Overview

Diagnosis

During a physical exam, a healthcare professional examines your joints for tenderness, swelling, and reduced movement. They may move the joint through various positions to assess whether the range of motion is limited.

Imaging tests
Imaging can help confirm avascular necrosis and identify the extent of bone damage:

  • X-rays. Can reveal bone changes in the later stages. Early-stage avascular necrosis often does not show up on X-rays.

  • MRI and CT scans. These produce detailed images that can detect early bone changes that may indicate avascular necrosis.

  • Bone scan. A small amount of radioactive tracer is injected into a vein, highlighting areas of bone injury or healing as bright spots on imaging.

Treatment

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

Medicines
In the early stages, medications may help manage symptoms and slow progression:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter options like ibuprofen or naproxen sodium may reduce pain. Prescription-strength NSAIDs are also available.

  • Osteoporosis medications. These may help slow bone damage, though evidence is mixed.

  • Cholesterol-lowering drugs. Reducing cholesterol and fat may prevent vessel blockages that contribute to avascular necrosis.

  • Vasodilators. Medicines that open blood vessels may increase blood flow to affected bone, though research is ongoing.

  • Blood thinners. In cases of clotting disorders, medications like warfarin can help prevent clots in vessels feeding the bone.

Therapy
Healthcare providers may recommend:

  • Rest. Limiting physical activity or using crutches can reduce stress on the affected joint.

  • Exercise. Physical therapy exercises help maintain or improve joint motion.

  • Electrical stimulation. Low-level electrical currents may encourage bone regeneration. This can be applied during surgery or through electrodes on the skin.

Surgical and other procedures
If the condition is advanced, surgery may be necessary:

  • Core decompression. Removes part of the inner bone layer, reducing pressure and stimulating healthy bone and new blood vessels.

  • Bone grafting. Healthy bone from another part of the body strengthens the affected area.

  • Osteotomy (bone reshaping). Removes a wedge of bone to shift weight away from damaged areas, potentially delaying joint replacement.

  • Joint replacement. Replaces collapsed or damaged bone with artificial components.

  • Regenerative medicine. Bone marrow aspirate with stem cells may promote new bone growth in early-stage cases. Research is ongoing.

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