Avascular Necrosis/Osteonecrosis

AVN Illustration

Figure 1. Illustration of AVN of the hip.

What is Avascular Necrosis/Osteonecrosis?

Avascular necrosis (AVN), also known as Osteonecrosis, literally meaning “bone death”, can occur in various bones of the body. When this occurs in the bone, it can cause significant pain and disability and eventually loss of the joint itself (Figure 1). The bone deteriorates due to loss of blood supply. Smoking, alcohol and steroid use are a few possibly causes of AVN. AVN is considered a progressive disease with four stages. We offer treatment for early stage AVN, also known as pre-collapse AVN.

There are a number of bones that we are able to treat including: hip/femoral head, talus/ankle, wrist/lunate and tibia.

To learn more, read Dr. Saad’s blog, What Causes Avascular Necrosis?

What are the Treatment Options?

Avascular necrosis can be treated in three main ways: core decompression, free tissue transfer, and joint replacement. Treatment choices are dependent on many different factors including patient age, any other diseases the patient has, and the cause and stage of AVN.

To learn more, read Dr. Saad’s blog Why is a Plastic Surgeon Treating AVN?

What is Free Periosteal Core Decompression?

Free periosteal core decompression combines core decompression with free tissue transfer. This procedure involves replacing the dead portion of the bone with new bone and restoring blood supply to the affected area. 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 then 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.

To learn more, read Dr. Saad’s blog What is free periosteal core decompression?

Who is a Candidate for this Surgery?

Candidates for this procedure include patients with earlier stage, pre-collapse AVN (Stage 1 and Stage 2).

Patients with later stage AVN (Stage 3 and Stage 4) are not candidates for this procedure due to the amount of bone and cartilage damage that is present. Patients who have AVN as a result of sickle cell disease or other hypercoagulable diseases are also not candidates for this procedure. This is because although this procedure aims to restore blood supply to the affected area, it has not been proven effective in those with sickle cell disease, due to the blood flow blockage caused by sickle cells.

What is the Future of AVN Treatment?

There is promising data suggesting that stem cell injections can be used to treat AVN. Stem cells may regenerate diseased bone tissue, delaying or eliminating complete bone death. While the data is favorable, additional research is still needed to support the potential benefits of this treatment.

Patient Stories

Susan’s Story – Avascular Necrosis

Months after a traumatic accident, Susan developed avascular necrosis in her ankle. Not accepting amputation as an option, she researched her condition extensively, only to find Dr. Saad, a plastic… Read more “Susan’s Story – Avascular Necrosis”

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More Information

To find out more about our free tissue transfer procedures and if you are a candidate please contact us.

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