Avascular Necrosis

Overview

Avascular Necrosis, also known as osteonecrosis, is a condition in which reduced or interrupted blood supply to the bone leads to bone tissue death. Over time, this lack of blood flow causes the bone to weaken, collapse, and eventually damage the surrounding joint. The condition most commonly affects the hip (AVN of hip), but it can also involve the knee, shoulder, or ankle.

At Sarvodaya Hospital, experienced orthopaedic doctors in Faridabad offer early diagnosis and advanced avascular necrosis treatment, including minimally invasive treatments for AVN hip, aimed at preserving the natural joint whenever possible.

Symptoms of Avascular Necrosis

• Mild or intermittent pain during movement or weight-bearing
• Stiffness in the affected joint
• Discomfort after prolonged activity
• Persistent pain in the hip, groin, knee, or shoulder
• Pain that worsens with walking, standing, or climbing stairs
• Reduced range of joint movement
• Limping (commonly seen in AVN of the hip)
• Pain even at rest in advanced stages

Causes of Avascular Necrosis

• Long-term or high-dose steroid use
  
• Excessive alcohol consumption
  
• Trauma or fracture affecting the blood supply to the bone
• Certain medical conditions, such as sickle cell disease or lupus
• Prolonged use of bisphosphonates
• Radiation therapy
• Blood clotting disorders
• Idiopathic causes (no identifiable reason in some patients)

Diagnosis of Avascular Necrosis

Early and accurate diagnosis is crucial in preventing joint collapse. At Sarvodaya Hospital, diagnosis involves a structured clinical and imaging-based approach.

• Clinical Examination: Clinical examination assesses joint pain, stiffness, range of motion, muscle strength, limb alignment, and gait abnormalities, helping doctors identify limitations and disease severity during evaluation.

• X-rays: X-rays help identify bone collapse, joint surface damage, and structural deformities in advanced avascular necrosis, guiding staging, prognosis, and surgical planning for appropriate treatment decisions.

• MRI Scan: MRI scan is the most sensitive investigation for early avascular necrosis, detecting bone marrow changes before collapse, enabling early diagnosis, staging, and joint-preserving treatment planning.

• CT Scan: CT scan provides assessment of bone architecture, joint surfaces, and structural integrity in advanced or complex avascular necrosis cases, assisting surgical planning and intervention decisions.

• Blood Tests: Blood tests help identify underlying medical conditions, metabolic disorders, or risk factors contributing to avascular necrosis, supporting evaluation and guiding personalised treatment and prevention strategies.

Treatment Options & Technology for Avascular Necrosis

• Medications – Pain relievers and disease-modifying drugs are used in early stages to reduce symptoms, slow bone damage, and support blood flow to the affected bone.

• Physiotherapy – Structured physiotherapy helps maintain joint mobility, improve muscle strength, reduce stiffness, and support functional movement during conservative and post-surgical care.

• Core Decompression Surgery – A minimally invasive procedure that reduces pressure within the bone, improves blood circulation, and is most effective in early-stage avascular necrosis.

• Biologic & Regenerative Therapies – Advanced regenerative techniques used alongside core decompression to promote bone healing and delay disease progression.

• Minimally Invasive Treatments for AVN Hip – Joint-preserving techniques designed to manage early AVN of the hip and delay the need for joint replacement surgery.

• Minimally Invasive Hip Replacement for AVN – In advanced stages with joint collapse, minimally invasive hip replacement uses smaller incisions and muscle-sparing techniques, resulting in less pain, reduced blood loss, faster recovery, and improved mobility.

• Joint Replacement Surgery (Advanced AVN) – Recommended when joint preservation is no longer possible, performed by experienced hip and knee specialists to restore function and long-term pain relief.

Prevention & Lifestyle Modifications for Avascular Necrosis

While not all cases can be prevented, lifestyle changes can slow disease progression and reduce complications.

• Avoid Excessive Alcohol Consumption: Avoiding excessive alcohol intake reduces disruption of blood supply to bones, lowers fat deposition in vessels, and decreases the risk of progression of avascular necrosis.

• Use Steroids Only Under Medical Supervision: Using steroids only under medical supervision prevents prolonged exposure that can impair blood circulation to bones and significantly increase the risk of avascular necrosis.

• Maintain a Healthy Weight: Maintaining a healthy body weight reduces mechanical stress on weight-bearing joints like hips and knees, helping slow disease progression and preserve joint function.

• Engage in Low-Impact Physical Activity: Low-impact activities such as swimming or cycling help maintain joint mobility and muscle strength without excessive load, reducing pain and preventing further joint damage.

Pre–Post Surgery / Treatment Lifestyle Modifications for Avascular Necrosis

• Activity modification to reduce stress on the affected joint and prevent further bone damage
• Medication review to avoid drugs that may worsen avascular necrosis and optimise treatment safety
• Physiotherapy guidance to maintain joint mobility, strengthen muscles, and prepare the joint for treatment or surgery

• Weight-bearing restrictions as advised to protect the healing bone and prevent joint collapse
• Rehabilitation and physiotherapy to restore movement, strength, and functional mobility gradually
• Medication adherence to control pain, inflammation, and support bone healing
• Regular follow-up monitoring to assess recovery progress, detect complications early, and adjust treatment plans