What's the treatment for avascular necrosis?
Appropriate treatment for avascular necrosis is necessary to keep joints from breaking down. If untreated, most patients will suffer severe pain and limitation in movement within 2 years. Several treatments are available that can help prevent further bone and joint damage and reduce pain. The treatment of avascular necrosis depends on the stage of the bone destruction.
Very early stages may be treated simply by reducing wieght bearing activity. Later stages may be treated by a procedure called a core decompression. This involves removing a core of bone, this allows a new blood supply to form. Late stages usually require a total joint replacement.
Simple treatment measures include use of nonsteroidal anti-inflammatory drugs (NSAIDs) or other analgesics for pain (Nonsteroidal Anti-Inflammatory Drugs), and avoidance of weight-bearing or strain on affected bones and joints. Often, these treatments must be maintained for 6 months or more. Exercises to increase a joint's range of motion are useful. However, these treatments are rarely adequate by themselves and do not cure the disorder.
The simplest surgical procedure is called core decompression, which involves taking a plug of bone out of the involved area. This procedure is very effective for early disease that has not yet progressed to bone collapse; it may even prevent collapse. Core decompression may also be used for someone younger than 50 whose bone has collapsed; this treatment may delay the need for a total joint replacement by several years because the person's pain is relieved or decreased. The procedure takes less than an hour to perform. The person must use crutches for 4 to 6 weeks afterward.
Core decompression is a procedure that involves drilling into the femoral neck (hip bone), through the necrotic (dead) area in order to relieve the pressure in the bone and to allow the bone to regrow in the area and heal on its own. This surgical procedure removes the inner layer of bone, which reduces pressure within the bone, increases blood flow to the bone, and allows more blood vessels to form. Core decompression works best in people who are in the earliest stages of avascular necrosis, often before the collapse of the joint. This procedure sometimes can reduce pain and slow the progression of bone and joint destruction in these patients. Patients are required to use crutches for 6 weeks following this procedure in order to prevent the risk of fracture.
Bone grafting is a procedure that involves taking a graft (segment of healthy bone) from the fibula (bone below the knee), and placing it into the core after core decompression. Bone grafting can either be non-vascularized (not using the blood vessels of the hip) or vascularized (using the blood vessels of the hip). In a vascularized procedure, the blood vessels of the graft are saved and are reattached to the blood vessels of the hip. The disadvantages of this procedure include a longer recovery period, less complete relief of pain than after total hip arthroplasty, and the potential of nerve injury to the calf in which the bone graft was taken. There is a lengthy recovery period after a bone graft, usually from 6 to 12 months.
Osteotomy. There are several types of osteotomies; however, all of these procedures attempt to shift the diseased femoral head by relocating some viable (living) cartilage in the weight bearing area so that you will have less pain when walking. After the procedure, your activities are very limited for 3 to 12 months.
Arthroplasty (total hip replacement) entails replacing the hip joint with an artificial femoral head and part of the femur with an artificial stem. The surgeon may, however, determine that the patient only needs replacement of the femoral head with an endoprosthesis (ball). A total hip replacement appears to provide the best results, and leads to complete or nearly complete relief of pain and relatively normal function in 90-95% of patients. With modern surgical techniques and devices, these artificial hips should continue to function for at least ten to fifteen years in the majority of patients.
In addition to the above surgical and non-surgical treatments, doctors and researchers are exploring the use of medications, electrical stimulation, and various therapies to increase the growth of new bone and blood vessels. These treatments are used experimentally, alone, and in combination with other treatments, such as osteotomy and core decompression. |
