Avascular Necrosis

Diagnosis

Doctor will perform a physical examination and look for tenderness around the joints. The joints will be moved to different directions to determine if the range of motion is still the same.

Imaging tests

• X-rays tends to be normal in the early stage of the disease. It will demonstrate abnormalities in the bones that appear in the advanced stages of avascular necrosis.
• Magnetic resonance imaging (MRI) and Computerized Tomogtaphy (CT) scan creates clear images that reveal changes in the bones from an early stage, which might be a sign of avascular necrosis.
• Bone scan is a procedure that requires a radioactive material to be injected into the vein. The material then goes to the injured or healing parts of the bones and appears as bright signs on the imaging plate.

Treatment

Medications

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (or naproxen sodium), can be used for pain relief.
• Osteoporosis drugs such as alendronate that may delay the development of avascular necrosis, however the proofs are not definite.
• Cholesterol-lowering drugs decrease the level of cholesterol and fat in the blood and stop the blockage of blood vessels that can result in avascular necrosis.
• Blood thinners such as warfarin, may be advised if you have clotting disorder to prevent blood clots in the vessels.

Therapy

• Rest or reduce stress on the bone that has been affected your will delay the destruction.
• Exercises can help maintain the joint’s range of motion.
• Electrical stimulation can be used to trigger the body to build new bones and replace the destroyed bones. This procedure can be carried out during surgery and used on the affected spot. It can also be applied through electrodes attached to the skin.

Surgery 

Surgery would be recommended when avascular necrosis has progressed to the later stages.

• Core decompression is the process of removing certain portion of the internal layers of the bones. Aside from diminishing the pain, the production of healthy bone tissue and new blood vessels can be stimulated.
• Bone graft (transplant) is the procedure that healthy bone is transplanted from other part of the body into the affected area of bone.
• Bone reshaping (osteotomy) is when a chunk of bone is removed from the above or beneath a weight-bearing joint. This is to help take the weight off the bone that has been damaged. Reshaping of bone may allow the patient to delay joint replacement surgery.
• Joint replacement surgery is performed when bones are collapsed or alternative treatments are not improving the condition.