From the Guidelines
Treatment for avascular necrosis (AVN) should be guided by the stage of disease, with early intervention being crucial to prevent joint collapse, and the most recent evidence suggests that core decompression, bone grafting, and joint replacement surgery are effective treatments for advanced cases 1. The goal of treatment is to alleviate pain, improve function, and prevent further damage to the affected joint. For early-stage AVN, conservative measures include:
- Protected weight-bearing using crutches or a walker
- Physical therapy to maintain joint mobility
- Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for pain relief
- Bisphosphonates like alendronate (70mg weekly) may help slow disease progression by inhibiting bone resorption 1 For more advanced cases, surgical interventions become necessary, including:
- Core decompression, which involves drilling into the affected bone to reduce pressure and improve blood flow
- Bone grafting, which replaces damaged bone with healthy tissue
- Osteotomy, which repositions the bone to reduce weight on the damaged area
- Joint replacement surgery (arthroplasty), which becomes the definitive treatment in severe cases with joint collapse 1 It is essential to address the underlying cause of AVN, such as reducing corticosteroid use, managing alcohol consumption, or treating underlying conditions like sickle cell disease or lupus 1. Regular follow-up imaging is also crucial to monitor disease progression and treatment effectiveness. The most recent study on the topic, published in 2022, provides a comprehensive update on the diagnosis and treatment of osteonecrosis, highlighting the importance of early intervention and individualized treatment plans 1.
From the Research
Treatment Options for Avascular Necrosis
- Core decompression, physiotherapy, and bisphosphonates are established therapies for early-stage avascular necrosis 2
- Stem cell therapy is a promising new therapy method for stage 2 avascular necrosis 3, 2
- Proximal femoral osteotomies and (non)vascularised bone transplantation are performed in stage 2 and 3 2
- Free vascularised fibular graft (FVFG) is a better treatment option than core decompression and nonvascularised fibular grafting for avascular necrosis of the femoral head 4, 5
- Resurfacing or short stem hip arthroplasty can be performed in stage 4, depending on the size and location of the necrotic zone and pathology of the adjacent bone 2
- Conventional total hip arthroplasty (THA) is still the golden standard for stage 4 avascular necrosis 2
Emerging Therapies
- Regenerative therapies, such as stem cell therapy, are being researched and integrated into treatment plans 3, 6
- Imaging technology advancements and ongoing research into genetic and molecular pathways are needed to improve treatment outcomes 6
Rehabilitation and Management
- Early detection and personalised treatment plans are crucial for effective management of avascular necrosis 6
- A multidisciplinary approach involving orthopaedic specialists, rheumatologists, and physical therapists is recommended 6
- Patient education and individualised care are essential for improving outcomes and enhancing the overall quality of life for individuals affected by avascular necrosis 6