How to Treat Avascular Necrosis

Download Article

Explore this Article

parts

1 Taking Care of Yourself

2 Getting Medical Treatment

3 Understanding the Disease

Other Sections

Tips and Warnings

Related Articles

Expert Interview

References

Article Summary

Co-authored by Arvind Madan and Bailey Cho

Last Updated: August 12, 2024 Fact Checked

Download Article

Avascular Necrosis (AVN or osteonecrosis) is a disease that occurs from temporary or permanent loss of blood supply to the bones, leading to death of bone cells. This process can make tiny breaks in the affected bone and lead to eventual collapse. Avascular necrosis can happen at any site in the body, but it’s commonly seen at the hip, knees, shoulders and ankles. If avascular necrosis afflicts you or someone you know, see Step 1 to start treating this disease effectively.

Steps

Part 1

Part 1 of 3:

Taking Care of Yourself

Download Article

1. 1
   Rest. Minimizing physical activity and keeping weight off the affected joint may help slow the bone damage. Apart from physical therapy, make efforts to restrict your daily activities to resolve pain and swelling.

   • You may need crutches if the affected joint is your hip, knee, or ankle. However, talk to your healthcare provider for the best treatment options.
2. 2
   Exercise. You should see a physiotherapist to show you certain exercises to maintain or improve the range of motion in the affected joint. The physiotherapist can help you change the way you walk to avoid limping or putting too much stress on the joint. Once you have improved, they may teach you stretching exercises that you can do in the clinic or at home.

   • The exercise bike is helpful because the forward and backward moves produce synovial fluid to lubricate the joints, and build muscles in your legs and core.
   • Your range of motion and strength will help the physiotherapist choose the proper exercises for you, plus teach you how to perform them on your own.
   • Alternatively, performing gentle yoga every day may improve bone mineral density, plus help you relax and avoid stress. The more relaxed you are, the better you'll feel.
   Advertisement
3. 3
   Limit your alcohol intake. Drinking excessive amounts of alcohol is one of the risk factors of developing avascular necrosis (AVN). Studies show that heavy drinking causes lower bone mineral density, which makes the bone more prone to fractures and may eventually lead to avascular necrosis.

   • There are a number of reasons you should limit your alcohol intake or consider quitting entirely, such as losing weight, sleeping better, and decreasing your risk of dementia and certain types of cancers. Take care of your body and go alcohol-free.
4. 4
   Maintain low cholesterol levels. Stick to a healthy, low-fat diet by avoiding hydrogenated oils and fried foods, and by reducing your intake of whole milk dairy products, which you can replace with low- or non-fat alternatives. Doing this will keep your cholesterol levels to a minimum, helping your blood and heart.

   • Before cooking meat, make sure to trim off any visible fat.
   • Consume food rich in omega-3 fatty acids, such as fish (mackerel, salmon, herring, tuna), walnuts, flaxseeds, and soybean oil.
5. 5
   Avoid or minimize the intake of high-fat condiments, like butter and mayonnaise. Get your fats from healthy sources, such as raw nuts, vegetable oils (like olive oil), and cold water fish (like salmon and mackerel). Eat lots of green leafy vegetables, fruits, and whole grains, and avoid foods with butter, whole-milk cheese, and cream sauces.

   • If you’re diabetic, make sure to keep your blood sugar levels in a normal state. Consult your doctor immediately if you notice any sudden high or low sugar concentrations, since diabetes is considered one of the risk factors that may lead to AVN. Monitoring your glucose level should be one of your top priorities, which you can do by paying attention to your food and medicines.
6. 6
   Consider acupressure therapy. Your physical therapist may recommend acupressure, which involves massaging areas on your body to stimulate blood flow and reduce inflammation. Talk to your physical therapist or healthcare provider if this could be an effective treatment for you.
Advertisement

Part 2

Part 2 of 3:

Getting Medical Treatment

Download Article

1. 1
   Ask your doctor about medication. Here's the knowledge you should be armed with:

   • Nonsteroidal anti-inflammatory drugs (NSAIDs): These work to relieve pain and swelling around the affected joint, reducing inflammation. Popular over-the-counter NSAIDs include ibuprofen, naproxen, and aspirin.
   • Osteoporosis drugs: These may slow the progression of AVN, but evidence is mixed. Alendronate (Fosamax) is prescribed to treat and prevent AVN in women who have undergone menopause and to treat AVN in men.
   • Cholesterol-lowering drugs: These are used to decrease the amount of fat and cholesterol in the blood in the blood circulation (due to corticosteroid intake); this prevents blood vessel blockage that leads to AVN.
   • Blood thinners: For patients with clotting disorders, blood thinners (like Warfarin) prevent clots from forming in the vessels feeding the bones.
2. 2
   Talk to your doctor about electrical stimulation. This is a process that encourages the body to grow new bone to replace the damaged bone. It can be performed during surgery by applying electrical currents directly to the affected bones, or by attaching electrodes to your skin. It's not surgery, but it is generally used in conjunction with surgery.

   • If surgery puts your bones in line, electrical stimulation sets the ball in motion. However, it's not right for everyone, so ask your doctor if it's a feasible option.
3. 3
   Consider surgery. Most people with avascular necrosis eventually have surgery, with more than 50% of patients with AVN of the femoral head needing major surgical intervention within 3 years of diagnosis. Your doctor will determine which type of procedure or therapy you may need. Here are the details:

   • Core decompression: The surgeon drills holes in the dead bone near the affected joint. The aim of this is to decrease the pressure inside, increase blood flow, and slow or stop bone and/or joint destruction.
   • Bone transplant (graft): This procedure involves transplanting healthy bone from one part of your body into the affected area. The bone graft may be inserted into the holes drilled for a core decompression procedure.
   • Bone reshaping (osteotomy): This is where the surgeon removes a section of the affected bone above or below a weight-bearing joint to reshape it and decrease stress on the affected area. It may help postpone joint replacement.
   • Joint replacement: When the affected bone has collapsed or other treatment options have failed, the damaged joint is replaced with an artificial one, usually made from plastic or metal parts.
4. 4
   Get physical therapy and stick to it. After surgery, it is absolutely imperative that your bones: A) heal and B) heal correctly. Regular physical therapy will ensure that both of these things happen. Here's how it may be beneficial:

   • Your physical therapist will hook you up with crutches, a cane, or some device to reduce weight on the joint. This will greatly speed up the healing process.
   • Your physical therapist will work on exercises with you to prevent joint damage and improve joint flexibility and mobility.
Advertisement

Part 3

Part 3 of 3:

Understanding the Disease

Download Article

1. 1
   Know what avascular necrosis really is. Avascular necrosis (AVN or osteonecrosis) is defined as the death of bone tissue due to lack and loss of blood supply. This may cause tiny breaks in the affected bone and lead to bone collapse. If AVN affects bones near a joint, the joint surface may collapse. Usually, the affected bone or joint area in AVN is the hip.

   • AVN occurs in bones with a terminal blood supply (meaning there is a limited blood supply), such as the femoral (hip) and humeral (shoulder) heads. Closure or interruption of this terminal blood supply will lead to death of bone tissue and, later, bone collapse.
   • Although bone tissue regenerates or grows back again, the rate of bone destruction is faster than bone regeneration. If the bone collapses, the joint structure breaks down and leads to pain. Corticosteroids and radiation therapy may contribute to AVN.
2. 2
   Know the risk factors and causes. Several causes can increase your risk of developing AVN. Any of the following can lead to AVN:

   • Osteoporosis
   • A bone fracture or joint dislocation, which can interrupt blood flow
   • Radiation during cancer treatment, which weakens the bone and affects the blood vessels
   • Elevated pressure inside the bone that narrows the blood vessels and makes it difficult for fresh blood to enter
   • Excessive alcohol consumption, which causes fats to block small blood vessels and reduce blood flow to bones
   • Prolonged corticosteroid (Prednisolone) use
   • Prolonged biphosphate (a treatment for osteoporosis) use
   • Diseases such as diabetes, HIV/AIDS, sickle cell anemia, organ transplantation, and decompression sickness
3. 3
   Know what the symptoms are. AVN may be missed because there are no symptoms in the early stages of the disorder. One of the first symptoms is pain in the affected bone/joint, such as groin pain in AVN of the femoral head. Here are the symptoms:

   • Intermittent pain that gets worse when you apply weight or pressure on the bone
   • Walking with a limp if you have AVN in your hips or knees
   • Joint movements that are limited and painful. The affected joint may be deformed or disfigured through time.
   • Difficulty climbing stairs, standing, or walking
     • Usually, signs and symptoms occur late in the course of the disease and patients consult doctors when the disease is advanced. Without treatment, the affected joint will be destroyed, leading to severe arthritis.
4. 4
   Know how AVN gets diagnosed. During a physical examination, your doctor will press around the pain site to check for tenderness. They may need you to move the joint in different positions to see if the pain increases or decreases, or if your range of movement is reduced. To determine if surgery is necessary, your doctor may require the following:

   • X-rays: They usually appear normal in the early stages of AVN, but can reveal clear bone change in the later stages.
   • Bone scan: Via an intravenous line, a safe radioactive material is slowly injected in your vein. The material flows with your blood until it reaches its destination; a picture on a special camera will show the affected sites as clear bright spots.
   • Magnetic resonance imaging (MRI): This is known as the most sensitive method for the early stages of AVN because it reveals any chemical change in the bone marrow and bone rebuilding process. This is done by radio waves and a strong magnetic field.
   • Computerized tomography (CT scan): This is more clear than x-rays and bone scans; it determines the extent of bone damage by taking a three dimensional picture of the bone.
   • Bone biopsy: This is a procedure where a small amount of bone tissue is taken and examined under a microscope to check for the appearance of AVN.
Advertisement

Expert Q&A

Search

Add New Question

Ask a Question

200 characters left

Include your email address to get a message when this question is answered.

Submit

Advertisement

Tips

• Consult your doctor before taking NSAIDs, and always take them with food to reduce your risk of stomach ulcers. Common side effects include: vomiting, irritation, and stomach pain. Patients with a history of stomach ulcers or gastrointestinal bleeding, kidney disease, and liver disease should avoid taking NSAIDs.
  Thanks

  Helpful 0 Not Helpful 0
• Sometimes, a splint or cast is used to immobilize the affected joint. This is done upon consulting your doctor or bone specialist.
  Thanks

  Helpful 0 Not Helpful 0
• Studies show that short-term, low-dose corticosteroids may raise plasma lipid levels. This may lead to plaque growth, which can block the blood vessels.
  Thanks

  Helpful 0 Not Helpful 0

Submit a Tip

All tip submissions are carefully reviewed before being published

Name

Please provide your name and last initial

Submit

Thanks for submitting a tip for review!

Advertisement

Warnings

• If you experience pain that doesn’t improve with rest or pain relievers, pain that makes walking or moving difficult, or unexplained limping, visit your healthcare provider immediately.
  Thanks

  Helpful 0 Not Helpful 0

Advertisement