Avascular Necrosis

Avascular necrosis, also called osteonecrosis, is a condition in which bone death occurs because of inadequate blood supply. Lack of blood flow may occur when there is a fracture in the bone or a joint dislocation that may damage nearby blood vessels. Steroids and heavy alcohol consumption are the two main risk factors for avascular necrosis. Initially, small breaks appear in the bone that may eventually collapse. The hip joint is most commonly affected; however, the knee and shoulder may also be involved.

The symptoms appear suddenly if it’s a result of an injury. In other situations, the pain and stiffness may gradually appear over a period. Typically, avascular necrosis causes pain and restricted range of motion in the joint affected. Dr. Fischer will diagnose the condition using imaging tests such as X-rays, MRI or CT that help rule out other causes of joint pain.

The treatment for avascular necrosis depends on the degree of damage at the time of diagnosis. Conservative treatment can potentially reverse early stages of avascular necrosis whereas surgical treatment may be required in more advanced stages.

Conservative approach

  • Medications: Non-steroidal anti-inflammatory drugs (NSAID’S) may be prescribed that help control your pain and swelling. Some literature supports the use of osteoporosis medication to help regrow healthy bone.
  • Rest: Restriction of physical activities and use of crutches to decrease weight bearing on your joints may be beneficial
  • Exercises: Regular exercises that improve your range of motion may be helpful

Surgical Treatment

  • Core Decompression: During this procedure, a portion of the inner layer of the bone is removed to relieve the pressure inside the bone. This decreases the pain and allows growth of new blood vessels thereby stimulates new bone growth
  • Bone Autograft: The fibula can be harvested and incorporated into the femur with microvascular attachment, attempting to restore blood flow to the femoral head.
  • Joint replacement: Joint replacement surgery is done as a last resort when the bone has collapsed requiring replacement