Multimodal Ayurvedic Management of Bilateral Non Traumatic Avascular Necrosis of Femoral Head with Associated Skin Disorder: A Case Report

In the femoral head, disruption of vascularity deprives bone cells of oxygen and nutrients, leading to osteocyte death, bone weakening, and eventual collapse. This pathophysiology forms the basis of Avascular Necrosis (AVN), a progressive disorder commonly seen in young adults. Risk factors include trauma, corticosteroid therapy, alcohol and tobacco use, etc. AVN of the femoral head is a progressive condition characterised by compromised blood supply leading to osteocyte death and structural collapse. In this case report a 32-year-old male presented with bilateral, non traumatic AVN of the femoral head—stage 3 on the right and stage 2 on the left—accompanied by severe pain, limited mobility, and poor quality of life. His history included prolonged corticosteroid use for a chronic skin condition, prior COVID-19 infection, and tobacco use. After unsatisfactory response to allopathic management, the patient opted for Ayurvedic treatment. Ayurvedic diagnosis was Asthi-Majjagata Vata with Twaka Vikara (Tridoshaj kushtha) and Raktavaha Strotodushti. The treatment approach integrated Shamana Chikitsa (oral medications), Shodhana Chikitsa (detoxification through kala basti), and Jalaukavacharana (leech therapy) over six months. Herbal medications like Dashamoola Kwatha, Kaishor Guggulu, Panchatikta Ghrita Guggulu, Asthiposhak Vati, and Avipattikar Churna were administered. Basti therapy, using a combination of medicated milk, oils, and decoctions, was provided in a 16-day Kala Basti regimen. Leech therapy was given biweekly to enhance circulation and reduce inflammation. Significant improvements were observed post-treatment. Pain scores on the Visual Analogue Scale (VAS) dropped from 10 to 2. Range of motion in both hips increased markedly. Straight Leg Raise (SLR) test improved from 20° to 90° on the right and from 90° to 120° on the left. The patient regained the ability to walk independently, and his sleep and digestion also normalised. Concurrently, the chronic skin condition showed resolution, eliminating the need for corticosteroids. This case highlights the effectiveness of a multidimensional Ayurvedic approach in managing non traumatic AVN, not only arresting disease progression but also enhancing joint function, systemic health, and quality of life.