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Basically, yes. The blood supply to that area of bone has been interrupted (avascular) and the cells which line the structure of the bone die off (necrosis) as a result. However the bone matrix or scaffold remains and so nearby cells can come back to the area as the bone blood supply recovers (usually incompletely). If the blood supply doesn't recover quickly enough, the scaffold can collapse and this leads to loss of joint surface shape and this results in arthritis. The scaffold collapses because it doesn't have the bone cells to keep the bone structure in good repair (to cope with the daily damage which occurs).

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Gaurav Batra

Orthopaedist

Salford

Avascular Necrosis (AVN) simply means the blood supply to an area of bone has failed. The blood supply generally re-establishes itself and the dead bone is replaced. If this occurs without a fracture or collapse of a joint surface then the result will be good. If fracture or collapse occurs then you will have on going problems and may need surgery. Lots of operations have been tried to prevent the collapse but in my opinion they don't usually work. Therefore if a weight bearing joint is effected I advise use of crutches. A wait and see what happens is perfectly reasonable. Best Wishes

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Mr. Matthew Oakley MB CHB, FRCS, FRCS(ortho) Premium Profile Has a more complete profile

Orthopaedic surgeon

Hereford

Well it's very difficult to say what to do without seeing him, but if you want more information, then you need to speak to the treating Orthopaedic Surgeon. You are entitled to a second opinion if you are not happy with this. In broad terms, early disease can be treated expectantly unless pain is bad. There is a procedure called core decompression, which can be coupled with a grafting procedure to reduce pain and hopefully improve the return of the blood supply to the affected femoral head. However, this can only be done before the surface of the joint has undergone permanent change on X-ray. If it is already altered, core decompression is not indicated. Unfortunately after this stage, most people with severe symptoms are managed with injections, physiotherapy and pain killers, but a significant proportion end up needing an early hip replacement.

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Gaurav Batra

Orthopaedist

Salford

AVN tends to occur because the blood supply to that part of the bone is from an end artery. This means that it is the only blood supply to that part of the bone and so is susceptible AVN as a result. Once the dead bone has been cut out for the purposes of arthroplasty, it usually leaves behind bone which has a much better blood supply so recurrence is very unusual.

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Gaurav Batra

Orthopaedist

Salford

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