Avascular necrosis

Diagnosis

During a physical exam your doctor will likely press around your joints, checking for tenderness. Your doctor might also move the joints through a variety of positions to see if your range of motion has been reduced.

Imaging tests

Many disorders can cause joint pain. Imaging tests can help pinpoint the source of pain. Options include:

• X-rays. They can reveal bone changes that occur in the later stages of avascular necrosis. In the condition's early stages, X-rays usually appear normal.
• MRI and CT scan. These tests produce detailed images that can show early changes in bone that might indicate avascular necrosis.
• Bone scan. A small amount of radioactive material is injected into your vein. This tracer travels to the parts of your bones that are injured or healing and shows up as bright spots on the imaging plate.

Treatment

The goal is to prevent further bone loss.

Medications and therapy

In the early stages of avascular necrosis, symptoms might be eased with medication and therapy. Your doctor might recommend:

• Nonsteroidal anti-inflammatory drugs. Medications, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) might help relieve the pain associated with avascular necrosis.
• Osteoporosis drugs. Medications, such as alendronate (Fosamax, Binosto), might slow the progression of avascular necrosis, but the evidence is mixed.
• Cholesterol-lowering drugs. Reducing the amount of cholesterol and fat in your blood might help prevent the vessel blockages that can cause avascular necrosis.
• Blood thinners. If you have a clotting disorder, blood thinners, such as warfarin (Coumadin, Jantoven), might be recommended to prevent clots in the vessels feeding your bones.
• Rest. Reducing the weight and stress on your affected bone can slow the damage. You might need to restrict your physical activity or use crutches to keep weight off your joint for several months.
• Exercises. A physical therapist can teach you exercises to help maintain or improve the range of motion in your joint.
• Electrical stimulation. Electrical currents might encourage your body to grow new bone to replace the damaged bone. 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 develop symptoms until avascular necrosis is fairly advanced, your doctor might recommend surgery. The options include:

• Core decompression. The surgeon removes part of the inner layer of your bone. Besides 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). A wedge of bone is removed above or below a weight-bearing joint, to help shift your weight off the damaged bone. Bone reshaping might enable you to postpone joint replacement.
• Joint replacement. If your diseased bone has collapsed or other treatments aren't helping, you might need surgery to replace the damaged parts of your joint with plastic or metal parts.
• Regenerative medicine treatment. Bone marrow aspirate and concentration is a newer procedure that might be appropriate for early stage avascular necrosis of the hip. Stem cells are harvested from your bone marrow. During surgery, a core of dead hipbone is removed and stem cells inserted in its place, potentially allowing for growth of new bone. More study is needed.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Preparing for your appointment

Your family doctor might refer you to a doctor who specializes in disorders of the joints (rheumatologist) or to an orthopedic surgeon.

What you can do

Make a list of:

• Your symptoms, including any that may seem unrelated to the reason why you scheduled the appointment, and when they began
• Key medical information, including other conditions you have and history of injury to the painful joint
• All medications, vitamins or other supplements you take, including doses
• Questions to ask your doctor

Ask a relative or friend to accompany you, if possible, to help you remember the information you receive.

Some questions to ask your doctor about avascular necrosis include:

• What's the most likely cause of my symptoms?
• What tests do I need?
• What treatments are available?
• I have other health conditions. How can I best manage them together?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, including:

• Where's your pain?
• Does a particular joint position make the pain better or worse?
• Have you ever taken steroids such as prednisone?
• How much alcohol do you drink?