What is AVN?
Avascular necrosis (AVN), literally meaning “bone death”, can occur in various bones of the body. When it occurs in the hip, it can cause significant pain and disability and eventually loss of the hip joint itself (Figure 1). The hip deteriorates due to loss of blood supply to the hip bone. Smoking, alcohol and steroid use have been known causes for AVN of the hip. AVN is considered a progressive disease with four stages. Dr. Saad offers treatment to early stage (stages 1-3), also known as pre-collapse AVN.
To learn more, read Dr. Saad’s blog What Causes AVN?
What are the Treatment Options?
Avascular necrosis can be treated in three main ways: core decompression, free tissue transfer, and hip replacement. Treatment choices are dependent on many different factors including patient age, any other diseases the patient has, and the cause and stage of the AVN.
To learn more, read Dr. Saad’s blog Why is a Plastic Surgeon Treating AVN?
Free periosteal core decompression combines core decompression with free tissue transfer. First, the patient undergoes a traditional core decompression with a hole drilled into the bone and the dead bone removed. Next, a periosteal flap, which is the lining of the bone, is placed into the hole created by the core decompression. Finally, the blood supply is the re-established under a microscope. This flap is much smaller than a fibula flap, is easier to harvest, and had almost no risk of side effect. Since the flap fits in the hole create by the core decompression, the patient can bear weight in 6 weeks. This procedure has similar benefits of the fibula flap with none of the down sides. It’s really the best of both worlds.
What is free periosteal core decompression?
To learn more, read Dr. Saad’s blog What is free periosteal core decompression?
Can stem cells be used to treat AVN?
There is promising data suggesting that stem cell injections can be used to treat AVN. While the data is favorable, more study is still needed.