At Stanford Health Care, our orthopaedic experts specialize in advanced treatments for avascular necrosis. We deliver a precise diagnosis and the highest quality care.
Overview
What is avascular necrosis?
Avascular necrosis (AVN) is also called osteonecrosis, aseptic necrosis, or ischemic bone necrosis. It can occur in any bone, but it is most common in the hip bone (femoral head). It can affect a portion of the bone or the entire joint, such as the hip, knee, or shoulder joint. Less often, it occurs in the wrist or ankle.
How does avascular necrosis develop?
Avascular necrosis can result from a traumatic injury that damages blood vessels near a bone. It can also develop as a result of many different diseases and medical conditions. Long-term or excessive use of alcohol or corticosteroids can also impact a bone’s blood supply and lead to this condition.
When the bone’s blood supply decreases or stops, the bone doesn’t get enough nutrients and oxygen to survive. The bone breaks down, develops tiny fractures, and begins to collapse. If this process progresses, loss of support from the bone affects the overlying joint cartilage. The cartilage degenerates and arthritis develops.
If avascular necrosis is diagnosed early, treatments may include medications, lifestyle changes, and physical therapy. As the condition progresses, doctors usually recommend surgery to limit the progression of osteonecrosis and repair the affected bone. If the joint becomes severely arthritic, surgeons replace the affected joint.
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The most common symptom of avascular necrosis is pain in the affected area. Pain usually develops gradually, but it can happen suddenly. It often worsens with movement or when standing, and gets better when resting.
Where the pain occurs varies depending on which bone is affected. Most often, avascular necrosis affects the femoral head of the hip joint, which is the rounded end of the thighbone (the ball part of the hip’s ball-and-socket joint). Doctors call this condition osteonecrosis of the femoral head (ONFH). Pain can start in the hip and move down the leg and into the groin or the buttocks.
Avascular necrosis can also affect the shoulder, knee, or ankle. Most often, knee pain occurs in the inner part of the knee (toward the center of the body). The area around the joint can become swollen and tender. When the condition affects bones in the lower body, the person may develop a limp.
The two main types of avascular necrosis are traumatic avascular necrosis and nontraumatic avascular necrosis, and the cause depends on the type. In about 1 out of 5 cases, the cause is unknown.
Traumatic avascular necrosis results from an injury. It can develop after breaking a bone or dislocating a joint. The traumatic injury damages the bone and the blood vessels that carry blood to the bone.
Nontraumatic avascular necrosis is a condition that occurs in males and females, usually between the ages of 20-50. It often affects bones on both sides of the body, such as both hips or both knees. Nontraumatic avascular necrosis can result from certain medications, treatments, and lifestyle choices, including:
- Excessive alcohol use over an extended time
- Long-term or heavy use of corticosteroids (anti-inflammatory drugs) or high doses of bisphosphonate medications to treat osteoporosis or bone cancer
- Radiation therapy or chemotherapy treatments for cancer
- Smoking
Many disorders, diseases, and conditions can also lead to nontraumatic avascular necrosis. Your risk is higher if you have received treatments for leukemia, Hodgkin lymphoma, or non-Hodgkin lymphoma. Your risk is also increased if you have:
- Cushing’s syndrome (Cushing’s disease)
- Decompression sickness, usually as a result of rising to the surface of the water too quickly following deep-sea diving
- Disorders affecting the blood, including sickle cell anemia, hyperlipidemia, and disorders that cause your blood to clot abnormally
- Gaucher disease, a genetic disorder that weakens bones
- HIV and AIDS
- Liver disease, chronic kidney disease, or pancreatitis
- Lupus (systemic lupus erythematosus)
- Perthes disease, which develops in children
- Tumors on or near the bone
It might not be possible to prevent all types of avascular necrosis. But you can lower your risk of corticosteroid-related avascular necrosis by limiting your use of this medication. To reduce your risk of avascular necrosis as well as a range of other health problems, avoid smoking and limit the amount of alcohol you drink.
If you have any risk factors for avascular necrosis, talk to your doctor. They will monitor your health with regular checkups.
Early diagnosis of avascular necrosis can help your care team save as much bone tissue and preserve your joint as much as possible. At Stanford Health Care, we use the latest technology and advanced expertise to deliver an accurate diagnosis.
Your doctor will examine you and ask about your health history and any medications you are taking. They may suggest blood tests to check for a health condition that causes avascular necrosis.
To see pictures of your bones, your doctor will recommend imaging tests. These include:
Avascular Necrosis (Osteonecrosis)
Our orthopaedic specialists have advanced expertise in treatments for avascular necrosis. We offer nonsurgical options and the latest surgical techniques.
Avascular necrosis
Osteonecrosis
treatments for avascular necrosis
osteonecrosis of the femoral head (ONFH)
joint replacement
hip replacement
knee replacement
aseptic necrosis
ischemic bone necrosis
symptoms of avascular necrosis