Ayurveda therapy and research on avascular necrosis

EFFICACY OF CUSTOMIZED AYURVEDA TREATMENT MODULE IN THE MANAGEMENT OF “ASTHIMAJJAGATA VATA (AVASCULAR NECROSIS OF FEMORAL HEAD AN EXPLORATORY CLINICAL STUDY”

Introduction
Avascular necrosis (AVN) of the femoral head is a degenerative bone condition marked by the death of bone cells due to the loss of blood supply. Commonly affecting the hip joint, AVN can lead to severe complications if not appropriately managed. While modern medicine offers various treatments, effective non-surgical management, especially for younger patients, remains a significant challenge. Ayurveda (traditional Indian medicine) presents a potential alternative by addressing the root causes of the disease and improving overall quality of life.

Objective
This study aims to evaluate the efficacy of customized Ayurvedic interventions in managing AVN of the femoral head and explore their role in preventing disease progression and delaying surgical intervention.

Methods
A total of 48 clinical cases of AVN were managed in the Panchakarma department at the All India Institute of Ayurveda, New Delhi. MRI findings confirmed the stages of AVN and monitored treatment progress.
Patients underwent Ayurvedic treatment regimen, based on their individual Prakruti which included Deepana-Pachana (digestive and metabolic stimulation), Snehapana (therapeutic oleation), Virechana (therapeutic purgation), Basti Karma (medicated enema), and Shamana (palliative) therapy,. Pain reduction, assessed by the Visual Analogue Scale (VAS), was the primary outcome measure. Secondary outcomes included improvements in the Harris Hip Score, Oxford Hip Score, and quality of life as per the SF-12 Health Survey which assesses both physical and mental parameters. Ethical clearance was obtained from the Institutional Ethics Committee (IEC) of AIIA, and written informed consent was secured from all patients. The study was registered with the Clinical Trials Registry of India (CTRI) to ensure ethical transparency.

Results
A one-way ANOVA showed significant differences between the time points (BT, AT1, AT2, AF) for all analyzed variables: VAS, Harris Hip Score, Oxford Hip Score and the physical and mental components of the SF-12. The extremely low p-value for the VAS indicates a significant reduction in pain over time. Harris Hip and Oxford Hip Scores showed significant improvements in hip function and quality of life, respectively. The positive changes in SF-12 scores reflect significant improvements in both physical and mental health and indicate the overall benefits of Ayurvedic treatment.

Discussion
The Ayurvedic approach to managing AVN is based on balancing the Vata Dosha (one of the body's three biological energies), which is central to the pathology of Asthimajjagata Vata (degenerative bone condition). The treatment modalities, including Panchakarma and specific herbal formulations, aim to restore Vata balance, enhance circulation, and promote bone and marrow regeneration. Individualized treatment plans, aligned with the patient's Prakriti and Koshta (gut type), played a crucial role in achieving positive outcomes while minimizing side effects.

Conclusion
This study suggests that Ayurvedic management of AVN offers a viable alternative to conventional surgical options, especially in the early stages. By addressing the root causes through personalized protocols, Ayurveda can delay disease progression, reduce pain, and improve overall quality of life. Further research with larger sample sizes and longer follow-up is recommended to confirm these findings and explore the long-term benefits of Ayurvedic management in AVN. Integrating these therapies into mainstream protocols could provide a non-invasive, holistic approach to this debilitating condition.