Avascular Necrosis Treatment
Appropriate treatment for avascular necrosis is necessary to keep joints from breaking
down. If untreated, most patients will experience severe pain and limitation in movement
within 2 years.
Determining the proper Avascular Necrosis Treatment
Several treatments are available that can help prevent further bone and joint damage
and reduce pain. To determine the most appropriate treatment, the doctor considers the
following aspects of a patient's disease:
The age of the patient
The stage of the disease--early or late
The location and amount of bone affected--a small or large area
The underlying cause of avascular necrosis--with an ongoing cause such as corticosteroid
or alcohol use, treatment may not work unless use of the substance is stopped.
Goal of Avascular Necrosis Treatment
The goal in treating avascular necrosis is to improve the patient's use of the affected
joint, stop further damage to the bone, and ensure bone and joint survival. To reach these
goals, the doctor may use one or more of the following treatments.
Conservative Treatment
Medicines--to reduce fatty substances (lipids) that increase with corticosteroid treatment
or to reduce blood clotting in the presence of clotting disorders. Nonsteroidal
anti-inflammatory drugs may also be prescribed to reduce pain.
Reduced weight bearing--If avascular necrosis is diagnosed early, the doctor may begin
treatment by having the patient remove weight from the affected joint. The doctor may
recommend limiting activities or using crutches. In some cases, reduced weight bearing can
slow the damage caused by avascular necrosis and permit natural healing. When combined
with medication to reduce pain, reduced weight bearing can be an effective way to avoid or
delay surgery for some patients.
Range-of-motion exercises--may be prescribed to maintain or improv e joint range of
motion.
Electrical stimulation--to induce bone growth.
Surgical Treatment of Avascular Necrosis
Conservative treatments have been used experimentally alone or in combination. However,
these treatments rarely provide lasting improvement. Therefore, most patients will
eventually need surgery to repair the joint permanently.
Core decompression--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.
Osteotomy--This surgical procedure reshapes the bone to reduce stress on the affected
area. There is a lengthy recovery period, and the patient's activities are very limited
for 3 to 12 months after an osteotomy. This procedure is most effective for patients with
advanced avascular necrosis and those with a large area of affected bone.
Bone graft--A bone graft may be used to support a joint after core decompression. Bone
grafting is surgery that transplants healthy bone from one part of the patient, such as
the leg, to the diseased area. Commonly, grafts (called vascular grafts) that include an
artery and veins are used to increase the blood supply to the affected area. There is a
lengthy recovery period after a bone graft, usually from 6 to 12 months. This procedure is
complex and its effectiveness is not yet proven. Clinical studies are under way to
determine its effectiveness.
Arthroplasty/total joint replacement--Total joint replacement is the treatment of choice
in late-stage avascular necrosis and when the joint is destroyed. In this surgery, the
diseased joint is replaced with artificial parts. It may be recommended for people who are
not good candidates for other treatments, such as patients who do not do well with
repeated attempts to preserve the joint. Various types of replacements are available, and
people should discuss specific needs with their doctor.
For most people with avascular necrosis, treatment is an ongoing process. Doctors may
first recommend the least complex and invasive procedure, such as protecting the joint by
limiting movement, and watch the effect on the patient's condition. Other treatments then
may be used to prevent further bone destruction and reduce pain. It is important that
patients carefully follow instructions about activity limitations and work closely with
their doctor to ensure that appropriate treatments are used.
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