Are your bones not getting enough blood? This is called Avascular Necrosis or Osteonecrosis!

Have you ever heard of what happens when your bones lose blood flow? It sounds a little scary, doesn't it? But it's something we need to know. Simply put, when our bones don't get the blood they need, the bone tissue slowly starts to die. That's what we call avascular necrosis or osteonecrosis. Shall we talk about this in more detail?

Why does this happen to our bones? What is Avascular Necrosis?

Think about it, like every cell in our body, our bones need oxygen and nutrients to live and stay strong. Who carries these? Blood. Our bones are not just pieces of rock. They are living tissues that are constantly being renewed, with old cells dying and new cells being formed. Just like repairing a house, old walls are being torn down and new ones are being built, which is what happens inside bones. We call this bone remodeling . Now think about it, what happens if for some reason the blood supply to these bones gets blocked or stopped? Just like a plant withers when it doesn't get water, the bones don't get the nutrition and oxygen they need. Then the production of new bone cells decreases, but the old cells continue to die. After a while, the part of the bone that doesn't get blood becomes weak, brittle, and can eventually crumble. Like wood that has been eaten by termites. That's what we call (Avascular Necrosis).

How common is this condition? Who is more likely to develop it?

Actually, this is not very common, but it is not non-existent either. For example, in a country like America, it is reported that about 10,000 to 20,000 people a year develop this condition. This can happen to anyone of any age, regardless of gender. However, people between the ages of 30 and 40 are at a slightly higher risk. This means that young, working-age people also need to be concerned about this.

Where does Avascular Necrosis occur most often?

Although this disease can affect any joint in the body, it is most often seen in the hip joint . This is where your leg joins your thigh. In addition, it can affect several other places. These are:

• Ankles
• Jawbone
• Knees
• Upper arm - humerus and shoulders

Think about it, the hip is one of the main weight-bearing joints in our body. So if there is a problem like this there, it can be difficult to walk or even stand.

Why does this (Avascular Necrosis) occur? What are the causes?

Simply put, anything that stops the blood supply to the bones can cause this. Sometimes, about 20% of cases, no clear cause can be found . But the main causes can be divided into two groups: 1. Traumatic Avascular Necrosis: This happens when a bone breaks or a joint is dislocated in an accident. Then the blood vessels that supply the bone can be damaged. 2. Non-traumatic Avascular Necrosis:This happens when the blood supply to the bones is impaired, either due to another disease or a medication. What's special about this is that when it develops in this way, it often affects the same joints on both sides of the body . For example, if you have avascular necrosis in your right shoulder, there's a good chance it will also develop in your left shoulder.

What types of fractures are most likely to cause Traumatic Avascular Necrosis?

This does not happen with every fracture, but some fractures are at higher risk.

• Hip fractures and dislocations : It is said that about 20% of people can develop avascular necrosis, especially when the hip joint is dislocated. This is because the main blood vessels that supply blood to the hip bone are located in very sensitive areas.

What diseases and other problems cause Nontraumatic Avascular Necrosis?

There are several things that could cause this:

• Osteoporosis : A disease that causes bones to break down. Especially in older women (and some men), avascular necrosis can develop suddenly in the knee. This is also called `(SPONK - Spontaneous Osteonecrosis of the Knee)`.
• Blood disorders: For example, diseases like sickle cell anemia . In these diseases, the shape of red blood cells changes and they can get stuck in small blood vessels .
• Diabetes Mellitus: People with diabetes are also at higher risk because diabetes can damage blood vessels.
• Cancer treatments : Some cancer treatments, especially radiation therapy , can damage the blood vessels in the area, causing avascular necrosis.
• Decompression sickness: When deep-sea divers ascend rapidly, air bubbles can form in the blood and clog blood vessels.
• HIV
• Lupus: This is a disease of the immune system.
• Organ Transplants: This risk is also present, especially after things like kidney transplants. One reason for this is some of the medications used.

What things in our lifestyle increase this risk?

Certain habits can also increase the risk of developing this (Avascular Necrosis).

• Excessive alcohol consumption: Drinking too much alcohol can increase the deposition of fats in the blood and clog blood vessels.
• Smoking: Smoking is also very harmful to blood vessels.
• Long-term use of corticosteroids: For example, medications like `(Prednisone).` These are medications that are given for many diseases. However, when taken for a long time and in high doses, these types of side effects can occur.

What are the symptoms of Avascular Necrosis?

Symptoms don't appear all at once. You may not notice anything for weeks or months. Over time, these symptoms appear:

• Pain that comes and goes: Pain that comes and goes, especially when pressure is applied to the affected bone, and then subsides when the pressure is removed.
• Gradually increasing pain and stiffness: It may hurt a little at first, but later the pain may become severe and it may be difficult to move the joint.
• Limited range of motion of the joint: For example, in the case of the shoulder, it becomes difficult to raise the arm. In the case of the hip, it becomes difficult to bend or straighten the leg.
• Limping: If you have this condition in your hip or knee, you may limp when you walk.
• Difficulty climbing stairs, standing, and walking.

If you have one or more of these symptoms, you should definitely see a doctor .

How do doctors diagnose Avascular Necrosis?

When you go to a doctor, they will first ask you about your symptoms and examine you. Then they may do one or more of the following tests:

• X-rays: They can look for things like fractures and arthritis. However, Avascular Necrosis may not be detected on X-rays in the early stages.
• MRI (Magnetic Resonance Imaging - MRI): This is the best and most sensitive test for diagnosing Avascular Necrosis. An MRI can clearly see even the smallest changes in the bones, even areas where blood flow has decreased.

How is Avascular Necrosis treated?

Treatment depends on the damage to your bones.

If the damage to the bones is minor, for small, non-weight-bearing bones:

In these cases, surgery may not be necessary. Your doctor may recommend things like:

• Cold and hot packs (Cold packs, Heat treatment): Reduce pain and swelling.
• Rest: It is very important to rest the affected joint.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Painkillers, such as ibuprofen, control pain and swelling.
• Physical Therapy:Exercises and other treatments to reduce joint pain and increase range of motion.
• Walking aids: Use walking aids such as canes and crutches to reduce the weight on the affected joint.

(Avascular Necrosis) If the condition is severe, surgery:

In many cases, especially if it is in a weight-bearing joint like the hip (avascular necrosis), surgery is required . There are several types of surgery that can be performed:

• Core Decompression: In this procedure, the surgeon makes several small holes (cores) in the affected bone. This helps to reduce the pressure inside the bone and helps new blood vessels grow. Sometimes , bone grafts or other injections are used to speed up bone healing. This is only successful if the disease is detected early.
• Joint Replacement: This involves removing the damaged joint and replacing it with an artificial joint. Hip Replacements and Knee Replacements are two very successful (about 95%) surgeries that relieve pain and help people with Avascular Necrosis regain good mobility.

Can Avascular Necrosis be prevented?

Sometimes this can't be prevented, especially when it's caused by an accident. But there are things we can do to reduce the risk:

• Quitting smoking: This is definitely something you should do.
• Limit alcohol consumption: It is best to reduce it as much as possible.
• Controlling cholesterol levels: Increased cholesterol in the blood is not good for blood vessels.
• If you are taking corticosteroids for a chronic medical condition, talk to your doctor about reducing the dose. Never stop taking your medication or change the dose without first asking your doctor.

Can Avascular Necrosis be completely cured?

Unfortunately, there is no cure for Avascular Necrosis. Treatment can only control the progression of the disease and reduce pain. Many people eventually need surgery, especially joint replacement surgery. People with Avascular Necrosis can also develop severe osteoarthritis over time.

When should I see a doctor?

Avascular necrosis is a disease that gradually worsens over time. If you have been diagnosed with this condition, you should pay close attention to your symptoms, especially pain and difficulty moving. See a doctor immediately if you have any of the following:

• Pain that doesn't go away even after resting or taking painkillers.
• The pain is so severe that it is difficult to walk or move.
• If you are limping for no reason .

What questions should I ask my doctor?

It's a good idea to ask these questions when you go to see the doctor:

• Why did I get Avascular Necrosis?
• What treatment method is best for me?
• What are the complications of these treatments?
• What kind of follow-up care do I need after treatment?

Avascular Necrosis is a very painful and life-threatening condition. If you have a medical condition that increases your risk of developing this condition, or if you are taking medications that increase your risk, talk to your doctor. He or she can explain the symptoms of Avascular Necrosis to you. Early diagnosis and treatment can help slow the progression of the condition.

The most important things to remember (Take-Home Message)

Okay, so let's summarize some of the things you need to remember from what we've talked about:

• Avascular Necrosis is when the blood supply to the bones stops, causing the bones to die.
• This most commonly affects the hip , but it can also affect areas like the knees and shoulders.
• This can be caused by things like bone fractures, certain diseases (e.g. diabetes, lupus), certain medications (e.g. corticosteroids), excessive alcohol use, and smoking .
• If you have symptoms such as frequent pain, joint stiffness, or limping, see a doctor.
• An MRI scan is the best way to find this out.
• Treatment includes rest, medication, physical therapy , and in severe cases, surgery (Core Decompression, Joint Replacement) may be necessary.
• Although this cannot be completely cured, the disease can be controlled if it is recognized early and treatment is started.

If you have any further questions about this, don't hesitate to talk to your doctor. Stay healthy!