How to Treat Avascular Necrosis

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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. [1] If avascular necrosis afflicts you or someone you know, see Step 1 to start treating this disease effectively.

Part 1
Part 1 of 3:

Taking Care of Yourself

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  1. Minimizing physical activity and keeping weight off the affected joint may help slow the bone damage. [2] Apart from physical therapy, make efforts to restrict your daily activities to resolve pain and swelling. [3]
    • You may need crutches if the affected joint is your hip, knee, or ankle. [4] However, talk to your healthcare provider for the best treatment options.
  2. You should see a physiotherapist to show you certain exercises to maintain or improve the range of motion in the affected joint. [5] The physiotherapist can help you change the way you walk to avoid limping or putting too much stress on the joint. [6] Once you have improved, they may teach you stretching exercises that you can do in the clinic or at home. [7]
    • 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. [8]
    • 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. [9]
    • Alternatively, performing gentle yoga every day may improve bone mineral density, plus help you relax and avoid stress. [10] The more relaxed you are, the better you'll feel.
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  3. Drinking excessive amounts of alcohol is one of the risk factors of developing avascular necrosis (AVN). [11] 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. [12]
    • 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. [13] Take care of your body and go alcohol-free.
  4. 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. [14] Doing this will keep your cholesterol levels to a minimum, helping your blood and heart. [15]
    • Before cooking meat, make sure to trim off any visible fat. [16]
    • Consume food rich in omega-3 fatty acids, such as fish (mackerel, salmon, herring, tuna), walnuts, flaxseeds, and soybean oil. [17]
  5. Get your fats from healthy sources, such as raw nuts, vegetable oils (like olive oil), and cold water fish (like salmon and mackerel). [18] Eat lots of green leafy vegetables, fruits, and whole grains, and avoid foods with butter, whole-milk cheese, and cream sauces. [19]
    • 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. [20] Monitoring your glucose level should be one of your top priorities, which you can do by paying attention to your food and medicines. [21]
  6. Your physical therapist may recommend acupressure, which involves massaging areas on your body to stimulate blood flow and reduce inflammation. [22] Talk to your physical therapist or healthcare provider if this could be an effective treatment for you.
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Part 2
Part 2 of 3:

Getting Medical Treatment

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  1. Here's the knowledge you should be armed with: [23]
    • 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. [24]
    • Osteoporosis drugs: These may slow the progression of AVN, but evidence is mixed. [25] Alendronate (Fosamax) is prescribed to treat and prevent AVN in women who have undergone menopause and to treat AVN in men. [26]
    • 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. [27]
    • Blood thinners: For patients with clotting disorders, blood thinners (like Warfarin) prevent clots from forming in the vessels feeding the bones. [28]
  2. 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. [29] It's not surgery, but it is generally used in conjunction with surgery. [30]
    • 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. 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. [31] Your doctor will determine which type of procedure or therapy you may need. Here are the details: [32]
    • 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. [33]
    • 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. [34]
    • 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. [35]
    • 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. [36]
  4. 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. [37] 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. [38]
    • Your physical therapist will work on exercises with you to prevent joint damage and improve joint flexibility and mobility. [39]
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Part 3
Part 3 of 3:

Understanding the Disease

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  1. Avascular necrosis (AVN or osteonecrosis) is defined as the death of bone tissue due to lack and loss of blood supply. [40] This may cause tiny breaks in the affected bone and lead to bone collapse. [41] If AVN affects bones near a joint, the joint surface may collapse. [42] Usually, the affected bone or joint area in AVN is the hip. [43]
    • 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. [44]
    • 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. [45]
  2. Several causes can increase your risk of developing AVN. Any of the following can lead to AVN: [46]
    • 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 [47]
    • Diseases such as diabetes, HIV/AIDS, sickle cell anemia, organ transplantation, and decompression sickness
  3. AVN may be missed because there are no symptoms in the early stages of the disorder. [48] One of the first symptoms is pain in the affected bone/joint, such as groin pain in AVN of the femoral head. [49] Here are the symptoms: [50]
    • 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. [51]
  4. 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. [52] To determine if surgery is necessary, your doctor may require the following: [53]
    • X-rays: They usually appear normal in the early stages of AVN, but can reveal clear bone change in the later stages. [54]
    • 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. [55]
    • 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. [56]
    • 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. [57]
    • 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. [58]
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      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. [59]
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      • Sometimes, a splint or cast is used to immobilize the affected joint. [60] This is done upon consulting your doctor or bone specialist.
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      • Studies show that short-term, low-dose corticosteroids may raise plasma lipid levels. [61] This may lead to plaque growth, which can block the blood vessels. [62]
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      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. [63]
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      References

      1. ↑ https://www.ncbi.nlm.nih.gov/books/NBK537007/
      2. ↑ https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/diagnosis-treatment/drc-20369863
      3. ↑ https://www.chop.edu/conditions-diseases/avascular-necrosis
      4. ↑ https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/osteonecrosis
      5. ↑ https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/diagnosis-treatment/drc-20369863
      6. ↑ https://nyulangone.org/conditions/osteonecrosis/treatments/nonsurgical-treatment-for-osteonecrosis
      7. ↑ https://centralorthopedicgroup.com/wp-content/themes/central-14/pdf/hip/hip_hip_avascular_necrosis.pdf
      8. ↑ https://www.arthritis.org/health-wellness/healthy-living/physical-activity/other-activities/benefits-of-stationary-biking
      9. ↑ https://nyulangone.org/conditions/osteonecrosis/treatments/nonsurgical-treatment-for-osteonecrosis
      1. ↑ https://www.hopkinsmedicine.org/health/wellness-and-prevention/9-benefits-of-yoga
      2. ↑ https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/osteonecrosis
      3. ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10340773/
      4. ↑ https://health.umms.org/2023/07/05/10-great-reasons-to-stop-drinking-alcohol/
      5. ↑ https://medlineplus.gov/howtolowercholesterolwithdiet.html
      6. ↑ https://health.clevelandclinic.org/high-cholesterol-diet
      7. ↑ https://www.ucsfhealth.org/education/guidelines-for-a-low-cholesterol-low-saturated-fat-diet
      8. ↑ https://my.clevelandclinic.org/health/articles/17290-omega-3-fatty-acids
      9. ↑ https://nutritionsource.hsph.harvard.edu/what-should-you-eat/fats-and-cholesterol/
      10. ↑ https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/fat/art-20045550
      11. ↑ https://my.clevelandclinic.org/health/diseases/14205-avascular-necrosis-osteonecrosis
      12. ↑ https://my.clevelandclinic.org/health/diseases/7104-diabetes
      13. ↑ https://nyulangone.org/conditions/osteonecrosis/treatments/nonsurgical-treatment-for-osteonecrosis
      14. ↑ https://my.clevelandclinic.org/health/diseases/14205-avascular-necrosis-osteonecrosis
      15. ↑ https://nyulangone.org/conditions/osteonecrosis/treatments/nonsurgical-treatment-for-osteonecrosis
      16. ↑ https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/diagnosis-treatment/drc-20369863
      17. ↑ https://medlineplus.gov/druginfo/meds/a601011.html
      18. ↑ https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/diagnosis-treatment/drc-20369863
      19. ↑ https://www.stoptheclot.org/about-clots/blood-clot-treatment/warfarin/
      20. ↑ https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/diagnosis-treatment/drc-20369863
      21. ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5534113/
      22. ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8683207/
      23. ↑ https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/diagnosis-treatment/drc-20369863
      24. ↑ https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/avascular-necrosis/treatments/core-decompression.html
      25. ↑ https://www.yalemedicine.org/conditions/avascular-necrosis-of-the-hip
      26. ↑ https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/diagnosis-treatment/drc-20369863
      27. ↑ https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/diagnosis-treatment/drc-20369863
      28. ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9902054/
      29. ↑ https://nyulangone.org/conditions/osteonecrosis/treatments/nonsurgical-treatment-for-osteonecrosis
      30. ↑ https://nyulangone.org/conditions/osteonecrosis/treatments/nonsurgical-treatment-for-osteonecrosis
      31. ↑ https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/osteonecrosis
      32. ↑ https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/symptoms-causes/syc-20369859
      33. ↑ https://www.hopkinsmedicine.org/health/conditions-and-diseases/avascular-necrosis
      34. ↑ https://my.clevelandclinic.org/health/diseases/14205-avascular-necrosis-osteonecrosi
      35. ↑ https://www.sciencedirect.com/topics/nursing-and-health-professions/avascular-necrosis
      36. ↑ https://my.clevelandclinic.org/health/diseases/14205-avascular-necrosis-osteonecrosis
      37. ↑ https://my.clevelandclinic.org/health/diseases/14205-avascular-necrosis-osteonecrosis
      38. ↑ https://www.ncbi.nlm.nih.gov/books/NBK534771/
      39. ↑ https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/osteonecrosis
      40. ↑ https://rheumatology.org/patients/osteonecrosis
      41. ↑ https://my.clevelandclinic.org/health/diseases/14205-avascular-necrosis-osteonecrosis
      42. ↑ https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/osteonecrosis
      43. ↑ https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/diagnosis-treatment/drc-20369863
      44. ↑ https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/osteonecrosis
      45. ↑ https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/diagnosis-treatment/drc-20369863
      46. ↑ https://www.cancer.gov/publications/dictionaries/cancer-terms/def/bone-scan
      47. ↑ https://www.acco.org/osteonecrosis-a-source-of-bone-pain-and-loss-of-function/
      48. ↑ https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/computed-tomography-ct-scan
      49. ↑ https://www.acco.org/osteonecrosis-a-source-of-bone-pain-and-loss-of-function/
      50. ↑ https://my.clevelandclinic.org/health/treatments/11086-non-steroidal-anti-inflammatory-medicines-nsaids
      51. ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6968880/
      52. ↑ https://www.atherosclerosis-journal.com/article/0021-9150(87)90117-1/pdf
      53. ↑ https://my.clevelandclinic.org/health/articles/11918-cholesterol-high-cholesterol-diseases
      54. ↑ https://my.clevelandclinic.org/health/diseases/14205-avascular-necrosis-osteonecrosis

      About This Article

      Article Summary X

      Avascular Necrosis is a disease that's triggered by poor blood supply to the bones, leading to the death of the bone tissue. If you have AVN, minimize your daily physical activity to help relieve your pain and slow down the damage to your bones so your body can heal. Another way to treat AVN is to limit your alcohol intake, which can worsen your condition. You'll also want to keep your cholesterol levels as low as possible, which will help strengthen your heart and blood. Acupressure therapy can also help treat AVN by pressing on certain areas of the body to help you relax. While you can do acupressure yourself, you can also see a professional for a fully relaxing experience. If possible, see a physiotherapist, who can show you certain exercises to maintain or enhance your joint movement. To learn how to use medication to treat AVN, keep reading!

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        Mar 14, 2017

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