Avascular Necrosis Treatment

Osteonecrosis, also known as avascular necrosis, is a condition in which decreased blood flow to bones leads to the death of bone tissue. It most commonly affects the hips, knees, shoulders and other large joints, causing pain, stiffness and eventual joint collapse if left untreated.

What is avascular necrosis (osteonecrosis)?

Osteonecrosis occurs when the blood supply to a bone is interrupted, depriving bone cells of essential nutrients and oxygen. Over time, the affected bone weakens and collapses, often resulting in joint damage.

What causes avascular necrosis?

Avascular necrosis is caused by bone fractures or diseases that block blood flow to bone tissue. About 20% of avascular necrosis cases occur without an obvious cause.

Known causes of avascular necrosis include:

Traumatic avascular necrosis:This condition can occur after a bone fracture or dislocation of a joint.

Non-traumatic avascular necrosis:This type of condition occurs if you have a disease or medical condition that blocks blood flow to your bone tissue. Non-traumatic avascular necrosis usually affects the same bones on both sides of the body. For example, if you have avascular necrosis in your right shoulder, you are likely to have it in your left shoulder as well.

Other medical conditions that can lead to avascular necrosis:

  • Osteoporosis
  • Blood disorders, such as sickle cell disease
  • Diabetes
  • Cancer treatments, such as radiation therapy
  • Decompression sickness (the bends)
  • HIV
  • Lupus
  • Organ transplant

Which bone fractures cause traumatic avascular necrosis?

Avascular necrosis is more likely to develop with certain bone fractures than with others. Common bone fractures that cause traumatic avascular necrosis are hip fractures and dislocations. Approximately 20% of people who dislocate their hips develop avascular necrosis.

What are the symptoms of avascular necrosis?

It may take weeks or months for you to notice signs that you have avascular necrosis. Some symptoms that develop over time and may indicate avascular necrosis include:

  • Pain in the affected joint during movement or at rest
  • Increasing pain and stiffness in the joints
  • Limited range of motion
  • Limping if you have avascular necrosis in your hips or knees
  • Difficulty climbing stairs, standing, or walking.
  • In advanced stages, visible deformity or joint instability is possible

Who is most commonly affected by avascular necrosis?

Avascular necrosis can affect any age and gender, but it is most common in people in their 30s and 40s. Some lifestyle activities that increase the risk of avascular necrosis include:

  • Excessive alcohol use
  • Smoking
  • Long-term use of corticosteroids (prednisone)

In which areas does avascular necrosis develop?

Avascular necrosis can affect bone tissue in any joint, but it most commonly targets your hips. Other joints that can develop avascular necrosis include:

  • Ankles
  • Jaw
  • Knees
  • Upper arms (humerus) and shoulders

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How is avascular necrosis diagnosed?

Diagnosis of the condition usually involves the following steps:

  1. Medical History and Physical Exam
  2. Imaging Tests:
    • X-rays show advanced bone damage.
    • MRI detects early bone changes.
    • CT scans provide detailed images for surgical planning.
  1. Bone Biopsy: Rarely, a biopsy is needed to confirm the diagnosis.

How is avascular necrosis (osteonecrosis) treated?

Your treatment will depend on the extent of damage to your bones. If your bone damage is limited to smaller, non-weight-bearing bones, possible treatments include:

  • Cold compresses
  • Heat therapy
  • Rest
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Physical therapy to relieve joint tenderness and increase range of motion
  • Walking aids, such as canes and crutches

In advanced cases, you will often need surgery to treat it. Some types of surgery include:

Core decompression:Your surgeon drills small holes (cores) into your affected bone to improve blood flow to the bone. This procedure may be combined with injections or bone grafts to promote healing.

Joint replacement (prosthesis):In this procedure, your damaged joint is replaced with an artificial joint (prosthesis/implant). Hip replacement and knee replacement are highly effective in relieving pain and restoring mobility in people with avascular necrosis.

Bone Grafting: The process of transplanting healthy bone tissue to support damaged areas.

Osteotomy: The realignment of bone to reduce stress on the affected area.

Is physical therapy helpful for avascular necrosis?

Which physical therapy applications in avascular necrosis focus on exercises to maintain joint mobility and strengthen the muscles around the affected joint. The benefits of physical therapy in the management of the disorder have been proven by many studies.

In a case report; it is shown that a multidisciplinary approach including medical, surgical treatment and physical therapy rehabilitation is extremely beneficial in reducing pain, improving functional independence and quality of life in a patient with stage 4 femoral avascular necrosis followed by pyogenic arthritis.

In another case report, improvement was observed in the patient’s hip joint limitation, pain, posture and posture disorders, balance and fatigue levels after physical therapy. In addition, an increase was recorded in daily living activities and functional mobility level.

What physical therapy applications are performed in avascular necrosis?

Physical therapy for avascular necrosis will begin after assessing your pain, joint mobility, and ability to complete tasks. Functional goals will be determined after this assessment. Your specialist may use the following methods to treat your condition:

  • If deemed necessary by your physical therapist, you may use walking aids such as crutches or a wheelchair.
  • In the early stages of the condition, reducing the amount of weight bearing will allow time for the bone to heal. Your physical therapist will have you gradually move the joint to prevent any swelling and encourage blood flow to the area.
  • A strengthening program is usually recommended to keep the muscles around the joint strong. This program will help protect the joint.
  • Gentle exercises will help increase circulation and promote healing. Heat packs can also be used to help increase blood flow to the area.
  • Electrical stimulation will help promote bone growth.
  • Hydrotherapy is effective for this condition because the heat of the pool increases blood flow to the area and the buoyancy of the water helps to keep the area free of weight bearing, which can aggravate pain.
  • If you have had a joint replacement (prosthesis), your specialist will focus on restoring range of motion in the joint followed by a strengthening program. Areas that are particularly important to strengthen include the back and abdominal muscles, as they play a major role in stabilizing the hip.

Can avascular necrosis be prevented?

Although not all cases are preventable, the following steps can reduce the risk:

  • Limit alcohol consumption.
  • Use corticosteroids only as prescribed.
  • Seek medical attention immediately for any underlying medical conditions.
  • Live a healthy lifestyle with regular exercise and a balanced diet.

How should you approach osteonecrosis?

Lifestyle adjustments and early intervention are essential for individuals diagnosed with osteonecrosis. Regular follow-ups with your doctor, adherence to prescribed treatments, and weight management can help slow the progression of the disease and preserve joint function.

Osteonecrosis is a serious condition that requires timely diagnosis and treatment. Advances in imaging and treatment offer hope for maintaining joint health and quality of life. If you suspect you may have osteonecrosis, consult a healthcare professional.

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