Ebooklet -Avascular Necrosis-2016

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

Tracking Pain – With A Journal

While each person’s experience with Osteonecrosis is different, I want to make sure you have the right information and support you need to live life your best life in spite of osteonecrosis.

There are ways I was able to control my pain, lower overall inflammation in my body which helped my pain.

Also did you know that for many people statins helped as well?

It was time I stopped just being a patient , and I became an advocate and patient leader. It was time to take a personal approach to my health many doctors didn’t understand how I felt, some often seemed as if I was exaggerating or making it up.

This pain wasn’t in my head, and if anything I’m downplaying my pain vs telling you doctors how terrible it is on a constant and daily basis.

Let’s face it when we have chronic pain we don’t always want to cook all day . But I found out trying to save time and energy by grabbing a pizza or burger isn’t helping my pain.

The more junk fats like fast food, processed garbage I removed from my life over time the better I was feeling.

It’s not a cure or a easy fix.

But it’s not hard and it’s delicious.

I’m the main cook in our family. So I prepared meals that have less and no meat more often.

From meatless Monday to now meatless M-W-S

And it was a great success , soon we only ate meat or chicken 1x a week and fish 1x -2 x a week.

We did eat eggs .

Before I knew it some weeks we didn’t eat meat or poultry at all.

We did have fish like cod , tuna, haddock ,crab,shrimp or tuna steaks.

We didn’t care for salmon much.

I also started a pain journal it had what I ate- what I did – my stress level- pain level

Whether you’ve been battling pain for more than a decade or you’re just starting to deal with consistent aches pains and stiff soreness, a pain journal can help you document what you are feeling from day to day.

Your pain journal is where you write down everything relating to your chronic pain what kind of pain you have, what level of pain you are experiencing, what you were doing when you were in pain, what you ate and so on.

Chronic Pain Journal Helps

This information is useful both for you and your doctor. It can be used to help identify patterns of pain, such as time of day or level of stress, or pain triggers from certain activities.

A pain journal can also show what doesn’t increase your pain, which can help you make better decisions about how you spend your day. At the very least, it can be a good reference when memory doesn’t serve you (for example, if you’re not sure how to answer when your doctor asks if your pain is worse after lunch).

Usually pain journal are set up like this.

• Give your pain a scale rating. Most pain scales use the 0-10 rating system, with 0 representing no pain and 10 representing the worst imaginable pain. Your pain will usually fall somewhere in between.

• Use pain descriptor words. Is your pain burning? Stabbing? Tingling? Pulsating? Constant? Using pain descriptor words in your journal can help you track changes and patterns in your pain quality.

• It can also help doctors pinpoint your type of pain.

• Track the time of day pain occurs. Do you hurt more in the morning or the evening? How are your afternoons?

• Write down what you ate and drank that day. Foods and beverages may contribute to or worsen the pain you are experiencing. Jot down everything you ingested food and beverages everyday.You will see a pattern.

• Describe your mood. It’s also important to note your mental state and how you feel when experiencing pain. Are you depressed? Anxious? Fatigued? Obviously, the pain might be triggering these emotions, and your doctor may recommend you see a mental health specialist to deal with the feelings that arise as a result of your chronic pain.

• Note what you are doing when your pain begins. Did you just get out of bed, or had you been sitting for a while when your pain started? Were you exercising or overusing certain muscles in your body? Write down how you feel after activities, such as walking the dog or playing with the kids.

• Look at elements that might contribute to your pain. Think about the external factors that may add to the pain, such as if you suffer from stiff joints; does this happen when it’s raining or cold outside

• Note if you take pain medication does it help? Does it ease pain, take it away do nothing .

It seems like a lot of work but actually it takes just a few days to get it down.

And it’s a valuable tool.

Often a lot of what we eat makes pain worse. Because it causes inflammation in the body.

Basic inflammation is normal chronic inflammation is not.

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).

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Osteonecrosis-Avascular Necrosis -Broken Down

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

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

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

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

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

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

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

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

Traumatic (following an injury)

Nontraumatic

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

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

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

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

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

Nontraumatic osteonecrosis

Excessive alcohol

Blood clotting (coagulation) disorders

Bone Marrow Edema

Chemotherapy

Corticosteroids

Cushing syndrome

Decompression sickness

Gaucher disease

High level of lipids in the blood (hyperlipidemia)

HIV infection

Liver disease

Lupus and other autoimmune connective tissue disorders

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

Organ transplantation

Pancreatitis

Radiation

Sickle cell disease

Smoking

Tumors

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

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

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

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

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

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

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

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

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

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

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

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

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

X-rays

Magnetic resonance imaging

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

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

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

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

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

Excessive alcohol use and smoking should be avoided.

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

Nonsurgical measures to relieve symptoms

Surgical procedures

Hip replacement

blood supply long bones

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

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

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

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

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

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

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

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

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

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

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

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

National Institute of Arthritis and Musculoskeletal and Skin Diseases

 

You are what you eat

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

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

I am a patient leader advocate and home cook

I have

Avascular Necrosis-Osteonecrosis From Injury

Osteoarthritis

Inherited Blood Clot Disorder

Hashimoto Thyroiditis

http://avascularnecrosiseducation.com

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

www.ChronicallyGratefulDebla.com

 

veg

 

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

Material Used In Hip Replacements

The Many Different Materials Used in Hip Replacement Devices.

If you need a hip replacement it’s best to educate yourself .

Hip replacement devices break into a few big categories:

Metal on Metal (MOM) – These are what they sound like. Both the socket and the ball are made of stainless steel, titanium, chromium, cobalt or some combination of these. One sub-type of a MOM hip is a minimally invasive model which usually is smaller in size, so it can be installed with a smaller incision.

Polyethylene and Metal on Polyethylene (MOP) – Polyethylene is basically plastic, so these hips usually have metal structural pieces and a plastic liner where the ball and socket meet. They can also have a metal ball meeting a plastic socket liner. A sub-type of a polyethylene hip is made with a newer plastic called cross linked polyethylene, which is more durable.

Ceramic on Metal (COM), Ceramic on Ceramic (COC), Ceramic on Polyethylene (COP) – Ceramic hips are made of specialized and more durable versions of the same type of material that plates and bowls are made from. There are ceramic on metal, ceramic on ceramic, and ceramic on polyethylene versions. While these are durable, they can be vulnerable to fracture and breaking under big stresses.

Wear Particles

If for some reason I would need a hip replacement, my single biggest concern would be wear particles. This phenomenon first came to light about 5 – 7 years ago when surgeons began to replace the first worn out or failed metal on metal (MOM) hips. What they found in some patients was scary. Basically, the entire area directly around the hip replacement device had turned into a mass of black goo.

Then studies were published showing that those microscopic metal shavings were leaching into the blood stream and causing elevated metal ion levels. Additional studies began to point out that some people’s tissue was so sensitive to this junk that they formed pseudotumors, which are basically big solid masses of irritated tissues, some of which could press on important nerves. Finally, genetic studies showed that not only was this tissue visibly unhappy, the cells were getting damaged at a genetic level from the wear particles.

When all of this first came to light, it looked like only MOM hips were involved. However, as the research below shows, the issue of wear particles extends to every type of hip made.

ARMD – Adverse Reactions to Metal Debris

Before we begin, it’s worth noting that there is now a name for pissed off tissue caused by wear particles. In a 90s movie, a nuclear war head falls into the wrong hands and the main character is informed that this is called a “Broken Arrow”. He responds to the effect of, “I’m not sure what’s more disturbing, the fact that we just lost a nuclear warhead or that you actually have a name for this”. I feel the same about the fact that the orthopedic joint replacement community now has a name for wear particles that cause problems in patients.

In addition to highlighting research on wear particles, I’ll also look at the durability of each type. So let’s take a look at how to navigate this minefield.

The Research on the Various Types of Hip Replacement Materials – Focused on Wear Particles and Device Failure

MOM or “Metal on Metal”

The “bad boy” of hip replacement types is clearly MOM hips. The funniest thing is that despite all of the absolutely horrific things published about these devices, you can still find Internet ads for many surgeons who will be happy to implant them. They do this by claiming that these are “minimally invasive” hips. While there’s a tiny kernel of truth in that hogwash (the incisions needed to implant them are smaller), there is nothing minimally invasive about amputating a joint and inserting a prosthesis, no matter how you skin that cat. In addition, the smaller the device, the bigger the wear particle issue.

MOM hips produce metal wear particles locally that are then taken up in the bloodstream. In general, smaller MOM hip devices (usually those used for small framed women) have a higher likelihood of producing metal wear particles. This study showed more metal ions in the blood with MOM devices compared to conventional hip replacement prostheses. This randomized trial again demonstrated more metal ions in the blood of women with MOM hips when compared to conventional hip replacement, but also noted that pseudotumors occurred both around these MOM devices and the more conventional MOP devices as well. This recent study showed that metal debris was present in both large and small MOM hip replacement devices.

Photo from Breaking Muscle It’s all in the hips

The latest 2015 consensus guidelines are now not to perform a MOM hip replacement in small women or anybody with a known metal allergy. The latest study on MOM hips and pseudotumors concludes, “Adverse reactions to metal debris in MOM hips may not be as benign as previous reports have suggested.” Not good.

Polyethylene and Metal on Polyethylene (MOP)

When I initially began this literature search, I thought that MOP hips may be better in the wear particle department. After all, you don’t have metal rubbing on metal, but usually metal on plastic. However, I was wrong.

To see how bad things can get with MOP wear particles, I didn’t have to look far. This recent study from 2014 showed an awful side effect of both polyethylene and metal wear particles, a pseudotumor that invaded a woman’s vaginal tissues. This 2015 study was very concerning in that it compared MOP hips to MOM hips with regard to metal levels and chromosome damage in cells. It couldn’t conclude that one was better than the other. Based on this 2014 study, MOP hips wear less, but their wear particles produce slightly more tissue reaction than MOM hips. This is all consistent with a recent study I blogged on, showing that conventional polyethylene wear particles reduced stem cell activity in bone marrow and muscle.

If there is one bright spot in this category, it’s likely the newer highly cross linked polyethylene (HCLP). Based on this recent study, HCLP hips produced fewer wear particles than regular polyethylene. In another study of shoulder replacement devices, the lower debris for these devices was confirmed. In addition, based on this 2014 study HCLP devices seem to withstand unexpected wear and part failure better.

Ceramic on Metal (COM), Ceramic on Ceramic (COC), Ceramic on Polyethylene (COP)

Maybe ceramic is the way to go? After all, what could go wrong with installing a hip replacement device made of the same substance as dinner plates?

This 2015 randomized trial showed that COM hips still regrettably produced metal wear particles that ended up in the blood stream. Some good news for COM hips could be found in this 2015 study. It concluded that while there was swelling around these devices, when compared to minimally invasive MOM hips, there were no pseudotumors seen in COM hips. However, based on this analysis of many studies, there doesn’t seem to be any advantage of COC compared to COP. How does COM and COC compare? Ceramic on metal doesn’t seem to have the same durability as ceramic on ceramic based on this study.

Is Your Surgeon Being Paid to Promote a Certain Type of Hip?

One of the real challenges in navigating this landscape is that regrettably, joint replacement devices have been one of the worst areas of payola in medicine. As reimbursements have declined for the surgical procedures of installing and replacing devices, many surgeons have figured out that they can keep their cash flow stable by taking money from the device manufacturers. This has been the subject of many Department of Justice lawsuits through the years.

The big issue for patients is how to know if their surgeon is recommending a hip device because they really feel that it’s the best, or because they’re getting paid by the company making the device. This Propublica web-site will allow you to research your surgeon’s payment history.

Correct Sizing is Key!

It’s very clear from reviewing the medical research on this topic that a poorly sized hip device is a huge problem for many reasons. First, it will reduce the longevity of the device. Perhaps more importantly, it virtually guarantees more harmful wear particles. And since we’re talking about replacing your hip, a good fit is common sense.

Given the modular nature of these hip devices and the wide array of options, a poor fit should never happen. However, in my experience, hardware fitting issues usually happen when the operating room and/or hospital don’t have the correct size in stock on the day of the surgery. So agree before hand on the size of the components and make sure the staff has double-checked to make sure the hospital has that size in stock.

The upshot? All hip replacement devices produce wear particles. But which is best? It’s clear that when metal on metal implants go bad, things can go very bad with a local tissue reaction that can cause pseudotumors and high metal ions levels in the blood. If I had to get my hip replaced, I would cross this type of implant off my list. Ceramics still produce wear particles and have the added problem of fracturing in an active individual. Polyethylene wear particles in a MOP hip can be just as bad as those from a MOM hip. Given that highly cross linked polythylene has the least wear particles, this is likely the winner. However, realize that not as much is known about tissue reaction to cross linked polyethylene, so that recommendation may change with time. In addition, there are newer types of ceramics that once mated with HCLP could produce less debris.

More information Hip Replacement Material- Regenexx

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