Avascular Necrosis Treatment Options
Avascular necrosis, also called osteonecrosis, is a condition characterized by the death of bone tissue due to a lack of blood supply. This condition can lead to the collapse of the bone structure and subsequent joint dysfunction if not addressed promptly. The management of avascular necrosis involves both nonsurgical and surgical interventions. The choice of treatment largely depend on the stage of the disease, the specific joint involved, and the patient’s overall health status.
Avascular necrosis affects the ends of the bones, and the most commonly affected joint is the hip. The treatment goal is to prevent joint destruction, as well as treating pain and restoring function. Once the bone has reached the point of collapse, the most effective treatment is hip joint replacement, as less invasive procedures cannot adequately restore joint integrity. Studies report that about 10% of hip joint replacements are due to avascular necrosis destruction of the hip joint.
In the early stages of the disease, conservative approaches may be used to improve symptoms and potentially slow disease progression. The goal is to relieve pain, preserve joint function, and prevent bone collapse. This may include:
- Activity modification: Patients are advised to limit weight-bearing activities to reduce stress on the affected joint, and to use of assistive devices such as crutches or canes to offload weight.
- Physical therapy: Physical therapy plays a crucial role in maintaining joint mobility and strengthening the surrounding musculature, thereby enhancing joint function.
- Medicines: This may include the use of nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation.
- Hyperbaric Oxygen Therapy (HBOT): Hyperbaric Oxygen therapy offers a promising adjunctive treatment for avascular necrosis, especially in its early stages. By enhancing oxygen delivery to compromised bone tissue, HBOT promotes healing processes that may alleviate symptoms and delay or prevent the need for surgical interventions. HBOT involves breathing pure oxygen in a pressurized chamber, which increases oxygen delivery to tissues, promoting angiogenesis (the formation of new blood vessels) and enhancing bone regeneration. Currently, this treatment is largely experimental.
Core Decompression
This minimally invasive procedure involves drilling into the dead bone tissue to reduce pressure, enhance blood flow, and stimulate the healing process. Core decompression is typically indicated in the early stages of avascular necrosis, prior to any significant collapse of the bone structure. The procedure may be augmented with bone grafting to provide structural support and promote regeneration. Newer options include the use of stem cell therapy along with core decompression to stop progression and give the bone a chance to repair itself. For avascular necrosis of the hip, this procedure is done in conjunction with hip arthroscopy to ensure drilling is done in the perfect position.
Bone Graft
When there is substantial bone loss, a healthy piece of bone, sometimes combined with cells taken from your bone marrow (which contain stem cells), is transplanted to promote healing and regeneration.
Osteotomy
A surgical procedure reshapes the bone by removing the dead area of bone to reduce stress on the joint and delay disease progression. This can be helpful if the cause for the avascular necrosis of the hip or knee is due to abnormal pressure on the bone because the alignment is off (too much pressure is put on some areas of the bone, and not enough in others)
Total Joint Replacement (Arthroplasty)
In advanced cases, where there is significant joint destruction and functional impairment, joint replacement may be necessary to restore function and relieve pain. This involves the replacement of the diseased joint with a prosthetic implant, aiming to restore function and alleviate pain. Total hip arthroplasty, for instance, is a common procedure for advanced AVN of the hip. Joint replacement is indicated when the avascular necrosis is advanced and the joint subchondral bone has collapsed.
Avascular necrosis is a potentially debilitating condition that, if left untreated, can lead to joint collapse and severe arthritis. Early recognition of symptoms, accurate diagnosis, and treatment are crucial for managing the condition. Patients experiencing persistent joint pain, stiffness, or mobility issues should seek evaluation from an orthopedic specialist like Dr. Danial Kaplan, a board-certified and fellowship-trained orthopedic surgeon and sports medicine expert in Brooklyn, New York. With expert diagnosis and individualized treatment plans, Dr. Kaplan provides comprehensive care to help patients manage avascular necrosis and maintain joint function.
References
- https://www.yalemedicine.org/conditions/avascular-necrosis-of-the-hip
At a Glance
Dr. Daniel Kaplan
- Fellowship-trained Sports Medicine and Shoulder Surgeon
- Expertise in Complex Shoulder Hip and Knee minimally-invasive reconstruction procedures
- Assistant Professor of Orthopedic Surgery at NYU
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