Avascular necrosis (AVN) is a disease in which the blood supply to the head of the joint bone reduces drastically, causing a complete disorganization and ultimate collapse of the head of the joint bone. Though the hip joint is most commonly affected, AVN can also involve other joints such as the shoulder. This condition may be caused due to sudden or repeated, low-grade trauma, long-term use of steroids, excessive intake of alcohol, and chronic diseases like blood disorders and auto immune disorders.
Of late, there has been a gradual increase in the incidence of auto immune disorders with a resulting increase in the use of steroids; hence, AVN is being diagnosed much more frequently. Patients in their late 20s and early 30s usually present with this disease. The condition may happen within a span of a few days to a few weeks, but the ensuing physical disability may remain life-long. A similar condition in children, known as Perthe’s disease, may reverse spontaneously within a year or two.
The conservative management of this condition in the modern system of medicine is to give biphosphonates in order to possibly reduce the rate of decrease of calcium and thereby preserve the joint structure to the maximum extent possible. This is supplemented with graded physiotherapy to preserve joint function and maintain muscular strength. A slightly advanced condition calls for core decompression surgery in order to reduce stress on the joint. Further management is only with the use of pain killers like paracetamol, and to adopt a ‘wait and watch’ policy.
Patients who progress to the third or fourth stage of the disease, involving gross destruction of the joint, are usually advised total replacement of the joint. Joint replacement surgery can be prohibitively costly; in addition, it may not provide the full range of movement which the person previously had with a normal joint. If the causative factors persist, other joints may become involved.
Most patients taking biphosphonates, or having undergone core decompression surgery, either do not benefit at all, or find the beneficial effects to be transitory. Such patients can be treated with Ayurvedic herbal medicines for a period of about four to six months and usually get complete and lasting benefit from pain, stiffness, and limitation of movement.
Patients having the third or fourth stage of the condition usually require higher doses of Ayurvedic oral medicines, supplemented with one or several courses of medicated enemas. Most patients with severe involvement of AVN do recover significantly with the regular use of Ayurvedic treatment for a period of about eight to twelve months.
To sum up, modern treatment is not very effective in controlling the severe pain and other symptoms associated with AVN. The much touted joint replacement surgery is available to only a select few, and has its own limitations. Ayurvedic herbal treatment is a comprehensive, safe and economical treatment for all the stages of AVN.
Avascular necrosis of hip, AVN, Ayurvedic treatment, herbal medicines.