Avascular necrosis (AVN) happens when you lose blood flow to your bone, such as the hip bone. Without blood flow the bone dies. Avascular necrosis treatment continues to improve. SVF or stromal cells are a good treatment option for AVN.
It is also known as Osteonecrosis, Aseptic Necrosis and Ischemic Bone Necrosis
Your body has special cells that break down bone cells (Osteoclasts), and special cells (Osteoblasts) that grow new cells. This is bone remodeling. This process needs a good blood supply. When blood flow slows down bones will get thinner because cells do not grow fast enough to replace those that Osteoclasts continue to take away. If blood flow stops the bone dies. The problem is in your arteries. You need to fix the arteries before you can fix the bone.
How is Avascular Necrosis Diagnosed.
IAVN is often seen in x-rays or MRIs taken while investigating an unrelated problem. Doing an MRI or x-ray of your bowel, prostate or ovaries will include your hips in the picture. The radiologist may then notice that you also have blood flow problems to your hips. Avascular necrosis of the hip is the most common location.
Pain indicates more advanced disease. X-rays will be ordered to diagnose the pain.
- X-rays in the early stages don’t usually show any problem but can be helpful in the later stages. If you think you are at risk further studies will be needed.
- MRI and CT scan can reveal early and late stages of AVN.
- Bone scans inject a small amount of radioactive material into a vein which will concentrate in the affected arteries and bone.
The most common sites are the hip, knee, ankle (Talus) and shoulder in that order. Wrist (Carpal bones) and jaw are less common.
Risks for Avascular Necrosis
Anything that affects blood flow is a risk (Shah).
Smoking, chemotherapy, radiotherapy and thermal injury directly attack the blood vessel wall.
Bone fractures and dislocations can interrupt blood flow.
Raised pressure inside the bone cavity may compress the artery slowing or stopping blood flow.
Raised pressure happens in Gaucher’s Disease, bleeding into the marrow, edema, and prolonged steroid use causing fatty infiltration.
Blood disorders causing clotting (Emboli), bleeding (eg Thrombophilia) or Sickle cell crisis.
If you have a painful and tender joint and you have these risk factors, consider AVN in your differential diagnosis
- Excessive use of alcohol.
- Smoking.
- Prolonged corticosteroids use (prednisone).
Action
- Quit smoking. Smoking damages the blood vessel wall and narrows the artery.
- Cut back on your alcohol intake.
- Watch your cholesterol levels.
- If you take corticosteroids for a chronic medical condition, talk to your doctor about reducing your dosage.
Is there a cure for Avascular Necrosis?
Treatment can slow the progress of avascular necrosis, but there is no recognized cure yet.
Medication
There are no proven medications for Avascular necrosis.
Pain tablets and NSAIDs help.
Surgery
Joint replacement. If the affected bone has collapsed or other treatments aren’t helping, surgery can replace the damaged parts of the joint with plastic or metal parts. Most people who have avascular necrosis eventually have surgery, including joint replacement
SVF treatment.
SVF has proven very good for many patients. Not everyone responds but those that do can repair their blood vessels which can allow the bone to replace itself as part of the normal cycle of removing and regrowing bone. If the bone has not collapsed full regrowth can be expected. People who have avascular necrosis can also develop severe osteoarthritis. End stage bone on bone Osteoarthritis can become totally pain free with SVF therapy and fully functional even though the cartilage will not grow.
All affected joints will be treated in the same session. Cells are delivered locally to the joints and Intravenously.
Patients who do not respond to their own cells will need to go on to total joint replacement.
More study is needed to be able to predict those who will not respond to their own cells (2.7%). There is also a group whose response is weak (28%). These people need a second treatment and 80% of those will get further improvement
Bone marrow concentrate and core decompression is being used with great success for hips. The bone marrow is harvested from a pelvic bone, a hole is drilled into the head of the femur, a trocar is introduced and the bone marrow is injected. This is reported as having over 80% success rate.