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Taking Charge of Your Health


Hello, I’m Dr. Adam Saad: a microsurgeon
at the Institute for Advanced Reconstruction. I’m a double board
certified reconstructive microsurgeon who specializes in the treatment of
avascular necrosis and osteonecrosis. Avascular necrosis or osteonecrosis
occurs when the blood supply to the affected bone is compromised. The cause of the compromise is usually unknown, but has been linked to steroid and alcohol
use. There are four stages of AVN and
treatment options depend on which stage of AVN you’re diagnosed with.
Treatment also depends on if you have pre-collapse or post-collapse AVN.
Option 1: Core decompression, which involves drilling a hole into the
femoral head and removing the dead bone to decrease the pressure on the
remaining bone and improve the blood flow. It has variable results. Option 2:
Free vascularized fibular graft, which involves drilling a large hole in the
femoral head, removing the dead bone, and replacing it with bone from the lower
leg–the fibula. The blood supply to the fibula is then re-established. This
treatment has better results than core decompression. Option 3: Hip
replacement surgery. This involves removing the entire hip
and replacing it with metal and plastic parts, which can become infected or fail
over time. A newer option in the treatment of AVN is free periosteal
core decompression, or FPCD. FPCD involves a core decompression followed by
placement of vascularized periosteum, which is the outer lining of the bone
into the hole created by the core decompression. This delicate surgery
requires advanced microsurgical techniques to harvest the periosteum and
re-establish the blood supply to the affected bone using a microscope. There
are several advantages of FPCD over the other treatments. Unlike core decompression alone, FPCD
reestablishes the blood supply. Unlike free vascularized fibular graft,
FPCD involves a shorter surgery and shorter recovery. Instead of no
weight-bearing at 6 to 12 months, you’ll be able to start weight bearing
in 6 weeks and fully recovered by 3 months. Additionally, the removal of
the periosteum which occurs in FPCD has minimal side effects unlike the removal
of a large segment of fibula which occurs in free vascularized fibular
graft and often leads to chronic pain and nerve damage. And unlike hip
replacement, FPCD allows the patient to use their own tissues to heal their body
there’s no foreign material that can get infected, be recalled, or wear out over
time as there is with hip replacement. If you’re interested in learning about FPCD and to see if you’re a candidate for the avascular necrosis program at the
Institute for Advanced Reconstruction, please fill out the patient contact form.
I look forward to meeting you.

31 thoughts on “AVN – Avascular Necrosis Breakthrough Treatment

  1. I have been in pain and limping now and use a cane since the end of june
    2016 after countless xrays and 2 mris my ortho doc says im not getting
    blood to my hip joint,first they tried therapy didnt work,5 different
    pain meds celebrex,mobic,diclofena,nothing helps with the pain,sometimes
    ibprofin helps a little.As soon as I stand up and put wieght on it its
    very painful.So my doc is sending me to a chief ortho dr for a secound
    opinion about having this decompression surgery.Im not so sure what to
    do ,I dont want to have this done and still be in pain ,does anyone know
    what the success rate is on this?Or would i be better getting a total
    hip replacement im 62 and i cant take this pain its been 4 months and my
    appointment is nov 8th with this other dr for 2nd opinion.This really
    sux .what is homoeopathic treatment?I was able to walk with no problem
    up until this crap happened. I already had 2 hip replacements on my left
    leg the first hip part they put in in 2007 and then had a recall 2010
    and had that part taken out and replaced, lol so at least i thought i
    had a one good leg left meaning my right leg ,but now this is happening
    and my good leg is going bad on me with this circulation problem,I would
    appreaciate any advice or suggestions on what to do hip implant or
    decompression surgery Im in pennsylvania im not sure they even do this
    in my state,,Thank you wish i understood what that guy was saying in
    last part about his situation….thank y

  2. So I have AVN in my right talus. I have a sub chondral cyst and have had numerous procedures. Anything new out there that could help me?

  3. I have AVN in both hips and both knees. I also have Systemic Lupus Ethro. I also have two bulging disc in my back and and am afraid that after AVN Hip Core Decompression that I will not be able to walk on crutches. I also seen the video about the free vascularized Fibular Graft and am wandering if I should ask my dr. if he knows about this surgery. I am 41, doctors don't want to perform hip or knee replacements at my age. My doctor has not even said what stage of AVN I am in. I just feel like I don't know the whole picture.

  4. I have a rare schaphoid fracture I been in a cast 8 weeks no healing at all. It is very painful I see a hand surgeon Friday the bone has a space of 1.6 mm gap any suggestions

  5. I also have a displaced tip of ulnar bone by my wrist I broke my schaphoid starting a lawn mower I don't understand how something like that could have caused such a fracture should I be tested for bone density test because my left wrist is starting to ache just like my right one before my injury please give me feed back I'm suffering greatly. The scaphoid fracture is so rare it is an unidentifiable one

  6. I have also this kind of illness…but there is no proper equipment here in the Philippines to help me undergo this kind of treatment…how I wish to get me cured my avascular necrosis…

  7. Im 48 yrs old and have AVN and just got my left hip replaced. My right hip replacement is scheduled for Feb 12. I’ve never even heard of these surgical options before. My family Dr doesn’t act like he knows much about my condition and my surgeon only seems to know his role in replacing my hip.

    I don’t know what to do.? Should I just go ahead with my next hip replacement? My left side is doing pretty good now but I don’t know how it’s going to hold-up over time.

    Why is it so hard for the patient to figure these things out?? I am all alone and I’m just not smart enough to make these decisions

  8. hello.doctor im a patient of Avn i had done core decompression of hip one year back now im felling pain in my back hip's .so please advice me some pain releaf exercise.

  9. My question is this. Why are so many other doctors unwilling to make this diagnosis in the first place? I started complaining of hip pain in the very early stages in the groin area at age 19 it wasn't until I hit my late 40s that I was diagnosed with Advanced osteoarthritis and offered hip replacement. Still at no time was I given this diagnosis as the cause for my osteoarthritis. I am thoroughly convinced that this is what I suffer from and why I have chronic hip pain a lack of leg movement.

  10. i was diagnosed with AVN about 15 years ago and i am now still can walk but with both legs somehow restricted to move much; it hurts a lot now but i really didn't have any idea what's happening with my AVN ,haven't seen the doctor quite a while and i guess my case would just be hopeless since it has been years that i haven't had my hips checked…
    i was wondering if this procedures can still be applicable on my case and will i be able to walk back to normal again?

  11. Not a treatment it is replacement.treatment is if you cure without replacement. Anyone can replace it it isnot big work.

  12. I was just diagnosed with Avascular Necrosis in my right hip. I had a consult with an orthopedic surgeon and the net result is total hip replacement. At the time I wasn’t aware of other treatment options. Am I to assume that my stage level is dictating that my only treatment is hip replacement ?

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