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How can avascular necrosis be treated?

Q: My 35 years old cousin has been diagnosed with avascular necrosis of left joint last year. She is taking certain medicines, but no pain killers, on doctor's prescription. Here are a few questions I want to ask:-

  1. Can her condition be cured by medication or is surgery the only option?
  2. Can her bone cells regenerate? Will her bones continue to deteriorate if she just takes medicines?
  3. How do we improve her blood circulation?
  4. Can she lead a normal married life?
  5. Why does the pain aggravate during winters?

A:The diagnosis of avascular necrosis (AVN) is made on the basis of an X-ray or MRI. What were the diagnostic criteria? AVN can be secondary to several medical conditions. Does she have any of those? These include steroid use, kidney disease, blood coagulation disorders, some lipid storage disorders and others. Quite often no cause is found; then we call it idiopathic necrosis. There is no specific treatment for this. No known medicine works though there is some controversy on a group of medicines called biphosphonates. There are some trials going on this. As of today, I do not think any medicine to be beneficial. I am not aware of any known mechanism to help regeneration of bone cells. There are some investigations on stem cells in this area. Core decompression is described as a surgery to improve circulation but there is no consensus on this. If at all it works it is in the very early stage before any X-ray change appears. Deterioration will take place in a majority of cases but there is no way of predicting it. If deterioration is occurring it will be evident on X-rays. Yes, she can lead a normal married life. Most joint problems are painful in cold and wet weather. In cold weather joints are stiffer and in wet weather because of low atmospheric pressure usually some fluid accumulates in the joint causing pain by distension.

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