Aseptic necrosis – Symptoms, causes, and management

Aseptic necrosis – Symptoms, causes, and management

Aseptic necrosis is a condition where the lack of blood flow to the bones leads to the death of the bone tissue. The condition is also called ischemic bone necrosis, avascular necrosis, and osteonecrosis. If the condition is not treated, the bone may develop fractures and finally collapse. Aseptic necrosis typically manifests in the hip and may also affect the knees, ankles, and shoulders. Osteonecrosis is a slow-growing condition and appears gradually, taking months to years.

Symptoms
Patients experience the symptoms only a few months or even years after the onset of aseptic necrosis. However, as it worsens, the condition usually becomes excruciating. The pain at first may come from pressure exerted on the broken bone and could then become more persistent. Following are some indications of avascular necrosis that may manifest gradually:
Pain that comes and goes when one exerts pressure on the bone and then releases it
Stiff joints and growing pain
Limited range of motion
Limping, if one has avascular necrosis in the hips and knees
Difficulty standing, walking, or climbing stairs

Causes
Osteonecrosis can be brought on by illness or severe trauma, including a fracture or joint dislocation, which disrupts the bone’s blood supply. It may also develop without these reasons.
The following are some other potential causes:
Acute myeloid leukemia
Bleeding issues
HIV
HIV treatments
Chemotherapy
Radiation therapy
Gaucher disease

An autoimmune condition called systemic lupus erythematosus causes the body’s immune system to wrongly target healthy tissue like the skin, joints, and some organs.

Certain bone density-increasing prescription treatments run the risk of causing jaw osteonecrosis. This is more likely to happen if one takes them for multiple myeloma or metastatic breast cancer.

Diagnosis
Physical exam
A healthcare provider will press around the joints during a physical exam to feel for any tenderness. To see if the range of motion is reduced, they might also move the joints into various positions and check.

X-rays
They can show bone alterations in the later stages of avascular necrosis. X-rays typically can’t reveal any issues present in the early stages of the illness.

CT and MRI scans
These procedures generate precise images that can reveal early bone alterations that could indicate avascular necrosis.

A bone scan
A radioactive device is inserted into a vein during this procedure. This tracer reaches the wounded or mending bones. Bright dots can be seen on the imaging plate as a result of this deposit.

Treatment
The treatments for aseptic necrosis are aimed at pain relief, joint improvement, and halting bone erosion. The best course of action will depend on several variables, such as:
A person’s age
The stage of the condition
The location and rate of bone degeneration
The cause of the disease

Aseptic necrosis cannot be cured, but if it is diagnosed early using X-rays or an MRI, nonsurgical treatments like activity restriction, anti-inflammatory prescription treatments, and physical therapy may be able to slow down the course of the disease. However, avascular necrosis frequently needs surgery because it is a gradually progressing disease.

Prescription treatments
Anti-inflammatory remedies
Aseptic necrosis-related pain may be reduced by taking these remedies.

Treatments used for osteoporosis
Although the evidence is conflicting, these might slow the development of aseptic necrosis.

Cholesterol-lowering remedies
Blood vessel obstructions that can result in avascular necrosis might be prevented by lowering blood cholesterol and fat levels.

Remedies that dilate blood arteries
These can increase the blood flow to the injured bone. However, more research is required on these.

Blood thinners
Blood thinners for clotting problems may prevent blood clots in the vessels that supply blood to the bones.

Surgical methods
Bone graft
To replace the broken bone, a portion of healthy bone tissue is extracted from another area of the body or a cadaver. An artificial substitute can also be used. Restoring blood flow aids in the healing process.

Vascularized fibular grafting
Hip aseptic necrosis usually affects adults between the ages of 20 and 35, a time in which hip replacement surgery may not be the best course of action. In this situation, a vascularized fibular graft technique enables younger patients to put off or even avoid getting a hip replacement in the future. In this procedure, the femoral head of the hip’s dead bone tissue is removed and replaced by a healthy bone (Usually taken from the fibula). Reconnecting the blood arteries in the area allows for the restoration of the blood supply.

Total joint replacement
An artificial joint, or prosthesis, made of metal, plastic, or ceramic, is used to replace the damaged tissue.

Core decompression
To treat the affected bone, diseased tissue is removed. This relieves discomfort and encourages the development of new blood vessels and bone structures. This surgery is for early-stage aseptic necrosis in patients 35 years of age or younger.

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