Avascular Necrosis

What Is Avascular Necrosis (AVN)?

This condition is likewise known by the name osteoporosis is a condition that happens when a particular region of the bone dies because of improper or poor blood supply. Internal Necrosis can likewise happen as a symptom of certain diseases and the therapy of those cancers.

The dangers are higher for youngsters who have been given high portions of corticosteroids like dexamethasone and prednisone. The condition can some of the time be gentle and could seek better once the treatment ends or it can keep going the drawn-out causing pain and long-term inability.

Avascular Necrosis in children having cancer:

This is quite a common side effect of therapies that are administered for leukemia and lymphoma types of cancers.  The greater part of the youngsters determined to have intense lymphoblastic leukemia have a specific level of AVN. It is also noted that the risk is higher in children who have undergone a bone marrow transplantation. 

On account of pediatric patients, avascular necrosis is frequently seen toward the end of the long bones in a space called the epiphysis. There is no telling on which bone this might occur, but in the case of pediatric patients, it is often seen at the end of the long bones. 

Avascular Necrosis can be quite painful and affects the function of the joints, especially the hips, knees, shoulders, and ankles.

Any harm that could happen in the bone is durable which in the long term can bring on some issues like joint breakdown and joint inflammation.

When contrasted with small kids, more seasoned youngsters are bound to foster AVN during disease treatment when contrasted with more youthful kids and the condition is even uncommon in youngsters over the age of 10.

It is not an easy task to detect Avascular Necrosis at an early stage and treat them. The pain or the other symptoms might not be there until the damage has become severe. Children who might be vulnerable to developing AVN should be kept under constant care and monitoring. 

Managing Avascular Necrosis:

The management of AVN is subject to the aggravation and the level of bone harm the condition has caused. In some cases, pain management programs and physical therapy have proven to help increase the blood flow and relieve the pressure within the bone.  In situations where the bone harm is profoundly serious or a joint breakdown happens, the patient will ultimately require a joint substitution medical procedure.

What are the symptoms of Avascular Necrosis?

In certain patients, the side effects probably won’t be apparent by any stretch of the imagination, particularly in the beginning phases. Slight pain indicates that the condition is becoming severe and with the worsening of the condition the patient might feel severe pain.  In the event that you notice your kid limping or tries not to utilize a specific joint, or has solidness or decreased scope of movement they could probably have AVN and it ought to be advised to the medical care expert right away. Disregarding the condition can some of the time bring about the breakdown of the bone and the abrupt deterioration of the aggravation. 

AVN can sometimes occur in just a single bone or might affect multiple bones.  

 On account of pediatric patients, AVN normally happens in different joints because chemotherapy medicine is directed all through the body. It mostly occurs in the knees and other joints likely to be affected by AVN are the shoulders and ankles. 

What are the causes of Avascular Necrosis?

The event of AVN is a complicated interaction. The essential explanation is deficient or loss of blood supply to the bones. The blood supply is sliced off because of veins being excessively little or being harmed or obstructed subsequently making it hard for the supplements and the oxygen to get deep down. This causes the bone cells to die.

The bone cells die or slow down the recuperating when cancer therapies including chemotherapy and radiation treatment are started. This makes the bone separate quicker than it can fix itself making it powerless and fragile. The medicines additionally influence the blood supply being sent to the bones.

As part of their chemotherapy treatment, children are required to take corticosteroid medications mostly for managing the side effects such as nausea and swelling. On the downside, teh corticosteroids can increase the lipids in the blood causing a build of fat. This results in the clogging and blocking of the blood vessels. Likewise, the intercessions additionally change the cells that line the veins making them more slender and frail. When compared to prednisone, high doses of dexamethasone are also associated with the development of AVN. the chances of avascular necrosis increase with the intake of medications such as asparaginase due to then affecting the action of dexamethasone due to their combined working in the body. Methotrexate (MTX) also causes bone damage and increases the chances of the patient developing AVN worsening when in combination with corticosteroids. 

Avascular Necrosis Diagnosis

The identification of the condition and monitoring of the patients having this condition vary according to each media center. The most widely recognized technique utilized to distinguish the regions impacted by AVN is done utilizing imaging tests which are some of the time called lesions. The most sensitive imaging tests for diagnosing AVN are MRIs and the least sensitive one is the X-ray which is highly helpful for monitoring the progression and the follow-up of the patient after surgery. The not-so-commonly used type of imaging tests is bone scan and computerized tomography. 

Complementary or integrative therapies

Some patients do not prefer to go for therapies that include medication and treatments rather they prefer mid-body therapies to be useful. 

These treatments incorporate needle therapy, biofeedback, back rub, and relaxation techniques. A portion of the previously mentioned methods can assist the patients with easing pain as well as dealing with their pressure, lessening muscle strain, and further developing the bloodstream to organs. If your child prefers this type of treatment method, talk to their healthcare team, before jumping to conclusions. 

Note: Not all therapies work the same for everyone. Do not blindly trust what others say and talk to your doctor for the right option to be provided to you. 

Adjustment of chemotherapy

In the event that your youngster is encountering extreme AVN conditions, the group of their medical service will prescribe specific changes to be done to the chemotherapy intended to diminish the openness to corticosteroids. The choice that is taken with respect to this should be adjusted against the dangers to their general wellbeing.


In severe cases, patients are required to drop surgery for efficient management of AVN. Doing surgery ensures that bone healing is promoted and further damage to the bone is avoided. Surgery can also be done in cases where you want to replace a joint. The following are the types of procedures most commonly used.

Core decompression: 

It is done to alleviate tension inside the bone for advancing recuperating and expanding the bloodstream. In this cycle, little openings penetrate the impacted tissues, the ones that are harmed. With the expulsion of the dead tissue from the inside, a bone graft material will be added to occupy the space. This medical procedure is negligibly obtrusive and just a tiny entry point is done. The recovery period lasts for several weeks during which the patient is not allowed to lift weights of any sort. The mending happened rapidly and there have been reports of further developed pain and capability in those bones.

Bone Graft:

To treat AVN condition through a medical procedure and consideration of bone join to supplant and modify the harmed bone. The interaction includes the relocation of sound bone tissue from some other piece of the body or a solid benefactor. In specific cases, counterfeit materials may likewise be utilized. In the event of ligament harm, the graft may incorporate both bone and ligament join. A cycle called a vascularized bone graft is done where the veins are relocated alongside the bone tissue to assist with further developing the blood supply to the joint.


A sort of insignificantly obtrusive medical procedure utilizes a minuscule camera and meager careful instruments that are embedded into the body through little entry points. This technique is generally utilized for fixing torn ligaments in patients, smoothing the outer layer of the bone, or eliminating the free bits of tissues from the joint. This can assist with facilitating the side effects of pain, firmness, and ‘catching’ of the joint.


This medical procedure is done to reposition or reshape the unresolved issue of how much weight is applied to the harmed region. This system is done to eliminate the wedge of bone with the goal that the bone can be disturbed by changing the load on the bone. To hold the bone in position for healing, plates, staples, or screws are inserted. Performing this medical procedure can stay away from joint breakdown accordingly postponing or keeping away from the joint substitution medical procedure.


Otherwise called joint substitution medical procedure, this is generally caused assuming the harm is very serious. In this medical procedure, the harmed bone is eliminated and supplanted with an artificial joint. Bone replacement surgery will also be done in young adults after a joint collapse. Yet, this medical procedure is additionally normal in more older patients and grown-up survivors who have joint pain or deteriorating joint capability because of their age. It is important to detect the AVN at quite an early stage to administer proper diagnosis and management and if the surgery can be prevented, it is better. 

Tips for Patients and Families for managing AVN

Be fully aware of the risks. While you are about to receive cancer treatment, talk to your healthcare team about the risk factors involved with it. If there are any symptoms to look out for, watch for them and go for regular screenings. If you experience any pain or joint problems you need to let your doctor know about it immediately. In your survivorship plan ensure that bone wellbeing is a part of it.

Make sure you are physically active: reduce lighting heavy-weight objects and do physical activities that might tire you out. Stay away from physical games to safeguard your bones and joints. If you want to be physically active but are not sure what to do, talk to your physical therapist.

Continuously wear steady shoes and use gadgets as recommended by your PCP. All these are aids to restoring the alignment and the function of the joints. Wear the right footwear to prevent injury due to falls. 

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