Avascular Necrosis Can Affect Joints

Ask The Expert Dr. Marc Hungerford, Mercy Medical Center

July 13, 2009

Avascular necrosis is a disorder of the bone. It affects the ends of long bones, primarily the hip, but the knee and shoulder and ankle can also be affected, says Dr. Marc W. Hungerford, director of joint replacement and reconstruction at Mercy Medical Center.

In avascular necrosis the circulation in the bone is interrupted and dead spots can appear. If these dead spots are close enough to the joint, then the joint can collapse and the patient can develop arthritis of the involved joint.

* In this country the top two risk categories for avascular necrosis are patients who take steroids for other conditions and patients who drink too much alcohol. Other patients at risk include those with blood clotting disorders, sickle cell, and a variety of other, rarer disease conditions.

* Primarily the hip joints are affected. However, patients can also develop problems with the knees, the shoulders, and the ankles. In patients who have knee or shoulder pain first, it is worthwhile to evaluate the hips, since they are most commonly affected in patients with more than one affected joint.

* The main symptom of avascular necrosis is generally a chronic aching pain, which is most commonly referred to as a toothache-type pain. The pain is generally not exacerbated by activity, but occasionally may be worsened with activity. The pain is also typically described as unrelenting and may be severe.

* If the condition is caught at an early stage before the joint collapses, efforts to preserve the joint can be successful. These efforts include surgical options such as core decompression, which involves drilling a hole in the bone that is affected. This treatment helps to relieve the pressure inside the bone and prevent the joint from collapsing. It can be very effective if the disease is caught early enough.

* If the joint has collapsed and has become arthritic, then the best option is a joint replacement. Even if one joint has collapsed and requires replacement, another joint may be affected and may have not collapsed yet.

This less affected joint may be preserved if treated in time. Therefore, even in collapsed joints it is worthwhile to perform a detailed evaluation of the patient's other joints to try to prevent them from collapsing.

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