Avascular necrosis (NAV) is a disease due to poor blood supply to the bones, either temporary or permanent, which leads to the death of bone tissue. This process can cause fissures in the area of the affected bone, causing the bone to collapse (collapse). NAV can occur in any location of the body, but generally affects the hips, knees, shoulders, and ankles. If you or someone you know has avascular necrosis, see Step 1 to begin treating the disease effectively.
Step
Part 1 of 3: Taking Care of Yourself
Step 1. Rest
Reducing the stress and strain on the affected bone has great benefits in relieving pain, slowing the rate of damage, and giving your body time to recover. In addition to physical therapy, try to minimize physical activity as much as possible.
You may need crutches or a walker if the joint area affected is the hip, knee, or ankle. Consider using crutches to help support your feet. However, you should use it on the advice of a physiotherapist
Step 2. Do physical exercise in a healthy manner
You should visit a physiotherapist, he will show you some special exercises to maintain or improve joint movement. The physiotherapist will assist you in using the walker the first time, and then gradually release you to do it yourself. When your condition seems to improve, you will then be taught stretching exercises that can be performed in the clinic or at home.
- Cycling exercises are also beneficial, forward and backward movement will support the overall state of the joints, increase blood flow, and maintain the strength of the waist and related muscles.
- Improved movement and strength will assist the physiotherapist in choosing the right exercises that suit you, and guide you to do the exercises yourself.
Step 3. Consider acupressure therapy
Another method that is also useful is done by pressing certain areas / points on the body. This treatment is useful for relaxing the body. Ask your physical therapist about this acupressure. You can do it yourself on a regular basis, or schedule an appointment with an expert, and have a full day stress-free.
Alternatively, yoga or simple massage therapy (especially for the buttocks, anterior and lateral hip muscles, and back) are also useful in relaxing and avoiding stress. The more relaxed you are, the better you will feel each day
Step 4. Limit alcohol consumption
Consumption of alcoholic beverages is one of the risk factors for NAV. Consumption of alcoholic beverages continuously will worsen your condition due to increased fat in the blood which tends to accumulate and clog blood vessels in the affected area. Just consume one glass of red wine at night if you really need to.
There are a variety of reasons why you should limit your consumption of alcoholic beverages-or consider quitting them. Sure, a glass of wine a day is fine, but more than that can damage your heart, internal organs, and, of course, your bones. Take care of your body and stay away from alcoholic drinks
Step 5. Keep cholesterol levels low
Make sure you are following a healthy low-fat diet by avoiding hydrogenated oils, fried foods, and reducing consumption of high-fat dairy products that can be substituted for low-fat or nonfat milk as an alternative. By doing this, you will keep your cholesterol levels low, thus helping to support the health of your blood and heart.
- When including red meat in your diet, be sure to remove any visible fat before cooking it.
- Eat foods rich in omega-3 fatty acids such as fish, walnuts, flaxseeds, soybeans, tuna, and olive oil. Try not to fry olive oil because it will damage the omega-3 content in it and eliminate its benefits.
Step 6. Avoid or minimize the consumption of food seasonings with high fat content, such as butter and mayonnaise
Sources of healthy fats such as raw fruit geluk (tree nuts), vegetable oils such as olive oil, and cold water fish such as salmon and mackerel can be used as substitutes. Eat green leafy vegetables, fruits, and whole grains without butter, cheese, and cream sauces.
If you have diabetes, make sure to always keep your blood sugar within a normal range. Immediately consult a doctor if your blood sugar level is suddenly high or low, diabetes is considered one of the risk factors that can trigger NAV. Keep your blood sugar level and make this one of the main priorities by paying attention to the food and drugs you consume
Part 2 of 3: Taking Medical Treatment
Step 1. Ask your doctor about medications for NAV
Here are some things you need to understand beforehand:
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Non-steroidal anti-inflammatory drugs (NSAIDs) are given to relieve pain and reduce inflammation (redness, swelling, pain). NSAIDs that are well known in pharmacies are “ibuprofen” and diclofenac salt/sodium (“Voltaren” or “Cataflam”); are available in various dosage forms.
Tablets should be taken as needed (when you feel pain), but the usual dose of Voltaren 50 mg twice daily after meals should suffice
- Osteoporosis medications such as Alendronate (“Fosamax”) can help slow the progression of NAV.
- Cholesterol drugs are used to reduce the concentration of fat in the blood circulation due to corticosteroid consumption; this prevents the blockage of the NAV-inducing blood vessels.
- Blood-thinning medications such as "warfarin" help prevent the formation of clots that can block blood vessels in patients with clotting disorders.
Step 2. Talk to your doctor about electrical stimulation
This method stimulates the body to grow new bone to replace damaged areas. Electrical stimulation is performed at the time of surgery by being attached to the area around the bone as an electromagnetic field, electricity is delivered directly to the bone or through the installation of electrodes on the skin. This method is not a standalone operation, but is generally used in conjunction with surgery.
If the operation succeeds in growing the bones well, the bones will be stimulated to mobilize with electrical stimulation. However, not everyone is suitable for this method, so ask your doctor if this option is possible for you
Step 3. Consider surgery
More than 50% of patients with NAV will require surgery within about 3 years of diagnosis. Your doctor will determine what type of surgery you may need. Here's the explanation:
- Core decompression. The surgeon removes some of the inner lining of the bone. The goal is to reduce internal pressure, increase blood flow, and provide extra space to stimulate the production of new healthy bone tissue with new blood vessels.
- Bone transplantation (graph). This transplant process involves removing a piece of healthy bone from another location in the body to support the area affected by NAV, usually after core decompression. Increased blood supply can be performed with vascular grafts of arteries and veins.
- Bone remodeling (osteotomy). In this operation, the surgeon removes a portion of the bone affected by the NAV above or below the weight-bearing joint of the body to reduce stress on it. This method is effective for early phase/small area NAV and delays joint replacement.
- Joint replacement. In the late phase of NAV, when the bone collapses or is completely damaged and medical treatment doesn't work, the damaged joint is replaced with an artificial joint, usually made of plastic or metal.
Step 4. Do physical therapy regularly
After surgery, there are two things that cannot be avoided, namely the bone then becomes A) healed, and B) healed well. Physical therapy (which is done regularly) will ensure the achievement of these two things. Here are the benefits you will get:
- A physical therapist will guide you in using crutches, a walker, or other assistive device to reduce the load on the joint. This will speed up the healing process.
- You will be invited to train with a physical therapist to prevent deformities (changes in shape) in the joints and increase flexibility and joint mobility. Two very important things!
Part 3 of 3: Understanding Avascular Necrosis
Step 1. Know the definition of avascular necrosis
Avascular necrosis (NAV) or osteonecrosis is defined as the death of bone tissue due to loss of blood supply to certain bones. The bone will have small gaps which, in general, will lead to bone breakdown. If the NAV hits the bone near the joint, the joint surface may collapse. Usually, the area of bone or joint affected by NAV is the hip.
- NAV occurs in bones with a single blood terminal or arterial supply end (meaning that the blood supply there is limited), such as the femur (hip) and humerus (shoulder), carpals (hand bones), and talus (leg bones). Blockage or disruption of a single terminal blood supply will cause bone tissue death and, subsequently, bone destruction.
- Although bone tissue regenerates or grows back, the rate of bone breakdown is faster than bone regeneration. If the bone collapses, the joint structure will be damaged and cause pain. Administration of corticosteroids and application of radiation to bone may contribute to worsening NAV progression.
Step 2. Know the causes and risk factors
Certain factors can increase the risk of developing NAV. Here are things that can trigger NAV:
- Bone fractures or joint dislocations can impair blood flow.
- Radiation in cancer treatment weakens bones and affects blood vessels.
- Increased pressure in the bones causes blood vessels to narrow and makes it difficult for fresh blood to enter, leading to poor blood supply.
- Consuming large amounts of alcoholic beverages (daily for several years) causes fat to accumulate in the bloodstream and clog it.
- Drugs such as corticosteroids ("prednisolone") when taken for a long time and in large doses can increase the risk of NAV. Other drugs, such as bisphosphates (medicines for osteoporosis), when used for prolonged periods can trigger osteonecrosis of the jaw, a rare condition.
- Diseases such as diabetes, HIV/AIDS, sickle cell anemia, organ transplants, and dialysis can trigger NAV.
Step 3. Know the symptoms
NAV is often not detected early because the symptoms are not visible. The first symptom that appears is pain in the affected bone/joint area such as groin pain in the head-femoral NAV. Here's a more complete explanation:
- This groin pain is exacerbated by weight on the leg, it can be mild or worsen progressively over time. Pain can occur at rest or at night.
- In cases involving the hip joint, the affected individual may be seen walking with a limp and tenderness will be felt on or around the area of the affected bone.
- Joint movement is limited and painful. Over time, the affected joint may become deformed or damaged.
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If there is pressure on a nerve in the area of the bone or joint that is affected, the muscles supported by that nerve can become paralyzed and deform over time.
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Generally, signs and symptoms appear at the end of the disease cycle and patients only consult a doctor when the disease is (more) severe. Without treatment, the affected joint will disintegrate within five years of the appearance of NAV.
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Step 4. Know how to diagnose NAV
During the examination, the doctor will identify your condition by pressing the area around the site of pain to check for tenderness. Your doctor may ask you to perform certain movements or positions – which will help in knowing if certain joint movements or positions are causing the increase/decrease in pain or if your ability to move your body is becoming more limited. To determine your condition and if surgery is needed, your doctor may order one of the following tests:
- X-ray. In general, the bones appear normal in the early stages, but then obvious bone changes become apparent.
- Bone scan. A safe radioactive material will be injected slowly intravenously into a vein. The material will flow with the blood circulation until it reaches its destination; the area affected by NAV will be shown as a light colored dot in the image on the special tool. This method is generally used when X-ray examinations are normal.
- Magnetic Resonance Imaging (“MRI”). MRI is known as the most sensitive method for early-phase NAV because it is able to detect chemical changes that occur in the bone marrow and in the process of bone remodeling. This detection is obtained through radio waves and strong magnetic fields.
- Computed Tomography (“CT scan”). This method provides clearer results than X-rays and bone scans; A CT scan determines the progression of bone damage by taking three-dimensional images of the bone.
- Bone biopsy. In this procedure, a small amount of bone tissue is removed and examined using a microscope for a microscopic view of the NAV.
Tips
- Eating fish such as tuna and salmon several times a week will increase your intake of omega-3 fats; Another way to support your healthy diet, for example, is to add geluk fruit and flax seeds to lettuce.
- Consult a doctor before taking NSAIDs, because these drugs have several side effects including digestive problems such as vomiting, irritation, stomach pain. It is recommended to take this medicine right after meals to minimize this effect. Patients with a history of gastric ulcers, renal disease, and myocardial infarction should use NSAIDs with caution.
- Restriction of movement (immobilization) of the affected joint and bone using splints and bandages is necessary in some cases, of course after consulting a doctor or orthopedist.
- Research has shown that corticosteroids can inhibit the process of fat breakdown thereby increasing levels of fat in the blood circulation and clogging blood vessels.
