Homeopathic Remedies for AVN – Avascular Necrosis Treatment

AVN, also known as osteonecrosis, bone infarction and ischemic bone necrosis/aseptic necrosis refers to a condition which leads to death of bone cells due to interruption in blood supply. Avascular Necrosis (AVN)  can cause unbearable pain in the bones. Since there is no blood supply to the bone, the bone breaks and finally collapses. AVN may involve almost any bone of the body, but it mostly affects hip joints, knees and shoulder joints.

Natural Homeopathic Remedies for Avascular Necrosis

The homeopathic treatment for Avascular Necrosis uses the body’s own restorative process to heal. It basically aims at halting the destruction of bones in patients of Avascular Necrosis because of interrupted blood supply. The second aim of these remedies is to reduce the pain in bones because of bone damage. Both these aims are accomplished by the use of natural medicines, which have zero side-effects and are completely safe. The medicines are selected after taking into account the proper case history of the patient. The medicines are prescribed based on the bone involved, the kind of bone pain and other peculiar symptoms in each individual case.

Top Homeopathic medicines for AVN

Top Homeopathic Medicines

The top recommended homeopathic medicines for treating AVN are Syphilinum, Strontium Carb, Natrum Sulph, Fluoric Acid, Asafoetida and Silicea. Some of the homeopathic medicines to manage hip pain in such cases include Rhus Tox, Bryonia and Colocynth.

1. Syphilinum – For Bone Pains At Night

Syphilinum is well known for its beneficial action on body tissues wherever the destructive process is present. Apart from its universal healing action to stop the destruction of body tissues, Syphilinum is of great help in treating bone necrosis. The most dominant feature for selecting Syphilinum in any given case of AVN is the worsening of bone pains at night. The person experiences pain throughout the night and is unable to sleep on account of the severe pain. The pains may compel the patient to walk, which seems to bring relief. Such persons remain comparatively well the whole day.

Another marked symptom that can help in selecting Syphilinum for AVN cases is a specific pattern regarding the appearance and disappearance of pains. The pattern followed is a gradual increase in bone pains and in the same way, a gradual disappearance of pains. The third symptom that may be present in a few AVN patients needing Syphilinum is worsening of pains because of heat and some relief by applying cold water. History of excessive alcoholism may be present in persons requiring Syphilinum.

2. Strontium Carb – For Avascular Necrosis of Femoral (bone in thigh) Bone

Strontium Carb is a natural remedy recommended for cases of AVN of femoral bone. Those needing it have worsening of pain in cold air. Besides AVN, it is a prominent medicine to deal with cases of weak and brittle bones prone to break easily.

3. Natrum Sulph– For Hip Joint Necrosis

Natural remedy Natrum Sulph should always be considered in cases of AVN of the hip joint. Natrum Sulph is one of the most beneficial medicines when dealing with hip joint AVN. The patient mainly complains of pain during movement or when stooping.

4. Fluoric Acid–For AVN of Long Bones

Fluoric Acid is the most effective for the necrosis of long bones. The bones include humerus (bone in the upper arm), femur (bone in the thigh) and tibia (bone in front of the leg). Fluoric Acid is mainly used to halt necrosis appearing in long bones. The persons needing Fluoric Acid usually have excess body heat and the external heat worsens the condition. Apart from long bones, necrosis of the bones of the ear (which are rarely involved) are also covered under Fluoric Acid, which helps in improving the blood circulation and preventing further necrosis of bones.

5. Asafoetida – For Necrosis Of Tibia ( A Bone In Leg) Bone

Asafoetida is a wonderful medicine for AVN of the tibia. There is worsening of pain at night along with over-sensitivity in bones. The bone pain can be darting, sharp or stitching in nature.

6. Silicea– For Necrosis of Bones

Silicea is considered among the best natural medicines for necrosis (premature death of cells) of a variety of bones ranging from long to small bones. The necrosis of jaw, wrist bones, hand bones, feet bones, ankle, knees and long bones —including humerus (bone in the upper arm), femur (bone in the thigh) and tibia (bone in front of leg) — are the sites of action for using Silicea. The general symptom for using Silicea is sensitivity to cold air when bone pain worsens even from the slightest exposure to cold air. Warmth brings relief.

 7. Aurum Metallicum – For Necrosis Of Nasal, Palatine Bones

Aurum Metallicum is a natural remedy which is very beneficial in the treatment of 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 odor from the mouth and nose along with pain. The patient may also feel depressed with a high degree of sadness.

8. Symphytum – For Bone Damage In Fracture

Natural medicine Symphytum is very beneficial as a remedy for bone-related complaints. Symphytum can be considered in all cases where the bone has suffered damage following fractures. It helps in proper knitting of the bone. This is helped by providing the necessary callous material needed for bone reformation. So, in every case of fracture where Symphytum is used, it acts as a preventive agent against necrosis as the bone is very neatly and efficiently woven by this medicine.

9. Phosphorus– For AVN Of The Jaw

Phosphorus is an effective remedy for treating lower jaw AVN. It is of great help when the lower jaw is affected due to lack of blood supply. It is pertinent to mention here that Phosphorus is used in match-box making factories and some persons may acquire AVN there inhaling Phosphorus fumes for a long duration.

10. Hekla Lava– For Decay Of Jaw With Marked Pains

Hekla Lava is a top natural remedy for Avascular Necrosis of the jaw when jaw destruction is accompanied by marked facial nerve pains.

Symptoms Of AVN

In the beginning, no symptom is noticed by the patient. But gradually when death of blood cells start increasing, pain in the affected joint is felt. For example, in case of AVN of hip joint pain may be felt in groin, thigh or buttock. Initially pain is felt when the joint is put under pressure. In case of hip or knee AVN, walking, standing, stair climbing become difficult. Limping occurs while walking. As the condition reaches the most advanced stages, pain in the affected joint increases in intensity due to small breaks in the bone and pain becomes a constant feature. Other symptoms include stiffness of joint and limited range of movement at the joint. When condition has progressed excessively, then the bone collapses. Bone collapse makes one unable to use the joint. The symptoms of AVN may occur on both sides of body. In jaw AVN, pus may be present.

Bones prone to AVN

Avascular Necrosis can involve almost any bone of the body, but it mostly affects hip joints, knees and shoulder joints. Among these, hip joint is the most commonly involved joint, the bone mainly involved is head of the femur (a bone in the thigh extending between the hip and the knee). Humerus (bone in the upper arm extending between shoulder and elbow) is the next commonly affected bone. Scaphoid bone (bone in wrist), jaw, ankles, hand and foot may be affected as well.

What are the Causes and risk factors behind AVN?

AVN results from decreased or hindered blood supply to bone. Reduced blood supply to bone causes death of bone cells. Under normal conditions, our body keeps replacing old bone tissue (which gets damaged as a part of daily wear and tear) with new one to keep bones healthy and maintain their strength. Blood supply to bones provides oxygen and nutrients essential for regeneration of new bone tissues. If due to any reason blood supply to bone is hindered, our body becomes unable to make new bone tissue at right pace. As a result, the old-aged bone breaks down and dies.

AVN may happen from many reasons. Broadly the causes can be divided into two categories:

1.Traumatic AVN: It occurs after breaking of bone or joint dislocation

2.Non-traumatic AVN: It arises from some medical health problem which is causing obstruction of blood supply  to bone. In most cases of non – traumatic AVN, same bones on the either side of the body get affected like AVN of left hip and AVN of right hip.

The various causes and risk factors are enumerated below:

1.Injury / trauma: An injury or trauma can reduce or stop blood supply to a bone which is the main cause of AVN. For example, joint dislocation or a fracture (broken bone).

2. Smoking: Smoking makes the blood vessels narrow that reduces blood supply to body tissues including that of bone.

3. Excessive consumption of alcohol: It is known that alcohol can lead to hyperlipidemia (increased level of lipids means fats like cholesterol, triglycerides in blood) and fatty deposits in blood vessels. High levels of fat tend to block blood vessels and reduce blood flow. Decreased blood flow to bone cells can cause death of bone cells (AVN). This condition is similar to the one when a person suffers a heart attack where arteries that supply blood to the heart become blocked from cholesterol cutting blood supply to heart muscle causing heart attack and damage to heart muscle.

Secondly, high number of fat cells in the head of the femur might increase pressure inside it contributing further to reduced blood flow. In addition to this, alcohol may damage bone cells directly from its toxic action. It has been estimated that those who consume 15 to 20 large pegs of alcohol per week are 10 times more at risk of developing AVN as compared to non–alcoholics (means who do not drink alcohol).

4. Excessive use of steroid medication, like prednisone, for a prolonged period of time also makes a person prone to develop AVN. The reason is that these medicines can raise lipids (fat) in the blood that causes blockage of small blood vessels. Around 3 % to 38% people consuming steroids go on developing steroid-induced AVN. High doses of steroids taken orally (from mouth) or intravenous steroids (administered through veins) for prolonged time period is linked with AVN.

5. Exposure to radiation and chemotherapy used for cancer treatment predisposes a person to AVN.

6. Bisphosphonate therapy used in the treatment of bone cancer and osteoporosis makes a person prone to AVN. It is mainly related to cause AVN of jaw.

7. Decompression sickness/caisson disease (a medical condition in which bubbles form in the blood of a person from rapid decrease in surrounding pressure), and Leg-Calve Perthes disease (a condition occurring in childhood from interruption of blood supply to the head of femur of hip joint)

8. Having high cholesterol, HIV infection, rheumatoid arthritis (an autoimmune joint disorder causing inflamed, stiff, painful joints especially starting from small joints and later on may involve large joints as well), high blood pressure, sickle cell anemia (Inherited disorder affecting shape of red blood cells, RBCs become sickle shaped that can slow blood flow), leukemia (blood cancer), Gaucher disease (build-up of fatty substance in certain organs), organ transplant like kidney transplant, pancreatitis, SLE (Systemic Lupus Erythematosus – an autoimmune disease causing inflammation and damage to various organs), HIV are other risk factors.

9. Sometimes AVN occurs without any cause, for example, spontaneous AVN in knee (known as SPONK or SONC).

10. In some cases, the reason for interrupted blood flow is not known, for example in Kienbock disease (breakdown of a bone in wrist known as lunate bone from interrupted blood supply) and Preiser’s disease (AVN of scaphoid bone which is one of the bones in wrist).

11. Chances of AVN are more in men as compared to women.

12. Persons aged between 30yrs to 60 yrs are the most at risk though it can occur in person of any age group.

Pathophysiology Of AVN

AVN begins when there is decrease in subchondral (bone lying beneath the cartilage) blood supply. It leads to low oxygen (hypoxia) in bone tissue resulting in death of cells (necrosis) of bone. It is suggested via experimental evidence that bone cells die within 12 hrs to 2 days’ time from reduced blood supply and low oxygen levels. With progression of the condition, degeneration and the collapse of joint occurs.

Complications

If AVN is left untreated, the condition goes on becoming worse and worse and finally may result in bone collapse. It can lead to severe arthritis.

Stages of AVN

There are four stages defined as per progression of AVN

Stage I: In this stage, X-ray is normal but in MRI, dead bone can be detected.

Stage II: X-ray can reveal bone damage changes related to AVN. At this stage, the collapse of bone of femoral head has not taken place.

Stage III: X-ray shows sign of bone collapse (crescent sign).

Stage IV: It is the serious stage. At this stage, X-ray shows bone collapse and significant cartilage damage (osteoarthritis)

Ficat: Four stages classification system of AVN based on standard radiographs

Stage I – Normal radiograph

Stage II – In this stage femoral head contour is normal but in radiographs, signs of bone remodelling are seen (cystic and sclerotic portions)

Stage III – Flattening of femoral head occurs in this stage

Stage IV – It is characterized by narrowed joint space and degenerative signs in acetabulum.

Differential Diagnosis of AVN

There are certain medical conditions that might have similar symptom presentation like AVN which need to be differentiated while making a diagnosis of AVN. These conditions include:

1. Osteoarthritis: Degenerative joint disease arising from the breakdown of joint cartilage (it cushions end of bones to allow smooth movement over each other) and underlying bone

2. Rheumatoid arthritis: An autoimmune joint disorder causing inflamed, stiff, painful joints especially starting from small joints and later on may involve large joints as well

3. Osteomyelitis: Infection of bone by bacteria or other microorganisms

4. Osteoporosis: Condition arising from reduced bone density whereby bones become weak, brittle and are at high risk of easy fracture (breaking of bone)

5. Osteochondrosis: Group of disorders affecting bone growth in children and adolescents

6. Septic arthritis: Joint infection occurring when germs from some infected body part travel via blood stream to the joint

7. Synovitis: Inflamed synovial membrane (it secretes synovial fluid needed for joint lubrication) of joint

8. Bone marrow edema syndrome: It is characterized by bone pain and bone marrow edema found in MRI.

9. Bone Cancer

Some measures to prevent AVN

1. Avoid smoking and limit alcohol use
2. Keep a check on cholesterol levels
3. Avoid excessive steroid use

Frequently Asked Questions of AVN

I have AVN of femoral head stage II on both sides, will homeopathy be helpful?

Yes, you can be benefitted by homeopathic medicines. Homeopathy has good scope of managing cases of AVN going through Stage 2. There are several natural remedies in homeopathy that can help to relieve pain and  stiffness, and improve the range of movement of the joint. These medicines also boost the body’s immunity to fight back disease naturally and halt further advancement of the disease.

I have been recommended hip replacement surgery for AVN Stage III, I do not want to go for surgery, can homeopathy help to avoid surgery?

Though homeopathy has limited scope in Grade 3 stage of AVN, if you wish to go for an alternative to surgery, you can try homeopathy. Homeopathic medicines will not be able to reverse the changes that have already occurred, but can surely help in pain management. Surgery should be the last option when all the alternative treatment methods have proved fruitless.

Can homeopathy help in Grade IV AVN cases?

Homeopathy has a good scope in treating Grade 1 and 2 AVN, limited role for grade 3 AVN patients and a very minimal role to play in cases of Grade 4 AVN. However, one can opt for homeopathy to ease pain-related issues before proceeding towards surgical options. The help it can offer in relieving pain varies from case to case.

Can homeopathy help in reversal of AVN changes?

There is no current treatment option available in any system of medicine that claims to reverse pathological changes that have already taken place in AVN cases. Homeopathy helps in slowing down the progression of bone changes in AVN and eases its symptoms, but unfortunately cannot reverse the bone damage that has already occurred.

Is there any natural homeopathic medicine to manage pain in hip joint from AVN?

Yes, several homeopathic medicines can help in managing hip joint pain in AVN cases. Though a specific medicine is selected after taking case details but some general medicines to relieve hip pain are Rhus Tox, Bryonia and Colocynth.

Can homeopathy help cases of AVN other than hip like AVN of jaw, knee, shoulder joint?

Yes, homeopathy can help AVN occurring in joints other than hip as well. There are several homeopathic medicines for it. The best prescription is finalized after taking the entire case details from the patient.

Is Syphilinum a good homeopathic remedy for AVN?

Yes, Syphilinum is one of the well-indicated homeopathic medicines to help cases of bone necrosis and decay. It is mainly indicated when there is worsening of bone pains at night.

What is the treatment duration in homeopathy to treat AVN cases?

The duration of homeopathic treatment for AVN depends on the stage, duration, intensity of complaint and duration varies from several months to a year or two, for good long term relief.

Can homeopathy cure AVN?

Homeopathy is a natural science of medicine that have a management role in AVN. Though they cannot cure the condition, the homeopathic medicines aim at preventing further bone loss and promise relief in the associated symptoms to a great extent.

I have hip pain from the last 6 months, am I suffering from AVN?

Hip pain may arise from various causes. AVN is just one among those causes. Other reasons might be osteoarthritis, rheumatoid arthritis, ankylosing spondylitis. So only having hip pain does not confirm AVN. A complete detailed case history and MRI of hip is required to confirm the diagnosis in each and every case.

Is groin pain indicative of hip AVN?

Though groin pain can occur in hip AVN but not all those having groin pain are actually suffering from AVN. There could be other reasons as well that could be causing groin pain. For example, inguinal hernia, kidney stones, sprains, tendinitis, pinched nerve, UTI (urinary tract infection), and certain male problems like hydrocele, varicocele, epididymitis, orchitis and testicular torsion. It is advised to consult a doctor for groin pain to find the exact cause behind it.

I have no pain in hip, but my MRI shows AVN hip joint on right side, do I need treatment?

See, AVN in early stages is usually painless. But if left untreated, there is progression of AVN, bone damage worsens and pain starts to appear which initially is intermittent (occurring at some intervals and not continuous) but gradually may become constant from intense bone damage. So, it is advised to not ignore it and start with its proper treatment to halt progression of this condition and prevent associated pain.

Can a person with AVN hip run, or do jogging?

In recently diagnosed AVN hip cases, it is usually advised to avoid running, jogging or other activities that put excessive pressure on the hip joint to prevent the collapse of femur head. A doctor should always be consulted to get advice regarding resumption of such activities.

Is AVN self-limiting and can it heal on its own?

AVN unfortunately is a progressive condition that goes on worsening. Very rarely if AVN’s cause is alcohol or steroid use and it is caught (diagnosed) in early stages entire stoppage of alcohol, or steroids can stop its progression and healing may take place from formation of new blood vessels.

Which investigations can confirm AVN?

MRI and CT scan are the most valuable to check and confirm AVN. These tests can reveal early bone changes in AVN cases. X-ray may also be done but it shows changes in bone only in later stages of AVN. For checking early AVN stages, X-rays are not helpful to detect any bone changes. A bone scan (nuclear bone scan or bone scintigraphy) is the next recommended investigation. In this test, a radioactive substance is injected via a vein before doing the scan and after that, the bone scan is done to see the injured areas of bone. In some cases, biopsy is advised in which the bone sample is removed with help of a needle or during surgery to check tissue for abnormal cells or cancer. If other tests are normal but still doctor doubts that it is AVN, then functional bone test is recommended. This test measures pressure inside the bone.

Is AVN curable?

Unfortunately AVN is not curable but with proper treatment its progression can be slowed down.

Is surgery the only option for AVN?

Not all cases of AVN require surgery. If it is diagnosed in early stages, it can be managed with medicines. The stage of AVN decides whether surgery is needed or not. Stages I and II of AVN can be managed with medicines. However, in stage III AVN surgery may be required. In IV stage, surgery may be the only treatment option when all the conservative methods have failed to provide relief, and the pain is unbearable. An orthopedic surgeon is the right person to tell whether a given case of AVN needs surgery or not.