Has your doctor told you that you or a member of your family have AVN, or written "avascular necrosis" on your scan report? The words sound alarming, and many people go home thinking their bone is simply dying away. It is not that simple, and it is not hopeless. Avascular necrosis is AVN Arogya's flagship speciality, and in the majority of the patients we treat for AVN, progression is arrested without surgery.
What does avascular necrosis mean?
The name explains itself once it is broken into two parts. "Avascular" means without blood supply. "Necrosis" means that tissue has died. So avascular necrosis means that a part of a bone has lost its blood supply, and the bone cells in that area have died.
You may also see it called osteonecrosis ("bone death"), aseptic necrosis or ischaemic necrosis of bone. These are different names for the same condition. Doctors usually shorten it to AVN. When the report says "AVN of the femoral head", it means the ball at the top of the thighbone, which sits in the hip socket.
Bone is living tissue. It is constantly repaired and renewed, and it needs a steady flow of blood to do that. When the flow to one area is cut off, the bone there weakens. If nothing changes, the weakened area can crack under the load of walking, and the smooth round surface of the joint can collapse.
Where in the body can avascular necrosis occur?
AVN most often affects the hip, and it often affects both hips. It can develop in any bone whose blood supply is interrupted:
- Hip (the femoral head): the most common site, and where our experience is deepest.
- Shoulder (the humeral head): the second most common site, often after a fracture or long-term steroid use. Read about AVN of the shoulder.
- Knee: the bone surfaces at the knee, including spontaneous osteonecrosis of the knee (SONK). Read about AVN of the knee.
- Ankle, wrist and foot: usually after a fracture, because some of these small bones have a fragile blood supply.
- In children: Legg-Calvé-Perthes disease is AVN of the hip in childhood.
What causes avascular necrosis?
AVN develops when the blood supply to a section of bone is cut off, and the causes fall into two groups.
After an injury. A fracture or dislocation, most often of the hip, wrist or ankle, can damage the blood vessels that feed the bone.
Without an injury. This is the more common story in the patients we see:
- Long-term or high-dose steroid medicines — the most common cause in India.
- Heavy or prolonged alcohol use.
- Blood disorders such as sickle-cell disease and clotting disorders.
- Autoimmune conditions such as lupus.
- Radiation or chemotherapy, and some rarer causes such as Gaucher's disease and decompression sickness in divers.
In some people no clear cause is found. If you have taken steroids for asthma, a skin or autoimmune condition, a transplant or COVID-19, read our article on steroids and AVN, and do not stop any prescribed medicine on your own.
What are the symptoms of avascular necrosis?
In the earliest stage there may be no symptoms at all, which is why AVN is often found late. In the hip it usually shows itself in this order:
- pain in the groin or hip, at first only with activity
- pain at night as the condition progresses
- a limp, or a change in the way you walk
- stiffness, especially when turning the leg inwards
- difficulty with stairs, squatting or standing for long
Hip AVN can also send pain down to the knee, so some people are treated for a knee problem while the real trouble is in the hip. We explain the early signs in more detail in Early signs of avascular necrosis of the hip.
How is avascular necrosis diagnosed?
An ordinary X-ray can look normal in early AVN, which is exactly why early, accurate diagnosis matters. MRI is the gold standard: it can detect AVN in its earliest stages, often before the bone has collapsed. The MRI also shows how much of the bone is affected, which decides the stage, or grade.
At AVN Arogya we also look for the reasons behind your AVN. Along with the scans, a panel of blood tests — including inflammation markers, cholesterol, clotting studies, homocysteine, blood sugar, liver and kidney function, and vitamin D3 and B12 — helps us find the factors that contributed, so each can be addressed.
Is avascular necrosis serious? What the stage tells you
AVN is serious because, left untreated, the joint can collapse. But the diagnosis is not the end of the story. What matters most is the stage at which it is found and how early the right treatment begins.
Doctors usually grade hip AVN from Grade 1 to Grade 4 on the Ficat-Arlet scale. In Grades 1 and 2 the ball of the hip is still round; in Grade 3 the bone beneath the surface has begun to collapse; in Grade 4 the ball has flattened and arthritis has set in. If you have been told you need a hip replacement, read Told you need a hip replacement for avascular necrosis? Read this first.
How Ayurveda helps the body heal in avascular necrosis
The body has a powerful capacity to heal itself, and Ayurveda strengthens it with medicines and therapies that work differently from modern drugs. At AVN Arogya, treatment begins with the root causes, found through a detailed history and tests. Then it works to reduce inflammation, improve blood flow to the affected bone, strengthen the bone by supporting bone metabolism, and remove whatever is getting in the way of the body's natural healing.
There is no fixed package. Every programme is designed personally by your physician, around your stage, how inflamed the joint is and how you respond. It brings together our own Ayurvedic medicines, made in-house and tested to international standards for heavy metals, classical therapies chosen for you, physiotherapy, yoga and diet. The first course of treatment is an inpatient programme, after a consultation in which the physician decides whether our treatment suits you.
In the majority of the patients we treat for early-stage AVN, progression is arrested, and many of our patients who were advised replacement have avoided or deferred it. When the damage is too advanced, we say so plainly and refer you to orthopaedic surgeons we trust.
Frequently asked questions
What is the full form of AVN?
AVN stands for avascular necrosis: bone tissue that has died because its blood supply was interrupted. It is also called osteonecrosis.
Is avascular necrosis the same as osteonecrosis?
Yes. Both names describe the same condition; "osteonecrosis" simply means bone death.
Can avascular necrosis heal?
Bone is living tissue, and when the blood supply and the conditions for healing improve, the body can do a great deal. In the majority of the patients we treat for early-stage AVN, progression is arrested, with real relief of pain and recovery of function. The earlier treatment begins, the more there is to preserve.
Is avascular necrosis cancer?
No. AVN is bone death from a lost blood supply, not a cancer. It can occur in people who have had radiation or chemotherapy for cancer.
Does AVN always affect both hips?
Not always, but often. We recommend checking the other hip with an MRI when it is clinically indicated, because early changes can be present before they cause pain.
Seek urgent care if your hip or groin pain suddenly becomes severe, if you suddenly cannot put weight on the leg, or if the joint is hot and swollen with a fever.
For an honest second opinion and a chance to avoid unnecessary surgery, consult an AVN Senior Physician and bring your MRI. Read about Ayurvedic treatment for avascular necrosis at AVN Arogya, or book a consultation — you can send your MRI and reports in advance.