Emergence and mechanisms of avascular necrosis

affecting individuals aging 30-50yrs old

Rhayan Batugan, Earl Casabuena, JC Del Rosario, Elmer Hufana, Joshua Loverez,

Princess Pedra Javar Nevado and Nicole Millicent Yambot

Sacred Heart Academy of Novaliches

115 Quirino Highway Novaliches, Quezon City

ABSTRACT
Avascular necrosis is a serious illness that is affecting most of the countries around the
world. In fact, according to Hamilton (2009), this affects 10,000 individuals in the USA each
year.
The aim of this study is to identify the mechanism of avascular necrosis that is most
likely to affect people with the age group of 30-50 years old. This paper uses descriptive
method under the qualitative approach where data are collected through form of word and not
with numerical figures.
This paper showed that avascular necrosis is an illness that involves our bones.
Avascular necrosis affects people who are alcoholic and at the age group of 30-50 years old.
The most common symptom of avascular necrosis is the pain in the groin, pain with flexion
and internal rotation, limping, decreased movement range, clicking in the hip and loss internal
rotation of the hip. It can affect your bones functionality and can lead to irreversible damage if
left unchecked. There are many said causes about this disease but usually happens when the
supply of the blood in our bones gets disrupted. But there are several ways in order to treat this
disease, we can use medicinal approach or surgical approach. Under medicinal approach are
nonsteroidal anti-inflammatory drugs, osteoporosis drugs, cholesterol-lowering drugs and
blood Thinners while under are the surgical approach electrical simulation and core depression.
There are also many ways in order to prevent this disease like avoiding excessive alcohol
consumption, eating foods that are rich with Calcium and vitamin D, avoiding bone injuries
such as bone fractures and joint dislocations and avoiding consumption of high-dose steroids.
Introduction to reduced blood flow thus weakening the

bone. Excessive alcohol intake also affects

Necrosis is a pathological death of
risk in getting this disease because
cells or portion of a tissues and organs that
consuming alcohol can add to your fatty
may result to an irreversible damages. It is
deposits to form in your blood vessels thus
almost always malign and fatal to the
affecting your blood flow. Age may also be
victim. It has many effects that includes
a factor in this disease, people that have age
mitochondrial swelling and granule
ranging from 30 to 50 may be at more risk
deposit. It can also trigger Pykonosis or
in getting this disease.
Karyorrhexis in our body. The affected

cells may merge and form a body of There are many complications that

coarsely granular amorphous or hyaline makes avascular necrosis fatal, but with

material. early diagnosis and treatment it can be

cured. With our technological and scientific

Among many types of necrosis,
advances in our generation, many surgical
there is one type that involves the bone, it is
and non-surgical treatment are available
called avascular necrosis or Osteonecrosis.
such as medications, reduced weight
This type of necrosis causes death of the
bearing, electrical stimulation, core
bone tissues due to lack of blood supply that
decompression, bone graft and arthroplasty
may result to small cracks in the bones that
or total joint replacement.
may eventually collapse. Injuries, such as

bone dislocation or fracture, could damage Although we can treat avascular

blood vessel and reduce blood flow to necrosis now, researches are still on going

bones. It is also associated with long term in order to find out more about this disease.

use of high dose steroid medications such Like why is the intake of steroid medication

as prednisone because corticosteroid can affects the progression of the disease,

increase lipid levels in your blood resulting creating new ways in order to diagnose this
disease more efficiently and developing 5.2 What are the surgical methods

new ways of curing this disease. The that we can do to treat avascular

medical field still advances in the field of necrosis?

avascular necrosis in order to improve the

6. What can we do to prevent the
chances of prevention and recovery for
occurrence avascular necrosis?
those patients who have this disease.
7. Cases of avascular necrosis in

In line with this, the researcher will America.

try to shed light to the following questions:

1. What is avascular necrosis?

2. What are the effects of avascular

necrosis in our body?

3. What are its symptoms of avascular

necrosis?

4. What are the causes and risk

factors that may affect one’s

chance at having this disease?

4.2.How can age affect the risk of

having avascular necrosis?

5. How can we treat avascular

necrosis

5.1 What are the medication that

can be used in order to treat

avascular necrosis?
Background of the study parts of the bone, hip, shoulders, knees and

ankles. But most diagnosis of AVN, occurs

AVASCULAR NECROSIS
in the hip.
This disease is also known as
Avascular Necrosis happens in the
Osteonecrosis, Aseptic Necrosis, or
epiphysis of long bones. Epiphysis is the
Ischemic Bone Necrosis. It is the state
end part of the long bones. These long
where the bone undergoes blood loss. The
bones are the femoral and humeral heads
bone tissue might malfunction when there
and the femoral condyles. But AVN can
is loss of blood, it may lead to tiny fractures
also occur in the small bones.
to the bone, and in no time be the cause of

bone damage.

When there is a fracture or a

dislocation of a joint, the blood flow might

discontinue. The discontinuation of the

blood flow may cause the bone to be

weaker. This kind of disorder occurs in

people that ranges on the ages of 30-50

years old. The reason why this occurs in

early ages, because of the uncontrolled

alcohol intake, use of un-prescribed I. Illustration of Epiphysis for visualization

medications or high-dose steroids that may of the parts of the bone.

cause a long-term condition which is

According to Jeanne K Toffen, MD,
Avascular Necrosis. This condition can
MPH, FACP, “AVN is associated with
cause pain, and the breakdown of joints.
numerous conditions. Patients taking
Avascular Necrosis occurs in the specific
corticosteroids and organ transplant
recipients are particularly at risk of avascular necrosis was discovered but our

developing the said disease. AVN of the current knowledge about this disease is far

jaw has been described in patients taking from complete. The first documentation of

bisphosphonates and, more recently, in this disease is way back on 1794 by

1.7% of cancer patients taking denosumab.” Professor James Russel after that, James

Paget followed through James Russel’s

Biphosphonate is the kind of drug
work and discovered the appearance of
that is consumed to strengthen the bone.
avascular necrosis. The first person who
The people who uses this kind of drug, are
wrote and published the description of the
the people who suffers from Osteoporosis,
said disease was Twynham. Another
a disorder in the bone.
milestone was discovered by Chandler on

It is said that when a person was 1948, as he postulated that somehow the

diagnosed late with this kind of disorder, it avascular disease is connected to coronary

may cause to a long-term AVN and it may artery disease. Up to now there is still many

lead to the renewal of joint. But if a person controversies that envelopes this disease.

had early diagnosis, there is no need for

EFFECTS
renewal of joint. When a treatment is not

performed or it has been ignored, this kind According to the book “Avascular

of condition might continue or progress, Necrosis of the Femoral head: Current

and it will take 5 years to lead to joint trends” that was written by Santori (2004),

destruction. avascular necrosis effects can only be seen

inside of the bone. We can also only see its

HISTORY
effect through various instrument that allow

As stated by Sudhir Babhukar us to see beyond our naked eyes. The

(2013), it has been over a century since effects will be seen 24 hours after the
interruption of the vascular supply. The much smaller. (Wikipedia,

effects are as follows: 2017)

 Loss of cell outline If the disease drags on, it can have

- This will affect your bone cells an advance symptoms like the emptying of

functionality. Lacunae which contains osteocyte that will

 Disruption of cell membrane affect the bone regulation in your body.

- The disruption in cell membrane Osteocyte has an important role to play in

might affect our bones calcium bone functions and without them the bone

transportation, electrical proper- will show significant increase in bone

ties and hormonal responses. resorption and decrease in bone formation.

(Messer, 1982) (Brendon, 2008)

 Homogenization of the cytoplasm The emptying of lacunae will result

- This will affect the organelles to disappearance of bone marrow 5-7 days
will cease to function and this after the disruption in vascular supply.
will start a chain that will lead to

cell death. (Thomison, 2012)

 Reduction of Basophilia

- This will affect your immune

response and induce inflamma-

tion and blood clotting.

(Khurana, 2006))
II. Illustration of lacunae in the bone for

better understanding of the process.

 Nuclear Pyknosis
The last structure of the bone to not
- This will clump your chromo-
be affected by avascular necrosis is the
somes and make the cell nucleus
osteocytes. At first stages, the osteocyte  Loss internal rotation of the hip

will show normal but low functionality. The

If you think that you have this
first one to be damaged is the bone marrow
symptoms you should immediately go to
cells, followed by endothelial cell, followed
the hospital. To receive an early diagnosis
by osteoblast and osteoclast and the last one
that will lead to better outcome.
before osteocytes are the fat cells. (Santori,
Commonly, if you experience this
2004)
symptoms, you have a high possibility rate

SYMPTOMS of having avascular necrosis but thorough

investigation must be done in order to be

The symptoms of avascular necrosis
sure that your suspicion is right.
does not show up in early stages of the

disease. As the disease develops the pain CAUSES AND RISK FACTORS

you suffers become more severe. (Mayo

According to Mayoclinic (2015),
Clinical Staff, 2015)
avascular necrosis happens when there is a

According to the book written by complication within the blood flow of a

Babhulkar (2013), the most common bone.

symptom of avascular necrosis is the

With that in mind here are several
feeling of pain in the groin. Other signs that
acronym that were given by Beall (2006) to
you might have avascular necrosis is as
easily retain the causes that triggers the said
follows:
disease. It is as follows:

 Pain with flexion and internal

- PLASTIC RAGS,
rotation
- STARS
 Limping

 Decreased movement range - ASEPTIC

 Clicking in the hip

 But we will be focusing more on  Alcoholism

PLASTIC RAGS as it covers all the three

According to Northwestern Health
given acronyms by Beall. PLASTIC RAGS
Sciences University (2001), alcoholism is a
stands for:
definite risk in avascular necrosis. Due to

• Pancreatitis alcohol our body makes fat emboli that will

affect your chances of having avascular

According to Dr. Weerakkody
necrosis. In addition to that, excessive
(n.d.), pancreatitis refers to the swelling that
drinking of alcohol is the same with the use
involves pancreas. This disease shows
of corticosteroid that can cause the fatty
direct relation in having avascular necrosis.
acids substances that can decrease the blood
• Lupus
supply to the bones.

In the article made by Medical news

 Steroids
today stated that being hyperactive of the
Dermatol (2008), explicate in his
body’s immune system can cause them
article that taking high dose of
confusion in classifying the healthy tissues
corticosteroid may cause a malfunction in
and antigens (a substance capable of
the bones that may result to avascular
inducing a specific immune response) that
necrosis. But this is an infrequent cause of
are practically needed in our body. This
the said disease.
phenomena is called lupus disease which

can cause several issue that adds to the risk • Trauma

in getting joint problems and other

According to Cendars-Senai (2017),
complications in the organs that may lead to
one of biggest factor can be from a pre-
avascular necrosis.
existing injury. This injury might cause

interruption in vascular supply that may

lead to avascular necrosis.

• Infection • Amyloid Arthropathy

As the researcher of this topic Glick and Radswiki (2017), said

infection may occur if there is a plenty of that it is the extracellular deposition of the

blood loss occurs that will result in the fibrous protein amyloid within the skeletal

proliferation of the disease in the bones. system.

• Caisson disease • Gaucher’s disease

Thomson and Young (1958), stated Genetic Home Reference (2017)

that caisson disease can also be called as explains that this disease is inherited and

decompression disease. It leads to blockage may be grow into mild up to severe

of the pressure in your body and will give condition. Also it occurs in damaging the

you excess gasses that aren’t needed that bone because of the loss in blood that will

may result in the blood interruption that will cause bone pain and fractures which can

cause severe damage to the bone. lead to avascular necrosis.

• Rheumatoid arthritis • Sickle cell disease

Mayoclinic (2017), explained that Webmd (n.d.) stated that, one who

rheumatoid arthritis can be correlated to develops this disease are the people who

Osteonecrosis as it shows that both of them have health problems and have been

can harm the bones. Avascular necrosis is through bone injuries. The causes can be

nothing compared to rheumatoid arthritis, if associated to the long term use of chronic

it is not treated early and properly it might corticosteroid.

damages the joint up to deformity.

In line with this Harding (n.d.) said

that it can be harmful to the bones and it

may cause the thinning of a bones cause is still not medically accepted

(osteoporosis). because there are still some patient who are

healthy and did not smoke but still got the

 Relation of age to avascular necrosis
disease.
There is a research study that was

done by the group of Diana Kamal (n.d.),

that suggest the relation of one’s age in  Disease that are related to avascular

developing avascular necrosis. This group necrosis.

of researcher observed a study group that

There are many disease that are
has 92 people who were diagnose with the
related to avascular necrosis. In order to
said disease; among them are 68 men and
know this, please see the table below.
24 women. As they observed, they noticed

that half of their study group’s age is

ranging from 30-60. Because of that they Trauma

concluded in their study that avascular

Fractures
necrosis mainly affects young adults with
Dislocations
the age of 30-50 years old.

Although avascular necrosis can come at Vascular injury

any age, it is still more common to people Thermal injury

at the age group of 30-50 years old. (Emily
Kienböck disease
Reisner, 2017)

 Relation of smoking to avascular

necrosis Table 1. Diseases that have direct

association with avascular necrosis.

Based on Healthline (n.d.), another

cause can be through smoking. But this

Cigarette Disseminated Highly active Organ
smoking intravascular antiretroviral transplantation
coagulation therapy
Connective Hyperparathyroidis
tissue Giant cell arteritis Infectious m
disease/rheumat
ologic Lipodystrophies
Hypofibrinolysis Osteomyolitis (hyperlipidemia)
Ankylosing
spondylitis Neurological injury
Hemophilia HIV
Ehlers–Danlos
syndrome Neoplastic
Idiopathic Meningococcem
thrombocytopenia ia
Polymyalgia
rheumatica Orthopedic
Leukemia Metabolic and
Polymyositis endocrine
Polycythemia Congenital hip
Chronic renal dislocation
failure
Post-venous Developmental
Raynaud’s thrombosis Cushing disease dysplasia of the hip
disease
Thrombophillia Hereditary
Sjögren dysostosis
syndrome Diabetes
Thrombophlebitis Legg–Calvé–
Septic lupus Perthes disease
erythematosus Fabray’s disease
Vasculitis Osteoporosis/osteo
Gastrointestinal malacia
Gout and
Gaucher’s disease hyperuricemia
Inflammatory
bowel disease Hypercholestero
Major arterial lemia
Obesity disease
Slipped femoral
Thalassemia capital epiphysis
Starvation
Pregnancy
Post-irradiation
Hematologic and
vascular
Corticosteroid
Arteriosclerosis therapy

Iatrogenic Table 2. Diseases that shows strong

Laser surgery
association with avascular necrosis.
Hemodialysis
TREATMENTS Osteoporosis Drugs are medicines

use to protect and cure osteoporosis, some

We have two ways in treating
medicines can help cure and avoid bone
avascular necrosis. First is the use of
loss include Bisphosphonates, Calcitonin,
medical drugs and the second one is the
Denosumab, Teriparatide and Raloxifene.
surgical method.
Bisphosphonates includes “Alendronate”
Medical drugs
that is used to prevent the bone loss in

Nonsteroidal anti-inflammatory drugs adults, Biphosphonates also includes

(NSAIDs) reduces inflammation and ease risedronate and “zoledronic acid” that is

fever and pain by preventing proteins called used in cancer chemotherapy to cure bone

“prostagladin”. Prostaglandins are group of problems. This medicinal drugs are used in

chemicals that are located near of all the treating avascular necrosis. Calcitonin is a

body’s cell membrane it causes pain, affects hormone that regulates calcium the relation

immune system and body temperature. is can repair or remodel the broken bones,

Protaglandins can also cause the death of Denosumab is used to treat bone loss,

bone tissue especially to older people Teriparatide increases the strength of a

because of its chemicals that the older bone and Raloxifene is estrogen modulator

people can’t control. NSAIDs also has a (WebMD, 2017)

side effects but some people does not feel

Cholesterol-lowering drugs can also
the side effects because they are able to
be used in treating avascular necrosis. One
fight against those side effects until it’s
of the main effects of cholesterol in our
completely gone. Some medicine such as
bones is it can weaken your bone. ’s high
ibuprofen may help ease the pain to those
cholesterol it can cause problem to your
people who has avascular Necrosis
bones because of high cholesterol your
(Nazario, 2014) (Health wise inc., 2015)
bones may become weak can cause pain
especially it causes injury because of no blood pressure means you are not doing a

Vitamin C because Vitamin C strengthens proper way of lifestyle that why you feel

your bones and muscles and it helps to dizzy, cause rashes, hair loss because blood

accomplish your daily activities but if you also make the hair alive everything is alive

have a high cholesterol you feel dizzy with blood without blood we are already

always because of high blood so in order to dead and muscle weakness all men do a

avoid this you must change your life style daily exercise but do not eat healthy foods

do a daily exercise, drink 8 glasses of water, because they only rely to their physical

eat fruits and vegetables every day, the strength even if you so strong but you have

most important is always drink milk so that low blood because you lack Vitamin C it’s

you have strong, healthy and white bones still useless in order to maintain the flow of

because having a shiny white bones is a your blood as our parents said that we

sign that your bones are strong cannot should eat vegetables and fruits because

easily cause pain or injury. It gives also a these helps your blood maintain reddish and

side effect like heart attack. You must have it’s a sign that you’re healthy in life (Debra

a balance in everything to have a healthy Sullivan, July 11, 2017).

body (WebMD, 2017).

Rest it’s the most important part in

Blood Thinners used to thins the our daily lives it restores your body

blood cells from sticking together in the functions, blood flow, cells, nerves in every

veins and arteries. Blood thinners also part of your body, adds strength to your

cause side effect in some people who has a body and the most important is it increases

unhealthy body functions like heavy your height. Rest is very important to us it

periods for women, nosebleeds, bleeding also prevent Avascular Necrosis to cause

gums and bleeding from a cut it also inflammation and pain in our body, bone

includes dizziness because having a low fractures or injury and other that affects
bone tissue. Every day we move to finish disorders occurs because of lack of

our activities and our body functions gets exercise, also the food that we ate everyday

slower because we are getting tired in what it also cause sickness especially meat so in

we are doing and nerves functions get order to remove you must drink water and

slower so it’s for us to think even if we want have a proper exercise to cleanse your body

to think immediately so the key to this and also don’t forget to take Vitamins to

answer is to have a nice and long rest protect your body system and it helps to

because it restores everything shortly you become athletic every day because we are

are recharging your body but many all athletes if we strived hard to achieve

millennial do not sleep properly because of anything also we must think positively and

using gadgets also what we’ve learned is fight. (webMD, 2005-2017)

that too much radiation kills your nerves in

SURGICAL PROCEDURES
your body especially so have a discipline in
Electrical Stimulation it grows a
yourself (restfulapi.net, n.d.) e
new bone to replace the area damaged by
Exercises we all know that exercise
Avascular Necrosis, It can also be used in
is good for our body because it gives you
surgery directly to the area that is damaged
blood a smooth flow and you can move
or it can be administered attached to your
lightly because those hormones that are
skins. Electrical stimulations works in the
going to attack your body system will get
way of mimicking in a natural in which the
blocked and cannot enter your body
body exercises the muscles, electronodes is
because of having strong hormone and
also attached to the skin that makes the
body system but most of the people now
muscle contract, it also increase the patients
don\t do daily exercise they just want to
range of motion and also improves the
sleep, eat and watch television that’s why
circulation of your body systems, it is also
many diseases, cancers and other problem
used in curing like sprains, arthritis and
back pain because according to what we’ve person than because of his proper hygiene

learned that electricity recharge or restore some cancer cells grows in his legs and he

everything our body also consist of cannot walk properly because of that so in

electricity in some parts our body like order to get well again he must take a

elbow when your elbow is hit hardly it operation in order to removed that cancer

grounded the bone like in some productions cell as early before it spreads to his legs and

in the malls like WAKI when you sit at the may it pass through his whole body but the

chair the machine that contains electricity result is successful the cancer cell is

enter your body systems and also cure some removed due to the cooperation of that

nerves that is being blocked or has a wrong person then now the person must take a rest

placement in our body it will enter the nerve and be patient until he gets his/her bones

then the proper replacement will occur strong again.

because the electricity awaken those

(Matt hew D. Miller, 2011)
hormones(advancequaticpt.com, Electric-
Prevention
stimulation, n.d.).

According to Planinz (2017),

Core Depression it is the removed
avascular necrosis can be triggered due to
part of the inner layer of your bone to
excessive alcohol consumption and other
reduce the pain so the extra space within
illnesses such as sickle cell anemia,
your bone stimulates the production of
pancreatitis, diabetes, HIV/AIDS,
healthy bone tissue and blood vessels.
Gaucher’s disease which triggers the
Some people have cancers in their legs
growth of harmful fatty substances and its
because some uncontrollable cancer cells
accumulation in our organs might lead to
produce and spreads to the legs because the
several disease like avascular necrosis.
person do not have a proper hygiene he
Radiation therapy, chemotherapy and
rarely takes a bath so the doctor said to that
improper nutrition also might trigger the body to ensure all systems to function

said disease. properly, it is also important to eat a variety

of nutritious foods including, oatmeal with

One good way of preventing this
whole grain, fresh fruits and vegetables
disease is to avoid excessive alcohol
every day.
consumption that may lessen the growth of

fatty substances that may build in the blood You should also lessen activities

vessels and could decrease the blood supply that may put too much stress on your bones

in the bones. it may include excessive running, football,

basketball, soccer, volleyball and other

Eating foods that are rich with
similar sports. Swimming and cycling are
Calcium and vitamin D can also prevent
more recommended for the health of bones.
avascular necrosis as they work together to
Always be consistent in your regular
build and maintain healthy bones. These
exercise, take a rest when you feel pain in
foods includes dairy products like milk,
your joints to avoid further swelling.
cheese and yogurt, oranges are important in

preserving bones. Avoiding bone injuries such as bone

fractures and joint dislocations would also

The National Institute of Health
lessen the risk of trauma-associated
(n.d.) stated that most people don’t get
avascular necrosis. Early diagnosis and
enough vitamin D or calcium to maintain
treatment of underlying causes such as bone
healthy bones. Most adults who are 70
injuries depletes the risk of developing
years older requires higher amounts of
avascular necrosis.
calcium and Vitamin D because they

needed stronger bones as they grow older. Also avoid consumption of high-

Other nutrients are also important because dose steroids and Bisphosphonate. High-

vitamins and minerals work together in the doses of corticosteroids like prednisone can
cause non-traumatic AVN. Research is still year 2016 she manage to go to a doctor, Dr.

ongoing to identify the main reason why the John Bergman, a renowned orthopedic

usage of steroid is risk but one hypothesis surgeon. The treatment that was given by D.

is corticosteroids can increase lipid levels in Bergman was to walk at the parking lot to

our blood that could cause for deterrence of the hospital, now, she is walking 1.5

blood flow and may lead to AVN. Long kilometers every day and the effects are

term usage of bisphosphonate may increase good. She can now climb stairs without

bone density and can be a risk for help and the inflammation was reduced.

development of AVN. And leaving a message "The power that has

made you is the power that believe you and

Conventional treatments for
you have to believe in that keep going on
avascular necrosis also typically include
what u need to do"
exercise, rest and surgery, such as bone

grafting and joint replacement. However, it Case #2

is better to avoid substances which can

Karim (2004) conducted a case
cause bone loss rather than spending huge
study about a 41- year old man that
for the treatment.
complained about having sever pain on his

Case of Avascular Necrosis lower back, hip and knee for the past six

months following to a reckless jump from a

Case #1
two meter roof and a landing by his feet. He
Vanita from San Diego was
moved to Canada for consultation purposes.
diagnose with avascular Necrosis in the
The patient has swollen limbs and walk
hips, last 2014, the symptoms that she
with the help of a cane. He reported pain on
experience was severe inflammation, she
his right groin and thigh region. The
can’t climb stairs, stretch/bend her legs, sit
symptoms occur as he walks or climbs the
properly, anything that related to hips. At
stairs and will only be relieved if he will sit
or rest. The patient did not experience He was referred to a radiologist for tests on

numbness or prickling sensation in his his spine, right hip and pelvis. The tests

lower torso, any bowel dysfunction or reported that there were irregularities on his

symptoms of flu. right femoral head with sclerosis,

subchondral lucency, and mild collapse.

The patient was prescribed to take
These tests revealed that the patient has
pain killers and anti-inflammatory drugs.
avascular necrosis on his right hip. Based
During the time radiographs from his limbs
on the report, the patient was immediately
were still normal. Still, there were no
referred to an orthopedic surgeon for
improvements on the symptoms he felt so
consultation and was scheduled for right
he was referred to a neurosurgeon.
hip replacement surgery.
On physical examinations, the

motion of his right hip was limited and is

painful in all ranges mostly during hip

rotation. Palpations on his right hip

revealed muscle tenderness. There were

also atrophies on his right hip muscles.

Raised and straight leg exercises produced

Fig.3 Illustration of right hip with
imminent pain. Posterior joint tests are
avascular necrosis.
painful, and muscle weakness was more

dominant on the right portion of the hip.

Impression:

The patient was suspected of having

avascular necrosis on the right hip and

diagnoses of hip osteoarthritis and fracture.

Fig. 4 comparison of right hip to the left hip

for better understanding.

Clinical course post-operation

A total hip replacement or

arhtroplasty was performed and the patient

was monitored post-surgical rehabilitations

for follow-ups. There were strengthening

exercises conducted such as passive

Fig. 5 right hip with total prosthesis gc
stretching of the hamstrings, quadriceps,
Discussion:
hip flexors and abductors, as well as passive

and active range of motion exercises for the Avascular necrosis is often

hip and knee, improvement of his characterized by osseous cell death due to

quadriceps, hip abductors and hamstrings vascular compromisation and generally

musculature by using a pulley system and results from trauma, pancreatitis,

ankle weights. And the progressed to close alcoholism, radiation, sickle cell disease,

kinetic chain strengthening, balance infiltrative disease and Cassion disease.

exercises including wobble boards for The most common affected site is the

muscle and join restoration. The femoral head and the patient might report

rehabilitation lasted for seven months. The pain on his right hip and knee.

patient reported reduced pain on his right

As said in the previous paragraphs,
hip and returned back to work after
his specific case shows that age also one of
discharge.
the factor that affects someone’s risk of

having avascular necrosis.

Conclusion

Based on the gathered data, the following conclusions are made:

Avascular Necrosis

It is concluded that avascular necrosis also known as osteonecrosis is a disease that is

usually common in the bones. It usually happens in the epiphysis of the long bone but it can
also occur in in the small bones. For this disease, when the diagnosis is made too late it can
result to damage to your bone to the point of needing it to be renewed.

Effects of avascular necrosis

It is unveiled that the effects of avascular necrosis in our body can only be seen inside
the bone. The effects will be seen 24 hours after the interruption of the supply of the blood in
our bones. At early stages the bones may be affected by losing cell outline, disruption of cell
membrane, homogenization of the cytoplasm, reduction of basophilia and nuclear pyknosis. If
it remains unchecked it can led to disappearance of your bone marrow that can severely damage
your bone.

Symptoms of avascular necrosis

It is deduced that symptoms of this disease does not show up in early stages. It
accumulates and when it shows up you will feel tremendous pain in the groin. The other sign
that might occur are limping, decreased movement range, pain with flexion and internal
rotation, clicking in the hip and loss of internal rotation of the hip. If you experience the
following symptoms, you have high risk of having avascular necrosis but thorough
investigation must still be done in order to know if the suspicion was right.

Causes and risk factor of avascular necrosis

There are several causes that might trigger avascular necrosis, these are as follows:
Pancreatitis, lupus, alcoholism, usage of high dose steroid, trauma related injury, infection,
caisson disease, rheumatoid arthritis, amyloid arthropathy, gaucher’s disease and sickle cell
disease. Age is also a risk factor that might affect your chances of having avascular necrosis.
People who are at the age group of 30-50 years old have high risk of developing the disease.
Smoking is also one cause that might trigger the disease but it is not yet medically accepted.
Treatment of avascular necrosis

There are three ways in which we can treat avascular necrosis. We can use the medicinal
approach, the surgical approach or the conventional approach. In medicinal approach we use
medical drugs such as nonsteroidal anti-inflammatory drug, osteoporosis drugs, cholesterol-
lowering drugs or blood thinner drugs. We use this approach in order to attack the risk factor
of the disease, we are preventing at the same time curing avascular necrosis. We usually do
this at the early stages of this disease. When the disease worsen, we use the surgical approach
such as electrical simulation or core decompression to treat it. The conventional approach are
as follow; exercise and rest.

Prevention of avascular necrosis

It is concluded that there are 5 ways in which we can prevent avascular necrosis. First,
we have to limit our alcohol consumption so that the fatty substance will not build up in our
blood vessels. Second, we should eat foods that have high contents of vitamin D and calcium
in order to maintain healthful bones. Third, you should lessen excessive activity that might put
strain in your bones. Fourth, you should avoid bone injuries as much as possible because it can
make the risk of getting trauma related avascular necrosis higher. Last is to avoid consumption
of high dose steroid to avoid the risk of non-traumatic avascular necrosis.
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