The treatment goal for avascular necrosis is to prevent further bone loss. What treatment you receive depends on the amount of bone damage you already have.

Medications

In some people, avascular necrosis symptoms may be reduced with medications such as:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Medications such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve) may help relieve the pain and inflammation associated with avascular necrosis.
  • Osteoporosis drugs. Some studies indicate that osteoporosis medications, such as alendronate (Fosamax, Binosto), may slow the progression of avascular necrosis.
  • Cholesterol drugs. Reducing the amount of fat (lipids) in your blood may help prevent the vessel blockages that often cause avascular necrosis.
  • Blood thinners. If you have a clotting disorder, blood thinners such as warfarin (Coumadin, Jantoven) may be prescribed to prevent clots in the vessels feeding your bones.

Therapy

In the early stages of avascular necrosis, your doctor might suggest:

  • Rest. Reducing the amount of weight and stress on your affected bone may slow the damage of avascular necrosis. You may need to restrict the amount of physical activity you engage in. In the case of hip or knee avascular necrosis, you may need to use crutches to keep weight off your joint for several months.
  • Exercises. Certain exercises may help you maintain or improve the range of motion in your joint. A physical therapist can choose exercises specifically for your condition and teach you how to do them.
  • Electrical stimulation. Electrical currents may encourage your body to grow new bone to replace the area damaged by avascular necrosis. Electrical stimulation can be used during surgery and applied directly to the damaged area. Or it can be administered through electrodes attached to your skin.

Surgical and other procedures

Because most people don't start having symptoms until the disease is fairly advanced, you may need to consider surgeries such as:

  • Core decompression. In this operation, your surgeon removes part of the inner layer of your bone. In addition to reducing your pain, the extra space within your bone stimulates the production of healthy bone tissue and new blood vessels.
  • Bone transplant (graft). This procedure can help strengthen the area of bone affected by avascular necrosis The graft is a section of healthy bone taken from another part of your body.
  • Bone reshaping (osteotomy). This procedure removes a wedge of bone above or below a weight-bearing joint to help shift your weight off the damaged bone. Bone reshaping may allow you to postpone joint replacement.
  • Joint replacement. If your diseased bone has already collapsed or other treatment options aren't helping, you may need surgery to replace the damaged parts of your joint with plastic or metal parts.

It's hard to tell if reducing your risk factors will help prevent avascular necrosis, but the following tips can also help improve your general health:

  • Limit alcohol. Heavy drinking is one of the top risk factors for developing avascular necrosis.
  • Keep cholesterol levels low. Tiny bits of fat (lipids) are the most common substance blocking blood supply to bones.
  • Monitor steroid use. Make sure your doctor knows about any past or present use of high-dose steroids. Steroid-related bone damage appears to worsen with repeated courses of high-dose steroids.
May. 04, 2012

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