Sachin Bhonsle, Senior consultant, Orthopedic surgery, Fortis Hospital, Mulund
COVID19 has labored too many atrocities upon us. After the outbreak of black fungus and other secondary fungal infections among patients who recovered from Coronavirus, Avascular Necrosis (AVN), also known as death of bone tissues, has been increasingly reported in various parts of the country. Most commonly it happens in those who have been on increased use of ayurvedic products, long-term steroids, and people who indulge in self-medication. Previously, Bone death was recognized amongst those who indulged in alcohol, Sickle Cell Disease, hip dislocations and a few other rare disorders. Most worrying is that this condition has now been found in many young patients. Here is what you should know to avoid the risk of AVN.
WHAT IS AVASCULAR NECROSIS (AVN)?
AVN is a condition in which blood supply to the bone gets disrupted. Hip joint has narrow blood vessels with hairpin bends; they get easily blocked. Subsequently, the bone becomes dead and dries off. As a result, the joint formed by this dead bone gets arthritic and damaged. Most are encountered in the hip joint but also sometimes in the knee, shoulder, ankle, and other joints. The main symptoms of AVN are pain and stiffness of the joint that leads to very painful walking. The causes can involve:
- Joint or bone trauma. Hip fracture or dislocation might damage nearby blood vessels
- Cancer treatments involving radiation also can weaken bone and harm blood vessels
- Fatty deposits in blood vessels. Fat (lipids) can block small blood vessels, reducing the blood flow that feeds bones
- Congenital conditions such as Sickle Cell Disease and Gaucher’s Disease, also can cause diminished blood flow to the bone
- Other rarer conditions like Pancreatitis, SLE, AIDS
For about 25% of people with Avascular Necrosis, the cause of interrupted blood flow is unknown. AVN is graded from one to four in order of severity. Early stages are less severe where joints can be preserved by medications or early intervention. In grades three and four, the bone has collapsed due to AVN and the joint cannot be preserved. Such patients need a joint replacement.
SYMPTOMS OF AVN? Pain associated with Avascular Necrosis of the hip might center on the groin, thighs, or buttocks. Besides the hip, the areas likely to be affected are the shoulder, knee, hand, and foot. Some people develop Avascular Necrosis on both sides (bilaterally) — such as in both hips and in both knees. Some people have no symptoms in the early stages of Avascular Necrosis. As the condition worsens, your affected joint might hurt only when you put weight on it. Eventually, you might feel the pain even when you are lying down. Pain can be mild or severe, and usually develops gradually.
WHAT RISK FACTORS INCREASE THE CHANCES OF AVN?
- Steroid use: The use of high-dose corticosteroids, such as Prednisone, is a common cause of Avascular Necrosis. The reason is unknown, but one hypothesis is that corticosteroids can increase lipid levels in your blood, reducing blood flow across hairpin bends of the hip bone
- Excessive alcohol use and smoking: Consuming alcohol for a prolonged time can cause fatty deposits to form in your blood vessels
- Bisphosphonate use: Long-term use of medications to increase bone density might contribute to development of Osteonecrosis of the jaw. This rare complication has occurred in some people treated with high doses of these medications for Cancers, such as Multiple Myeloma and Metastatic Breast Cancer.
- Certain medical treatments: Radiation Therapy for Cancer can weaken the bones. Organ transplantation, especially Kidney transplants, also are associated with Avascular Necrosis.
TREATMENT OPTIONS FOR AVN: Medications or minimally invasive Stem Cell Therapy will cure this condition in early stage. In this treatment, the patient’s Bone Marrow sample rich in Stem Cells are aspirated with a syringe and sent to a lab. The lab then isolates bone-forming cells or Osteoblasts and multiplies them manyfold. These multiplied and cultured Osteoblasts or bone-forming cells are then implanted after cleaning out the dead bone thus curing the disease completely. In late cases where the hip gets irreparably damaged, a total hip replacement which is an excellent long-term solution is recommended. Hip replacements tend to last for decades and have an excellent track record. Take home – early detection using X-ray and MRI and timely intervention can usually reverse the disease, any reconstructive surgery required has excellent results.
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