Avascular necrosis is a condition in which bone tissue dies because of the absence of a blood supply. This condition, also called osteonecrosis or ischemic bone necrosis, has several potential causes, including joint injury, blood vessel damage and certain other medical conditions. The most common avascular necrosis treatment regimen includes medication and physical therapy. In some cases, surgery might be required. Avascular necrosis treatment can not immediately reverse the damage that has been done to the affected bone, but it can replace a diseased joint or graft new bone into an area where bone has been depleted.
When bone tissue is affected by avascular necrosis, bone cells, which are called osteocytes, begin to die off. This leads to the formation of tiny cracks within the bone matrix. If this condition is not treated, the progressive depletion of bone tissue eventually can cause the bone to collapse entirely. The most common joints to be affected are the shoulder, hip and knee. Symptoms include joint pain and loss of mobility, eventually leading to bone collapse and disability if not treated.
Although this condition is most often caused by an injury to the bone or damage or disease of blood vessels feeding the bone, there are other possible causes. These include long-term use of corticosteroids and chronic alcohol abuse. Other risk factors include diabetes, human immunodeficiency virus (HIV), lupus erythematosus, sickle cell disease and undergoing chemotherapy or radiation therapy for cancer treatment.
The primary goal of avascular necrosis treatment is to prevent further depletion of bone tissue. An additional goal is to restore lost joint function whenever possible. Generally, treatment is more conservative when the disease is diagnosed early, and treatment is likely to include surgery only when there are no other alternatives.
The most common avascular necrosis treatment for the early stages of the disease is medication. Medications commonly used include non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for mild pain and inflammation. If pain and inflammation does not respond to over-the-counter medication, prescription NSAIDs might be used. Early indications for other medication use suggest that osteoporosis medications such as bisphosphonates might be useful for the treatment of avascular necrosis.
Early-stage avascular necrosis treatment also includes physical therapy to help improve joint mobility. Newly diagnosed patients often work with a physical therapist to learn how to do exercises to increase the joint’s range of motion and to strengthen muscles to reduce joint strain. Resting the affected joint as much as possible also is important to help reduce the rate of bone depletion caused by the disease.
If the disease progresses or is diagnosed late, treatment often includes surgery. Surgical procedures include reshaping of bone to reduce joint and long bone stress, joint replacement or bone transplant. The success of surgery typically depends on whether the disease has been diagnosed early enough that bone health can be improved. Even though surgery often is successful, no treatments can as yet halt the progression of the disease or altogether prevent eventual bone destruction.