Avascular Necrosis of the Femoral Head
Definition and Causes
Avascular necrosis (AVN) or osteonecrosis of the femur head (ONFH) is a result of an interruption of blood supply to the bone.
The femoral head lays at the most remote part of the bone's vasculature and is enclosed by cartilage. Its access to local blood vessels is restricted, making the femur head vulnerable to necrosis caused be ischemia (lack of blood supply).
The possible causes may be idiopathic, alcohol- or drug-induced, blockage in a blood vessel supplying the femoral head, or fat embolism.
Other causes are anemia, Gaucher disease, increase bone marrow pressure, impaired arterial supply, obstruction of venous drainage, vasculitis, intermedullary hemorrhage and hypofibrogenemia.
Joint pain is usually the initial symptom which can either be dull, aching, sharp, or intermittent. Pain may be confined over the hip or radiating to the buttocks, gonads, or knee and is usually aggravated by standing or walking and relieved by rest.
The pain can be debilitating, limiting the joint range of motion.
The main mechanism of AVN is hypoxia (lack of oxygen) to the bone which results in ischemia and death of the marrow and the osteocytes.
Treatment with Hyperbaric Oxygen Therapy
With the main therapeutic goal of preventing collapse of the femoral head and preserving the joint rather than replacing it, hyperbaric oxygen can accomplish this alongside with other orthopedic interventions. Predominantly, hyperbaric oxygen reduces joint edema, stimulates revascularization and boosts bone resorption and regeneration.
Hyperbaric oxygen increases oxygen availability in blood plasma to relieve ischemia caused by poor vascularization of the femur head. The reparative processes result in enhanced fibroblastic, angioblastic, osteoblastic, and osteoclastic activity, which are all extremely important in healing necrotic bone structures.
Benefits of Hyperbaric Oxygen Therapy
* Hyperbaric oxygen is used as an addition to surgery or its replacement therapy with the main therapeutic goal of joint preservation and preventing collapse of the femoral head.
Reduces joint swelling and stimulates revascularization and bone resorption and regeneration. This willdecrease pain and improve range of motion.
Decreases edema and inflammation, thereby lowering intra-osseous pressure and restoring venous drainage.
Induces angiogenesis, improving themicrocirculation which facilitates resorption of the necrotic dead bone and replacement with living bone.
Stimulates the body's metabolism. Increased metabolism raises the rates of resorption, halting the further progression of the necrosis, conserving the femoral head, keeping its structural integrity and reducing the incidence of surgeries.
Promotes new bone formation or osteogenesis. HBO rebuilds and remodels the damaged bone by increasing the differentiation of stem cells to osteocytes, the bone-forming cells.
increases stem cell formation resulting in faster wound healing and recovery after hip arthroplasty or core decompression.
Reduces edema and decreases pain. Improvement of range of motion is noted when pain is reduced.
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