Avascular Necrosis Treatment Options

What is AVN?

Avascular necrosis (AVN), also known as osteonecrosis, is a condition characterized by the death of bone tissue due to a lack of blood supply. It commonly affects the femoral head, leading to significant implications for hip joint health and function. AVN can result from various factors such as trauma, corticosteroid use, excessive alcohol consumption, or underlying medical conditions. Symptoms typically include gradual onset of hip pain, limited range of motion, and difficulty walking or bearing weight on the affected hip. Diagnosis involves physical examination, imaging studies, and blood tests to assess bone health and rule out underlying causes.

What are the treatment options for avascular necrosis?

Treatment of avascular necrosis of the femoral head aims to relieve symptoms, preserve hip joint function, and prevent further deterioration of the affected bone tissue. The choice of treatment depends on various factors, including the stage and severity of AVN, the extent of bone damage, the patient’s age, overall health, and functional goals. Treatment options may include:

Conservative Management

• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) or pain relievers may be prescribed to alleviate hip pain and inflammation associated with AVN.
• Protected Weight-Bearing: Limiting weight-bearing activities or using assistive devices such as crutches or walkers can reduce stress on the affected hip joint and prevent further damage.
• Physical Therapy: Physical therapy plays a crucial role in improving hip joint mobility, strength, and stability. Therapeutic exercises may focus on stretching tight muscles, strengthening hip abductor muscles, and improving gait mechanics to alleviate symptoms and enhance functional outcomes.

Core Decompression

Core decompression is a surgical procedure aimed at reducing pressure within the femoral head and promoting new blood vessel formation to restore blood supply. During the procedure, a small core of bone is removed from the center of the femoral head to relieve pressure and stimulate bone healing. Core decompression may be performed alone or in combination with other surgical techniques, such as bone grafting or bone marrow aspirate concentrate (BMAC) injection, to enhance bone regeneration and healing.

Osteotomy

In cases where AVN is associated with underlying hip deformities or malalignment, osteotomy may be performed to realign the hip joint and redistribute weight-bearing forces. This procedure involves cutting and repositioning the bones around the hip joint to improve joint mechanics and reduce stress on the affected femoral head.

Joint Replacement Surgery

In advanced stages of AVN where conservative or joint-preserving treatments are ineffective, total hip replacement (arthroplasty) may be necessary to relieve pain and restore hip joint function. During hip replacement surgery, the damaged femoral head and acetabulum are replaced with artificial prostheses made of metal, ceramic, or plastic components. Total hip replacement can provide long-term pain relief and improve quality of life for individuals with severe AVN of the femoral head.

What is the prognosis for AVN?

The prognosis for avascular necrosis of the femoral head varies depending on several factors, including the stage and severity of the condition, the underlying cause, the effectiveness of treatment, and the patient’s overall health and compliance with treatment recommendations. In early stages, prompt diagnosis and intervention may help preserve hip joint function and prevent progression of AVN. However, if left untreated or if the condition progresses to advanced stages, avascular necrosis can lead to irreversible damage to the femoral head, collapse of the hip joint, and significant functional impairment. Timely diagnosis, appropriate treatment, and regular follow-up care are essential to optimize outcomes and minimize complications associated with AVN of the femoral head.

What is the return to activity after AVN?

Return to activity after AVN of the femoral head typically involves a gradual and cautious approach to minimize the risk of further damage and optimize hip joint function. Depending on the severity of the condition and the treatment received, individuals may initially need to avoid high-impact or weight-bearing activities that could exacerbate symptoms. Physical therapy plays a vital role in rehabilitation, focusing on strengthening the muscles surrounding the hip joint, improving range of motion, and enhancing stability. As symptoms improve and hip joint function progresses, individuals can gradually reintroduce low-impact activities such as swimming, cycling, or walking, while closely monitoring for any signs of discomfort or pain. The timing and extent of return to more demanding activities, such as running or sports, should be guided by Dr. Shane J. Nho and based on individual recovery progress, overall health, and functional goals. Close communication between patients and Dr. Nho’s care team is essential throughout the rehabilitation process to ensure a safe and successful return to activity following AVN.

Dr. Shane J. Nho is a board-certified fellowship trained sports medicine orthopaedic surgeon who specializes in the treatment of AVN. If you believe you are affected by AVN, schedule a consultation today with our experienced orthopaedic care team.