Treatment options for Avascular Necrosis (AVN)
What can be done for the condition?
Once AVN has occurred, the treatment choices are determined by how long the problem is persisting and your symptoms. While the symptoms may be reduced with pain medications and anti-inflammatory medications, no medical treatments will restore the blood supply to the femoral head and reverse the AVN.
If you are diagnosed with AVN at stage II or even III, then it is too early for a total hip replacement. Your surgeon will ask you to take medication to manage your pain; or perform core decompression. Since any of these treatment modalities do not reverse the disease, you are bound to require hip replacement in the future. Artificial hips do not restore all types of joint movements. You can only walk, sit on a chair or sofa and climb stairs. You may be refrained from routine activities like running, jogging, routine exercises like surya namaskara, sitting down of floor with crossed legs. This artificial hip also has a life span and needs to be changed after about 10-12 years. Even there may be loosening of the attachments as a nonliving artificial part is attached to living bony structures; in which case you may require frequent interventions or revision surgeries.
In India there is one GOLD STANDARD cell based treatment available that has shown promising results in more than 250 patients with more than 98% success rate. It is done in two simple minimally-invasive steps – Harvesting Biopsy and Implantation.
Step I: Harvesting Biopsy
The cell based treatment is personalized and autologous, where you will be asked to admit for a short day care procedure in the hospital. A small quantity (4 ml) of your bone marrow (thick blood tissue within the flat or round ends of bones) will be taken out with a long needle. A special Biopsy Kit will be used to collect and transport this bone marrow biopsy for cell processing. Collected bone marrow specimen is sent under temperature controlled mode to cell processing center (Laboratory) for cell culturing for about 4-6 weeks to grow your own bone forming cells, Osteoblasts in a controlled environment.
Step II: Implantation of live cultured Osteoblast cells
This involves small opening through a small incision, necrotic (dead) bone is gently removed with the help of curette; followed by implantation of patient’s own live cultured bone cells (Osteoblasts) at defect area of hip joint(s). Once the cell dose is ready, you will be again asked to get admitted in the hospital. The entire procedure to implant in your body may take not more than 30 minutes and is done under anesthesia.
The aim of this treatment is to CURE AVN by helping body for forming completely new healthy bone tissue and stops the disease process through osteogenesis and new vascularisation. This is a completely natural way to regenerating true bone tissues and does not require any repetition like artificial hip replacement. Proper rehabilitation and exercises will help you regain all normal movements and activities including running, jumping, sitting down, using the stairs, walking without limp and support.Download Patient Guide
- Non-operative treatment for symptomatic AVN of the hip.
- Restricted patient weight bearing with the use of a cane or crutches has been useful only in controlling symptoms and also does little to alter disease progression.
Surgical treatment of AVN can be broadly categorized as either prophylactic measures (to retard progression) or reconstruction procedures (after femoral head collapse)
- Core decompression: One or more cores of necrotic femoral head bone is removed in order to stimulate repair. Core decompression is often supplemented with bone grafting (cancellous autograft or structural allograft) to enhance mechanical support and augment healing.
- Osteotomies: It is performed to move necrotic bone away from primary weight-bearing areas in the hip joint. This technique may delay arthroplasty, but used for small pre-collapse or early post-collapse of the femoral head in patients who don’t have an ongoing cause of AVN.
- Arthroscopic evaluation: It can help better define the extent of chondral flaps, joint degeneration, even joint collapse and may help with the temporary relief of synovitis.
- Prosthetic replacement is used as most predictable means of pain relief in advanced AVN.
- Femoral resurfacing arthroplasty: Mainly used for younger patients. Both the femoral head and acetabulum are “resurfaced” with metal, indicating minimal bone resection. However, there is a 1% incidence of femoral neck fracture with this procedure.
- Bipolar arthroplasty is used when the replacement takes place on both sides of the body, such as both knees and hips.
- Total hip arthroplasty is used when damaged bone and cartilage is removed and replaced with prosthetic components. The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow centre of the femur.