Do you sometimes have pain in your hip, knee, or shoulder that doesn't go away no matter how much medication you take? You may find it difficult to walk or even climb stairs. This may be because the blood supply to a part of the bone inside the joint is cut off, causing it to die. In medical terms, we call this Avascular Necrosis (AVN) , or Osteonecrosis . Although the name may be a bit complicated, it is important for you to understand this condition simply.
What is Avascular Necrosis (AVN)?
Simply put, this is a condition where our bones are "suffocating." Think about it, like every cell in our body, bones need oxygen and nutrients to live, stay strong, and grow new ones. These are brought by the blood. What happens if, for some reason, the blood flow to a part of the bone stops completely or to a large extent? Just like a tree dies without water, that part of the bone begins to die little by little without getting any nutrition. This is what we call AVN.
This dead bone becomes weak over time, begins to crumble, and breaks. If this happens around a joint, the joint itself can collapse. Although this condition can affect any bone in the body, it is most common in:
- Hip joint: The upper end of the thigh bone.
- Knee joint: The lower end of the thigh bone.
- Shoulder joint: The upper end of the arm bone.
This is not something that happens suddenly. It is a condition that gradually worsens over time. Therefore, it is very important to identify and treat it at an early stage .
What are the symptoms of this condition?
The symptoms of AVN do not appear suddenly. They develop gradually over weeks, sometimes months. There may be no pain at first. However, as the condition worsens, these symptoms may appear.
| Symptom | Description |
|---|---|
| Joint pain | Initially, the pain only starts when the joint is under load, such as when standing or walking. Later, the pain can occur even when just standing or sleeping at night. |
| Difficulty bending and extending the joint | There is pain and discomfort when bending or extending the limb. The joint may even feel as if it is stuck. |
| Limping | Especially if your hip or knee is affected, you may unknowingly start walking with a limp. This is something your body does to avoid the pain. |
| Difficulty with daily tasks | Even simple things like climbing stairs, standing, and walking become painful and difficult tasks. |
Why is this happening? What are the reasons?
There are various reasons why blood flow to the bones can stop. We will discuss these reasons by dividing them into two main categories.
Due to an accident (Traumatic AVN)
This is the most common cause. If you have a serious accident and break a bone (fracture) or dislocate a joint (dislocation), the delicate blood vessels that supply blood to the bone can be damaged. This risk is especially high in cases like a hip fracture . Once the blood supply is cut off, the bone slowly begins to die.
Due to other medical conditions or causes (Nontraumatic AVN)
This condition can occur without any danger. Let's look at some of the causes that affect it below. If AVN develops due to such a reason, it can affect both sides of the body. For example, if it affects the right shoulder, it is possible that the left shoulder will also be affected.
| Cause/Risk factor | A simple explanation |
|---|---|
| Long-term steroid use | Corticosteroids , such as Prednisone, are a major cause of this, as they can increase blood lipid levels and narrow blood vessels. |
| Excessive drinking | This risk is also higher for those who drink alcohol excessively over a long period of time. Alcohol can also cause an increase in fat particles in the blood and clog blood vessels. |
| Smoking | Smoking can cause blood vessels to narrow and interfere with blood flow. |
| Certain medical conditions | AVN can be caused by diseases such as sickle cell anemia, lupus , HIV infection, and radiation therapy for cancer. |
| Organ transplantation | This risk is also increased by the medications (especially steroids) given to prevent the body from rejecting the organ after an organ transplant. |
| Decompression Sickness | This is a condition that can occur in deep-sea divers. When you surface too quickly, air bubbles can form in your blood and block blood vessels. |
How does a doctor find this?
When you tell us about your symptoms, the doctor will first ask you about your medical history, medications you take, and lifestyle (alcohol, smoking). Then he will examine your body.
But the best way to confirm this disease is with an MRI (Magnetic Resonance Imaging) scan . It is difficult to diagnose this condition in the early stages with a regular X-ray. This is because changes in X-rays only become visible after significant damage has occurred to the bone. However, an MRI scan can detect reduced blood flow to the bone and even subtle changes in the bone at an early stage.
What are the treatments for this?
Treatment depends on many factors, including the extent of damage to your bone, the stage of the disease, your age, and your overall health. The main goals of treatment are to stop further bone damage, reduce pain, and maintain joint function.
Non-surgical treatments
If the disease is detected early, you can try to control it without surgery with these things:
- Rest: Weight-bearing on the affected joint, which means reducing excessive walking, running, and jumping.
- Painkillers: Things like non-steroidal anti-inflammatory drugs (NSAIDs) prescribed by your doctor can help reduce pain and swelling.
- Physical Therapy: Exercise strengthens the muscles around the joint and helps maintain joint mobility.
- Supports such as crutches: If the hip or knee is affected, using crutches can reduce the weight on the joint.
- Cold/Heat packs: These can help temporarily relieve pain.
Surgical treatments
If the damage to the bone is extensive, or if the above treatments cannot control it, surgery may be necessary.
| Surgery | What happens to it? |
|---|---|
| Core Decompression | This involves drilling one or more small holes (cores) into the damaged bone. This reduces the pressure inside the bone, allowing new blood vessels to form and improve blood flow. This is effective in the early stages of the disease. |
| Bone Grafting | The dead bone is surgically removed and replaced with a healthy piece of bone from another part of your body or a bone from a donor. |
| Joint Replacement | If the damage to the bone is severe, or the joint itself has collapsed, the damaged joint is completely removed and replaced with an artificial joint made of metal or plastic. Hip/Knee Replacement is commonly performed. |
What does the future hold for someone with AVN?
The first thing to say is that Avascular Necrosis is not a life-threatening condition . It will not affect your lifespan. However, it can have a significant impact on your quality of life. The pain can make it difficult to perform daily tasks, walk, and work.
Also, when AVN causes bone damage, the cartilage in the joint can wear away, leading to severe osteoarthritis . In such cases, joint replacement surgery may eventually be required.
When should I see a doctor?
This is the most important part. Many people ignore joint pain, thinking it's normal. However, if you have these symptoms, you should definitely see a doctor.
If you have pain when walking or moving your body, and it doesn't go away even after resting or taking painkillers, or if you feel like you're limping for no reason, see a doctor without delay and seek advice.
Remember, the sooner a condition like this is recognized, the more successful treatment can be, the less damage to the bone can be reduced, and the better your quality of life can be maintained.
Take-Home Message
- Avascular Necrosis (AVN) is when the blood supply to the bones stops, causing the bones to die.
- The hip, knee, and shoulder joints are most commonly affected.
- The main symptom is joint pain that gradually increases and does not subside even with rest.
- This can be caused by accidents, long-term steroid use, excessive alcohol consumption, and certain medical conditions.
- If you have unexplained joint pain or limping, don't ignore it and definitely see a doctor.
- Early detection and treatment can prevent the disease from getting worse.
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