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

Hip Replacement

FDA on Hip Replacement Parts

Kummel Disease

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

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

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

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

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

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

 

text ©Debla2017

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

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

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

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

How Doctors Diagnose Avascular Necrosis 

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

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

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

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

How Is Avascular Necrosis Treated?

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

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

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

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

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

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

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

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

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

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

Your Outlook with Avascular Necrosis (Kummel Disease)

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

Educating On Bone Marrow Edema ©

Good Morning Pain Warriors Around The World
It is time to educate on the various causes of
Avascular Necrosis-Osteonecrosis
So twice a week we will post some educational info on a cause with links

Today Its Bone Marrow Edema

What is Bone Marrow Edema?
Bone marrow edema is a condition when excess fluids in the bone marrow build up and cause swelling. It is often caused by a response to an injury, such as a broken bone or a bruise, or a more chronic condition such as osteoporosis. Bone marrow edema most commonly occurs in the hips, knees and ankles. In this case, bone marrow edema of the knee is a main cause of localized knee and joint pain, and is only diagnosable via a Magnetic Resonance Imagining test (MRI).
It is usually caused by the following scenarios:
• Avascular necrosis, or “bone death”. This is when a small portion of the bone dies, and can result in a painful bone marrow edema
• Any type of knee bone trauma, including broken bones and bone bruises.
• Joint disorders such as osteoarthritis or osteoporosis. In this case, the knee joint is lacking the cushion that cartilage provides, which can lead to easier fracture and wear on the bone. Subsequently, if a fracture of the bone occurs, the injured area becomes susceptible to edema..
• Knee ligament injuries.
• A condition such as synovitis (an inflammation of the lining the joints, called synovial membranes).
• In rare conditions, bone tumor.
Symptoms of Bone Marrow Edema in the Knee
Bone marrow edemas may not bother you at all, or they may be painful and inconvenient. They can feel more intense than a muscular injury (for example, a muscle bruise) at times due to the nature of the bone. A muscle is capable of swelling, which increases blood flow to heal the area. Unfortunately, bones are not capable of swelling, and thus the fluid (edema) that collects in the marrow can create intense pressure within the bone, resulting in more intense pain. In fact, in many osteoarthritic patients, it isn’t the lack of cartilage that’s causing them pain, but rather the pressure due to the edema.

Some of the most common symptoms of bone marrow endema include:
• Varying degrees of pain, from mild to moderate, depending on the severity and Trauma.
• Swelling of the knee area.
• Inability to put full pressure on the knee to walk.
• Recurrent pain and tenderness.
• Bruising.
Treatment of Bone Marrow Edema in the Knee
Thankfully, most bone marrow edemas will settle down and heal on their own after the injury has subsided. For example, in some cases of osteonecrosis the bone will regenerate itself and heal the edema but note : not all cases of osteonecrosis or spontaneous osteonecrosis of the knee will have the ability to heal itself. Unfortunately, though, in the case of osteoarthritis, the edema may only get worse over time. In this circumstance, treatment options may be explored.
Traditional treatments for bone marrow edema usually involve rehabilitation through physiotherapy and rest. Ice, medications such as ibuprofen or acetaminophen, and even a crutch or a cane can help as well. There is one drug-facilitated treatment that uses a bisphosphonate and vitamin D mixture to help increase bone density. When this treatment is delivered via intravenous, it is found to be quite effective in reducing pain and increasing density. Other drugs that usually treat the vascular system have been found effective for bone marrow edema, in that they encourage blood flow and treat any vascular abnormalities that may exist in the bone and marrow.
In some more challenging cases, core decompression may be used. This is a type of surgery where a surgeon drills a hole into the affected part of the bone allowing that area of the bone to experience increased blood flow, form new blood vessels, and heal.
Another option is subchondroplasty, which can be especially effective for osteoarthritis patients. In this procedure, an x-ray determines where the edema is. The patient is then sedated, and a small needle injects a paste into the area of the edema. The paste then hardens and provides more strength and density to the bone. By improving the strength of the bone, it will enable the bone to deal with the pain of the edema and of the osteoarthritis.
http://louisvillebones.com/understanding-bone-marrow-edema/

Knee
https://www.g2orthopedics.com/bone-marrow-edema-in-the-knee/
https://www.researchgate.net/…/7224238_Bone_marrow_edema_in…
https://www.researchgate.net/…/7224238_Bone_marrow_edema_in…
https://www.hindawi.com/journals/crirh/2018/7657982/

Hip Study
https://academic.oup.com/jcem/article/94/4/1068/2596208

https://www.ajronline.org/doi/10.2214/AJR.05.0086

https://www.ncbi.nlm.nih.gov/pubmed/15049532

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4972799/

Shoulder
https://www.sciencedirect.com/…/veterinary-sc…/osteonecrosis

Ankle
https://www.ncbi.nlm.nih.gov/pubmed/21189186
https://www.footanklesurgery-journal.com/…/S1268-7…/abstract

 

If you have #Osteonecrosis feel free to join our #group

AvascualrNecrosis/Osteonecrosis Support Int’l

 

©Debla2014

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Tired of Doctors? I am also.

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

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

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

So here we go:

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

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

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

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

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

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

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

6. What do you recommend as far as treatment?

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

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

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

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

 

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

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

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

Will this be temporary?

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

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

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

Never start or stop anything without talking to your doctor.

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

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

 

Specific Questions To Ask Your Otho

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

 

Here is some info you may be interested in.

Clinical Trials

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

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

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

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

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

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

Steinberg Stages Of Osteonecrosis-Avascular Necrosis

Steinberg Staging Of Avascular Necrosis/ Osteonecrosis

History and etymology

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

Classification

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

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

stage II: cystic and sclerotic radiographic changes

stage III: subchondral lucency or crescent sign

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

mild: <2 mm

moderate: 2-4 mm

severe: >4 mm

stage V: joint space narrowing with or without acetabular involvement

stage VI: advanced degenerative changes

Quantification of extent of involvement is necessary for stages I to V:

stage I and II

A, mild: <15% head involvement as seen on radiograph or MRI

B, moderate: 15% to 30%

C, severe: >30%

stage III

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

B, moderate: crescent beneath 15% to 30%

C, severe: crescent beneath >30%

stage IV

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

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

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

stage V

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

Steinberg Staging Osteonecrosis

See also

Avascular Necrosis Of The Hip

Fixated and Arlet Staging

Legg-Calvé Perthes Disease

AVN CharityUK

References

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

Terminology

I have taken the time to list all the jargon on avn-on

Medical Definition of Avascular necrosis

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

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

Medical Definition of avascular

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

Necrosis is

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

superficial necrosis

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

coagulation necrosis

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

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

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

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

aseptic necrosis necrosis without infection or inflammation.

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

Links

 

Glossary of terms used in  Avascular Necrosis –Osteonecrosis

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

 

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

Ref – Wikipedia

 

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

 

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

 

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

 

Aseptic Necrosis – Another name for Avascular Necrosis or Osteonecrosis.

 

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

 

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

Ref – Wikipedia

 

Avascular – Having few or no blood cells.

Ref – Encyclopaedia Britannica

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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

 

Diaphysis – Shaft of the bone.

 

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

 

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

 

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

 

Epiphysis – Ends of the bone.

 

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

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

 

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

 

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

 

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

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

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

 

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

 

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

 

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

 

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

 

Ligaments – Fibrous tissue that connects bones to other bones.

 

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

 

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

 

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

 

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

 

 

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

 

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

 

Necrosis – Death of living tissue.

 

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

 

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

 

Osteonecrosis – Another name for Avascular Necrosis.

 

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

 

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

 

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

 

Osteoporosis – Condition of fragile bones.

 

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

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

 

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

 

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

 

Sagittal – Imaginary line, used in MRI scans.

 

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

 

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

 

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

 

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

 

Subchondral – Below the cartilage.

 

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

 

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

 

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

Ref – Synovial Sarcoma Survivors Network

 

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

Ref – Trabeclularbone.org

 

UKR – Unicompartmental Knee Replacement, or partial knee replacement.

 

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

 

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

 

Seven (7) Cervical vertebrae in the neck.

 

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

 

Five (5) Lumbar vertebrae in the lower back.

 

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

 

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

 

 

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

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

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

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

AVN is not always seen on an Xray

 

 

term

 

 

Guest Speaker

Tonight the support group I started

Avascular Necrosis/ Osteonecrosis Support Int’l has a guest speaker

I can’t wait to hear Dr. Michael Mont discuss Osteonecrosis and Joint preservation

More to come ……

He discussed Osteonecrosis and the 3 decades he has been treating it.

He answered a lengthy Q and A from several members.

He prefers to preserve the joint so we discussed CD(core decompression) it’s success and failure rates, surgery

He is doing a second Q and A

June 19,2018

Avascular Necrosis / Osteonecrosis Support Int’l.

https://www.facebook.com/groups/DeadBoneDiseaseAVN/

Non -Surgical Treatment’s of Avascular Necrosis – Osteonecrosis

Non -Surgical Treatment s of Avascular Necrosis – Osteonecrosis

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

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

Let’s be real here

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

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

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

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

Bisphosphonates

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

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

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

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

Nonsteroidal Anti-inflammatory Drugs

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

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

Statins

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

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

Medical Marijuana

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

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

Pain medication  

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

Physical Therapy

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

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

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

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

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

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

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

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

All content found on this Website, blog,, including: text, images, audio, or other formats were created for informational purposes only.

The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Never disregard professional medical advice or delay in seeking it because of something you have read on this website,blog,page.

If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately.

I do not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on here .

Reliance on any information provided by this website , blog is solely at your own risk.

I discuss and educate.

I tell my story.

National Orthopedic Societies By Country

I talk so many people around the world with Avascular Necrosis/ Osteonecrosis so often it’s sad because they struggle to find qualified doctors and surgeons knowledgeable about the disease.

I also here in the USA found it hard to find doctors who are not just educated in avn but really know about it and have a true interest in helping their patients.

The only I have spoke with are listed in my list for USA doctors.

I am working on a world wide list.

Here is also great information on orthopedic societies by country.

Deb

They are in alphabetical order.

National Orthopedic Societies By Country

Argentina

Asociación Argentina de Ortopedia y Traumatología (AAOT)

Australia

Australian Orthopaedic Association (AOA)

Austria

Österreichischen Gesellschaft für Orthopädie und Orthopädische Chirurgie (ÖGO)

Bangladesh

Bangladesh Orthopaedic Society (BOS)

Belgium

Société Royale Belge de Chirurgie Orthopédique et de Traumatologie (SORBCOT)

Belgische Vereniging voor Orthopedie en Traumatologie (BVOT)

Orthoweb

Bolivia

Sociedad Boliviana de Ortopedia y Traumatología (SBOLOT)

Bosnia and Herzegovina

Orthopaedic and Traumatology Surgeons Association of Bosnia and Herzegovina (OTSABH)

Brazil

Sociedade Brasileira de Ortopedia e Traumatologia (SBOT)

Bulgaria

Bulgarian Orthopedics and Traumatology Association (BOTA)

Canada

Canadian Orthopaedic Association (COA)

Chile

Sociedad Chilena de Ortopedia y Traumatología (SCHOT)

Colombia

Sociedad Colombiana de Cirugía Ortopédica y Traumatología (SCCOT)

Croatia

Croatian Orthopaedic and Traumatology Association (HUOT)

Czech Republic

Ceská Společnost pro Ortopedii a Traumatologii (CSOT)

Denmark

Dansk Ortopaedisk Selskab (DOS)

Ecuador

Sociedad Ecuatoriana de Ortopedia y Traumatología (SEOT)

Egypt

Egyptian Orthopaedic Association (EOA)

El Salvador

Asociación Salvadoreña de Ortopedia y Traumatología (ASOT)

Estonia

Estonian Association of Traumatology and Orthopedics (ETOS)

Finland

Finnish Orthopaedic Association (SOY/FOA)

France

Société Française de Chirurgie Orthopédique et Traumatologique (SOFCOT)

Germany

Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC)

Berufsverband der Fachärzte für Orthopädie und Unfallchirurgie e. V. (BVOU)

Greece

Hellenic Association of Orthopaedic Surgery and Traumatology

Hong Kong

Hong Kong Orthopaedic Association

Hungary

Magyar Ortopéd Társaság (MOT)

Iceland

Icelandic Orthopedic Society

India

Indian Orthopaedic Association (IOA)

Iran

Iranian Orthopaedic Association (IOA)

Ireland

Irish Orthopaedic Association

Israel

Israel Orthopaedic Association

Italy

Società Italiana di Ortopedia e Traumatologia (SIOT)

Japan

Japanese Orthopaedic Association (JOA)

Jordan

Jordan Orthopedic Association (JOA)

Korea

Korean Orthopaedic Association (KOA)

Kosovo

Kosovo Society of Orthopaedics and Trauma Surgeons (KSOTS)

Lebanon

Lebanese Orthopaedic Association (LOA)

Lithuania

Lithuanian Society of Orthopaedics and Traumatology (LSOT/LOTD)

Luxembourg

Luxembourgian Society of Orthopaedics and Traumatology (SLOT)

Macedonia

Macedonian Association of Orthopaedics and Traumatology (MAOT)

Malaysia

Malaysian Orthopaedic Association (MOA)

Mexico

Sociedad Mexicana de Ortopedia (SMO)

Montenegro

Association of Orthopaedics and Traumatology of Montenegro (AMOT)

Morocco

Société Marocaine de Chirurgie Orthopédique et de Traumatologie (SMACOT)

Netherlands

Dutch Orthopaedic Association (NOV)

New Zealand

New Zealand Orthopaedic Association

Norway

Norsk Ortopedisk Forening (NOF)

Pakistan

Pakistan Orthopaedic Association

Paraguay

Sociedad Paraguaya de Ortopedia y Traumatología (SPOT)

Peru

Sociedad Peruana de Ortopedia y Traumatología (SPOT)

Poland

Polskie Towarzystwo Ortopedyczne i Traumatologiczne (PTOiTr)

Portugal

Sociedade Portuguesa de Ortopedia e Traumatologia (SPOT)

Puerto Rico

Sociedad Puertorriqueña de Ortopedia y Traumatología (SPOT)

Romania

Societatea Romana de Ortopedie si Traumatologie (SOROT)

Russian Federation

Association of Orthopaedists and Traumatologists of the Russian Federation

Saudi Arabia

Saudi Orthopaedic Association

Serbia

Serbian Orthopaedic Trauma Association (SOTA)

Singapore

Singapore Orthopaedic Association (SOA)

Slovakia

Slovenská Ortopedická a Traumatologická Spoločnosť (SOTS)

Slovenia

Slovenian Orthopaedic Society (ZOSZD)

South Africa

African Orthopaedic Association (SAOA)

Spain

Sociedad Española de Cirugía Ortopédica y Traumatología (SECOT)

Sweden

Svensk Ortopedisk Förening (SOF)

Switzerland

Société Suisse d’Orthopédie et de Traumatologie (SSO/SGO)

Taiwan

Taiwan Orthopaedic Association

Thailand

Royal College of Orthopaedic Surgeons of Thailand (RCOST)

Turkey

Turkish Society of Orthopaedics and Traumatology (TOTBID)

United Kingdom

British Orthopaedic Association (BOA)

United States

American Academy of Orthopaedic Surgeons (AAOS)

Uruguay

Sociedad de Ortopedia y Traumatología del Uruguay (SOTU)

Venezuela

Sociedad Venezolana de Cirugía Ortopédica y Traumatología (SVCOT)

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

Also booklet will be updated every 2 years

2014 check

2016

2018

2020

I am continually writing to our Senators state by state asking for an awareness day proclamation.

So AVN-ON can get the recognition it deserves.

 

Supprt Group Link  Avascular Necrosis/ Osteonecrosis Support Int’l

Wishing you all a pain free and relaxingI am

God Bless

Debbie

 

ChronicallyGratefulDebla2018© ™️

Debla©2014-2019 ™️

 

All rights reserved. Thia booklet on line or in print may not be reproduced in any form, stored in any retrieval system, or transmitted in any form by any means—electronic, mechanical, photocopy, recording, or otherwise—without prior written permission of the publisher, except as provided by United States of America copyright law. For permission requests, write to the author on this web site.

©Debla2014

 

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