Avascular Necrosis

What is Avascular Necrosis

Avascular necrosis is a disease resulting from the temporary or permanent loss of blood supply to a bone. This disease may also be known as:

  • Osteonecrosis.
  • Aseptic necrosis.
  • Ischemic bone necrosis.

Without proper blood supply, the internal layer of the affected bone dies and the outer layer of the bone may break down. If this process affects a bone near a joint, it may lead to collapse of that joint. Common bones that are affected by this condition include:

  • The top of your thigh bone (femoral head).
  • One or more bones in your wrist (scaphoidor lunate).
  • One or more bones in your foot (metatarsals).
  • One of the bones in your ankle (navicular).

The joint most commonly affected by this condition is the hip joint.

Avascular necrosis rarely occurs in more than one bone at a time.

What are the causes?

  • Damage or injury to a bone or joint.
  • Using corticosteroid medicine for a long period of time.
  • Changes in your immune or hormone systems.
  • Excessive exposure to radiation.

What increases the risk?

  • Alcohol abuse.
  • Previous traumatic injury to a joint.
  • Using corticosteroid medicines for a long period of time or often.
  • Having a medical condition such as:
    • HIV or AIDS.
    • Diabetes.
    • Sickle cell disease.
    • An autoimmune disease.

What are the signs or symptoms?

The main symptoms of avascular necrosis are pain and decreased motion in the affected bone or joint. In the early stages the pain may be minor and occur only with activity. As avascular necrosis progresses, pain may gradually worsen and occur while at rest. The pain may suddenly become severe if an affected joint collapses.

How is this diagnosed?

Avascular necrosis may be diagnosed with:

  • A medical history.
  • A physical exam.
  • X-rays.
  • An MRI.
  • A bone scan.

How is this treated?

Treatments may include:

  • Medicine to help relieve pain.
  • Avoiding placing any pressure or weight on the affected area. If avascular necrosis occurs in your hip, ankle, or foot, you may be instructed to use crutches or a rolling scooter.
  • Surgery, such as:
    • Core decompression. In this surgery, one or more holes are placed in the bone for new blood vessels to grow into. This provides a renewed blood supply to the bone. Core decompression can often reduce pain and pressure in the affected bone and slow the progression of bone and joint destruction.
    • Osteotomy. In this surgery, the bone is reshaped to reduce stress on the affected area of the joint.
    • Bone grafting. In this surgery, healthy bone from one part of your body is transplanted to the affected area.
    • Arthroplasty. Arthroplasty is also known as total joint replacement. In this surgery, the affected surface on one or both sides of a joint is replaced with artificial parts (prostheses).
  • Electrical stimulation. This may help encourage new bone growth.

Follow these instructions at home:

  • Take medicines only as directed by your health care provider.
  • Follow your health care provider’s recommendations on limiting activities or using crutches to rest your affected joint.
  • Meet with a physical therapist as directed by your health care provider.
  • Keep all follow-up visits as directed by your health care provider. This is important.

Contact a health care provider if:

  • Your pain worsens.
  • You have decreased motion in your affected joint.

Get help right away if:

Your pain suddenly becomes severe.

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