Role of Homoeopathy in Avascular Necrosis

What is Avascular Necrosis ?  Avascular necrosis is the death of bone tissue due to a lack of blood supply. Also called osteonecrosis, avascular necrosis can lead to tiny breaks in the bone and the bone’s eventual collapse.The blood flow to a section of bone can be interrupted if the bone is fractured or the joint becomes dislocated. Avascular necrosis is also associated with long-term use of high-dose steroid medications and excessive alcohol intake

LCPD usually occurs in children aged 4-10 years Legg-Calvé-Perthes disease (LCPD) is avascular necrosis (AVN) of the proximal femoral head resulting from compromise of the tenuous blood supply to this area. The disease has an insidious onset and may occur after an injury to the hip.But anyone can be affected by avascular necrosis. However, it’s most common in people between the ages of 30 and 60. Because of this relatively young age range, avascular necrosis can have significant long-term consequences.

Avascular necrosis occurs when blood flow to a bone is interrupted or reduced. Reduced blood supply can be caused by:

Joint or bone trauma. An injury, such as a dislocated joint, might damage nearby blood vessels. Cancer treatments involving radiation also can weaken bone and harm blood vessels.

Fatty deposits in blood vessels. The fat (lipids) can block small blood vessels, reducing the blood flow that feeds bones.

Certain diseases. Medical conditions, such as sickle cell anemia and Gaucher’s disease, also can cause diminished blood flow to bone.

For about 25 percent of people with avascular necrosis, the cause of interrupted blood flow is unknown.

Risk Factors : –

• Trauma. Injuries, such as hip dislocation or fracture, can damage nearby blood vessels and reduce blood flow to bones.
• Steroid use. High-dose use of corticosteroids, such as prednisone, is the most common cause of avascular necrosis that isn’t related to trauma. The exact reason is unknown, but one hypothesis is that corticosteroids can increase lipid levels in your blood, reducing blood flow and leading to avascular necrosis.
• Excessive alcohol use. Consuming several alcoholic drinks a day for several years also can cause fatty deposits to form in your blood vessels.
• Medical conditions associated with avascular necrosis include:
• Pancreatitis
• Diabetes Gaucher’s disease
• HIV/AIDS
• Systemic lupus erythematosus
• Sickle cell anemia
• Bisphosphonate use. Long-term use of medications to increase bone density may be a risk factor for developing osteonecrosis of the jaw. This complication has occurred in some people treated with these medications for cancers, such as multiple myeloma and metastatic breast cancer. The risk appears to be lower for women treated with bisphosphonates for osteoporosis.

Certain medical treatments. Radiation therapy for cancer can weaken bone. Organ transplantation, especially kidney transplant, also is associated with avascular necrosis.

How to diagnose AVN ? 

During a physical exam your doctor will likely press around your joints, checking for tenderness. Your doctor may also move the joints through a variety of positions to see if your range of motion has been reduced.

Imaging tests:

Many disorders can cause joint pain. Imaging tests can help pinpoint the source of pain. The options include:

X-rays. They can reveal bone changes that occur in the later stages of avascular necrosis. In the condition’s early stages, X-rays usually appear normal.

MRI and CT scan. These tests produce detailed images that can show early changes in bone that may indicate avascular necrosis.

Bone scan. A small amount of radioactive material is injected into your vein. This tracer travels to the parts of your bones that are injured or healing and shows up as bright spots on the imaging plate.

Treatment of AVN :

• In the early stages of avascular necrosis, symptoms can be reduced with medication and therapy. Your doctor might recommend:
• Non steroidal anti-inflammatory drugs. 
• Osteoporosis drugs. 
• Cholesterol-lowering drugs. 
• Blood thinners.
• Rest. Exercises. 
• Electrical stimulation. Electrical currents might encourage your body to grow new bone to replace the area damaged by avascular necrosis. Electrical stimulation can be used during surgery and applied directly to the damaged area. Or it can be administered through electrodes attached to your skin.
• Hip -Joint Replacement may be necessary on late stage disease for pain unresponsive to other measures 

ROLE OF HOMOEOPATHY :

• Homeopathy is Safe ,Gentle & Effective 
• There are more than 137 Homoeopathic Remedies for Bone Necrosis.
• Homeopathic treatment for Avascular Necrosis uses the body’s own restorative process to heal, its aim is to stop the destruction of bones in patients of Avascular Necrosis because of interrupted blood supply. 
• Homeopathic remedies can reduce the pain in bones  & heal the necrosis 
• Syphilinium  – Syphilitic Bone pain night that get worse at night The most dominant feature for selecting Syphilinum in any given case of AVN is the worsening of bone pains at night. The pains are experienced throughout the night. The patient is not able to sleep on account of the severe pain.
• Silicea-small bones  to large bones .The necrosis of jaw, wrist bones, hand bones, feet bones, ankle, knees and in addition long bones.
• Fluoric Acid:  A remedy for the necrosis of long bones. The bones include humerus (bone in upper arm), femur (bone in thigh) and tibia (bone in front of leg). 
• Asafoetida: Darting pain and caries in bones. Periosteum painful, swollen, enlarged. Ulcers affecting bones; thin, ichorous pus.
• Angustura Vera :  It has special affinity for the long bones such as the humerus, femur, tibia, etc.. We think about Angustura specially in carious affections of these bones and in exostosis and necrosis of lower jaw. The carious ulcers pierce the bones down to the marrow
• Strontium Carb : AVN on Long Bones  Mainly action on femur mainly recommended for patients who experience aggravated pain in cold air.  
• Aurum Metallicum: in the treatment for necrosis in nasal and palatine bones. The mastoid bone is also the site that benefits with the use of Aurum Met. The patient complains of pains at night and may suffer from extremely offensive odour from the mouth and nose along with pain. The patient may also feel depressed with a high degree of sadness. In addition, the zest for life is lost.
• Gettysburg Aqua: had proved efficacious in affections of the joints and bones. Hip – disease, Pott’s Disease, with ulceration, the discharge being thin, watery and offensive.Caries of vertebrae, or hip ulceration of the joints when the discharge excoriates. 
• Stillingia Sylvatica :Aching pains in the bones of the extremities and back .Syphilitic affections of the long bones, such as, tibia, femur, humerus, etc.Ostitis; peri – ostitis. Exostoses.Hip – joint disease, in connection with the secondary or inherited syphilis, 
• Lithium Carb :  Itching about joints. Rheumatic pains throughout shoulder-joint, arm, and fingers and small joints generally. Pain in hollow of foot, extending to knee. Swelling and tenderness of finger and toe joints; better, hot water. Nodular swellings in joints. 
• Heckla Lava :It has marked action on the lower jaw, and has the power to arrest many forms of bone diseases, osteo-sarcoma, osteitis, caries and necrosis; exostosis, which are sensitive and painful to touch. Facial neuralgia from carious teeth and after extraction.
• Merc Sol – Nightly bone pains ,necrosis of bone, recurrent mouth apthae , Syphilis history.Offensive odors .Salivation of mouth  .
• Hepar Sulph – Oversensitive to cold , Necrosis of bone .Aggressive hatred towards people who doesn’t argue .cannot tolerate draft of air .Bone pains  
• There are more than 130 Homoeopathic remedies which can be used  for healing the necrosis but only totality of symptoms and help not specific !

The Homeopathic medicines are selected after taking into account proper case history of the patient. The Homeopathic medicines are prescribed based on the bone involved, the kind of bone pain and other peculiar symptoms in each individual case.

©Dr.Jitesh Sharma