Avascular Necrosis – Diagnosis and Treatment
Diagnosis
Imaging Procedures
Doctors use different scans to check for avascular necrosis in the hip or other joints. X-rays help spot bone damage, but they may not show early bone death because changes are hard to see at first.
MRI scans and CT scans can reveal small changes in bone tissue and show problems with blood supply before the bone collapses.
Doctors may use a bone scan, which uses a safe tracer injected into the bloodstream to highlight areas of the bone with poor blood flow. Bright spots on these scans may show injured or dying bone.
Additional Details
Stiffness and joint pain often occur with avascular necrosis. Joint injuries, dislocations, and conditions that affect blood vessels are risk factors. Early detection helps prevent hip bone collapse.
Treatment
Medicine Options
Doctors suggest different medicines to manage joint pain and slow bone damage. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen help with pain and swelling.
Doctors may prescribe stronger NSAIDs if regular doses do not work. Medicines for bone health, such as those for osteoporosis, may slow bone changes, but they do not help everyone.
Some patients take medicine to lower cholesterol, since high cholesterol can block blood vessels in the bone. Doctors may give medicines that widen blood vessels to improve bone blood flow.
Blood thinners are sometimes used if blood clots are a concern. Doctors choose medicines based on the patient’s health, stage of bone damage, and other conditions. Not everyone needs all of these medicines.
Physical Approaches and Support
Rest protects the joint. Doctors may recommend keeping weight off the joint, sometimes using crutches, to prevent more damage. Physical therapy helps support joint movement and keeps people active.
Therapists teach exercises that improve mobility. Some treatments use electrical currents to help the body create new bone. Doctors can apply “electrical stimulation” during surgery or through pads placed on the skin over the damaged area.
Doctors and physical therapists often create a care plan together. The goal is to reduce pain and keep the joint working well.
Operations and Other Interventions
If medicines and therapy do not control the condition, doctors may recommend procedures.
The options depend on how much bone has been damaged:
| Procedure | Description |
|---|---|
| Core decompression | Removes a small section from inside the bone to relieve pressure. |
| Bone transplant (graft) | Places healthy bone from another site to provide strength and support. |
| Bone reshaping (osteotomy) | Removes or reshapes part of the bone to shift weight from the damaged area. This might delay the need for full joint replacement. |
| Joint replacement | Swaps out the damaged joint with artificial parts, most often metal or plastic. |
| Regenerative procedures | Uses stem cells from bone marrow to help new bone grow, but more study is needed. |
Doctors help each patient choose the best surgical approach based on bone damage, age, and daily needs.
Getting Ready for Your Visit
Steps You Can Take Beforehand
Write down all symptoms, even those that seem unrelated to joint pain. Note when symptoms started and how they have changed.
Keep a list of health conditions, past injuries, and all medicines or supplements, including the dose. Bring this list to share with your provider.
Prepare questions about pain, injury, joint movement, physical activities, physical therapy, use of crutches, or assistive devices. Ask about alcohol consumption and managing other conditions like HIV.
Consider bringing a family member or friend for support and to help remember details.
Example of a Symptom Log:
| Symptom | Start Date | Changes Over Time |
|---|---|---|
| Hip pain | 2 weeks ago | Worse after walking |
| Decreased motion | 2 days ago | Only in the mornings |
What the Doctor Might Discuss
A healthcare provider may ask where you feel pain and if certain activities make it better or worse. They could talk about how previous injuries or health problems affect your symptoms.
The provider may ask about your current medications or if you use steroids. They might also ask how much and how often you drink alcohol.
The provider may ask if you can move the joint, take part in physical therapy, or use aids like crutches. These questions help the provider decide what to do next.
