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Avascular necrosis or AVN, also called osteonecrosis, is a condition that happens when parts of bone die because of poor blood supply.
AVN can occur as a side effect of some cancers or cancer treatments. It can also occur with serious illnesses such as sickle cell disease.
AVN can affect one bone. Or it can affect many bones. AVN can cause pain and affect joint function in the:
Avascular necrosis may be mild. The condition may also be severe. It can cause pain and long-term disability.
Up to half of children treated for acute lymphoblastic leukemia (ALL) have some degree of AVN. Children who have received a bone marrow transplant have some degree of AVN. Children who received a bone marrow transplant are also at high risk of developing AVN.
AVN can happen in any bone. But it is usually seen at the end of long bones in pediatric cancer patients. This is an area called the epiphysis.
Damage to bones and joints can lead to long-term problems including joint collapse and arthritis.
Older children and teens are more likely to develop AVN during cancer treatment. It is less common in children under 10.
Early stages of AVN can be hard to detect. Your child may not have pain or other symptoms until bone damage is severe.
Some patients may need surgery to improve blood flow and relieve pressure within the bone. If there is severe damage or joint collapse, your child may eventually need a joint replacement.
People with sickle cell disease have red blood cells that are sticky and shaped like a banana. Normal red blood cells are round and flexible.
Sickle cells can block blood flow in small blood vessels of the body. When blood flow is blocked in vessels that supply bone, the bone does not get enough oxygen. That can cause bone tissue to die.
Avascular necrosis results from losing blood supply to bone in the joint. This loss of blood causes narrowing of the joint and collapse of the bone.
Avascular necrosis can affect a single joint or more than one joint.
Some patients may not have any symptoms at first. But as AVN progresses, they can have joint and bone pain.
If your child has AVN, you may notice them:
AVN can sometimes result in collapse of bone. And the pain may suddenly worsen.
Pain and disability usually depend on:
Pain is not a reliable indicator of how severe AVN is. Small areas of AVN can be very painful. Other patients may not have pain, even when areas of AVN are very large.
Avascular necrosis is a complex condition that can be based on many factors. But the main cause of AVN is a loss of blood supply to the bone. This can happen during cancer treatment or because of conditions such as sickle cell disease.
When blood vessels are too small or become damaged or clogged, nutrients and oxygen cannot get to the bone. Bone cells begin to die.
Your care team can help you understand more about what might cause AVN in your child’s specific situation.
The main goals of treatment are pain control, maintaining joint function, and preventing further damage.
Your child’s care team will create a care plan to help manage AVN. Doctors consider:
Ways you can help your child manage avascular necrosis include:
In some cases, surgery might be used to treat avascular necrosis. These options can include:
Your child may find help from mind-body therapies such as massage, acupuncture, biofeedback, and relaxation techniques.
Specific techniques can help your child:
Talk to your child’s care team before trying any new therapy. They will ensure that it is safe and fits well with your child’s needs.
Reviewed: September 2022