Drilling and Bone Grafting Avascular Necrosis (AVN)

Avascular necrosis (AVN) is a condition in which the subchondral bone (bone beneath the cartilage of a joint) dies from an interruption its blood supply. Once the bone dies, it is unable to maintain itself and it eventually fractures and collapses under the physiologic (normal)
but significant compressive forces across the joint. This death and fracturing of the bone is associated with symptoms of pain. Often, surgery is necessary to stimulate the bone to
re-vascularize and heal and/or repair/replace missing bone to support the joint surface. Avascular necrosis is associated with proximal humerus fractures, dislocations, repetitive trauma, compromised blood supply following injury, and prolonged steroid use.

Some bony AVN lesions can be repaired while others cannot, depending on the size, location, age, etc. of the lesion. In most, Dr. Chudik evaluates and treats AVN through small limited incisions and specialized instruments of his own design with the use of an arthroscope (small camera). Limited areas of AVN without collapse are drilled percutaneously with small pins to stimulate the bone to re-vascularize and heal. If the bone has collapse or left a void, a larger tunnel may be drilled to the lesion to allow a passage way to insert bone graft to repair the defect and regain support of the joint surface and cartilage. More advanced stages of AVN can lead to collapse of the bone beneath the joint surface. This can compromise the cartilage and joint surface leading to arthritis of the shoulder joint and the need for shoulder replacement surgery. Dr. Chudik will discuss various options with you and help determine the best treatment for you.