Treatments and drugsBy Mayo Clinic staff
The 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.
In some people, avascular necrosis symptoms may be reduced with medications such as:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Medications such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve) may help relieve the pain and inflammation associated with avascular necrosis.
- Osteoporosis drugs. Some studies indicate that osteoporosis medications, such as alendronate (Fosamax, Binosto), may slow the progression of avascular necrosis.
- Cholesterol drugs. Reducing the amount of fat (lipids) in your blood may help prevent the vessel blockages that often cause avascular necrosis.
- Blood thinners. If you have a clotting disorder, blood thinners such as warfarin (Coumadin, Jantoven) may be prescribed to prevent clots in the vessels feeding your bones.
In the early stages of avascular necrosis, your doctor might suggest:
- 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
Because most people don't start having symptoms until the disease is fairly advanced, you may need to consider surgeries such as:
- Core decompression. In this operation, your surgeon removes part of the inner layer of your bone. In addition to reducing your pain, the extra space within your bone stimulates the production of healthy bone tissue and new blood vessels.
- Bone transplant (graft). This procedure can help strengthen the area of bone affected by avascular necrosis The graft is a section of healthy bone taken from another part of your body.
- Bone reshaping (osteotomy). This procedure removes a wedge of bone above or below a weight-bearing joint to help shift your weight off the damaged bone. Bone reshaping may allow you to postpone joint replacement.
- Joint replacement. If your diseased bone has already collapsed or other treatment options aren't helping, you may need surgery to replace the damaged parts of your joint with plastic or metal parts.
- Firestein GS, et al. Kelley's Textbook of Rheumatology. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2009. http://www.mdconsult.com/das/book/body/208746819-6/0/1807/0.html. Accessed Feb. 28, 2012.
- Questions and answers about osteonecrosis (avascular necrosis). National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Osteonecrosis/default.asp. Accessed Feb. 28, 2012.
- Jones LC. Osteonecrosis (avascular necrosis of bone). http://www.uptodate.com/index. Accessed Feb. 28, 2012.