Avascular Necrosis-Osteonecrosis Education and Resources
Avascular Necrosis-Osteonecrosis Education and Resources
Thank you to Youngstown Ohio Mayor Jamael Tito Brown and Senator Michael Rulli and Senate President Larry Obhof
What an honor
Help me raise awareness today and please like and share this post.
Thank You.
1st annual
#AvascularNecrosis #Osteonecrosis
#AwarenessDay #November29
AvascularNecrosis/Osteonecrosis Support Int’l
https://www.vindy.com/news/local-news/2019/11/city-state-recognize-poland-woman-with-rare-disease/
Finally Avascular Necrosis-Osteonecrosis has an official awareness date.
The date is November 29
I have been working on proclamations for several months and I am in the process of getting the awareness day Nationally recognized as well.
I’m so grateful that our elected officials took the time to talk to me.
And set a date for AVN-ON awareness
I have heard back from several officials that will also be adopting November 29 .
I have been advocating for over 5 years on Avascular Necrosis -Osteonecrosis and I am proud and grateful that our elected officials are also recognizing this awareness day.
What is a proclamation?
A proclamation is a formal way to make a public announcement or declaration. Government officials, such as mayors and state legislators, often issue proclamations to announce upcoming events or celebrations or to increase public awareness of particular issues.
I am proud to say I was issued a proclamation by my local Mayor of Youngstown Ohio
And also by Senator Michael Rulli of Ohio.
I have heard from Washington DC and it’s a longer procedure but it’s being looked at.
Right Now AVN-ON falls under the rare disease / disorder category.
In the United States, a rare disease is defined as a condition that affects fewer than 200,000 people. This definition was created by Congress in the Orphan Drug Act of 1983. Rare diseases became known as orphan diseases because drug companies were not interested in adopting them to develop treatment
Well I am hoping that now that AVN is getting recognition we can get more research to help all of us that are dealing with this painful condition.
Thank you to
Senator Michael Rulli -Ohio
and
Mayor Jamael Tito Brown – Youngstown Ohio
For helping us who suffer finally get the awareness day we deserve
God Bless You and Thank You.
To Our Dear Readers
Often being diagnosed with a rare disease is not easy , it can often leave you feeling alienated exhausted and at times discouraged. We often end up having more questions than answers.
There also is very little to no public attention when you have a rare disease/disorder such as fun runs, fundraisers ,even research money is limited when it comes to having a rare disease.
Far too often doctors may not be as educated or skilled on a certain a rare medical condition which often causes patients to be misdiagnosed.
Those suffering often go months to years without a proper diagnosis.
Then there is the treatment options which appear just as limited.
There are about 7,000 different types of rare diseases with new discoveries every day. In the United States alone there have been approximately 25-30 million people given the diagnosis of an uncommon medical condition.
But we cannot give up. We must keep going, we must live mindfully and even in pain we must try to live our best life.
Avascular Necrosis/Osteonecrosis is one of those rare diseases and today I am happy to introduce you to the creator of it’s just a bad day not a bad life.
But before I do, I want to tell you a bit about her.
She is the VP of WEGO Health patient network as well as a Patient Empowerer, Certified Holistic Health Coach, Yoga Instructor, Speaker and Patient Leader Blogger who is thriving with psoriatic arthritis and avascular necrosis of the femur and has battled melanoma, complex regional pain syndrome, depression, and anxiety.
Please welcome Julie Croner
She is using her personal mantra ‘It’s just a bad day, not a bad life’, she started itsjustabadday.com, which has been named one of the top 5 Psoriatic Arthritis blogs by EveryDay Health, top 7 Psoriasis blogs by HealthLine, top 40 Arthritis blogs by Feedspot and has been highlighted by The Mighty, WedMD, The National Psoriasis Foundation, and many other online sources.
Staying busy is a way of life for Julie. Some of her accomplishments and activities include:
Vice President of the Patient Leader Network for WEGO Health, 2016 Standford MedX Ignite Talk and Oral Presenter, 2014 Stanford Medicine X ePatient Scholar, Psocial Ambassador for the National Psoriasis Foundation, member of the Advocacy and Mission Committee for Arthritis Foundation, WEGO Health
Best In Show: Twitter in the 2015 Health Activist Awards, Psoriasis Social Media Ambassador and Health Guide for HealthCentral, blogger for PsoStrong.com, contributor to Everyday Health and Yoga Instructor.
Julie is an army wife and new mama. When she’s not working, Julie can be found jamming out to Celine Dion, taking a yoga class, traveling, cooking, geeking out over health-related things or enjoying life in Pittsburgh, PA.
You can find Julie at
Blog: Itsjustabadday.com
Twitter: twitter.com/justagoodlife
Facebook: Facebook.com/itsjustabaddaynotlife Instagram: Instagram.com/itsjustabaddaynotlife LinkedIn: http://www.linkedin.com/in/juliecerrone
Blog Email: justabaddaynotlife@gmail.com
Please welcome Julie Cerrone
So Julie : How long have you had Avascular Necrosis -Osteonecrosis?Where do you have avn-on?
I was diagnosed with AVN in my left femur bone in December of 2012.
Is your Avascular necrosis in more than one joint or bone?
It was in just one bone, but I had 2 places within the bone. A smaller section and then a larger section that was crumbling due to me putting weight on my leg.
How did you feel when you were diagnosed?
Up to the day I was diagnosed I had been continuously going to my doctor complaining I was in pain. I had 2 back to back surgeries (my 4th and 5th knee surgeries overall), had been in therapy, was on crutches and was in so much pain I had been unable to work for the previous 6 months. He kept saying that there wasn’t anything wrong – but I pushed for every test under the sun.
I’ll always remember December 17th, 2012 and the look on my doctor’s face when he came into my exam room. He said you have AVN. I know what it is, I’ve seen it before, but I don’t know really how to best treat it and I don’t know where to send you.
I’m a pretty positive person – but hearing that from someone I had trusted for years as my orthopedic surgeon really hit me. I literally went home, laid on the couch and cried for the rest of the night. I had NO idea bone could die. And for my doctor to tell me he had no idea what to do . . . . that was hard.
Did they say what may have been the cause of your avn-on?
So obviously no one can pinpoint it exactly, but this is what I have deduced from reflecting on it for the past 7 years.
In February of 2012, I started having knee problems. I had had knee problems my whole life, so it was kinda like “here we go again” thing in the back of my mind.
As months went on, it wasn’t getting any better – in fact it was getting worse. I went to my orthopedic and in June I had surgery. I ended up going back into the OR in September because I was still in so much pain.
Looking back, it’s very clear to me now that there wasn’t anything surgery could have fixed- I was having a psoriatic arthritis flare. In middle school a doctor had suggested that I had PsA but I never took it seriously because 1) I had no idea what it was 2) I was young and thought there’s no way I had arthritis.
December 26th, 2012 (right after I was dx with AVN) I ended up in the hospital because I was in so much pain I couldn’t stop shaking. That’s when I was officially dx with psoriatic arthritis.
A year after getting diagnosed with AVN I found out that I have prothrombin thrombophilia which is a blood clotting mutation. Basically, I think that the mutation predisposed me to be susceptible to AVN, and then coupled with the back to back unneeded surgeries and a psoriatic arthritis flare = the perfect storm.
Did you ever hear of avn-on before your diagnosis?
Nope. I had never heard of it. And honestly, I didn’t even know your bone could die!
What are some of the treatment options have you tried? Were any helpful?
So I was on crutches for 3.5 years. The longest ‘treatment’ I did was to stay off of it and give my knee a chance to recover. I also took pain killers around the clock to deal with the pain. I then subsequently did 2 things that ultimately got my pain under control and helped me get my life back together.
1) I took high doses of blood thinner injections to get my blood flowing to the necrosed areas of my bone. This actually worked wonders and it revived the smaller AVN part of my bone. Today on MRIs you can’t even see it!
2) I had a Regenexx stem cell procedure done. This was AMAZING. I blogged the entire journey: http://www.itsjustabadday.com/regenexx-avn-procedure/
I’m 4.5 years out from the procedure and feel amazing. I haven’t had ANY pain, ANY issues or ANY concerns. The last MRI I had was at a year out and my bone had regenerated 60%. The way it had regenerated it encapsulated the dead part that was crumbling and strengthened the bone. I’m able to live life, function, walk, run – do anything I want without any worry of AVN.
Can you tell me do you work or are you unable to work?
I was on disability for almost 4 years. I’m back to work full-time now. I’m even a yoga instructor!
How many doctors have or did you see before getting diagnosed?
I was only going to my 1 orthopedic doctor and it took me 6 months to get a proper diagnosis. But in order to TREAT my AVN, I lost track at 29 providers.
You know who ended up helping me? PATIENTS. Patients online were my saving grace and the reason I found out about the blood thinner injections and the stem cell procedure.
What would you tell someone who has been newly diagnosed with avn-on?
Stop what you’re doing, go to the Regenexx website and lookup an office near you. They’re the ones who have been doing this the longest, have the most research and help AVN patients all the time. I’m living testimony that this can work. But don’t just take my word for it – I’ve connected with hundreds of other patients who have received benefits fro the Regenexx stem cell procedure.
But on that note, be weary of stem cell procedures. I personally endorse the Regenexx procedure because of their process and their standard of quality. Others do not do it the same way they do it (even Mayo Clinic or Cleveland Clinic). Also- do not get stem cell injections that are not your own. If you’re getting anything other than your own mesenchymal stem cells you’re wasting your money.
And for those who are worried about the financial aspect of the stem cell procedure, I say this to you. Yes, it’s an investment. But without your health- what do you have? I was on disability, didn’t have a ton of money in the bank and still found a way to get it done. I’m not any more entitled than anyone else out there. If there’s a will, there’s a way.
Most people look at it from the upfront cost – but you don’t consider this…
To get a joint replacement, on average, in most markets it costs around $40k. (sure, you don’t pay all of that, but you’re paying your insurance costs). Then you’ll have follow up doctor visit, etc.
Then you have to go to therapy – for MONTHS.
With a joint replacement, you’ll be off work, you’ll be unable to really function properly for a good amount of time.
And to be blunt, a lot of people have problems with joint replacements and end up spending more time and money on fixes and follow-ups.
Oh- and also, depending on your age – you’ll need to get another one because they don’t last very long. Especially if you live an active life.
People always think that having insurance cover a core decompression or a joint replacement is the better way to go. I BEG you to think of it not in those terms. Think of YOUR LIFE. The quality of life you want to have.
By having a stem cell procedure, I not only still have my own joint, but it’s healthy and I don’t have to worry about having to go through it all again in the future.
Name something positive that has been a result of getting avn-on?
I’ve had amazing experiences since being diagnosed with AVN. I had the opportunity to share my story of how patients were the ones who got me back to walking and regrew my femur bone at Stanford MedX: http://www.itsjustabadday.com/2017/03/09/medx-ignite-talk-replay/ (If you scroll to the bottom of the post you can see my Ignite talk)
And I was invited by the FDA to share my story on stem cells at a hearing: http://www.itsjustabadday.com/2016/09/28/fda-stem-cell-hearing/ (If you scroll down to the bottom of this post you can see my testimony)
But honestly, the most positive thing that has resulted from my diagnosis is getting to connect with patients all over the world, on a weekly basis, and helping them know they’re not alone. I try to pass on my own advice, my own journey and my own thoughts to help them feel a little less alone and to have a bit more knowledge than I did when I was in their shoes. It really helps me to know that I didn’t go through this for nothing. I went through this to help others and to really find my passion in life.
Thank you so much Julie not only for this interview but for being a great inspiration to so many and educating others while raising awareness on this rare disease. May you have continued success in your advocacy and all that you do and wishing you continued wellness.
To follow Julie on social media her links are listed below.
Blog: Itsjustabadday.com
Twitter: twitter.com/justagoodlife
Facebook: Facebook.com/itsjustabaddaynotlife Instagram: Instagram.com/itsjustabaddaynotlife LinkedIn: http://www.linkedin.com/in/juliecerrone
Blog Email: justabaddaynotlife@gmail.com
Please help raise awareness by sharing this blog post in the hopes it reaches someone who may benefit from the information provided.
*If you are interested in sharing your Avascular Necrosis -Osteonecrosis story or Group in an interview please email me at.
If you know of someone or if you are someone who suffers from AVN-ON and you need a great support group
Click on the link to find this Facebook group – Avascular Necrosis/Osteonecrosis Support, Int’l.
https://www.facebook.com/groups/DeadBoneDiseaseAVN/?ref=share
Also please like and subscribe to my blog and if you want to follow me you can find me at the links below.
Thank you again Julie and
Here is wishing everyone a pain free day.
To learn more about me check out
Deborah Andio links below please like follow and share.
Thank you God Bless You.
Click on the link to visit and subscribe to my website :
www. ChronicallyGratefulDebla.com
Instagram Personal :
http://www.instagram.com/deborah_andio
Instagram Awareness Chronically Grateful Me
http://www.instagram.com/chronicallygratefulme
Twitter:
More links are in my blog
Deborah Andio
Patient Leader Blogger Empowerer
I am hoping to be selected for the Health eVoice 2020 conference.
This would be such an honor.
Here is a short video
Thank you.
Your eating what?
Before you take one more bite of that fast food lunch or dinner consider how it affects your osteoarthritis.
I am posting this because many with Avascular Necrosis/ Osteonecrosis also end up with osteoarthritis.
Did you know that research shows that diets high in saturated fat – found in red meat, butter, cheese, lard and processed foods – can weaken knee cartilage, making it more prone to damage.
Yep so start eating more plants
There was a study in 2017 published in Arthritis Care & Research, researchers followed more than 2,000 patients with OA for up to four years, checking disease progression and diet at yearly intervals. Participants who ate the most fat, especially the saturated kind, showed increasing joint damage, whereas those who ate healthy fats like olive oil and avocados had little disease progression.
Another recent animal study showed that it even may harm the underlying bone, according to Yin Xiao, PhD, a professor at Queensland University of Technology in Australia and lead author of a 2017 study that looked at the effect of diet on OA.
“Our findings suggest that it’s not wear and tear but diet that has a lot to do with the onset of osteoarthritis,” he says.
Blame It On Inflammation
Fat’s not the only culprit, though. Sugar, refined carbs, red meat, processed food and corn and soybean oils can spark inflammation, too. Barry Sears, PhD, a long-time researcher in inflammatory nutrition, says eating them is “like throwing a match into a vat of gasoline.”
These foods also tend to pack on pounds, putting extra pressure on stressed joints. To make matters worse, body fat, especially the kind that collects around your belly, makes its own inflammatory proteins, perpetuating the cycle of inflammation even after you’ve sworn off junk food forever.
Fighting Back
The solution is to change the way you eat. Switching to an anti-inflammatory or Mediterranean-style diet can help you lose weight and significantly improve your joint, heart and brain health without sacrificing good taste.
An anti-inflammatory diet is heavy on fruits and vegetables, whole grains, fish and healthy fats like olive oil, avocados and nuts. Poultry’s allowed now and then and you can have one glass of red wine or beer a day. Off the menu, as you might expect, are sugar, red meat, and processed foods.
What sets this way of eating apart is that it actively fights inflammation, experts say.
“There are a variety of foods in the Mediterranean diet that are high in fiber, beta carotene, magnesium and omega 3s, all of which have been found to reduce inflammatory markers in human studies,” explains Michelle Babb, MS, RD, a Seattle-based nutrition educator.
“I’ve had [arthritis] patients who have been able to discontinue the use of non-steroidal anti-inflammatory drugs (NSAIDs) as a result of transitioning to a Mediterranean diet. Some even report a noticeable difference in pain in the first week.”
Even so, changing the way you eat can be daunting.
“Don’t expect your diet to change overnight,” advises Sotiria Everett, EdD, RD, an assistant professor at Stonybrook University Medical Center in New York. “Start by looking at what you’re eating now (a food diary is a great way to do this) and identifying areas where you can improve.”
But Babb doesn’t see a problem. Her patients “really enjoy this food plan and don’t feel it’s a hardship to follow it,” she says.
She admits it takes more work and advance planning than the drive-through and recommends prepping some food for the week in advance.
I personally can agree with this as when I stopped eating so much red meat and cut out sugar and most processed junk I felt much better .
And when I eat things that are not as healthy as they should be I feel more pain.
So try a plant based diet or as they suggest Mediterranean
You will be so glad you did.
This taken from article Arthritis Foundation Blog
I need you to help me get to my goal
I have started a petition to get the rare disease Osteonecrosis recognized by asking for an awareness month week or day. If they won’t allow a month.
I could use as many supporters as possible to help me and share this.
No money at all is needed.
I hope you will help me raise awareness
Take Action: We Need Osteonecrosis Awareness To Have The Month Of October to Recognized & raise awareness #Osteonecrosis #AvascularNecrosis please help and sign and share
Link requesting osteonecrosis awareness-month-october
Or copy and paste
https://www.petition2congress.com/ctas/osteonecrosis-awareness-month-october
To President Donald Trump, The U.S. House and The U.S. Senate
We, the patients of a rare disease called Osteonecrosis respectfully ask the United States of America in this petition to the US Congress to pass legislation to establish and recognize October as Osteonecrosis Awareness Month in the United States.
The people of the United States are called upon to observe the month of October with appropriate educational and awareness opportunities, and recognition.
With hundreds of thousands of US residents suffering from this disease and more being diagnosed everyday , there is a need for this community to have an active voice and recognition.
It is happening in all age groups from child to elderly
Osteonecrosis, also known as Avascular necrosis (AVN), aseptic necrosis or ischemic bone necrosis, is a disease resulting in the death of bone cells. If the process involves the bones near a joint, it often leads to collapse of the joint surface and subsequent debilitating often crippling arthritis due to an irregular joint surface.
Although it can happen in any bone, osteonecrosis most commonly affects the ends (epiphysis) of long bones such as the femur (thigh bone). Commonly involved bones are the upper femur (ball part of the hip socket) the lower femur (a part of the knee joint), the upper humerus (upper arm bone involving the shoulder joint), and the bones of ankle joint. The disease may affect just one bone, more than one bone at the same time, or more than one bone at different times.
Osteonecrosis can cause severe pain and disability. Early diagnosis and early treatment may improve the outcome.
Osteonecrosis may result from use of glucocorticoid (sometimes called corticosteroid) medicine or from drinking too much alcohol but there are many causes and also some that are unknown.
Though osteonecrosis can occur in almost any bone of the body, the hips, knees,ankle and shoulders are the most common sites affected.
The cause and treatment for osteonecrosis of the jaw differs from that for osteonecrosis found elsewhere.
The most common causes of osteonecrosis are:
Serious trauma to bone or joint (injury), which interrupts a bone’s blood supply
Corticosteroid medications (such as prednisone, cortisone or methylprednisolone), mainly when a high dose is used for a prolonged period of time
Excess alcohol consumption
Systemic lupus erythematosus
Other risk factors for osteonecrosis include:
Decompression disease (also called the “Bends” that can occur with scuba diving)
Blood disorders such as sickle cell anemia, antiphospholipid antibody syndrome (APS) and lupus anticoagulant, factor v leiden, and others
HIV infection (the virus that causes AIDS)
Radiation and Chemotherapy
Bisphosphonates, which may be linked to osteonecrosis of the jaw
Organ transplants
Osteonecrosis is not life-threatening, but it is debilitating and hurts our quality of life. Although it isn’t well-known and its exact cause is unknown, AVN-ON affects 10,000-to-20,000 Americans annually. Between 30 and 60 percent of patients will experience AVN-ON bi-laterally, which means both sides so if one hip or knee has it most likely so will the other.
Please help those of us that suffer from this condition by creating more research , funding studies and allowing us the recognition, as only through education, research and awareness can we get better treatment options, earlier diagnosis and hopefully prevention.
Thank You
Deb
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
©Debla2019
The real term is Osteonecrosis
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.
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.
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.
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.
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
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.
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
Avascular Necrosis-Osteonecrosis Education and Resources 