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Treatments and drugs
By Mayo Clinic staffThe goal of avascular necrosis treatment 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) can relieve pain caused by avascular necrosis. Examples of NSAIDs include aspirin and ibuprofen.
Bisphosphonate medications, such as alendronate (Fosamax), also may play a role in the treatment of this disease. In some studies of people with avascular necrosis affecting the ball portion of the hip joint (femoral head), bisphosphonates appeared to slow the progression of the disease and reduce pain. More research is needed before doctors can make a strong recommendation about the use of bisphosphonates in the treatment of avascular necrosis.
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 one to three 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.
Surgery
Surgical procedures for people with avascular necrosis include:
- Core decompression. In this operation, your surgeon removes part of the inner layer of your bone. This relieves pressure within your bone, reducing your pain. The extra space allows your bone to form new blood vessels and stimulate the production of new bone. Core decompression works best in people with early-stage avascular necrosis.
- 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.
- 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 a core decompression. Recovery may take six to 12 months. More studies are needed to establish the effectives of this treatment for avascular necrosis.
- Joint replacement. If your diseased bone has already collapsed or other treatment options aren't helping, you may need joint replacement surgery (arthroplasty). Joint replacement surgery replaces your joint with an artificial one. It requires months of recovery, including time spent learning to use your new joint.
Because avascular necrosis is a progressive disease, your doctor may start with conservative treatments. As those measures, such as rest, become less effective, you may move to more aggressive treatments, such as surgery.
