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Treatments and drugs
By Mayo Clinic staffThe treatment goal for avascular necrosis is to prevent further bone loss. What treatment you receive depends on the amount of bone damage you already have. Early stages of avascular necrosis may benefit from more conservative treatment, while later stages may require surgery.
Medications
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as aspirin or ibuprofen (Advil, Motrin, others), may help relieve the pain and inflammation associated with avascular necrosis.
- Bisphosphonates. Some studies indicate that osteoporosis medications, such as alendronate (Fosamax), may slow the progression of avascular necrosis.
Therapy
- Rest. Reducing the amount of weight and stress on your affected bone may slow the damage of avascular necrosis. You may need to restrict the amount of physical activity you engage in. In the case of hip or knee avascular necrosis, you may need to use crutches to keep weight off your joint for several months.
- Exercises. Certain exercises may help you maintain or improve the range of motion in your joint. A physical therapist can choose exercises specifically for your condition and teach you how to do them.
- Electrical stimulation. Electrical currents may encourage your body to grow new bone to replace the area damaged by avascular necrosis. Electrical stimulation can be used during surgery and applied directly to the damaged area. Or it can be administered through electrodes attached to your skin.
Surgical and other procedures
- Core decompression. In this operation, your surgeon removes part of the inner layer of your bone. This can relieve pressure within your bone, reducing your pain. The extra space allows your bone to form new blood vessels and stimulates the production of new bone.
- Bone transplant (graft). During this procedure, your surgeon takes healthy bone from another part of your body and implants it into the area affected by avascular necrosis. Sometimes this is done in conjunction with core decompression.
- Bone reshaping (osteotomy). This procedure reshapes the bone to reduce the amount of stress placed on the area affected by avascular necrosis. Osteotomy is usually used in people with advanced avascular necrosis. Recovery may take up to a year.
- Joint replacement. If your diseased bone has already collapsed or other treatment options aren't helping, you may need joint replacement surgery. Joint replacement surgery replaces your joint with an artificial one. It requires months of recovery, including time spent learning to use your new joint.
References
- What is osteonecrosis? National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Osteonecrosis/osteonecrosis_ff.asp. Accessed Oct. 26, 2009.
- Donohue JP. Osteonecrosis (avascular necrosis of bone). http://www.uptodate.com/home/index.html. Accessed Oct. 26, 2009.
- McKown K. Osteonecrosis. American College of Rheumatology. http://www.rheumatology.org/public/factsheets/diseases_and_conditions/osteonecrosis.asp?aud=pat. Accessed Oct. 26, 2009.
- Osteonecrosis of the hip. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfmtopic=A00216. Accessed Oct. 26, 2009.
- Chang C, et al. Osteonecrosis. In: Firestein GS, et al. Kelley's Textbook of Rheumatology. Philadelphia, Pa.: W.B. Saunders Co.; 2008. http://www.mdconsult.com/das/book/body/167338938-3/908256960/1807/704.html#4-u1.0-B978-1-4160-3285-4..10094-4_3424. Accessed Oct. 27, 2009.
- Goytia RN, et al. Bisphosphonates and osteonecrosis: Potential treatment or serious complication? Orthopedic Clinics of North America. 2009;40:223.
- Dabov G. Osteonecrosis. In: Canale ST, et al. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa.: Mosby Elsevier; 2007. http://www.mdconsult.com/das/book/body/167687025-3/909040867/1584/174.html#4-u1.0-B978-0-323-03329-9..50028-3--cesec56_987. Accessed Oct. 28, 2009.
