Have You Been Diagnosed With
Avascular Necrosis?

Avascular necrosis (AVN) can be a scary diagnosis. What is AVN? Could your hip joint pain be related to AVN? If so, what are the treatment options? Is surgery always necessary? The more information you have, the more confidence you’ll have in making the right treatment choice for you.



What is Avascular Necrosis?

The word avascular refers to a lack of blood flow or lack of vascular supply. Necrosis is a term that means death of tissue. Thus avascular necrosis is death of tissue secondary to a lack of blood supply.

The specific tissue that is affected by AVN is bone tissue. Bone, like other tissue, requires a blood supply in order to survive. When the blood supply to the bone becomes disrupted, either on a temporary or permanent basis, the bone can begin to die. In significant cases this death of bone tissue can cause the bone to collapse.


What Bones Are Affected by AVN?

avascular necrosis of the hip

The most common joint affected by avascular necrosis is the hip. The hip joint is comprised of the head of the femur (ball) and the acetabulum of the pelvis (socket). All of the blood supply to the ball or head of the femur comes through one artery. Disruption of this artery can cause AVN of the head of the femur and can cause the head of the femur to collapse. When AVN of the femoral head occurs in children it is called Legg-Calvé-Perthes syndrome.

In addition to the head of the femur, other bones can also be affected by AVN. The scaphoid is a bone in the wrist that is also prone to AVN, specifically when a scaphoid fracture has occurred. Other bones that can be affected include the jaw, and the ends of bones including the humerus of the shoulder, the knees, and ankles.


What Causes Avascular Necrosis?

Unfortunately there is not a clear understanding of what causes AVN. In some cases, such as trauma, the cause is straight forward. A fracture or dislocation that damages the blood supply to the bone can obviously cause bone death. However, in many cases, a true cause is not always evident.

There are some suggestions that the narrowing of arteries from fat droplets can impact bone blood supply. Other risk factors associated with AVN include alcoholism, chronic steroid use (such as prednisone), high blood pressure, sickle cell anemia, rheumatoid arthritis , and lupus.


Symptoms of AVN

What might you feel if you have AVN? The symptoms of AVN are generally not felt in the early stages. Once weakening of the bone has occurred, joint pain becomes the main symptom. Symptoms can start as mild and progress to more severe. As AVN occurs most commonly in weight bearing bones, weight bearing pressure during walking and stair climbing generally recreates pain.

In addition to pain, a loss of joint range of motion can also occur. For AVN of the hip, a loss of internal rotation generally is the most common hip movement that becomes limited.


How is Avascular Necrosis Diagnosed?

Part of the diagnostic process is a thorough physical exam by your physician. Additional diagnostic tests are also utilized to help make the diagnosis including x-rays, MRI, and bone scans. Scans are used to help determine the density and health of the bone tissue and the extent of bone loss or damage.


Typical Treatment

Treatment for AVN is based on the extent or progression of the disease. The use of anti-inflammatory medication is frequently utilized to reduce joint pain. As weight bearing generally aggravates symptoms, the use of crutches or a walker to minimize weight bearing is often recommended.

For joints that have lost mobility, physical therapy may be utilized to help restore range of motion. For less significant bone loss, electric stimulation devices to promote bone growth can also be utilized to help restore bone tissue.

In cases in which bone damage is significant, surgery may be required. Surgical procedures can include osteotomy , bone graft, and even joint replacement. Hip replacement surgery is a common result when advanced bone loss of the femoral head has occurred.

Treatment of AVN must be monitored over time. The least invasive treatments are generally recommended initially with ongoing monitoring of bone health utilized to determine treatment effectiveness. It is important to communicate with your doctor regarding pain and limited function as treatment for AVN progresses.


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