Avascular Necrosis

Question

I am having difficulty finding extensive information concerning AVN. I have had the arthritis in both ankles for which I now have a right ankle fusion and a left total ankle replacement done by Sigvard Hansen at Seattle’s Harborview Med. Center. I now find that the AVN has spread to both of my hips. Can I expect to require hip replacements and maybe even knees or wrists later? Also, my oldest daughter has been diagnosed with AVN of both of her ankles. Is AVN hereditary? Is there a cure? Maybe gene therapy?

Answer

>Avascular necrosis (AVN) also called osteonecrosis is a condition in which blood supply to the bone is disrupted and the bone dies. AVN ususally affects large weight bearing joints such as the hips or knees but on occasion can affect the shoulders, ankles or wrists. The most common cause of AVN is fractures after trauma that disrupts the blood supply– particularly common after certain hip fractures. Certain blood disorders such as sickle cell anemia or problems that cause excessive blood clotting can cause AVN. Acohol abuse and high doses of prednisone have also been associated with AVN. In your case, I agree that you need a careful evaluation for diseases that can cause AVN.

Unfortunately, many cases of AVN cannot be treated medically and joint replacement is required. In the early stages, a procedure called core decompression can be tried.

Alan Matsumoto, M.D.

About Alan Matsumoto, M.D.

Part-time Faculty, Division of Rheumatology
Johns Hopkins University