How is avascular necrosis of the femoral head treated?

In early stages of AVN (precollapse), core decompression with or without bone graft is typically considered the most appropriate treatment. In late stages, characterized by collapse, femoral head deformity, and secondary osteoarthritis, total hip arthroplasty is the most appropriate treatment.

How is femoral head necrosis treated?

Core decompression. Core decompression is the most commonly performed surgical procedure for treatment of early ONFH. It decreases the intraosseous pressure in the femoral head and increases blood flow to the necrotic area, thus augmenting neobone formation [Figures ​1 and ​ 2].

Does avascular necrosis require surgery?

There is no cure for avascular necrosis, but if it's diagnosed early using X-rays or MRI, nonsurgical treatments such as activity modification, anti-inflammatory medications, injections, and physical therapy may slow its progression. Because avascular necrosis is a progressive condition, it often requires surgery.


What is the best treatment for avascular necrosis?

Treatment
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter medications like ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) might help relieve pain associated with avascular necrosis. ...
  • Osteoporosis drugs. ...
  • Cholesterol-lowering drugs. ...
  • Medications that open blood vessels. ...
  • Blood thinners.


Can avascular necrosis heal on its own?

Treatment can slow the progress of avascular necrosis, but there is no cure. Most people who have avascular necrosis eventually have surgery, including joint replacement.


Avascular Necrosis and Minimally Invasive Treatment Using Stem Cells - Mayo Clinic



How do you increase blood flow to the femoral head?

  1. The simplest operation is to drill one or several holes through the femoral neck and into the femoral head, trying to reach the area that lacks blood supply. ...
  2. A more complicated procedure to try to increase the blood supply to the femoral head is a vascularized fibular bone graft procedure.


What happens if you don't treat avascular necrosis?

Untreated, avascular necrosis worsens. Eventually, the bone can collapse. Avascular necrosis also causes bone to lose its smooth shape, possibly leading to severe arthritis.

How serious is avascular necrosis?

Avascular necrosis is a localized death of bone as a result of local injury (trauma), drug side effects, or disease. This is a serious condition because the dead areas of bone do not function normally, are weakened, and can collapse.

Is avascular necrosis life threatening?

AVN is not life-threatening, but it is debilitating. Although it isn't well-known and its cause is unknown, AVN affects 10,000-to-20,000 Americans annually. Risk factors for AVN include Caisson's disease, Glycogen storage disease, renal disease, Sickle cell anemia, alcoholism and steroid use.


What causes avascular necrosis of the femoral head?

These causes include fractures, dislocations, chronic steroid use, chronic alcohol use, coagulopathy, congenital causes; among many others. Avascular necrosis of the femoral head is a debilitating disease and is an important condition requiring healthcare professionals to be vigilant for its presentation.

Who treats AVN?

If you are diagnosed with AVN, seek out treatment from a specialist interested in the disease. Endocrinologists, rheumatologists and orthopedic surgeons are the subspecialties that usually treat this disorder.

What are the 4 stages of avascular necrosis?

Stage 1 has a normal x-rays but MRI reveals the dead bone. Stage 2 can be seen on regular x-ray but there is no collapse of the femoral ball. Stage 3 shows signs of collapse (called a crescent sign) on x-ray. Stage 4 has collapse on x-ray and signs of cartilage damage (osteoarthritis).

Can osteonecrosis be reversed?

Treatment for Osteonecrosis

Medication may be able to reverse bone damage if osteonecrosis is diagnosed before it is advanced. If the disease has caused severe damage, surgeons who specialize in joint-preserving and joint-replacement surgeries can perform procedures designed to improve mobility and relieve pain.


Is avascular necrosis a disability?

Although avascular necrosis is itself not a listed disability, if you have suffered major damage to your joints as a result of the disease, you may be eligible for automatic approval under the joint listing.

What is Stage 1 avascular necrosis?

Avascular necrosis can be classified into five different stages: Stage 1: Radiographic changes are absent or show minor osteopenia. An MRI scan is required for identification (can show oedema). The onset of this disease is asymptomatic.

What happens when the femoral head collapse?

Cause. Osteonecrosis of the hip develops when the blood supply to the femoral head is disrupted. Without adequate nourishment, the bone in the head of the femur dies and gradually collapses. As a result, the articular cartilage covering the hip bones also collapses, leading to disabling arthritis.

What does avascular necrosis look like on MRI?

Numerous studies have demonstrated that MRI is highly sensitive, specific, and accurate in the detection of AVN. T1-weighted images: AVN most often presents with a crescentic, ring-like or well defined band of low signal within the superior portion of the subchondral femoral head bone marrow (5a).


What are the first signs of necrosis?

Pain, warmth, skin redness, or swelling at a wound, especially if the redness is spreading rapidly. Skin blisters, sometimes with a "crackling" sensation under the skin. Pain from a skin wound that also has signs of a more severe infection, such as chills and fever. Grayish, smelly liquid draining from the wound.

Is avascular necrosis painful?

In its early stages, AVN usually doesn't have symptoms. As the disease gets worse, it becomes painful. At first, it might only hurt when you put pressure on the affected bone. Then, pain may become constant.

What bones are prone to avascular necrosis?

The most common sites for AVN to occur are the femoral head, knee, talus, and humeral head. The hip is the most common location overall. [2] AVN less commonly occurs in other bones of the body, such as the carpus and jaw. [3][4] Therefore, early recognition and treatment of osteonecrosis are essential.

Does AVN pain come and go?

In fact in the earliest stage there are usually no symptoms at all. Other people may notice that you are limping before you feel any pain. Once symptoms begin they come and go. If the condition is left untreated progressive bone damage will often occur.


Can cortisone injections cause avascular necrosis?

Cortisone injections (particularly bursa and tendon sheath infiltrations) are extremely common treatments in primary care, but avascular necrosis is rarely seen. Although one always has to be careful when using steroid infiltrations, they are usually quite safe.

How long does avascular necrosis take to develop?

AVN can progress through these stages quite rapidly over a period of just a few months or it may take 12 – 18 months. This is in contrast to osteoarthritis of the hip which is a generally slowly progressive condition that takes years to develop.

Why does the femoral head lose blood supply?

The primary cause of avascular necrosis is the interruption of blood supply within the bone which can be caused by: Trauma or injury to a joint or bone: A traumatic injury like an accident or a condition like a dislocated joint can obliterate the adjacent blood vessels.

Can you exercise with osteonecrosis?

For example, stretching exercises and movements such as leg lifts or squats can prevent the joint from becoming stiff. In addition, adding exercise such as tai chi or swimming to your regular workout routine can help you maintain flexibility in the joint without putting too much stress on the bones.