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.
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
When you have tried everything an all non-surgical treatments stop relieving your chronic hip pain, or your pain reaches debilitating levels, hip replacement surgery may be the best option to relieve your discomfort, restore your mobility and improve your quality of life.
Hip pain due to Osteonecrosis is an increasing problem for many.
After time over-the-counter pain medications can lose their efficacy and chronic hip pain can quickly escalate often requiring prescription medications, physical therapy, and the use of canes or walkers to aid mobility.
If your pain is severe and debilitating, isn’t it time to do something about it.
Talk to your Doctor or Orthopedic because you don’t need to suffer and have a poor quality of life.
What Signs & Symptoms Indicate a Need for Hip Replacement Surgery?
Hip pain can have a number of causes, not all of which can be relieved by a hip joint replacement.
Among the listed causes of AVN are steroid use, trauma, hypertension, rheumatoid arthritis, and alcoholism, blood clot disorder, smoking, vasculitis Bisphosphonate use, Chemo or radiation or it could be idiopathic, meaning no cause can be determined. Certainly Napoli has had his share of wear and tear, being a catcher.
For instance, constant or long-lasting stiffness in your hip joint can be a sign of rheumatoid arthritis while pain that centers in the buttocks region and radiates down the leg may be related to sciatica.
However, many cases of hip pain and discomfort are directly related to your hip joint.
Symptoms and signs that it may be time for hip replacement surgery include:
• Mobility issues, especially if your level of mobility progressively worsens
• Persistent or recurring pain, swelling or discomfort in your hip
• Hip pain that worsens during rainy weather
• Inability to sleep due to hip pain and discomfort
• A “grating” feeling in your hip joint
• Increasing difficulty in climbing stairs or getting in and out of cars, bathtubs, and chairs
• OTC medications no longer effectively manage your hip pain
If you have any or all of these symptoms, talk to an orthopedic surgeon about the possible need for hip replacement surgery.
How Is a Diagnosis Made?
To determine if you are a good candidate for hip replacement surgery, you will need a thorough examination by an experienced orthopedic surgeon. This examination will include:
• A complete medical history evaluation, including any previous injuries or illnesses that could be contributing to your pain
• A physical assessment to determine your range of motion, pain level and the strength of your affected hip
Your orthopedic surgeon may also order additional medical testing, including MRIs and X-rays. If your surgeon decides that the next step is hip replacement surgery, be sure to discuss any questions or concerns you have about the surgery or recovery from hip replacement surgery.
What Do You Need to Know About Hip Replacement Surgical Procedures?
Potential candidates for hip replacement surgery need to know that the surgery is a time-tested procedure that has been used successfully for more than four decades to relieve chronic hip pain and improve both flexibility and mobility. More than 300,000 Americans opt for hip replacement surgery each year to rid themselves of hip pain and improve their quality of life.
Total hip replacement surgery, or total hip arthroplasty, uses a ball and socket prosthetic joint to replace your damaged one. Special metals, such as cobalt-chromium and titanium, and polyethylene plastics, are used to make your prosthetic joints. These materials are safe for use inside the body and are extremely durable and long lasting.
The procedure for your total hip replacement surgery will most likely include the following steps:
1 Separating your femur from your hip socket
2 Removing the damaged ball from the femur
3 Removing your damaged bone and cartilage
4 Inserting a metal shell into your pelvic bone socket and using bone grafting material to secure it
5 Completing the artificial socket by adding the plastic liner
6 Preparing your femur to receive the metal implant
7 Placing the metal implant into the hollowed end of your femur
8 Attaching a metal ball component to the stem
Hip replacement surgery is a very effective procedure, and most patients experience a dramatic reduction in pain and improvements in their mobility and stamina. With the proper recovery procedures and physical therapy, you should be able to enjoy walking, swimming, biking and other low-impact activities without impediment.
If you can no longer bare the pain or have problems walking talk to your ortho about your options.
We’re praying for you
Your hips are largest and most powerful of muscle groups—the glutes, quads, and hamstrings—all connect at the hips, and they allow you to walk, run, climb. The hip joint is crucial to all movement, in sports and day-to-day life, which is why persistent hip pain can be such a pain in the ass literally and often debilitating.
Wear and tear on your hip joint can worsen with age. According to the Centers for Disease Control and Prevention, 7 percent of adults in the U.S. suffer from hip pain, the third most common joint pain behind shoulder pain, at 9 percent, and knee pain, at 18 percent. There’s also a growing prevalence of young athletes with hip injuries, especially young women, due to repetitive overuse and acute trauma.
Trauma can sometimes lead to osteonecrosis in any joint but we are focusing on the hip , and some of the medications given to help inflammation and strengthen bones can also be a cause of osteonecrosis aka avascular necrosis.
Your Hip Pain May be the Sign of a Rare Condition
If you have hip pain don’t always brush it off as arthritis, if it persists, get it checked out to be safe
Persistent or worsening hip pain warrants a visit to your health care provider and possibly a sports medicine specialist or ortho. Some problems, particularly hip stress fractures, are commonly misdiagnosed due to the confusing presentation of symptoms.
A thorough evaluation is necessary and often includes X-rays and other studies, such as an MRI or bone scan. As with all injuries, the absence of pain does not mean that all is well. Strength and flexibility deficits must be addressed to allow a healthy return to helping your quality of life.
Although a person may not initially experience symptoms, hip pain is usually the first indicator. The earlier the diagnosis is achieved, the better the patient’s potential outcome. AVN has four stages that can progress over a period of several months to more than a year. In Stage I, the hip is healthy; in Stage II, the patient experiences mild to moderate pain in direct proportion to the deterioration of the head of the femur (or ball of the hip joint). By Stage III, usually the patient will find it difficult to stand and bear weight on the hip, and joint movement will be painful. During this stage, the ball of the hip has deteriorated to what is called a subchondral fracture and early collapse. Stage IV is a full collapse of the femoral head and degenerative joint disease (DJD).
Treatment for AVN is recommended based on the stage of the disease coupled with the age of the patient. In Stage I, medication and crutches may be prescribed to provide relief and enable the bone to heal on its own. This treatment may require the patient to be non-weight-bearing for up to six months. It also has a failure rate greater than 80-percent.
On the horizon treatments are stem cell.
Surgical treatment is recommended with a Stage II diagnosis, or very early in a Stage III diagnosis. A procedure, known as a core decompression, typically involves drilling one large hole in the core of the effected bone, with or without a bone graft, to reduced pressure and improve blood circulation in the hip. Another surgical option is the vascularized fibular graft, which takes a healthy piece of bone from the fibula, along with the artery or vein, and transplants and reattaches it into the hip, to help healthy bone grow. Recovery can take several months.
Because most patients are diagnosed in late Stage III or IV of the disease, when the bone quality of the femoral head is poor (subchondral fracture) or has collapsed, total hip replacement is the most successful treatment for AVN. This procedure replaces the damaged bone with artificial parts. Recovery takes about eight to twelve weeks. If left untreated, AVN progresses and results in pain and severe debilitating osteoarthritis.
Treatment decisions for AVN are ultimately up to the patient and are based on his or her lifestyle and goals. If you are suffering with hip pain, talk with your primary care doctor about a referral to an orthopedic surgeon
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.
The real term is Osteonecrosis
Synonyms of 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:
• 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:
• Steroid use
• Gaucher disease
• Caisson disease
• Alcohol use
• Blood disorders, such as sickle cell anemia, factor V, eNOS, mthfr, factor viii
• Radiation treatments
• Decompression disease
• Hypercoagulable state
• Autoimmune disease
• Bone Marrow Edema
• Legg Calves Perthes is avn in childhood
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.
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.
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.
If for some reason I would need a hip replacement, my single biggest concern would be wear particles. This phenomenon first came to light about 5 – 7 years ago when surgeons began to replace the first worn out or failed metal on metal (MOM) hips. What they found in some patients was scary. Basically, the entire area directly around the hip replacement device had turned into a mass of black goo.
Then studies were published showing that those microscopic metal shavings were leaching into the blood stream and causing elevated metal ion levels. Additional studies began to point out that some people’s tissue was so sensitive to this junk that they formed pseudotumors, which are basically big solid masses of irritated tissues, some of which could press on important nerves. Finally, genetic studies showed that not only was this tissue visibly unhappy, the cells were getting damaged at a genetic level from the wear particles.
When all of this first came to light, it looked like only MOM hips were involved. However, as the research below shows, the issue of wear particles extends to every type of hip made.
ARMD – Adverse Reactions to Metal Debris
Before we begin, it’s worth noting that there is now a name for pissed off tissue caused by wear particles. In a 90s movie, a nuclear war head falls into the wrong hands and the main character is informed that this is called a “Broken Arrow”. He responds to the effect of, “I’m not sure what’s more disturbing, the fact that we just lost a nuclear warhead or that you actually have a name for this”. I feel the same about the fact that the orthopedic joint replacement community now has a name for wear particles that cause problems in patients.
In addition to highlighting research on wear particles, I’ll also look at the durability of each type. So let’s take a look at how to navigate this minefield.
The Research on the Various Types of Hip Replacement Materials – Focused on Wear Particles and Device Failure
MOM or “Metal on Metal”
The “bad boy” of hip replacement types is clearly MOM hips. The funniest thing is that despite all of the absolutely horrific things published about these devices, you can still find Internet ads for many surgeons who will be happy to implant them. They do this by claiming that these are “minimally invasive” hips. While there’s a tiny kernel of truth in that hogwash (the incisions needed to implant them are smaller), there is nothing minimally invasive about amputating a joint and inserting a prosthesis, no matter how you skin that cat. In addition, the smaller the device, the bigger the wear particle issue.
MOM hips produce metal wear particles locally that are then taken up in the bloodstream. In general, smaller MOM hip devices (usually those used for small framed women) have a higher likelihood of producing metal wear particles. This study showed more metal ions in the blood with MOM devices compared to conventional hip replacement prostheses. This randomized trial again demonstrated more metal ions in the blood of women with MOM hips when compared to conventional hip replacement, but also noted that pseudotumors occurred both around these MOM devices and the more conventional MOP devices as well. This recent study showed that metal debris was present in both large and small MOM hip replacement devices.
Photo from Breaking Muscle It’s all in the hips
The latest 2015 consensus guidelines are now not to perform a MOM hip replacement in small women or anybody with a known metal allergy. The latest study on MOM hips and pseudotumors concludes, “Adverse reactions to metal debris in MOM hips may not be as benign as previous reports have suggested.” Not good.
Polyethylene and Metal on Polyethylene (MOP)
When I initially began this literature search, I thought that MOP hips may be better in the wear particle department. After all, you don’t have metal rubbing on metal, but usually metal on plastic. However, I was wrong.
To see how bad things can get with MOP wear particles, I didn’t have to look far. This recent study from 2014 showed an awful side effect of both polyethylene and metal wear particles, a pseudotumor that invaded a woman’s vaginal tissues. This 2015 study was very concerning in that it compared MOP hips to MOM hips with regard to metal levels and chromosome damage in cells. It couldn’t conclude that one was better than the other. Based on this 2014 study, MOP hips wear less, but their wear particles produce slightly more tissue reaction than MOM hips. This is all consistent with a recent study I blogged on, showing that conventional polyethylene wear particles reduced stem cell activity in bone marrow and muscle.
If there is one bright spot in this category, it’s likely the newer highly cross linked polyethylene (HCLP). Based on this recent study, HCLP hips produced fewer wear particles than regular polyethylene. In another study of shoulder replacement devices, the lower debris for these devices was confirmed. In addition, based on this 2014 study HCLP devices seem to withstand unexpected wear and part failure better.
Ceramic on Metal (COM), Ceramic on Ceramic (COC), Ceramic on Polyethylene (COP)
Maybe ceramic is the way to go? After all, what could go wrong with installing a hip replacement device made of the same substance as dinner plates?
This 2015 randomized trial showed that COM hips still regrettably produced metal wear particles that ended up in the blood stream. Some good news for COM hips could be found in this 2015 study. It concluded that while there was swelling around these devices, when compared to minimally invasive MOM hips, there were no pseudotumors seen in COM hips. However, based on this analysis of many studies, there doesn’t seem to be any advantage of COC compared to COP. How does COM and COC compare? Ceramic on metal doesn’t seem to have the same durability as ceramic on ceramic based on this study.
Is Your Surgeon Being Paid to Promote a Certain Type of Hip?
One of the real challenges in navigating this landscape is that regrettably, joint replacement devices have been one of the worst areas of payola in medicine. As reimbursements have declined for the surgical procedures of installing and replacing devices, many surgeons have figured out that they can keep their cash flow stable by taking money from the device manufacturers. This has been the subject of many Department of Justice lawsuits through the years.
The big issue for patients is how to know if their surgeon is recommending a hip device because they really feel that it’s the best, or because they’re getting paid by the company making the device. This Propublica web-site will allow you to research your surgeon’s payment history.
Correct Sizing is Key!
It’s very clear from reviewing the medical research on this topic that a poorly sized hip device is a huge problem for many reasons. First, it will reduce the longevity of the device. Perhaps more importantly, it virtually guarantees more harmful wear particles. And since we’re talking about replacing your hip, a good fit is common sense.
Given the modular nature of these hip devices and the wide array of options, a poor fit should never happen. However, in my experience, hardware fitting issues usually happen when the operating room and/or hospital don’t have the correct size in stock on the day of the surgery. So agree before hand on the size of the components and make sure the staff has double-checked to make sure the hospital has that size in stock.
The upshot? All hip replacement devices produce wear particles. But which is best? It’s clear that when metal on metal implants go bad, things can go very bad with a local tissue reaction that can cause pseudotumors and high metal ions levels in the blood. If I had to get my hip replaced, I would cross this type of implant off my list. Ceramics still produce wear particles and have the added problem of fracturing in an active individual. Polyethylene wear particles in a MOP hip can be just as bad as those from a MOM hip. Given that highly cross linked polythylene has the least wear particles, this is likely the winner. However, realize that not as much is known about tissue reaction to cross linked polyethylene, so that recommendation may change with time. In addition, there are newer types of ceramics that once mated with HCLP could produce less debris.
More information Hip Replacement Material- Regenexx