E-ISSN:2456-3110

Case Report

Avascular Necrosis

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 5 June
Publisherwww.maharshicharaka.in

Ayurvedic management of Avascular Necrosis of Femoral Head - A Case Study

Thomas A.1*, Giri R.2
DOI:

1* Amal Thomas, Final Year PG Scholar, Department of Shalya Tantra, Sri Dharmasthala Manjunatheshwara College of Ayurveda, Udupi, Karnataka, India.

2 Rajneesh V Giri, Professor and HOD, Department of Shalya Tantra, Sri Dharmasthala Manjunatheshwara College of Ayurveda, Udupi, Karnataka, India.

Avascular necrosis (AVN) is the death of bone tissue due to loss of blood supply, therefore also called as osteonecrosis, ischemic bone necrosis. There is no permanent treatment other than hip replacement Surgery. Other treatments include physiotherapy and NSAIDs. And all the treatments are costly and having poor prognosis. The present case was aimed to evaluate the efficacy of Ayurveda system in the conservative management of AVN. In this present case a 47 year old male was diagnosed with AVN of right hip joint, was managed with Pichu followed by Anna Lepa along with Manjishtadi Kshara Basti and other internal medications. Patient was observed for symptomatic improvements based on signs and symptoms before and after treatment. The therapy provided marked improvements in the gait, pain, tenderness and range of movements. Conservative management of AVN through Ayurvedic principles provided significant relief in sign and symptoms and improved quality of life.

Keywords: Avascular necrosis (AVN), Asthi-Majjagata Vata, Manjisthadi Kshara Basti, Pichu, Anna Lepa

Corresponding Author How to Cite this Article To Browse
Amal Thomas, Final Year PG Scholar, Department of Shalya Tantra, Sri Dharmasthala Manjunatheshwara College of Ayurveda, Udupi, Karnataka, India.
Email: 		Amal Thomas, Rajneesh V Giri, Ayurvedic management of Avascular Necrosis of Femoral Head - A Case Study. J Ayu Int Med Sci. 2022;7(5):150-152.
Available From
https://jaims.in/jaims/article/view/1827

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-04-30 2022-05-02 2022-05-09 2022-05-16 2022-05-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 17%

© 2022by Amal Thomas, Rajneesh V Giriand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Thomas A et al: Ayurvedic management of Avascular Necrosis of Femoral Head

Introduction

Avascular necrosis (AVN) is Osteonecrosis and is also called Ischemic bone disease.[1] AVN of femur head is that the most typical type of necrosis of the bones. The arteries which supply the femoral head area are very tiny and thus area is simply susceptible to injury followed by mere dislocation or a sub capital fracture (near the head) of femur.[2] This can be caused by Trauma or occlusion of blood vessels etc. It generally affects people between age of 30 to 50 years. It commonly affects Head of the Femur. In the early stages, the patient will not be having any symptoms other than mild pain around the hip joint. In the later stage pain will be severe in hip, buttocks, groin, thigh and restriction of all movements of the hip joint will be there. The treatment will aim to reduce the bone damage. Usually, its treatment ends with Surgery. Also, all the treatments are costly and prognosis is poor. The present case aimed at the conservative management of Avascular necrosis of Femur Head.

In Ayurveda AVN can be correlated to the Asthi-Majja Gatha Vata. Its symptoms are Bhedoasthiparvanam (breaking type of pain in bones and joints), Sandhishoola (joint pain), Mamsakshaya (muscular wasting), Balakshaya (weakness), Sandhi Shaithilayam (laxity of joints), Aswapanasantat Ruk (sleeplessness due to continuous pain), Shiryantiva Cha Asthinidurbalani (destruction of bony tissue causing generalized weakness).[3]

Materials and Methods

Selection of patient: Patient selected from IPD - SDM College of Ayurveda, Udupi.

Materials required

Internal Medicine

1. Gandha Thailam 1-0-1

2. Dhanwanthara Kashaya 4 tsp BD B/F with equal hot water

3. Manjishtadi Kshara Basti 7 days

External Treatment

1. Pichu with Murivenna (Around Right Hip joint)

2. Anna Lepa - Sashitika Shali (Around Right Hip joint)

Patient Particulars

Name                    : Xyz

Age                        : 47 Years

Sex                         : Male

Religion                : Hindu

Address                : Chhattisgarh

DOA                       : 16\09\2021                                      

DOD                       : 30\09\2021

Chief Complaint: Difficulty in walking associated with pain in groin and the thigh region for 5 months.

A 47 years old male patient known case of Hypertension for the last 10 years and under medication was apparently healthy and was able to walk 5 months before. 15th November 2020 he got diagnosed with Covid 19 positive and took allopathic medication. Gradually he developed Generalised body pain and consulted a Physician. Then he diagnosed Bacterial infection of the Spine with the help of MRI Spine. He has taken medication for the same. On June 9th he diagnosed with Synovitis of Right Hip joint. And he underwent Arthrotomy, Synovectomy and biopsy on 18th June 2021. Then he has taken bed rest for more than 15 days. Later he was not able to walk properly without support and gradually developed dull ache pain in Groin and thigh.

Local Examination

Site - Right Hip Joint

Tenderness was present at hip region. There was significant loss in range of movements. He had limping gait also.

Examination of patient: Both general and systemic examination was done as per Ayurveda and contemporary methods

Inspection

Arthrotomy scar mark seen

No Swelling, No colour Change

Palpation

Mild tenderness at the right hip joint

Mild raise in temperature


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Thomas A et al: Ayurvedic management of Avascular Necrosis of Femoral Head

Table 1: Range of Movements

Range of Movement Before Treatment (In degree) Right Hip Joint Before Treatment (In degree) Left Hip Joint
Flexion 70 100
Extension 10 20
Abduction 15 (Painful) 30
Adduction 10 25
Internal rotation 15 (Painful) 30
External rotation 15 25

Investigations

1. X-ray (Both hip joint) - No significant Changes

2. MRI - Septic arthritis and Avascular necrotic changes in the right hip treated by Synovectomy and Arthrotomy

Table 2: Observation

Range of Movement After Treatment (In degree) Right Hip Joint After Treatment (In degree) Left Hip Joint
Flexion 100 110
Extension 20 25
Abduction 25 (No Pain) 30
Adduction 25 25
Internal rotation 20 (No Pain) 30
External rotation 20 25

Results

Range of Movements of the Right Hip joint significantly improved.

Discussion

Avascular necrosis (AVN) is a death of bone tissue because of interference of the blood supply. In the early stage, there might be no symptoms. But in the later stage it affects both bone and nearby structures. Aetiology can be traumatic and non-traumatic. where in nontraumatic caused by occlusion of blood due to intra vesicular or outer compression of blood vessel to reduce blood flow on the femoral head leads to AVN.

In this case there was no history of trauma or other factors which reduces bone composition. As there is involvement of Vatha and Raktha treatment started with Basti. Kshara Basti[4] which is mentioned by Chakradatta and Manjishthadi Kwatha[5] which is mentioned by Sharanghdhara. Based on these views Manjishthadi Kshara Basti was considered for the treatment. Pain indicates Vata involvement and Taila is the best Shamana treatment for

Vata. So Murivenna Pichu was introduced.[6] Gandha Thailam[7] capsule has added to the prescription as it is Asthi Sthairya Krith and help to subside Vata Pittodbhava Vyadhi and Dhanwanthara Kashaya is best for Marmasti Kshatha Ksheena.

Conclusion

As there is no permeant cure for AVN, Core decompression in the initial stage and Hip replacement in the later stage are the only option which have its own complications. Here, in this case study the Ayurveda treatment for AVN helps to improve the range of movements of hip joint. And the treatments are non-invasive and cost effective.

Reference

1. "Avascular necrosis." Synonyms.com. STANDS4 LLC, 2020. Web. 24 Mar. 2020. <Avascular Necrosis Synonyms & Antonyms | Synonyms.com>

2. Ram Lakhan Meena, Santhosh Bhatted, Prashanth Dharmarajan, Nilam Meena, Jitender Kumar, Hanumant Nirmal. Management of Avascular Necrosis through Ayurveda - A Case Study. J. res. tradit. med. (2017)

3. Acharya YT, editor, Shri Chakrapanidatta, commentator, Agnivesha, Charka Samhita, Chikitsasthana; Vatavyadhichikitsa Adhyaya, 28/33, Chaukhamba Surbharati Prakashan, Varanasi, 2014; page 617.

4. Chakradatta, Indradev Tripathi, Chaukhamba Sanskrit Sansthan, Varanasi, 2005, PP 542, Page Number 455.

5. Sharangdhar Samhita, Bramhanand Tripathi, Chaukhamba Surbharti Prakashan, Varanasi, 2007, PP 488, Page number 153.

6. Paul, Raiby & Dharmarajan, Prasanth. (2015). Clinical study to evaluate the efficacy of janu basti and janu pichu with murivenna in janu sandhigata vata. Anweshana Ayurveda Journal.

7. Ayurveda K. Buy Gandha Thailam Capsule Online | Kerala Ayurveda Limited [Internet]. www.keralaayurveda.biz. [cited 2022 Jan.29]. Available from: https://www.keralaayurveda.biz/product/gandha-thailam-capsule.


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