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Treatment and Prevention of AVN in Sickle Cell Disorder

Avascular necrosis (AVN), or osteonecrosis or bone infarction, is death of bone tissue attributed to interruption of the blood supply. At the onset, there may be no symptoms. But gradually joint pain may develop and may limit the ability to move. Complications include collapse of the bone or joint surface.

In sickle cell disorder, the risk factor of having AVN is very high due to the complications from restricted blood supply to vital organs in the body. Up to 50% of sickle cell patients may develop AVN by the time they reach the age of 35. However, it is very rare in sickle cell trait (SCT), a much milder form of sickle cell disease in which patients are usually asymptomatic.

Treatment for AVN is recommended based on the stage of the disease coupled with the age of the patient. In Stage I, medication and crutches may be prescribed to provide relief and enable the bone to heal on its own. This treatment may require the patient to be non-weight-bearing for up to six months. It also has a failure rate greater than 80-percent.

Surgical treatment is recommended with a Stage II diagnosis, or very early in a Stage III diagnosis. A procedure, known as a core decompression, typically involves drilling one large hole in the core of the effected bone, with or without a bone graft, to reduced pressure and improve blood circulation in the hip. Another surgical option is the vascularized fibular graft, which takes a healthy piece of bone from the fibula, along with the artery or vein, and transplants and reattaches it into the hip, to help healthy bone grow. Recovery can take several months.

Because most patients are diagnosed in late Stage III or IV of the disease, when the bone quality of the femoral head is poor (subchondral fracture) or has collapsed, total hip replacement is the most successful treatment for AVN. This procedure replaces the damaged bone with artificial parts. Recovery takes about eight weeks. If left untreated, AVN progresses and results in pain and severe osteoarthritis. Treatment decisions for AVN are ultimately up to the patient and are based on his or her lifestyle and goals. If you are suffering with hip pain, talk with your primary care doctor about a referral to an orthopedic surgeon.

Prevention of AVN

AVN in sickle cell warriors can be prevented by ensuring that blood flow to the bones and vital organs do not cease. Cessation of blood flow occurs when rigid sickled cells accumulate and block smaller blood vessels thus leading to significant reduction or cessation of blood and oxygen supply. Free radicals are highly reactive and unstable molecules that are produced in the body naturally as a byproduct of metabolism (oxidation), or by exposure to toxins in the environment such as tobacco smoke and ultraviolet light. Free radicals are agents that are involved in the mechanisms of damage associated with disease development. Free oxygen radicals and other free radical activity is responsible for the rigidity and sickling of the red blood cells. They react with healthy cells to bring about a pathological state where the cell is starved of oxygen thus causing it to become sickled and rigid

Antioxidants delay or inhibit cellular damage mainly through their free radical scavenging property. Antioxidants play a vital role in inhibiting the activity of free radicals. They help to maintain the integrity of the cell by “mopping up” highly reactive free radical agents. As a result, healthy blood and nutrient flow is maintained to vital organs.

Comment (1)

  1. A round of applause for your post. Thanks Again. Really Great. April Saxe Macomber

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