD For Adults and Kids****
****Peter D. Holmberg, MD Adults and Kids****

ROBERT B. HARTMAN, MD
Twin Cities Orthopedics
BOARD CERTIFIED ORTHOPEDIC SURGEON
Minimally Invasive Surgery (Arthroscopy), Shoulder, Hip & Knee Surgery Specialist

Dr. Robert Hartman is committed to excellence by pledging to provide the highest quality of orthopaedic care possible.
Along with the treatment of immediate or chronic problems,
Dr. Hartman strives to integrate the doctrine of prevention in all of his treatment plans
as a way to alleviate possible future difficulties.
1000 West
140th Street, #201
Burnsville,MN 55337
(952) 808-3000 Fax(952) 808-3023

Mississippi

Bienville Orthopaedic Specialists
John K. Drake, M.D.
Harold M. Hawkins, M.D.
Charles J. Winters, M.D.
Alexander D. Blevens, M.D.
Robert E. Terrell, M.D.
Jeffrey D. Noblin, M.D.
Chris E. Wiggins, M.D.
George T. Salloum, M.D.
Eric D. Washington, M.D.
Donnis K. Harrison, M.D.
Henry T. Leis, M.D.
Yekaterina Karpitskaya, M.D.
Joel A. Tucker, M.D.
Daniel A. Wittersheim, M.D.
The largest provider of orthopaedic care on the Mississippi Gulf Coast.
Bienville Orthopaedic Specialists include hand, shoulder, spine, joint replacements, sports medicine, as well as non-operative treatment and care.

Contact Us
228-230-BONE (2663) or 1-800-588-0365
Ocean Springs Office • Phone: 228-875-1849 • Fax: 228-546-3258
Biloxi Office • Phone: 228-392-9355 • Fax: 228-546-3258
Pascagoula Office • Phone: 228-762-3664 • Fax: 228-546-3258
Gulfport Office • Phone: 228-679-3001 • Fax: 228-546-3258
Lucedale Office • Phone: 228-230-2663

Referring Physicians • Fax: 228-546-3228

MS Sports Medicine Clinic
Orthopedic Surgery, Sports Medicine,
Orthopedic Hip Knee Shoulder Wrist Foot & Ankle Surgery
Dr. Jeff D. Almand, MD
Dr. Austin M. Barrett, MD
Dr. Walter R. Shelton II, MD
1325 E Fortification St
Jackson, MS 39202
(601) 365-2230

Missouri

Dr. Steven C. Mingos & Associates
816-759-8130
4746 Belleview Ave
Kansas City, MO 64112

Dr. Ryan R Snyder, MD
(816) 523-8433
Truman Medical Ctr 2301 Holmes Ortho Surgery
Kansas City, MO

Dr.Clinton Pickett, DO
2301 Holmes St
Kansas City, MO
Specialties
Orthopedics, Hand Surgery
Medical School: Univ Of Hlth Sci, Coll Of Osteo Med, Kansas City Mo 64124

Montana

Montana Orthopedic Works with Adulats and Children with AVN
Nicholas Blavatsky MD Only one in group that works with AVN in kids and adults
BUTTE – MAIN OFFICE
RMAP Building (Butte, MT)
435 S. Crystal Suite 400
Butte, MT 59701
Phone: (406) 496-3400
http://www.montanaorthopedics.com/patient-education

Nebraska

Hohl Ortho
5700 Thompson Creek Blvd,
Lincoln, NE 68516
(402) 421-8000

Strasburger Orthopaedics
7121 Stephanie Ln,
Lincoln, NE 68516
(402) 466-0100

Triumph Prosthetics & Ortho
3233 Cornhusker Hwy,
Lincoln, NE 68504
(402) 434-5080

Nevada

Silver State Orthopedics
3006 S Maryland Pkwy
Las Vegas, NV 89109
(702) 216-2670

Institute Of Orthopaedic Surg
2800 E Desert Inn Rd,
Las Vegas, NV 89121
(702) 735-7355 http://www.ioslv.com/

Spine Institute of Nevada
2800 E Desert Inn Rd Ste. 100,
Las Vegas, NV 89121
(702) 239-3787 http://www.spineinstituteofnevada.com/

Seip Orthopedic Specialty
1569 E Flamingo Rd,
Las Vegas, NV 89119
(702) 304-1911

Orthopaedic Specialists
701 S Tonopah Dr,
Las Vegas, NV 89106
(702) 388-1008 http://www.orthopaedicspecialists.org/

Bone & Joint Specialists
2020 Palomino Ln,
Las Vegas, NV 89106
(702) 474-7200 http://mendezortho.com/about/

Nevada Orthopedics
10635 Professional Cir. Ste A
Reno, NV 89521
(775) 852-0505 http://www.nvorthopedics.com/

New Hampshire

New Hampshire Orthopedic Center
17 Riverside St,
Nashua, NH 03062
(603) 883-0091 http://www.nhoc.com/

Rockingham Orthopaedic Associates
168 Kinsley St,
Nashua, NH 03060
(800) 591-1815

St Joseph Orthopedic Assoc
168 Kinsley St,
Nashua, NH 03060
(603) 578-9363

New Jersey

Alan S. Nasar, MD, FAAOS
Freehold Office
Ph: 732.720.2555
Monroe Office
Ph: 609.235.4100
http://advancedorthosports.com/professionals/alan-nasar/

Rothman Institute
John A. Abraham, M.D. Hip and Knee
Michael F. Harrer, MD Hip and Knee
Andrew M. Star, M.D. Hip and Knee
Joseph A. Abboud, M.D. Shoulder and Elbow
Asif M. Ilyas, M.D. Hand and Wrist
Brian S. Winters, M.D Foot and Ankle
Barrett I. Woods, M.D. Spine
Phone Number: +1 800-321-9999
Fax: + 215-642-3597

Locations
1327 Old York Road
Abington, PA, 19001
United States
Phone Numbers
Phone Number: 800-321-9999
Hours
Monday – Friday:
08:00AM – 04:30PM

3300 Tillman Drive
2nd Floor
Glenview Corporate Center
Bensalem PA, 19020
Phone Numbers
Phone Number: 800-321-9999
Fax: 215-642-3597
Hours
Monday – Friday:
08:00AM – 04:30PM

2500 English Creek Avenue
Building 1300
Egg Harbor Township NJ, 08234
United States
Phone Numbers
Phone Number: 800-321-9999
Fax: 609-677-7000
Hours
Monday – Friday:
08:00AM – 04:30PM

More locations check out website
https://www.rothmaninstitute.com

Non operative treatment of avn
Eric Levicoff MD
New Mexico

Dr. Anthony F Pachelli, MD
(505) 724-4300
201 Cedar St SE
Albuquerque, NM
Frank Richard Heckl, MD
(505) 724-4300
201 Cedar St SE Ste 6600
Albuquerque, NM

Dr. Moheb S Moneim, MD
(505) 272-4107
MSC10 5600-1,
Albuquerque, NM

New York

Michael Mont MD

Lenox Hill Orthopaedics

130 East 77th Street
New York, New York 10075

(855) 434-1800

Expert in Osteonecrosis over 25 years

James D. Slover, MD
Hip & Knee Reconstruction
(212) 598-6000
NYU Center For Musculoskeletal Care
333 East 38th Street, 4th Floor
New York, NY 10016 also NYU Langone Orthopaedic Associates – Long Island
1999 Marcus Avenue, Suite 306
New Hyde Park, NY 1104
NYU Langone Orthopaedic Surgery Associates
1999 Marcus Ave, Ste 306
Lake Success, 11042
CONTACT
Phone: 516-467-8600

Jonathan Vigdorchik, MD
Hip & Knee Reconstruction
(212) 598-6000
NYU Langone Preston Robert Tisch Center for Men’s Health
555 Madison Avenue, 2nd Floor
New York, NY 10022

William J. Long, MD
646-293-7515
ISK Institute
260 East 66th Street, 1st Floor
New York, NY 10065

Hip & Knee Reconstruction at NYU Langone Medical Center
Richard Iorio, MD
(212) 598-6000
NYU Center For Musculoskeletal Care
333 East 38th Street, 4th Floor
New York, NY 10016

Thomas A. Einhorn Office Address
NYU Langone Center for Musculoskeletal Care
333 East 38th Street, Fourth Floor
New York, NY 10016
Telephone: (646) 501-7300.
Fax: (646) 501-7234
Patient Appointments/Referrals
Please call to schedule an appointment..
(212) 598-2775

Hospital for Joint Diseases Orthopaedic Institute
301 East 17th Street
New York, NY 10003
(212) 598-6000

Sabrina Strickland MD
New York

523 East 72nd Street, 6th Floor
New York, New York
(212) 606-1725
also sees patients 2x a month on Tuesdays in CT

1 Blachley Road
Stamford, CT 06902

North Carolina

Dr Selene Parekh
He is an orthopedic surgeon in Durham, North Carolina and is affiliated with Duke University Hospital. He received his medical degree from Boston University School of Medicine and has been in practice between 11-20 years. Dr. Parekh accepts several types of health insurance, listed below. He is one of 106 doctors at Duke University Hospital who specialize in Orthopedic Surgery. He also speaks multiple languages, including Spanish, Gujarati, Hindi and Urdu.
3609 SW Durham Dr
Durham, NC 27707
(919) 471-9622 Phone Number

Specialty: Orthopedic Surgery

Orthopedic surgeons diagnose and treat ailments affecting muscles, bones and joints, treating sports injuries, degenerative diseases, tumors, infections, and birth defects. They regularly perform joint repair and replacement operations.

Subspecialties: General Orthopedic Surgery, Foot & Ankle Surgery, Orthopedic Sports Medicine, Orthopedic Trauma

Robert I Saltzman FACS, MD
2 Locations
208 Old Mocksville Rd
Statesville, NC 28625
704-878-9800
2
770 Hartness Rd
Statesville, NC 28677
704-878-9800
North Dakota

Sanford Downtown Walk-In Clinic
715 E Broadway Ave,
Bismarck, ND 58501
(701) 323-5740 http://www.sanfordhealth.org/MedicalServices/COE/Ortho

Bone & Joint Center Of Orthopaedic Excellence
310 N 9th St,
Bismarck, ND 58501
(701) 530-8800 http://www.bone-joint.com/

Matthys Orthopaedic Center
2829 University Dr S
Fargo, ND 58103
(701) 241-9300 http://www.jointpain.md/home/

Ohio

Nabil Ebraheim, MD

Professor and Chairman, Trauma Specialist Awards One of America’s Leading Experts on:Bone FracturesFracture FixationSpinal FusionUnunited FracturesCastle Connolly America’s Top Doctors® (2008, 2010 – 2015)Patients’ Choice Award (2008 – 2010)Top 10 Doctor – City (2014)Toledo, OH
Orthopaedic SurgeonAppointmentsUniversity of Toledo Medical Center (1985 – Present)
Chairman and Professor, Department of Orthopaedic SurgeryMedical College Of Ohio, Toledo, Oh (1985 – Present)AssociationsOrthopaedic Trauma AssociationAmerican Board of Orthopaedic SurgeryAmerican Academy of Orthopaedic Surgeons

1125 Hospital Drive Toledo, OH 43614

Make an Appointment: 419.383.3761, Toll-free: 866.593.5049

Glendale-Heatherdowns
3065 Arlington Ave
Toledo, OH 43614
419-383-3761
Get directions
Glendale-Heatherdowns
University of Toledo Medical Center
3000 Arlington Ave
Toledo, OH 43614
419-383-3761

The UT Orthopaedic Center’s physicians can an appointment within 24 hours of calling . If there is an emergency, such as a fracture, the Center will see the patient immediately! Call 419.383.3761 for an appointment. guarantee for new patients

George Muschler, MD
Orthopaedic Surgery
Vice Chair, Orthopaedic and Rheumatologic Institute
Location:
Cleveland Clinic Main Campus
Mail Code A41
9500 Euclid Avenue
Cleveland, OH 44195
Appointment:
216.444.2606
Desk:
216.444.5338
Fax:
216.445.6255

Department:
Taussig Cancer Institute
Location:
Cleveland Clinic Main Campus
Mail Code A41
9500 Euclid Avenue
Cleveland, OH 44195
Appointment:
216.444.2606
Desk:
216.444.5338
Fax:
216.445.6255

Department:
Transplantation Center

Avascular Necrosis Of The Hip
Avascular Necrosis Of The Knee
216.444.2606
Wael Barsoum, M.D.
Department of Orthopaedic Surgery (A41)
The Cleveland Clinic Foundation
9500 Euclid Avenue
Cleveland, Ohio 44195
Phone: (440) 808-4682
Fax: 216/445-3585

John Vincent Gentile DO
Location:
1044 Belmont Ave ,
Youngstown, OH 44504-1006
Phone: (330) 480-3990

Michael P Stanich MD
Location:
7067 Tiffany Blvd , Ste 150
Youngstown, OH 44514-1981
Phone: (330) 726-9077

John Cletus Paumier MD
Location:
2376 Southeast Blvd ,
Salem, OH 44460-3472
Phone: (330) 337-7255

Roger S Palutsis MD
Location:
1401 S Arch Ave ,
Alliance, OH 44601-4202
Phone: (330) 821-0201

Michael A Necci MD
Location:
1900 S Union Ave , # 100
Alliance, OH 44601-4355
Phone: (330) 596-6500

Oklahoma

Orthopedic Solutions
10914 Hefner Pointe Dr
Oklahoma City, OK 73120
(405) 749-8326 http://www.orthopedicsolutionsokc.com/

Oregon

Dr Ira Weintraub
Orthopedics/Sports Medicine Center1515 NW 18th AvePortland, OR 97209(503) 224-8399
Orthopedics/Sports Medicine Center51385 SW Old Portland Rd Ste AScappoose, OR 97056(503) 224-8399
Orthopedics/Sports Medicine Center5050 NE Hoyt StPortland, OR 97213(503) 224-8399 (Office)

Pennsylvania

Rothman Institute
John A. Abraham, M.D. Hip and Knee
Michael F. Harrer, MD Hip and Knee
Andrew M. Star, M.D. Hip and Knee
Joseph A. Abboud, M.D. Shoulder and Elbow
Asif M. Ilyas, M.D. Hand and Wrist
Brian S. Winters, M.D Foot and Ankle
Barrett I. Woods, M.D. Spine
Phone Number: +1 800-321-9999
Fax: + 215-642-3597

Locations
1327 Old York Road
Abington, PA, 19001
United States
Phone Numbers
Phone Number: 800-321-9999
Hours
Monday – Friday:
08:00AM – 04:30PM

3300 Tillman Drive
2nd Floor
Glenview Corporate Center
Bensalem PA, 19020
Phone Numbers
Phone Number: 800-321-9999
Fax: 215-642-3597
Hours
Monday – Friday:
08:00AM – 04:30PM

2500 English Creek Avenue
Building 1300
Egg Harbor Township NJ, 08234
United States
Phone Numbers
Phone Number: 800-321-9999
Fax: 609-677-7000
Hours
Monday – Friday:
08:00AM – 04:30PM

More locations check out website
https://www.rothmaninstitute.com

Non operative treatment of avn
Eric Levicoff MD
Jonathan P. Garino, MD
4 Locations

Barr Building,
266 Lancaster Avenue
Suite 200, Malvern, PA 19355

Baxter Building
491 John Young Way
Suite 210, Exton, PA 19341

Main Line Health Center
599 Arcola Road, Collegeville, PA 19426

Phoenixville Medical Office Building
826 Main Street
Suite 202, Phoenixville, PA 19460
For all appointments and inquiries, please call (610) 644-6900

Brian J MD
Penn Orthopedics: Sennett
Orthopedic Surgeon
Address: 235 S 33rd St, Philadelphia, PA 19106
Phone:(215) 662-3340
http://www.pennmedicine.org/providers/profile/brian-sennett

Rhode Island

University Orthopedics-Sports
345 Valley Rd
Middletown, RI 02842
(401) 849-5596 http://universityorthopedics.com/

Coastal Orthopaedics
1816 Main Rd,
Tiverton, RI 02878
(508) 646-9525

South Carolina
Sc Sports Medicine & Orthopedic Center
Orthopedic Surgeon
9100 Medcom St
(843) 572-2663
Open until 5:00 PM
http://pdoa.com/index.php/our-providers/physicians
Spine Surgery
Hand & Upper Extremity
Microvascular
Foot/Ankle Surgery
Shoulder Surgery
Joint Replacement Surgery
Hip & Knee Replacement
Arthroscopy
Sports Medicine
General Orthopaedics
Patient Line: (843) 572-BONE (2663)
Business Line: (843) 569-3367

Orthopaedic Specialists of Charleston
Orthopedic Surgeon
2093 Henry Tecklenburg Dr, Suite 200 E
(843) 958-2500
Open until 5:00 PM
http://www.oscharleston.com/
http://www.oscharleston.com/OurTeam.aspx

Roper St Francis Orthopedic & Joint Replacement Center
Orthopedic Surgeon
316 Calhoun St, 6th Floor
(843) 724-2211
Foot and Ankle Surgery
Orthopaedic Specialists of Charleston
http://www.rsfh.com/orthopedics/doctors/
Joshua Lamb, MD
Blake Ohlson, MD

General Orthopaedics & Sports Medicine

Charleston Bone & Joint
William Carroll, MD
Robert Lowery, MD
Keith D. Merrill, MD
Harry “Rhett” Rudolph, MD

Charleston Sports Medicine
Bright McConnell, MD

Orthopaedic Associates of Charleston
Dowse Rustin, MD

Orthopaedic Specialists of Charleston
Kenneth M. Caldwell, MD
John M. Graham, Jr. MD
Robert Schoderbek, Jr. MD

Palmetto Orthopedics of Charleston
James R. DeMarco, MD
Waddell Gilmore, MD
Marshall R. Hay, MD
Heather McIntosh, MD

Parkwood Orthopaedic Clinic
Robert H. Bowles, MD
Hand and Upper Extremity

Charleston Hand Group
R. Christopher Brooker, MD, DMD
John McFadden, MD
William Muirhead, MD
Kim Young, MDhttp://www.rsfh.com/orthopedics/

Joint Replacements

Charleston Bone & Joint
William Carroll, MD
Robert B. Lowery, MD
Keith Merrill, MD
Harry Rudolph, MD

Charleston Hip & Knee Replacement
John J. McCrosson, MD
Patrick Murray, MD

Orthopaedic Specialists of Charleston
James L. Price Jr., MD

Palmetto Orthopedics
Waddell H. Gilmore, MD
Marshall Hay, MD

Parkwood Orthopaedic Clinic
Howard L. Brilliant, MD
Podiatry

Associated Foot Specialists
Charles Gudas, DPM

Carolina Foot Specialists
Adam Brown, DPM

Charleston Bone & Joint
Jeffrey Armstrong, DPM
Brian Ralph, DPM

Coastal Carolina Podiatry
William Hatchett, DPM

Coastal Podiatry
Rahn Ravenell, DPM

The Foot Institute
James Cawthorne, DPM

Marshall Kalinksy, DPM

Palmetto Podiatry
John Marino, DPM

Rapha Family Footcare
Beulah Brooks, DPM

Blue Ridge Orthopedics
100 Healthy Way Anderson, SC 29621
(864) 260-9910 http://www.ghs.org/healthcareservices/orthopaedics/blue-ridge-orthopaedics#.Vl24Q3arSHs

McCain Orthopaedic Center
1812 Hampton St, # B,
Columbia, SC 29201
(803) 254-8800 http://www.mccainortho.com/

South Carolina Orthopaedic
1175 Cook Rd,
Orangeburg, SC 29118
(803) 395-3837

Camden Bone And Joint LLC
1112 Mill St, Camden, SC 29020
(803) 432-4498 http://camdenboneandjoint.com/

Usc Sports Medicine Center
2 Medical Park Rd,
Columbia, SC 29203
(803) 434-6812

Midlands Orthopaedics PA
910 Blanding St, Columbia, SC 29201
(803) 587-8658 http://www.midlandsortho.com/

South Dakota

Orthopedic Institute
1204 S Burr St Mitchell, SD 57301
(605) 995-1098 http://www.orthopedicinstitutesf.com/

Black Hills Orthapedic & Spine Ctr
7220 S Highway 16 Black Hls Rapid City, SD 57702
(605) 341-1414

Tennessee

Michael D Neel MD

6286 Briarcrest Ave Ste 200

Memphis, TN 38120
901-259-1600

Texas

Stephen J Incavo MD
6550 Fannin St
Ste 2500
Houston, TX 77030
713-441-3569

Melvyn A Harrington MD
University Place
6620 Main St
Ste 1325
Houston, TX 77030
713-986-5660

Kurt W Rathjen MD
East Dallas
411 N Washington Ave
Ste 7500
Dallas, TX 75246
214-824-4866

Works with Adults and Children

Timothy G Schacherer MD
4 Locations
Vickery
Texas Orthopedic Assoc
8210 Walnut Hill Ln
Ste 130
Dallas, TX 75231
214-750-1207
Get directions
Accepting new patients
2
Northwest Dallas
5323 Harry Hines Blvd
Dallas, TX 75390
214-645-3300
Get directions
3
Arlington Park
1801 Inwood Rd
Dallas, TX 75235
214-645-3300
Get directions
4
709 Ed Hall Dr
Ste B
Kaufman, TX 75142
972-932-2122

Dr. Stefan Kreuzer, MD
Memorial Bone & Joint Clinic
1140 Business Center Drive
Suite 101
Houston, TX 77043
713-486-3900

Utah

Utah Orthopaedic Assoc
280 N Main St Tooele, UT 84074
(435) 843-0648

Endurance Orthopedics
2645 Parleys Way Suite 5
Salt Lake City, UT 84109
(801) 424-5042 http://www.utahorthopediccenters.com/locations/salt-lake-city-east/

Vermont

Vermont Orthopaedic Clinic3 Albert Cree Drive
Rutland, VT 05701
(802) 775-2937 http://www.rrmc.org/vermont-orthopaedic-clinic/

Champlain Valley Orthopedics
1436 Exchange St Middlebury, VT 05753
(802) 388-3194

Virginia

Orthopedic Clinic of Central Virginia
1201 Sam Perry Blvd Fredericksburg, VA 22401
(540) 370-1600 http://www.occv.net/

Fredericksburg Orthopaedic
3310 Fall Hill Ave Fredericksburg, VA 22401
(540) 372-4233 http://fredortho.com/

Atlantic Orthopedic Specialists
1800 Camelot Dr Virginia Beach, VA 23454
(757) 321-3300 http://www.atlanticortho.com/

Carilion Orthopedic Surg
2900 Lamb Cir
Christiansburg VA 24073 (540) 731-2436

Tuckahoe Orthopaedic Associates
1501 Maple Ave Richmond, VA 23226
(804) 285-2300 http://www.tuckahoeortho.com/

West End Orthopedic
5899 Bremo Rd Richmond, VA 23226
(804) 288-8512 https://www.orthovirginia.com/
Commonwealth Orthopaedics, based in Northern Virginia, and OrthoVirginia, based in Richmond, have announced that their practices will merge effective January 1, 2015. At that time, Commonwealth Orthopaedics will change its name to OrthoVirginia.

Commonwealth Orthopaedics is the largest orthopedic specialty group practice in Northern Virginia with 37 physicians and OrthoVirginia is a 45-physician orthopedic specialty group practice with offices in Richmond and throughout Central Virginia.

The new practice will become the largest orthopedic specialty group practice in Virginia, with 82 physicians, 21 office locations, an MRI facility, and multiple physical and occupational therapy clinics and outpatient surgery centers.

Nova Orthopedic and Spine Care
Paymaun M. Lotfi, M.D.
Richard L. Layfield, III, M.D.
Cyrus M. Press, M.D
Wylie D. Lowery Jr., M.D.
703.490.1112
14605 Potomac Branch Dr, Suite 300, Woodbridge VA 22191
1515 Chain Bridge Rd, Suite 202, Mclean VA, 2210

Washington DC
Dr. Danziger
Dr. Stein
Orthopaedic Medicine & Surgery
1850 M St NW
Washington, DC 20036
b/t N 19th St & N 18th St
Get Directions
Transit information
Red
Farragut North Metro and 2 more stations
Phone number (202) 835-2222
dcorthodocs.com

Washington

Orthopedic Specialty Institute
26 E 5th Ave Spokane, WA 99202
(509) 747-5615 http://osinw.com/

Keith V Anderson, MD
Orthopedic Surgery
Washington Orthopaedic Center
1900 Cooks Hill Rd
Centralia, WA 98531
P (360) 736-2889
F: (360) 736-3136

Edmonds Orthopedic Center
7320 216th St SW
Edmonds, WA 98026 http://www.edmondsorthopediccenter.com/

West Virginia

Alexander D. Rosenstein, MD~ AVN

David E. Ede, MD
Center For Joint Replacement
Suite 900,3100 MacCorkle Avenue, SE
Charleston, WV 25304 http://www.camc.org/body.cfm?id=18&action=detail&ref=1022
http://www.camc.org/dr-rosenstein-explains
http://camc.org/total-joint-replacement
http://camc2.staywellsolutionsonline.com/Search/SearchResults.pg?SearchPhrase=OSTEONECROSIS&SearchType=text&SearchOperator=And

Wisconsin

Orthopaedic Specialists
1516 S Commercial St
Neenah, WI 54956
(920) 725-0077 https://www.thedacare.org/Health-Library-and-Conditions/Bone-Muscle-and-Joint-Pain.aspx

Heiner, John P., MDOrthopedic Surgery Clinic 
University Hospital
(608) 263-7540
(800) 323-8942Orthopedic Oncology Clinic (Adult and Pediatric) University Hospital
(608) 263-7540
(800) 323-8942Orthopedic Surgery Clinic

UW Health at The American Center
(608) 263-7540
(844) 607-4800

Wyoming

Premier Bone & Joint Centers Several Locations
1950 Blue Grass Cir #100
Cheyenne, WY 82009
(800) 446-5684
https://www.premierboneandjoint.com/locations/
LARAMIE
Phone: (307) 745-8851
Phone: (800) 446-5684
CASPER
Phone: (307) 237-0304
Phone: (800) 446-5684
CHEYENNE
Phone: (307) 632-5889
Phone: (307) 632-5467
Phone: (800) 446-5684
DOUGLAS
Phone: (307) 358-6000
Phone: (800) 446-5684
GILLETTE
Phone: (307) 682-8899
Phone: (800) 446-5684
GREEN RIVER
Phone: (307) 875-7576
Phone: (800) 446-5684
RAWLINS
Phone: (307) 324-2104
Phone: (800) 446-5684
RIVERTON
Phone: (307) 856-4053
Phone: (800) 446-5684
Fax: (307) 856-5546
ROCK SPRINGS
Phone: (307) 382-5112
Phone: (307) 382-2324
Phone: (800) 446-5684
Fax: (307) 382-5042
TORRINGTON
Phone: (307) 532-2001
Phone: (800) 446-5684
WHEATLAND
Phone: (307) 322-3636 ext. 2474
Phone: (800) 446-5684

Puerto Rico

Dr. Mark E. Trautmann, MD
373 Calle Manuel Domenech
San Juan, PR 00918
(787) 274-0822 (Office)
(787) 296-2293 (Fax)

Orthopedic Surgery
Dr. Orlando Fernandez, MD
150 Ave De Diego Ste 603
San Juan, PR 00907
(787) 724-8820 (Office)
(787) 722-0117 (Fax)

Orthopedic Surgery
Dr. Felipe Fontanez, MD
25 Calle B
2 Locations
BAYAMON MEDICAL PLAZA
1845 Carr 2 Ste 701
Bayamon, PR 00959
(787) 798-5500 (Office)
(787) 787-2101 (Fax)
Guaynabo, PR 00965

Dr. Fernando Villamil MD
1372 Ashford Avenu
Condado, PR 00907
Phone: (787) 977-7402
Fax: (787) 977-7401

US Virgin Islands

Jeffrey Chase MD
Fellow of the American Academy of Orthopaedic Surgeons
http://orthodoc.aaos.org/chase
Virgin Islands Orthopaedics and Sports MedicineParagon Building Suite 104 Estate Thomas
Saint Thomas, VI 00802 USA
Phone: 340-714-2845 | Fax: 340-714-2843

*************************************************

Micro Vascular Surgery 
There is also a Dr Adam Saad not an ortho but has started cutting edge
microvascular surgery for AVN 

Dr Adam Saad

Address: 535 Sycamore Ave # A, Shrewsbury, NJ 07702
Phone:  732-741-0970
****************************************************
Stem Cell Information
Regenexx.com
888-525-3005

The Stem Cell and Ortho Institute if Texas
210-293-3136

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).

#RareDiseaseDay2019February28

#RareDiseaseDay

#CelebrateYourRare

#Awareness #Education

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

 

Avascular Necrosis – Osteonecrosis eBooklet

 

Click link below

 

AVN Awareness Booklet    

To access link on cell press on above link and you will be re-directed to Booklet.

If on computer just click above link.

🌻 Hi, I’m Deborah Andio

I wrote this booklet in 2016  to help patients like myself and their families understand avascular necrosis- osteonecrosis  and give helpful ideas to patients and help our doctors understand the pain we often feel.

My goal is throughout this booklet is to first let you know you are not alone .

Those who also have been diagnosed with avn know exactly how your feeling,scared, afraid, searching for knowledge and resources and coming up with very little.

That’s why I started a support group and wrote this booklet.

Disclaimer

  • This booklet is not intended as a substitute for the medical advice of physicians. The reader should regularly consult a physician in matters relating to his/her health and particularly with respect to any symptoms that may require diagnosis or medical attention.
  • No part of this eBook may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission from the author.
  • The information provided within this eBook is for general informational purposes only.
  • Copyright © protected
  • While I try to keep the information up-to-date and correct, there are no representations or warranties, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the information, products, services, or related graphics contained in this eBook for any purpose. Any use of this information is at your own risk.

I give an actual copy to members of my support group. But many felt the information was so helpful, I wanted to share it with everyone.

I have recently completed a better spell check and next print will have all errors corrected.

No-one can use any contents of this booket words or graphics

 

Supprt Group Link  Avascular Necrosis/ Osteonecrosis Support Int’l

Wishing you all a pain free and relaxing day

God Bless

Debbie

 

ChronicallyGratefulDebla2018© ™️

Debla©2014-2019 ™️

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