Avascular Necrosis (AVN) of Hip: Guide

Avascular Necrosis (AVN) of Hip

Avascular necrosis occurs most commonly at the hip and has recently been a common complication of Covid. Many young people come with debilitating hip pain BBhaskar can you enumerate the conditions commonly associated with AVN and also the exact description of AVN?

At Ashirvad Institute for Pain Management and Research, we consider that any joint pathology communicates pain to the muscles that move the joint via the nerves that supply both the joint and the muscles . This is governed by a physiological law called the Hilton’s law which states that the synovium of the joint shares a reciprocal innervation with the muscles that move the joint” Synovium is the inner lining of the joint which is highly sensitive because of its rich innervation. Thus any joint pain is actually expressed by the muscles that move the joint be it, hip, shoulder, knee, elbow, ankle, wrist or the joints of knuckes.

Pain from AVN of hip is also expressed by the buttock, and thigh muscles that move the hip joint. The continuing spasm of muscles initially shortens the muscle physiologically due to contraction and later there is an actual structural shortening of muscles because of muscle knots where the actin and myosin that are usually mobile sliding over each other during muscle contraction and moving apart during relaxation. Synovial irritation because of joint inflammation communicates itself to muscles causing constant muscle spasm via the Hiton’s law. This in turn causes the actin and myosis to get stuck causing a myofascial trigger point (MTrP or muscle knot).

In covid, a viral infection that causes coagulation abnormalities there may be a double whammy in that, the thin artery supplying the ball of the hip gets clogged by the thickened blood while the muscle might independently be affected by viral myositis (inflammation in the muscle) which is a hallmark of many viral infections. This might be the reason for post COVID AVN.

All viral infections are usually self-limiting, and the myositis also disappears once the viral infection is over. Unfortunately, in Chikungunya it persists even after the virus has disappeared to cause these joint pains.

However these pains can be relieved by a treatment called ultrasound guided dry needling (USGDN) Which relaxes the muscle knots formed by the muscle inflammation, thereby reducing the pull of the tendons on the joints.

The muscle knots developing because of the inflammation with this strain of virus, cause such intense simultaneous muscle spasm of both the agonist and antagonist muscles of joints (the muscles that move the joints) of the limb that they actually splint the joints of the limb. (hip, knee and ankles in lower limb and the shoulder elbow and wrist in upper limbs) I have described this phenomenon of agonist antagonist contraction causing paralysis like clinical picture in other neuropathic/neuromyopathic diseases in my book “Chronic pain: Out-of-box treatments that cure” available on Amazon ( chapter 8, pages 135-152 case studies- the paralyzed shall walk).

They are welcome to seek help at Ashirvad or with any pain specialist trained by me in USGDN at Ashirvad. Please call Ashirvad 9869029391 or 9820135430 to know the number of pain specialist near you who would be able to help. I am particularly mentioning the names of 2 specialists in Pune (where these cases are being reported) trained by me.