What Is Avascular necrosis?

Avascular necrosis is a condition of bone tissue that dies from lack of blood supply. In the early stages, avascular necrosis is generally asymptomatic. But over time, affected joints will feel pain when moving. Then the joint will feel pain, even if the patient is just lying down. Pain that feels can be mild or severe, the pain will feel more severe in the joints that hold the body weight, such as joints in the groin or buttocks. In addition, pain can also be felt on the shoulders, knees, hands and feet.

The perceived pain may increase due to microfractures or small cracks in the bone. This condition can cause bone death and joint damage that develop into arthritis , and will restrict movement. Keep in mind, the distance from the first time the symptoms appear until the patient is difficult to move, varying in each patient, can be in a matter of months or more than a year. Symptoms can also appear on both sides of the body, such as on both thighs or both knees.

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Cause Avascular Necrosis
Avascular necrosis occurs because of a disorder that results in reduced blood supply to the bone. Some conditions that can make blood supply to the bone are reduced, among others:

• Injury to the joint or bone. Injuries such as joint dislocations can damage the surrounding blood vessels.
• Stacking fat in blood vessels. Fats can close small blood vessels and result in reduced blood supply to the bone. This can happen to people who use long-term corticosteroids or people who are addicted to alcohol.
• Disease. Sickle cell anemia disease or Gaucher's disease, can reduce blood supply to bone. In addition, other diseases that can cause avascular necrosis are pancreatitis, diabetes, lupus , and HIV / AIDS.
• Medical treatment. Medical measures, such as radiotherapy , can weaken bones and damage blood vessels. In addition, kidney transplant action is also associated with avascular necrosis.

However, the cause of avascular necrosis is not always certain, because the disease can occur in healthy individuals without having the above risk factors. Avascular necrosis is more susceptible to men than women. However, women with lupus are also at risk for this disease. Although avascular necrosis can occur at any age, but generally it affects people aged 30-60 years.


Diagnosis Avascular Necrosis
After asking for a history of symptoms and physical examination, the orthopedic doctor will run a number of checks. X-rays will be done to see the bone changes that occur in avascular necrosis. In addition, imaging with MRI or CT scan can also be done to see the condition of the bones in more detail.

If the results of Rontgen imaging show no problems and the patient also does not have risk factors for this disease, then the doctor will recommend a bone scan . This examination begins by injecting a radioactive substance into a blood vessel. The substance will go to the bone area that has interference and will be caught when done with gamma camera photos.

If doctors still suspect the patient is affected by avascular necrosis although all imaging tests do not show this disease, patients may be advised to undergo surgical tests to measure the pressure on the diseased bone. This test is called the functional bone test .


Treatment and Prevention Avascular Necrosis
Treatment for avascular necrosis sufferers depends on age, cause of disease, damaged bone parts, and extent of damage. To treat avascular necrosis in the early stages, recommended therapies and treatments include:

• Non-steroidal antiinflammatory drugs (NSAIDS) . Drugs such as ibuprofen or diclofenac can reduce signs of inflammation, such as pain due to avascular necrosis.
• Cholesterol-lowering drugs. Decreased levels of fat in the blood can help prevent the blockage of blood vessels that can trigger avascular necrosis.
• Anticoagulants . Types of anticoagulant drugs such as warfarin, will be advised to prevent blood clots.
• Drug bisphosphonates. In some cases, bisphosphonates such as alendronate may slow the progression of avascular necrosis disease. However, there are even precisely reports of bisphosphonates making avascular necrosis in the jawbone.

If you have a condition of avascular necrosis, you should not do a lot of activities that can burden the sick bones. At the same time, it can also perform physiotherapy to help maintain and improve the function of damaged joints.

If the illness is already in severe condition, the doctor will suggest surgery, such as:

• Bone transplantation. This procedure aims to strengthen the damaged bone, by taking healthy parts of the bone from other areas of the patient's body.
• Replacement of joints. If the affected part is no longer feasible, the patient may undergo a surgical operation to replace the damaged joint with imitation joints of the metal.
• The damaged portion of the bone will be removed, and the healthy part is expected to reshape the bone structure to strengthen the support of the joints, in order to better use.
• Bone core decompression. The procedure is to remove the inside of the bone to reduce the burden on the joints, and to form new blood vessels.

This disease can be prevented by avoiding alcohol consumption and keeping cholesterol at normal value. If the patient is a corticosteroid user, be sure to consult a doctor to monitor their use. Bone damage may worsen if accompanied by corticosteroid use.

Meanwhile, to prevent avascular necrosis of the jaw, it is recommended to regularly clean the teeth and visit the dentist for dental examination and treatment, especially for those who undergo treatment with bisphosphonates.

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