INTEGRATIVE MANAGEMENT OF AVASCULAR NECROSIS OF FEMORAL HEAD THROUGH AYURVEDA AND PANCHAKARMA: A CRITICAL REVIEW OF CURRENT EVIDENCE

Avascular necrosis (AVN), more precisely termed osteonecrosis of the femoral head (ONFH), is a progressive disorder caused by loss of blood supply to the subchondral bone, leading to osteocyte death, structural weakening, collapse of the femoral head and secondary osteoarthritis. It commonly affects younger adults and may result from corticosteroid exposure, excessive alcohol intake, trauma, sickle cell disease and several other systemic conditions. Early diagnosis is important because joint-preserving treatment becomes progressively less effective once subchondral fracture and femoral head collapse have occurred. Contemporary evidence supports magnetic resonance imaging as the most accurate imaging modality for early disease, while treatment is selected according to stage, lesion size, location, symptoms and patient factors.[1,2] Ayurveda does not describe AVN as a single classical disease entity. Published Ayurvedic reports have interpreted its clinical presentation through concepts such as Asthi-Majjagata Vata, Asthivaha Srotodushti, Dhatu Kshaya and Vata Prakopa.[3] This correlation remains interpretative and should not be considered an exact classical equivalent of ischemic osteonecrosis. Panchakarma-based management reported in case literature commonly includes Rukshana, Snehana, Swedana, Basti, Ksheera Basti, Shashtika Shali Pinda Sweda and internal medicines intended to address pain, stiffness and tissue depletion.[3,4] The available Ayurvedic evidence is encouraging mainly with respect to symptomatic outcomes such as pain, gait, range of motion and quality of life. However, most publications consist of individual case reports or small uncontrolled studies, and convincing evidence that Ayurveda can reverse necrotic bone, restore vascular supply or prevent structural collapse is currently lacking. Modern joint-preserving treatments such as core decompression, with or without biological augmentation, remain important particularly in pre-collapse disease, while arthroplasty is often required after advanced collapse.[5] This review critically examines the modern pathophysiology and staging of ONFH, its cautious Ayurvedic interpretation, the rationale for Panchakarma interventions, available clinical evidence and opportunities for integrative research. A safe integrative approach should aim to improve pain, function and quality of life while maintaining MRI-based staging and timely orthopedic referral. Future trials require standardized Ayurvedic protocols, validated functional outcomes, serial imaging and long-term follow-up before disease-modifying claims can be justified.