Diagnosis

During a physical exam your doctor will likely press around your joints, checking for tenderness. Your doctor may 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. The 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 may 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. Specific treatment usually depends on the amount of bone damage you already have.

Medications and therapy

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

  • Nonsteroidal anti-inflammatory drugs. Medications, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may help relieve the pain and inflammation associated with avascular necrosis.
  • Osteoporosis drugs. Medications, such as alendronate (Fosamax, Binosto), may slow the progression of avascular necrosis, but the evidence is mixed.
  • Cholesterol-lowering drugs. Reducing the amount of cholesterol and fat in your blood may 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), may 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. You may be referred to a physical therapist to learn 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 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 avascular necrosis is fairly advanced, your doctor may recommend surgery. The options include:

  • Core decompression. The 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). In this procedure, 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 allow you to postpone joint replacement.
  • Joint replacement. If your diseased bone has already collapsed or other treatment options aren't helping, you might need surgery to replace the damaged parts of your joint with plastic or metal parts. An estimated 10 percent of hip replacements in the United States are performed to treat avascular necrosis of the hip.
  • Regenerative medicine treatment. Bone marrow aspirate and concentration is a novel procedure that in the future 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 hip bone is removed and stem cells inserted in its place, potentially allowing for growth of new bone.

Clinical trials

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

Preparing for your appointment

You may be referred to a doctor who specializes in disorders of the joints (rheumatologist) or to an orthopedic surgeon.

What you can do

  • Write down your symptoms, including any that may seem unrelated to the reason why you scheduled the appointment.
  • Write down your key medical information, including other conditions and any history of injury to the painful joint.
  • Write down key personal information, including any major changes or stressors in your life.
  • Make a list of all your medications, vitamins or supplements.
  • Ask a relative or friend to accompany you, to help you remember what the doctor says.
  • Write down questions to ask your doctor.

Questions to ask your doctor

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

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may make time to go over points you want to discuss in-depth. You may be asked:

  • Where exactly does it hurt?
  • How long have you had this pain?
  • Does any particular joint position make the pain better or worse?
  • Have you ever taken steroids, such as prednisone?
  • How much alcohol do you drink?
March 21, 2015
References
  1. Ferri FF. Ferri's Clinical Advisor 2015: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2015. https://www.clinicalkey.com. Accessed Jan. 23, 2015.
  2. Jones LC, et al. Osteonecrosis (avascular necrosis of bone). http://www.uptodate.com/home. Accessed Jan. 19, 2015.
  3. Firestein GS, et al. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2013. http://www.clinicalkey.com. Accessed Jan. 23, 2015.
  4. AskMayoExpert. Who gets avascular necrosis of the hip? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2015.
  5. Questions and answers about osteonecrosis (avascular necrosis). National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Osteonecrosis/default.asp. Accessed Jan. 23, 2015.
  6. Chang-Miller A (expert opinion). Mayo Clinic, Phoenix/Scottsdale, Ariz. Jan. 29, 2015.
  7. Issa K, et al. Osteonecrosis of the femoral head: The total hip replacement solution. Bone & Joint Journal. 2013;95-B:46.