Avascular Necrosis-Osteonecrosis Education and Resources
Avascular Necrosis-Osteonecrosis Education and Resources
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 (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.
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
AVN has several risk factors, including medical conditions and lifestyle choices that may increase your chances of developing the disorder:
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:
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:
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.
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.
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.
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Specific Questions To Ask Your Otho
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 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
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
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
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.
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)
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
Iceland
India
Indian Orthopaedic Association (IOA)
Iran
Iranian Orthopaedic Association (IOA)
Ireland
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
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)
Click link below
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
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
ChronicallyGratefulDebla2018© ™️
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
Avascular Necrosis-Osteonecrosis Education and Resources 