Avascular Necrosis (AVN)
Avascular necrosis results when the bone of a joint loses its normal
blood supply. Deprived of nutrition from blood circulation, bone
structure may weaken and collapse. In the majority of cases, the
cause of AVN is unknown. However, factors that increase the risk
of AVN include heavy alcohol consumption or the use of cortisone
for treatment of RA, severe respiratory conditions, cancer or organ
Gout is the most common of several inflammatory joint conditions.
Gout causes rapid onset of severe joint pain, redness and swelling.
Gout is most common in the base of the big toe and knee, but may affect
any joint. In severe cases, uric acid crystal may form visible lumps
under the skin, and clog the kidneys.
The diagnosis of gout requires aspiration of fluid from the affected
joint. Joint fluid examination in gout shows the characteristic
needle shaped crystals of uric acid. Blood tests for uric acid are
not diagnostic for gout, and are frequently normal, even during
an acute attack.
Gout is a lifelong problem. Some patients have infrequent attacks
that can be treated with injection of steroids into the joint, anti-inflammatory
medicines like indocin, or colchicine. Other patients have more
frequent and severe attacks that are treated with medication like
allopurinol on a daily basis.
In some cases, gout can cause severe joint damage. The role of
the orthopaedic surgeon is to obtain fluid for proper diagnosis,
perform joint aspiration and injection in the acute phase, and joint
reconstruction in severe cases.