Avascular necrosis (osteonecrosis)

During a physical exam, a health care provider will press around your joints, checking for tenderness. They might also move the joints through different positions to see if the range of motion is lessened.

Imaging tests

Many conditions can cause joint pain. Imaging tests can help pinpoint the source of pain. Tests may include:

• X-rays. They can reveal bone changes that occur in the later stages of avascular necrosis. In the condition's early stages, X-rays usually don't show any problems.
• MRI and CT scan. These tests produce detailed images that can show early changes in bone that might indicate avascular necrosis.
• Bone scan. A small amount of radioactive material is injected into a vein. This tracer travels to the parts of bones that are injured or healing. It shows up as bright spots on the imaging plate.

The goal is to prevent further bone loss.

Medications

In the early stages of avascular necrosis, certain medications may help ease symptoms:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter medications like ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) might help relieve pain associated with avascular necrosis. Stronger nonsteroidal anti-inflammatory drugs (NSAIDs) are available by prescription.
• Osteoporosis drugs. These types of medications might slow the progression of avascular necrosis, but the evidence is mixed.
• Cholesterol-lowering drugs. Reducing the amount of cholesterol and fat in the blood might help prevent the vessel blockages that can cause avascular necrosis.
• Medications that open blood vessels. Iloprost (Ventavis) might increase blood flow to the affected bone. More study is needed.
• Blood thinners. For clotting disorders, blood thinners, such as warfarin (Jantoven), might prevent clots in the vessels feeding the bones.

Therapy

Your health care provider might recommend:

• Rest. Restricting physical activity or using crutches for several months to keep weight off the joint might help slow the bone damage.
• Exercises. A physical therapist can teach exercises to help maintain or improve the range of motion in the joint.
• Electrical stimulation. Electrical currents might encourage the body to grow new bone to replace the damaged bone. Electrical stimulation can be used during surgery and applied directly to the damaged area. Or it can be administered through electrodes attached to the skin.

Surgical and other procedures

Because most people don't develop symptoms until avascular necrosis is advanced, your health care provider might recommend surgery. The options include:

• Core decompression. A surgeon removes part of the inner layer of bone. Besides reducing pain, the extra space inside the bone triggers the production of healthy bone tissue and new blood vessels.
• Bone transplant (graft). This procedure can help strengthen the area of bone affected by avascular necrosis. The graft is a section of healthy bone taken from another part of the body.
• Bone reshaping (osteotomy). A wedge of bone is removed above or below a weight-bearing joint, to help shift weight off the damaged bone. Bone reshaping might help postpone joint replacement.
• Joint replacement. If the affected bone has collapsed or other treatments aren't helping, surgery can replace the damaged parts of the joint with plastic or metal parts.
• Regenerative medicine treatment. Bone marrow aspirate and concentration is a newer procedure that might help avascular necrosis of the hip in early stages. During surgery, the surgeon removes a sample of dead hipbone and inserts stem cells taken from bone marrow in its place. This might allow new bone to grow. More study is needed.

Your health care provider might refer you to a doctor who specializes in disorders of the joints (rheumatologist) or to an orthopedic surgeon.

What you can do

Make a list of:

• Your symptoms, including those that seem unrelated to the reason you scheduled the appointment, and when they began
• Key medical information, including other conditions you have and history of injury to the painful joint
• All medications, vitamins or other supplements you take, including doses
• Questions to ask your provider

Ask a relative or friend to accompany you, if possible, to help you remember the information you receive.

Some questions to ask your provider about avascular necrosis include:

• What's the most likely cause of my symptoms?
• What tests do I need?
• What treatments are available?
• I have other health conditions. How can I best manage them together?

Don't hesitate to ask other questions.

What to expect from your doctor

Your provider is likely to ask you questions, including:

• Where's your pain?
• Does a particular joint position make the pain better or worse?
• Have you ever taken steroids such as prednisone?
• How much alcohol do you drink?