Avascular Necrosis Treatment Options

Activity Modification and Weight-Bearing Restrictions

Reducing stress on the affected joint is critical. Patients may be advised to limit high-impact activities and use crutches or a cane to offload weight, particularly if the hip is involved. This can help prevent further bone damage during the early stages of AVN.

Medications

While there are no medications that can reverse AVN, certain drugs may be used to manage symptoms or slow progression:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can help control pain and inflammation.
• Bisphosphonates, which are typically used to treat osteoporosis, have been studied for their potential to prevent bone collapse in AVN, although their effectiveness is still debated.
• Anticoagulants may be used if AVN is associated with clotting disorders or to improve blood flow in certain cases.
• Physical Therapy

A supervised physical therapy program can maintain joint mobility, strengthen surrounding muscles, and help reduce pain. However, therapy must be carefully managed to avoid stressing the compromised bone

Electrical Stimulation and Bone Growth Stimulator

Some patients may benefit from pulsed electromagnetic field (PEMF) therapy or electrical stimulation, which are designed to encourage bone healing and regeneration. These are typically used in early-stage AVN and are considered adjunctive therapies.

When AVN progresses and the bone begins to collapse, surgical treatment becomes the most effective option. The choice of surgery depends on the stage of the disease, the patient’s age, and the specific joint affected.

Core Decompression

Core decompression is often used in early to mid-stage AVN before significant bone collapse has occurred. In this procedure, a surgeon drills one or more channels into the necrotic area of the bone to reduce pressure, improve blood flow, and stimulate healing. In some cases, bone grafts or biologic materials (e.g., stem cells or bone marrow aspirate) are added to enhance bone regeneration. Many patients experience pain relief and slowed disease progression with this minimally invasive option.

Bone Grafting

When a larger area of bone is affected or if the structural integrity of the bone is compromised, bone grafting may be used to replace damaged tissue and support the joint. This can be done in conjunction with core decompression or as part of more extensive reconstruction procedures. Grafts may be autografts (from the patient’s own body) or allografts (donor tissue).

Osteotomy

An osteotomy involves cutting and repositioning the bone to shift weight away from the area affected by AVN. This joint-preserving procedure is usually reserved for younger patients and is more commonly performed in the knee than in the hip. The goal is to redistribute mechanical load and delay the need for joint replacement.

Total Joint Replacement (Arthroplasty)

If AVN has advanced to the point of joint collapse and arthritis, total joint replacement becomes the most reliable solution. In the case of hip AVN, a total hip replacement can relieve pain and restore mobility with long-term success. Advances in implant technology and surgical techniques have made this procedure highly effective, even for younger and more active patients.