Avascular necrosis (also osteonecrosis, bone infarction[1], aseptic necrosis, ischemic bone necrosis[2], and AVN) is a disease where there is cellular death (necrosis) of bone components due to interruption of the blood supply.[3] Without blood, the bone tissue dies and the bone collapses.[2] If avascular necrosis involves the bones of a joint, it often leads to destruction of the joint articular surfaces (see Osteochondritis dissecans).
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Stage | Clinical | Surgical potential |
Stage 0 | Theoretical stage: Assymptomatic. All diagnostic tests are normal. Biopsy from histology - is the only abnormality. | Nil Required : Theoretical stage only Not a clinical problem. |
Stage 1 | X-Rays and CT-scan are normal MRI and Tc99 and histology are abnormal. Symptoms may or may not be present. | Surgery is possible / desirable. Core - decompression possible. |
Stage 2 | X-Rays are abnormal - With linear sclerosis or cysts. There is no Subchondral lucency Head of the femur is still spherical. | Surgery is possible / desirable. Core - decompression possible. |
Stage 3 | The femoral head starts to fail mechanically - With Trabecular collapse. The radioluscent crescent sign is visible at the Subchondral endplate. The femoral head itself is still spherical | Surgery is possible Core - decompression possible. Success depends on degree of changes. |
Stage 3a. | Crescent < 15% | Surgery still possible. |
Stage 3b | Crescent 15-30% | Increasing risk of failure of preventative surgery. |
Stage 3c | Crescent>30% | Increasing risk of failure of preventative surgery. |
Stage 4 | Flattening of the femoral head is now seen | Preventative surgery NO HELP Medical Management. Total Hip Replacement Required. |
Stage 4a | <15% of the surface is collapsed Depression <4mm | Preventative surgery NO HELP Medical Management. Total Hip Replacement Required. |
Stage 4b | 15-30% collapse or 2-4mm depression | Preventative surgery NO HELP Medical Management. Total Hip Replacement Required. |
Stage 4c | >30% Collapse or >4mm depression. | Preventative surgery NO HELP Medical Management. Total Hip Replacement Required. |
Stage 5 | Any or all Xray features may be present There is a decrease in joint space. Secondary Osteoarthritis is present with: Sclerosis / Cysts / Osteophytes | Preventative surgery NO HELP Medical Management. Hip Replacement Required. |
Stage 6 | Extensive destruction | Total Hip Replacement - Where available / Possible. |
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CARTILAGE INJURY
Hyaline articular cartilage is a firm and durable tissue. Cartilage covers the ends of bones in joints and enables the bones to move smoothly over one another. Therefore, healthy cartilage is crucial to the smooth and painless mobility of most joints, including the knee.
Cartilage damage can be caused by athletic activity, traumatic injury, and even daily wear and tear. Injuries to the articular cartilage of the knee can take the form of lesions, which are like potholes in the cartilage. Symptoms of an injury can include aching, pain, swelling, locking, catching and giving way.
Damaged cartilage has limited capacity to repair or restore itself. If untreated, the damage may progressively worsen and may lead to chronic conditions such as osteoarthritis.
Hyaline articular cartilage is a firm and durable tissue. Cartilage covers the ends of bones in joints and enables the bones to move smoothly over one another. Therefore, healthy cartilage is crucial to the smooth and painless mobility of most joints, including the knee.
Cartilage damage can be caused by athletic activity, traumatic injury, and even daily wear and tear. Injuries to the articular cartilage of the knee can take the form of lesions, which are like potholes in the cartilage. Symptoms of an injury can include aching, pain, swelling, locking, catching and giving way.
Damaged cartilage has limited capacity to repair or restore itself. If untreated, the damage may progressively worsen and may lead to chronic conditions such as osteoarthritis.
Current treatment options
Current treatment options are limited and vary depending on individual patient factors and surgeon preference.
Despite the availability of a range of procedures and treatments, patients are often left searching for new options due to incomplete recovery or limited duration of effect. Microfracture is commonly performed and is considered the current standard of care for most cases of severe cartilage injury in the knee. Microfracture works by creating tiny holes, or “fractures,” in the bone underneath the injured cartilage, leading to formation of a blood clot in the affected area. The blood and bone marrow that seep out to form the clot contain stem cells, which are thought to grow into cartilage-building cells. Although symptoms may improve for a period of time after the surgery, microfracture has been unsuccessful in reliably solving the underlying problem of the injured cartilage. In most cases, the repair tissue formed by the procedure is not the same healthy joint cartilage that joints require to withstand the normal forces of movement and weightbearing.
Made from a patient’s own cells, NeoCart® is an investigational cartilage tissue implant to treat knee cartilage injuries. Learn more about NeoCart and its potential benefits to people suffering from cartilage injury in the knee.
Current treatment options are limited and vary depending on individual patient factors and surgeon preference.
Despite the availability of a range of procedures and treatments, patients are often left searching for new options due to incomplete recovery or limited duration of effect. Microfracture is commonly performed and is considered the current standard of care for most cases of severe cartilage injury in the knee. Microfracture works by creating tiny holes, or “fractures,” in the bone underneath the injured cartilage, leading to formation of a blood clot in the affected area. The blood and bone marrow that seep out to form the clot contain stem cells, which are thought to grow into cartilage-building cells. Although symptoms may improve for a period of time after the surgery, microfracture has been unsuccessful in reliably solving the underlying problem of the injured cartilage. In most cases, the repair tissue formed by the procedure is not the same healthy joint cartilage that joints require to withstand the normal forces of movement and weightbearing.
Made from a patient’s own cells, NeoCart® is an investigational cartilage tissue implant to treat knee cartilage injuries. Learn more about NeoCart and its potential benefits to people suffering from cartilage injury in the knee.
See also
References
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