Avascular necrosis or osteonecrosis is a condition caused by the temporary or permanent interruption of the blood supply to the bones, resulting in the death of the bone tissue. This process can aggravate an already damaged bone and lead it to collapse. It is a disease that can affect any part of the body, but is more common in the hips, knees, shoulders and ankles. If avascular necrosis has affected you or someone you know, read on to learn how to treat it effectively.
Steps
Part 1 of 3: Taking Care of Yourself
Step 1. Rest
By decreasing the pressure due to your weight on the affected bones, you also find relief from pain, decrease the speed with which the bone is damaged and give the body the opportunity to heal. Excluding physical therapy, try to minimize your movements and daily motor activity.
You may need crutches or a walker if the disease has developed in the hip, knee or ankle. However, these tools should only be used on the advice of the physiotherapist
Step 2. Do some healthy physical exercises
You should consult with a physical therapist who can show you some exercises to maintain or improve joint motility. This specialist will help you walk with supports and then slowly do without them. These improvements will help you do some stretching exercises that you can do at home or in the hospital.
- The exercise bike can also be very useful, since the forward and backward movement of the pedal stroke improves the general condition of the joint, increases the flow of blood in the area and helps the hip muscles to strengthen.
- Your improvements in motility and regained strength will tell the therapist which exercises are best suited to you and how to teach them for you to perform on your own.
Step 3. Evaluate acupressure
This is another useful treatment method that works by pressing certain areas / points of the body to trigger relaxation. Talk to your therapist. You can also self-practice it or make an appointment with a professional who will transform the experience into a completely stress-free day.
Alternatively, you can practice yoga or a therapeutic massage session (especially the buttocks, lateral and front muscles of the hips and back). This way you relax and avoid stress; the more relaxed you are, the better you will feel all day, every day
Step 4. Limit your alcohol consumption
Alcoholic beverages are one of the risk factors for osteonecrosis because they cause the accumulation of fatty substances in the bloodstream that can block some vessels in the affected area. Do not exceed the recommended dose of a glass of red wine in the evening, if you really have to drink.
There are many reasons why you should consider limiting or even completely stopping alcohol intake. Of course, a glass of wine a day is fine, but higher quantities can wreak havoc on the heart, internal organs and bones. Take care of your body and choose to be a teetotaler
Step 5. Keep your cholesterol levels low
Follow a healthy, low-fat diet, avoid fried foods, hydrogenated oils and reduce the intake of fatty dairy products that can be replaced with lean or completely fat-free products. This way you keep cholesterol to a minimum and help your heart and blood.
- When you decide to consume red meat, be sure to remove any visible fat before cooking it.
- Eat foods rich in Omega 3 fatty acids, nuts, flax seeds, soy beans, tuna and olive oil. Do not fry the olive oil because in doing so it destroys its Omega 3 and all its beneficial effects.
Step 6. Avoid and minimize fatty toppings like butter and mayonnaise
Try to get fats from healthy sources like walnuts, vegetable oils like olive oil, and cold-water fish like salmon and cod. Eat lots of green leafy vegetables, fruits, and whole grains without butter, cheese, or cream-based sauces.
If you are diabetic, always check your blood sugar so that it stays within normal limits. See your doctor right away if you experience abnormal (excess or low) blood sugar spikes, as diabetes is considered a risk factor for avascular necrosis. Maintaining and regulating blood sugar is a top priority when it comes to nutrition and medication
Part 2 of 3: Undergo Medical Treatments
Step 1. Discuss with your doctor the advisability of taking medications
Here's what you should know:
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Non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed to reduce pain and inflammation (redness, swelling, pain). Among these, the most common are ibuprofen and diclofenac ("Voltaren") available in pharmacies also with different concentrations and dosages.
These are tablets that must be taken as needed (when you feel pain) but the usual dose of Voltaren is 50 mg twice a day after meals
- Medicines against osteoporosis such as alendronic acid help slow down the evolution of avascular necrosis.
- Cholesterol drugs are prescribed to lower the concentration of fat in the bloodstream caused by the use of corticosteroids. This prevents blockages of blood vessels that can cause osteonecrosis.
- Anticoagulant drugs such as warfarin help patients with thrombosis problems avoid the formation of potentially dangerous clots that could block blood vessels.
Step 2. Discuss electrical stimulation with your doctor
This procedure stimulates the body to form new bone to replace the damaged one. It is performed during a surgical session in which electromagnetic fields are applied to the bone by placing electrodes directly in contact with the bone or on the skin. This is not a surgery per se but is often used in conjunction with an operation.
If the surgery realigns your bones, the electrical stimulation starts the "engines" of tissue regeneration. However, this does not necessarily apply to all patients, so talk to your doctor
Step 3. Surgery
More than half of patients with osteonecrosis require treatment in the operating room within the first 3 years of diagnosis. Your doctor will choose which procedure is best suited to your case. Here are the details:
- Core decompression. During this procedure, the surgeon removes parts of the inner layer of the bone. The goal is to decrease internal pressure, increase blood flow and create more space to stimulate the production of healthy bone tissue and new vascularization.
- Bone transplant. This is an operation during which a section of healthy bone taken from another part of the body is implanted. It is usually performed after a core decompression. To increase the blood supply, the veins and arteries are also transplanted.
- Bone remodeling (osteotomy). The surgeon removes a section of diseased bone just above or below the joint pad to change its shape and thereby relieve the pressure. This is an effective procedure in the early stages of the disease and for small areas; it is useful for postponing a joint replacement graft.
- Joint prosthesis. In the advanced stages, when the joint is completely collapsed or damaged and no other medical therapy has been successful, the joint is replaced with an artificial prosthesis usually made of plastic or metal.
Step 4. Get physical therapy and be consistent
After surgery it is imperative that your bones a) heal and B) heal properly. Physiotherapy (done regularly) ensures that both situations occur. Here's why you benefit from it:
- Your physiotherapist will teach you to use crutches, a walker or other devices to reduce the weight that the joint has to bear. This way healing will be faster.
- The physiotherapist will work with you to teach you and help you perform some exercises that prevent joint deformity, improve flexibility and mobility. All very important things!
Part 3 of 3: Understanding the Disease
Step 1. Know what avascular necrosis is
Osteonecrosis is defined as the death of bone tissue caused by the lack of blood supply to a specific bone. The affected bone develops microfractures which, over time, lead to bone collapse. If the diseased area is located near a joint, this can also collapse. The hips are usually the most affected area.
- Avascular necrosis develops in bones that have only one arterial termination that guarantees the blood supply (which means that the bone receives a limited supply of blood). Bones of this type are, for example, the head of the femur (hip) and humerus (shoulder), the carpus (hand bones) and the talus (foot). The closure or interruption of the only way that supplies blood causes the death of the bone tissue and, subsequently, the failure of the bone.
- Although bone tissue regenerates, the rate at which it grows back is less than the rate at which it is destroyed. If the bone collapses, the joint structures break and cause pain. Corticosteroids and radiation applied to bone can contribute to the progression of avascular necrosis.
Step 2. Recognize the risk factors
There are causes that can increase the risk of developing osteonecrosis:
- Fracture of the bone or joint dislocation that interrupts the blood supply.
- Radiotherapy treatments for cancer that weaken or undermine the health of blood vessels.
- High intraosseous pressure that narrows the diameter of the blood vessels making it difficult to supply oxygenated blood.
- Consumption of alcohol in large doses (on a daily basis and for many years) which causes the accumulation of lipids in the blood with consequent vascular blockage.
- Medicines such as corticosteroids (Prednisolone) when taken in high doses and for prolonged periods. Another drug that can play a significant role is bisphosphate (a treatment for osteoporosis) taken for a long time, which causes a rare disease called mandibular osteonecrosis.
- Diseases such as diabetes, HIV / AIDS, sickle cell anemia and dialysis can contribute to the development of avascular necrosis.
Step 3. Recognize the symptoms
Often osteonecrosis is not recognized because, in the early stages, it is asymptomatic. The first signs are pain in the affected bone / joint, such as the groin, in the case of avascular necrosis of the femoral head. Here are some details:
- Groin pain worsens when weight is placed on the affected leg, it could be mild and worsen over time. Pain also occurs at rest or at night.
- You walk with a limp when the hip is involved, pain and pressure manifest themselves on the affected bone or in the surrounding area.
- Joint movements are limited and painful. Over time, the joint deforms.
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If a nerve in the affected area is compressed, the muscle controlled by that nerve can become paralyzed and deformed over time.
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Usually the signs and symptoms present in the advanced stages and patients go to the doctor when the disease is now quite severe. If left untreated, the joint affected by osteonecrosis is completely destroyed within 5 years of the development of the disease.
Treat Avascular Necrosis Step 14 Step 4. Recognize how it is diagnosed
During the examination, the doctor will check you by pressing around the painful area in search of soft tissue. It will ask you to make certain movements or to assume some positions to understand if the pain on the joint decreases or increases, or if the mobility is limited. To understand your status and evaluate if surgery is needed, your doctor may request:
- X-rays. Usually they do not reveal anything abnormal in the early stages of the disease, but in the advanced stages a change in the bone appears clear.
- Bone scan. A safe radioactive liquid is administered intravenously. The liquid flows through the blood throughout the body and into the bones and thanks to a particular machinery reveals the presence of clear points in the bones. This method is usually used when x-rays have failed.
- Magnetic resonance "MRI". It is recognized as the most sensitive diagnostic imaging technique for the early stages of the disease because it reveals any chemical changes in the bone marrow and the process of bone reconstitution. It is based on the use of radio waves and a strong magnetic field.
- Computed tomography "CT scan". Generates clearer images than x-rays and bone scans; reveals bone damage by providing a three-dimensional image.
- Bone biopsy. This is a procedure that involves the removal of a small amount of bone tissue which is then analyzed under a microscope in search of even the smallest signs of osteonecrosis.
Advice
- Consuming fish such as tuna and salmon several times a week increases your intake of Omega 3 fats; you can further improve your diet by adding chestnuts and flax seeds to salads.
- Consult with your doctor before taking NSAIDs, as they have side effects including gastrointestinal upset, vomiting, irritation and stomach pain. It is recommended that these medications be taken on a full stomach to limit symptoms. Patients who have suffered from ulcers, kidney problems and myocardial infarction should use NSAIDs with great caution.
- In some people it is necessary to immobilize the affected joint and bones with the use of casts and rigid bandages. This must be done at the request of an orthopedist.
- Studies have confirmed that corticosteroids inhibit the metabolization of lipids with a consequent increase in their presence within the blood circulation, with the risk of blocking the vessels.
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