It is a type of osteonecrosis.
Bone death or severe marrow and bone cell damage due to decrease in blood supply.
Sites:
- Femoral head
- Scaphoid
- Talus
- Lunate
- Head of humerus
Pathogenesis
Arterial insufficiency
- Fracture
- Dislocation
Venous occlusion
- Perthes disease
Intraosseous capillary compression
- Infection
- Gaucher;s disease - cortisone, alcohol
- Caisson's disease
Intravascular capillary occlusion
Articular space normal
- Sickle cell disease
- Alcohol
- Caisson disease
- Corticosteroid
Pathology
Changes begin within a week of the insult and evolve over a period of 2-4 years.
Pathology same in all conditions whatever the cause + features of underlying disorder
Bone cells die in 12-48hrs
Necrotic segment gets demarcated and granulation tissue grows in
New bone is laid down on the dead: increase in mineral mass: seen as sclerosis on Xray
With weight bearing: structural failure in new bone
Cracking of subchondral bone
Fragmentaation of necrotic bone/new bone
Destruction of joint surface
Is avascular necrosis reversible? Does complete healing occur? yes
Clinical Features
- Pain: in or near a joint.
- Only in certain movements
- Tenderness/ swelling
- Only in the superficial bones
- Clicks in the join
- Loose articular surfave
- Stiffness of joint
- In later stages of the disease
- Movements: one plane restricted early on
- Advanced cases: fixed deformities.
Radiology
Increased bone density
Subchondral fracture
Distortion of articular surface
Staging: Ficat & Arlet
Stage I: Pre-clinical phase: no radiological abnormality
Stage II: Early sclerois, bone contour normal
Stage III: Sclerosis, structural damage, bone contour altered
Stage IV: Collapse or articular cartilage and secondary OA
Other Investigations
Radionuclide
- AVN seen as cold spot
- Surrounding area seen as hot spot
MRI
- identifies in preclinical phase
Treatment
Factors influence natural course
= type of ischaemia
= area affected
= stage of disease
= patient's age
= capacity for bone repair
= persistence of etiological agent.
Treatment
Early stage (Stage I/II)
Bone contour normal, small lesions
Weight bearing bone vs non weight bearing
Non operative Rx
Traction: spasm decreases
Operative Rx: Eliminate etiology
Surgery: better results
Core decompression
Muscle pedicle bone grafting
Defunctioning osteotomy
Treatment
Late stage III/IV
Structural damage and articular distortion present
Operative treatment
- Pain/ loss of function: should demand for the procedure
- Realignment osteotomy
- Arthroplasty
- Arthrodesis
Avascular Necrosis (AVN) is a bone disease that occurs by temporary or permanent loss of blood supply to one or more bones. Find the best Avascular Necrosis treatment from here.
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