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Avascular Necrosis Treatment

Surgery as a Treatment Option

There are several surgical options for treating avascular necrosis. Some of these options include:
  • Core decompression
  • Osteotomy
  • Bone graft
  • Arthroplasty/total joint replacement.
Core Decompression
Core decompression removes the inner layer of bone, which reduces pressure within the bone, increases blood flow to the bone, and allows more blood vessels to form. Core decompression works best in people who are in the earliest stages of avascular necrosis, often before the collapse of the joint. This treatment sometimes can reduce pain and slow down the progression of bone and joint destruction in these patients.
An osteotomy reshapes the bone to reduce stress on the affected area. There is a lengthy recovery period, and the patient's activities are limited for 3 to 12 months after an osteotomy. This procedure is most effective for patients with advanced avascular necrosis and those with a large area of affected bone.
Bone Graft
A bone graft may be used to support a joint after core decompression. Bone grafting is surgery that transplants healthy bone from one part of the patient, such as the leg, to the diseased area. In many cases, grafts (called vascular grafts) that include an artery and veins are used to increase the blood supply to the affected area.
There is a lengthy recovery period after a bone graft, usually from 6 to 12 months. This avascular necrosis treatment is complex and its effectiveness is not yet proven. Clinical studies are underway to determine its effectiveness.
Arthroplasty/Total Joint Replacement
Total joint replacement is the treatment of choice in late-stage avascular necrosis and when the joint is destroyed. In this surgery, the diseased joint is replaced with artificial parts. It may be recommended for people who are not good candidates for other avascular necrosis treatments, such as patients who do not do well with repeated attempts to preserve the joint.
Various types of replacements are available, and people should discuss specific needs with their doctor. Two common total joint replacements are total hip replacement and total knee replacement.
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