Avascular Necrosis (Osteonecrosis)

Avascular necrosis is diagnosed through a combination of physical examination and imaging tests to pinpoint bone damage.

Physical exam:

During the exam, a healthcare professional presses around joints to check for tenderness.
They may move the joint through different positions to assess range of motion and detect limitations.

Imaging tests:

X-rays: Can reveal bone changes in later stages, but early-stage avascular necrosis may not show on X-rays.
MRI and CT scan: Provide detailed images to detect early bone changes, helping confirm avascular necrosis.
Bone scan: A small amount of radioactive material is injected into a vein. The tracer highlights areas of bone injury or healing as bright spots on imaging.

More Information:

The primary goal of treatment is to prevent further bone loss and preserve joint function.

Medicines:

Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter options like ibuprofen (Advil, Motrin IB) or naproxen sodium (Aleve) can relieve pain. Prescription-strength NSAIDs are also available.
Osteoporosis drugs: May help slow disease progression, though evidence is mixed.
Cholesterol-lowering drugs: Reducing cholesterol and fat in the blood may prevent vessel blockages that lead to bone damage.
Medicines that open blood vessels: Aim to increase blood flow to affected bones; research is ongoing.
Blood thinners: For clotting disorders, medications like warfarin (Jantoven) may prevent vessel clots feeding the bones.

Therapy:

Rest: Limiting physical activity or using crutches to reduce joint weight can slow bone damage.
Exercises: Physical therapists teach range-of-motion exercises to maintain or improve joint flexibility.
Electrical stimulation: Currents may stimulate new bone growth. This can be applied directly during surgery or through electrodes on the skin.

Surgical and other procedures:

Core decompression: Removes part of the inner bone layer, reduces pain, and stimulates growth of healthy bone and new blood vessels.
Bone transplant (graft): Strengthens affected bone using a section of healthy bone from another area.
Bone reshaping (osteotomy): A wedge of bone is removed to shift weight off damaged areas, potentially delaying joint replacement.
Joint replacement: Replaces collapsed or severely damaged bone with plastic or metal parts if other treatments fail.
Regenerative medicine treatment: Bone marrow aspirate and concentration is a newer procedure. Dead hipbone is replaced with stem cells from bone marrow to encourage new bone growth. This method is still under study.

Overview