Avascular Necrosis Mask

Many requested masks as so many cannot find them , so I contacted a local shop in my area and we made these two designs. The mask are washable

I don’t get paid anything for or a portion of the masks just doing this as a way to help those wearing a mask support the cause of Osteonecrosis aka Avascular Necrosis.

If you wish to purchase here is info. And they ship worldwide

They are closed on Sundays and Holidays

Afterburner FX

3600 Schotten Road

Hubbard Ohio 44425

3305347653 phone

Afterburner FX

Mask design

@Debla2020

Osteonecrosis and osteoradionecrosis of the Jaw

Some individuals get ONJ

Osteonecrosis of the jaw, commonly called ONJ, occurs when the jaw bone is exposed and begins to starve from a lack of blood. Most cases of osteonecrosis of the jaw happen after a dental extraction. … ONJ is much more common in those patients who use these medications for cancer of the bone treatment.

Most patients with ONJ who are taking antiresorptive therapy for osteoporosis can be healed with conservative treatment. Surgery is not usually required and could contirbute to the poor bone healing. 

Good oral hygiene and regular dental care is the best way to lower the risk of ONJ

ONJ is associated with cancer treatments (including radiation), infection, steroid use, or antiresorptive medications used for osteoporosis. Examples of antiresorptive medications include bisphosphonates such as alendronate (Fosamax); risedronate (Actonel and Atelvia); ibandronate (Boniva); zoledronic acid (Reclast), and denosumab (Prolia).

ONJ is much more common in those patients who use these medications for cancer of the bone treatment. When used for osteoporosis in much lower doses, it is very rare.

While ONJ is associated with these conditions, it also can occur without any identifiable risk factors.

Osteonecrosis of the jaw is a condition in which an area of jawbone is not covered by the gums, a condition of poor healing. The condition must last for more than eight weeks to be called ONJ. When the bone is left uncovered, it does not receive blood and begins to die. ONJ most often develops after an invasive (surgical) dental procedure such as dental extraction. ONJ also may occur spontaneously over boney growths in the roof or inner parts of the mouth.

ONJ has occurred in patients with herpes zoster virus infections, in those who are undergoing radiation therapy of the head and neck (radiation osteonecrosis), osteomyelitis (bone infection), and in persons taking steroid therapy chronically.

Patients taking antiresorptive medications to reduce their risk of bone fracture also may rarely experience ONJ. Why some patients taking antiresorptive medications get ONJ is unknown. It may be due to a decrease in the bone’s ability to repair itself; a decrease in blood vessel formation; or possible effects of infection.

There is no diagnostic test to determine if an individual patient is at increased risk for ONJ, but some factors are known to raise the risk in very rare circumstances. The condition itself is diagnosed only by the presence of exposed bone, lasting more than eight weeks. Patients typically complain of pain, which is often related to infection, soft tissue swelling, drainage, and exposed bone.

Most patients with osteoporosis who develop ONJ are treated conservatively with rinses, antibiotics, and oral analgesics. Studies have shown conservative treatment to be effective. There are case reports of the use of teriparatide in management of ONJ.

Rheumatologists are specialists in musculoskeletal disorders including osteoporosis and therefore are best qualified to review the risks and benefits of antiresorptive therapy for osteoporosis. They can also advise patients about the best treatment options available.

Prevention

A health program of oral hygiene and regular dental care is the optimal approach for lowering osteonecrosis of the jaw risk. Patients should inform their dentists that they are taking potent antiresorptive therapy, such as alendronate (Fosamax), risedronate (Actonel and Atelvia), ibandronate (Boniva), zoledronic acid (Reclast) or denosumab (Prolia).. Dentists should consider conservative invasive dental care in patients taking potent antiresorptive therapies.

For instance, endodontic (root canal) treatment is preferred to dental extraction if the tooth can be saved. If dental extraction is needed, full mouth dental extractions or periodontal surgery should be avoided. (It may be better to assess healing by doing individual extractions.)

Patients with periodontal disease should consider non-surgical therapy before agreeing to surgical treatment. Many patients taking bisphosphonates may undergo dental implants without problems. Although some dentists recommend the use of blood tests to decide who is at risk, this practice is controversial due to a very limited evidence base and should not be used at this time.This is in agreement with current American Dental Association suggestions.

Those on oral bisphosphonates are at low risk for ONJ. If patients detect any mouth pain or problems, they should seek dental care right away. It is not necessary to stop bisphosphonate use before a dental procedure, but it may be best to delay starting the drug therapy until after a scheduled dental procedure.

**Osteoradionecrosis is bone death due to radiation. The bone dies because radiation damages its blood vessels.

Osteoradionecrosis is a rare side effect that develops some time after radiation therapy has ended. It usually occurs in the lower jaw, or mandible. The lower jaw is at risk of osteoradionecrosis because it has a limited blood supply. Very rarely, osteoradionecrosis can start in the upper jaw, or maxilla.

Doctors usually classify osteoradionecrosis based on what tissue it affects, if it responds to treatment and if it has caused a fracture. They give osteoradionecrosis a grade from 1 to 3, usually as a Roman numeral (I, II or III). They use these grades to plan treatment.

Causes

Osteoradionecrosis is caused by radiation therapy to the bone. It may develop years after radiation therapy for head and neck cancers. 

The risk of developing osteoradionecrosis increases when the dose of radiation received is greater than 60 grays. It is also higher if the bone treated with radiation is exposed.

There is also a higher risk of developing osteoradionecrosis if a dental exam and necessary dental repairs aren’t done before radiation therapy. People with poor oral hygiene before or after radiation therapy are also at higher risk. So are people who develop dry mouth after radiation therapy.

Damage or trauma to the jaw after radiation therapy, especially within the first year after treatment, can also increase the risk for osteoradionecrosis. Damage or trauma can be caused by:

  • tooth extraction
  • cancer surgery or biopsy
  • denture irritation
  • accidents 

In rare cases, osteoradionecrosis may develop even if there isn’t any trauma or damage to the mouth, teeth or jaw.

Symptoms

Symptoms can vary depending on the grade or extent of the osteoradionecrosis and include:

  • pain
  • swelling
  • a sore, or ulcer, in the mouth or on the jaw
  • difficulty opening the jaw, or trismus
  • an abnormal opening, or fistula, between the jaw and the surface of the body
  • less feeling in the mouth or jaw, or even a complete loss of sensation in the area
  • infection
  • teeth that aren’t aligned properly, which is called malocclusion
  • jaw fracture not related to an accident or other trauma 
  • exposed bone inside the mouth
  • bone sticking out through the skin, which is called sequestrum 

Exposed bones and sequestrum are most often found under the jaw.

Report symptoms to your doctor or healthcare team as soon as possible.

Diagnosis

Your doctor will try to find the cause of osteoradionecrosis. This usually includes doing a physical exam, including a complete head and neck exam. Your doctor may also review your medical records to find out the total dose of radiation you received and the area that was treated.

You may also need the following tests:

  • x-ray of the whole jaw
  • CT scan
  • MRI
  • biopsy of the area to check if the cancer has come back or a second cancer has developed

Find out more about these tests and procedures.

Preventing osteoradionecrosis

Your healthcare team will take steps to prevent osteoradionecrosis. The following measures should be taken before and after radiation therapy.

Before radiation therapy begins

Visit your dentist for a thorough dental exam and teeth cleaning before you have radiation therapy. If you need to have any teeth removed or cavities filled, do so before radiation therapy.

You should also start using daily fluoride treatments. Talk to your dentist or healthcare team about these treatments.

During and after radiation therapy

Be sure to practise good oral care before and after treatment. Keeping the teeth and gums healthy is important for proper healing. Also eat a healthy diet, including foods and beverages that are low in sugar.

Have regular dental exams. Be sure to have any cavities filled or infections in the mouth treated as soon as possible. If a tooth needs to be removed, wait until after radiation therapy is complete. 

Your dentist or healthcare team will recommend fluoride treatments to help prevent cavities. If you have dry mouth, they will also suggest ways to replace saliva and keep your mouth moist.

Managing osteoradionecrosis

Once the extent of osteoradionecrosis is known, your healthcare team can suggest ways to treat it. You will also be given antibiotics if there is an infection in the bone. Other treatment options may include the following measures. 

Surgery

Your doctor may need to do surgical debridement. This means removing dead or infected tissue from around a wound. Dead, or necrotic, bone may also need to be removed. This is called sequestrectomy.

Depending on where osteoradionecrosis develops and how far it progresses, your doctor may need to do surgery to help restore the area.

This may include microvascular reconstructive surgery to restore blood flow to the area.

Bone grafts may be needed to replace the sections of the jawbone that are removed.

Soft tissue grafts can be used to replace muscle and other tissues that have been removed. You may also need dental implants if teeth are removed.

Hyperbaric oxygen therapy

Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized room. It is done in a special chamber where the pressure inside is higher than the normal pressure of the atmosphere.

The higher pressure allows more oxygen to get into your blood, which can help heal damaged and infected tissues.

Hyperbaric oxygen therapy is used in combination with wound care and surgery.

The treatment plan often includes 20 treatments before surgery and 10 more treatments after surgery.

This treatment plan may be adjusted based on your personal situation and how well the osteoradionecrosis responds to the hyperbaric oxygen therapy.

After you finish radiation therapy, your healthcare team may recommend that you have hyperbaric oxygen therapy before you have any teeth removed.

Hyperbaric oxygen therapy may not be available in all centres.

Reference https://www.google.com/amp/s/www.mskcc.org/cancer-care/patient-education/osteonecrosis-jaw-onj%3famp

Thank You Arizona

The good news keeps rolling in

Rare Disease Day is February 29 usually 28 on non leap years.

So as you know I have been working very hard on November 29 being National – Avascular Necrosis Osteonecrosis awareness day and all states have come on board so far but still waiting to hear from maybe 10 states.

They are doing all they can. And I am so pleased many states have issues proclamations for November 29 and many still are in the process.

Today The State of Arizona sent a proclamation for rare disease awareness we got the entire week February 20-27

And they will also be recognizing November 29

So blessed.

Hard work pays off

Thank you State of Arizona

Deb Andio

Founder Avascular Necrosis Osteonecrosis Support Int’l

#Osteonecrisis #AvascularNecrosis

Radionuclide bone scan to diagnose or confirm Avascular Necrosis-Osteonecrosis

Radionuclide bone scan. This nuclear imaging technique uses a very small amount of radioactive material, which is injected into the blood to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.

Overview

A bone scan is a nuclear imaging test that helps diagnose and track several types of bone disease. Your doctor may order a bone scan if you have unexplained skeletal pain, a bone infection or a bone injury that can’t be seen on a standard X-ray.

Why it’s done

Images of bone scans depicting hot spots

Hot spots

If you have unexplained bone pain, a bone scan might help determine the cause. The test is very sensitive to any difference in bone metabolism. The ability to scan the entire skeleton makes a bone scan very helpful in diagnosing a wide range of bone disorders, including:

Fractures

Arthritis

Paget’s disease of bone

Cancer originating in bone

Cancer that has metastasized to bone from a different site

Infection of the joints, joint replacements or bones (osteomyelitis)

Impaired blood supply to bones or death of bone tissue (avascular necrosis)

Thank You Proud Moment

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/

Is Your Hip Pain The Sign of a Rare Condition?

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.

hip

 

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

You won’t keep me down ©

Osteonecrosis can be painful you never know when the pain will come or go.

But I do know it’s already taken my job away from me.

I love the optical field. But the pain was too intense.

Well I’m back in school learning something new.

#YourNeverToOldToLearn

 

©Debla2019

You are what you eat©

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

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

I am a patient leader advocate and home cook

I have

Avascular Necrosis-Osteonecrosis From Injury

Osteoarthritis

Inherited Blood Clot Disorder

Hashimoto Thyroiditis

http://avascularnecrosiseducation.com

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

www.ChronicallyGratefulDebla.com

 

veg

 

Avascular Necrosis-Osteonecrosis

The real term is Osteonecrosis

Synonyms of Osteonecrosis

  • aseptic necrosis
  • avascular necrosis of bone
  • ischemic necrosis of bone

What is avascular necrosis-osteonecrosis ?

AVN-ON is a disease that results from the temporary or permanent loss of blood supply to the bone.

When blood supply is cut off, the bone tissue dies and the bone collapses. If it happens near a joint, the joint surface may collapse.

This condition may happen in any bone. It most commonly happens in the ends of a long bone. It may affect one bone, several bones at one time, or different bones at different times.

What causes avascular necrosis?

Avascular necrosis – Osteonecrosis may be the result of the following:

• Injury

• Fracture

• Damage to blood vessels

• Long-term use of medicines, such as corticosteroids

•To many steroid injections

• Excessive, long-term use of alcohol

• Specific chronic medical conditions

What are the risk factors for avascular necrosis-osteonecrosis?

Risk factors include:

• Injury

• Steroid use

• Gaucher disease

• Caisson disease

• Alcohol use

• Blood disorders, such as sickle cell anemia, factor V, eNOS, mthfr, factor viii

• Radiation treatments

• Chemotherapy

• Pancreatitis

• Decompression disease

• Hypercoagulable state

• Hyperlipidemia

• Autoimmune disease

• HIV

• Vasculitis

• Bone Marrow Edema

• Legg Calves Perthes is avn in childhood

Vasculitis

Smoking

High cholesterol

What are the symptoms of avascular necrosis?

The following are the most common symptoms of avascular necrosis. However, each person may experience symptoms differently. Symptoms may include:

• Minimal early joint pain

• Increased joint pain as bone and joint begin to collapse

• Limited range of motion due to pain

The symptoms of avascular necrosis may look like other medical conditions or bone problems. Always talk with your healthcare provider for a diagnosis.

How is avascular necrosis treated?

Specific treatment for avascular necrosis will be determined by your healthcare provider based on:

• Your age, overall health, and medical history

• Extent of the disease

• Location and amount of bone affected

• Underlying cause of the disease

• Your tolerance for specific medicines, procedures, or therapies

• Expectations for the course of the disease

Key points about avascular necrosis

• Avascular necrosis is a disease that results from the temporary or permanent loss of blood supply to the bone. It happens most commonly in the ends of a long bone.

• Avascular necrosis may be the result of injury, use of specific medicines, or alcohol.

• Symptoms may include mild to severe joint pain and limited range of motion.

• Medications,assistive devices, new experimental treatments like Prp and stem cell injections have show great promise but usually not covered by insurance or you may need to have surgery to improve functionality or to stop further damage to the affected bone or joint.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions. You’re physician should always take a few minutes to talk to you and discuss concerns, treatments all treatments not just the ones they do.

If you don’t get good communication you may want to get another opinion and consider changing providers.

Learn to be your own advocate

Your worth it.

Osteonecrosis has many different causes. Loss of blood supply to the bone may lead to bone cell death and can be caused by an injury (bone fracture or joint dislocation; called traumatic osteonecrosis). At times, there may be no history of injury (non-traumatic osteonecrosis); however, other risk factors are associated with the disease such as some medications (steroids, also known as corticosteroids), alcohol usage or blood coagulation disorders. Increased pressure within the bone also is associated with osteonecrosis. One theory is that the pressure within the bone causes the blood vessels to narrow, making it difficult for blood to circulate through the bone. Osteonecrosis can also be associated with other disorders.

The exact reason osteonecrosis develops is not fully understood for some risk factors. Sometimes, osteonecrosis occurs in people with no risk factors (idiopathic).

Some people have multiple risk factors. Osteonecrosis most likely develops because of the combination of factors, possibly including genetic, metabolic, self-imposed (alcohol, smoking), and other diseases that you may have and their treatment. 

Injury:
When a joint is injured, as in a meniscus tear, fracture or dislocation, the blood vessels may be damaged. This can interfere with the blood circulation to the bone and lead to trauma-related osteonecrosis. Studies suggest that this type of osteonecrosis may develop in more than 20% of people who dislocate their hip joint. And 15 % of people who have trauma to knee.

Corticosteroid Medications:
Corticosteroids, such as prednisone, are commonly used to treat diseases in which there is inflammation, such as systemic lupus erythematosus, copd, rheumatoid arthritis, inflammatory bowel disease, and vasculitis.

Studies suggest that long-term, high dose systemic (oral or intravenous) corticosteroid use is a major risk factor for non-traumatic osteonecrosis with reports of up to 35 percent of all people with non-traumatic osteonecrosis.

However, there is still some risk of osteonecrosis associated with the infrequent use of corticosteroids, inhaled corticosteroids, or most steroid injections into joints.

Patients should discuss concerns about corticosteroid use with their doctor.

Doctors aren’t sure exactly why the use of corticosteroids sometimes is associated with osteonecrosis. They may have negative effects on different organs and tissues within the body. For example, they may interfere with the body’s ability to build new bones and to break down fatty substances.

These substances would then build up in and clog the blood vessels, causing them to narrow. This then would reduce the ability of blood to flow inside a bone.

Alcohol Use:
Excessive alcohol use is another major risk factor for non-traumatic osteonecrosis. Studies have reported that alcohol accounts for about 30% of all people with non-traumatic osteonecrosis. While alcohol can slow down bone remodeling (the balance between forming new bone and removing bone), it is not known why or how alcohol can trigger osteonecrosis.

Other Risk Factors:
Other risk factors or conditions associated with non-traumatic osteonecrosis include Gaucher disease, pancreatitis, autoimmune disease, cancer, HIV infection, decompression disease (Caisson disease), and blood disorders such as sickle cell disease, factor v, mthfr, and more so always ask your doctor to check you for a clot disorder.

Certain medical treatments including radiation treatments and chemotherapy can cause osteonecrosis. People who have received a kidney or other organ transplant may also have an increased risk.

Affected Populations

Osteonecrosis usually affects people between 20 and 50 years of age; about 10,000 to 20,000 people develop osteonecrosis each year in the United States alone.

Osteonecrosis affects both men and women and affects people of all ages. It is most common among people in their thirties and forties. Depending on a person’s risk factors and whether the underlying cause is trauma, it also can affect younger or older people.

Diagnosis

After performing a complete physical examination and asking about the patient’s medical history (for example, what health problems the patient has had and for how long), the doctor may use one or more imaging techniques to diagnose osteonecrosis. As with many other diseases, early diagnosis increases the chances of treatment success.

It is likely that the doctor first will recommend an x-ray. X-rays can help identify many causes of joint pain, such as a fracture or arthritis. If the x-ray is normal, the patient may need to have more tests.

Research studies have shown that magnetic resonance imaging (MRI) is currently the most sensitive method for diagnosing osteonecrosis in the early stages. The tests described below may be used to determine the amount of bone affected and how far the disease has progressed.

X-Ray
An x-ray is a common tool that the doctor may use to help diagnose the cause of joint pain. It is a simple way to produce pictures of bones. The x-ray of a person with early osteonecrosis is likely to be normal because x-rays are not sensitive enough to detect the bone changes in the early stages of the disease. X-rays can show bone damage in the later stages, and once the diagnosis is made, they are often used to monitor the course of the condition.

Magnetic Resonance Imaging (MRI)
MRI is a common method for diagnosing osteonecrosis. Unlike x-rays, bone scans, and CT (computed/computerized tomography) scans, MRI detects chemical changes in the bone marrow and can show osteonecrosis in its earliest stages before it is seen on an x-ray. MRI provides the doctor with a picture of the area affected and the bone rebuilding process. In addition, MRI may show diseased areas that are not yet causing any symptoms. An MRI uses a magnetic field and radio waves to produce cross-sectional images of organs and bodily tissues.

Bone Scan
Also known as bone scintigraphy, bone scans should not be used for the diagnosis of osteonecrosis because they may miss 20 to 40% of the bone locations affected.

Computed/Computerized Tomography (CT)
A CT scan is an imaging technique that provides the doctor with a three-dimensional picture of the bone. It also shows “slices” of the bone, making the picture much clearer than x-rays and bone scans. CT scans usually do not detect early osteonecrosis as early as MRI scans but are the best way to show a crack in the bone. Occasionally it may be useful in determining the extent of bone or joint surface collapse.

Biopsy
A biopsy is a surgical procedure in which tissue from the affected bone is removed and studied. It is rarely used for diagnosis, as the other imaging studies are usually sufficiently distinct to make the diagnosis with a high level of confidence.

Standard Therapies

Treatment
Appropriate treatment for osteonecrosis is necessary to keep joints from collapsing. If untreated, most patients will experience severe pain and limitation in movement within two years. There is no agreed upon optimal treatment for individuals with osteonecrosis.

Early intervention is essential to preserve the joints, but most people are diagnosed late in the disease process. 

Several treatments are available that can help prevent further bone and joint damage and reduce pain. To determine the most appropriate treatment, the doctor considers the following aspects of a patient’s disease: the age of the patient; the stage of the disease–early or late; the location and amount of bone affected–a small or large area. The underlying cause has not been shown to influence outcomes of treatment.

The goal in treating osteonecrosis is to improve the patient’s use of the affected joint, stop further damage to the bone, and ensure bone and joint survival. If osteonecrosis is diagnosed early enough, collapse and joint replacement can be prevented. To reach these goals, the doctor may use one or more of the following treatments.

Non-operative Treatment

There is no known pharmaceutical cure for osteonecrosis. Several non-operative treatments have been studied including hyperbaric oxygen therapy, shock wave therapy, electrical stimulation, pharmaceuticals (anticoagulants, bisphosphonates, vasodilators, lipid lowering agents), physiotherapy and muscle strengthening exercises, and combinations thereof. There are conflicting results for some of these treatments, therefore, rigorous, randomized controlled trials with large numbers of patients are still needed to determine the effectiveness of these treatments. Non-operative treatment may be part of a wait-and-see approach based on the size of the area of dead bone. Non-operative treatments cannot be labeled as conservative, since many of them do not slow the progression of the disease or lead to avoidance of a total hip arthroplasty. Most are simply pain-relieving at best.

Reduced weight bearing does not alter the course of the disease and is not a treatment. It may be used to simply permit the patient to better cope with pain until appropriate treatment is instituted. 

Surgical Treatment

Core decompression – This surgical procedure removes or drills a tunnel into the area of the affected bone, which reduces pressure within the bone. Core decompression works best in people who are in the earliest stages of osteonecrosis, before the collapse of the dead bone. This procedure sometimes can reduce pain and slow the progression of bone and joint destruction in these patients.

Osteotomy – This surgical procedure reshapes the bone to reduce stress on the affected area. There is a lengthy recovery period, and the patient’s activities are very limited for 3 to 12 months after an osteotomy. This procedure is most effective for patients with advanced osteonecrosis and those with a small area of affected bone.

Bone graft – Bone grafts can be used as part of the surgical treatment for osteonecrosis. Bone grafts can use bone from the same patient or donor bone. Bone graft or synthetic bone graft can be inserted into the hole created by the core decompression procedure. A specialized procedure, called vascularized bone grafting, involves moving a piece of bone from another site (often the fibula, one of the bones of the calf, or the iliac crest, a portion of the pelvic bone) with a vascular attachment. This allows for support of the diseased area as well as a new source of blood supply. This is a complex procedure and is performed by surgeons that are specially trained. Another type of bone grafting, involves scraping out all of the dead bone and replacing it with healthier bone graft, often from other portions of the patient’s skeleton. 

A unique type of bone graft involves the use of a patient’s own cells that are capable of making new bone. Often these cells are a type of stem cell from the bone marrow or other bodily tissues. There has been increasing interest in the potential of stem cell therapy. This is also being studied for the treatment of osteonecrosis. Mesenchymal stem cells, which are a type of ‘adult’ stem cell, can grow and develop into many different cell types in the body. Physicians take the patient’s own mesenchymal stem cells (autologous transplant) and place them into the affected bone to stimulate bone repair and regeneration.

Arthroplasty/total joint replacement – Total joint replacement is the treatment of choice in late-stage osteonecrosis when the joint is destroyed. In this surgery, the diseased joint is replaced with artificial parts. It may be recommended for people who are not good candidates for other treatments, such as patients who do not do well with repeated attempts to preserve the joint. Various types of replacements are available, and people should discuss specific needs with their doctor.

For most people with osteonecrosis, treatment is an ongoing process. Doctors may first recommend the least complex and invasive procedure, such as protecting the joint by limiting high impact activities, and watch the effect on the patient’s condition.

Other treatments then may be used to prevent further bone destruction and reduce pain such as core decompression with bone graft/stem cell therapy,Prp injections, A2m injection. But some of these new treatments may not be covered by your insurance.

Eventually patients may need joint replacement if the disease has progressed to collapse of the bone. It is important that patients carefully follow instructions about activity limitations and work closely with their doctor to ensure that appropriate treatments are used.

Investigational Therapies

Scientists, researchers, and physicians continue to pursue a better understanding of how this disease occurs as well as compare the effectiveness of current and newly developed therapies. Often, this requires a clinical trial to answer questions and gain additional knowledge.

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

Information

Stem Cell

Alcohol and Osteonecrosis

Osteonecrosis Knee

Various Links Osteonecrosis