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Treatments for AVN. Page 1 of 3

Treatments for avascular necrosis AVN offered by different Orthopaedic Surgeons will vary between cases, the patients age will also be taken into consideration on any decision or recommendation.

Goals for all treatments

Hospital treatments for AVNHospital treatments for AVN

Preserve joint function and strength.

Relieve symptoms.

Halt the progress of the disease.

Decrease symptoms.

Decision for surgical intervention using x-rays, MRI scans, clinical and physical symptoms.

Limiting load bearing

There is no indication that this prevents the final collapse of the joint, but pain relief can be effective. Load bearing can be achieved simply by using a walking stick, crutches or wheelchair for extended mobility. Even a combination of the three depending on individual circumstances.

Core decompression

Removing part of the inside of the bone (core decompression) to relieve pressure and allow new blood vessels to form. This involves drilling small holes in the bone from the uninfected through to the infected part of the bone. This encouraging blood to flow to the infected part with the hope of regrowth.

For hips

The simplest operation is to drill one or several holes through the femoral neck and into the femoral head, trying to reach the area that lacks blood supply. The drill bores out a plug of bone within the femoral head. This operation is thought to do two things: (1) it creates a channel for new blood vessels to quickly form into the area that lacks blood supply, and (2) it relieves some of the pressure inside the bone of the femoral head. Relieving this pressure seems to help decrease the pain patients experience from AVN.

Decompression is often accompanied by the use of bone grafts with or without growth factors, a procedure designed to stimulate bone growth at the site of the defect. The donated bone comes from the patient (taken from the pelvic bone or lower leg). The bone is crushed up into tiny pieces and applied to the hole or defect caused by the necrotic process.

The decompression operation (with or without bone grafting) is done through a very small incision in the side of the thigh. The surgeon watches on a fluoroscope as a drill is used. A fluoroscope is a type of X-ray that shows the bones on a TV screen. The surgeon uses the fluoroscope to guide the drill where it needs to go. This operation is usually done as an outpatient procedure, and you will be able to go home with crutches the same day.

.../Cont. Treatments for AVN. Page 2 of 3

Fibular vascularised bone graft

For hips

TreatmentsTreatmentsA more complicated procedure to try to increase the blood supply to the femoral head is a vascularised fibular bone graft procedure. This is actually a tissue transplant. The graft is taken from the fibula (the thin bone that runs next to the shin bone). The graft is vascularised, meaning it has a blood supply of its own. Because it supports the femoral head, the graft is also referred to as a strut graft.

The surgeon removes a piece of the small bone in your lower leg (the fibula) along with the blood vessels to the bone. The surgeon then drills a hole through the side of the femur and into the femoral head. The surgeon attaches the blood vessels from the fibula to one of the blood vessels around the hip. This creates instant blood flow into the bone graft and into the head of the femur.

This operation does two things:

1. Brings blood flow to the femoral head through the bone graft.

2. Fibular bone graft is strong, and keeps the femoral head from collapsing as the bone heals itself.

The procedure is an inpatient procedure and will require you to stay in the hospital for several days.

This is a very complicated operation and is not commonly done. It is not always successful because the blood supply to the graft is fragile and may not form completely.


Osteotomy for hips

Cutting the bone and changing its alignment to relieve stress on the bone or joint. In cases of small lesions involving less than one-third of the surface of the femoral head, rotational osteotomy has been very successful. The procedure involves making a cut through the bone and turning the head of the femur so that the necrotic bone is no longer bearing any weight.

Osteotomy for knees

Surgery involves cutting and re-aligning the bone (usually shin bone/tibia) in order to re-distribute the weight going through the knee. Re-alignement can be achieved by either taking a slice of bone out of the tibia (shin bone) or femur (thigh bone) close to the knee joint (closing wedge) or opening a gap in the bone (opening wedge).

Stem cell therapy

Using the patients own stem cells taken from bone marrow, these cells are inserted into the small holes performed with core decompression. This is a relatively new technique. Results are inconclusive, some report excellent recovery and others report no improvement at all.

Hyperbaric Oxygen Treatment HBOT

Still under debate -  No verified results are available.

Claims made for HBOT:

  1. Reduces bone marrow oedema
  2. Increases oxygen delivery to ischemic (blood deprived) cells
  3. Reduce pain by reducing marrow pressure
  4. Stimulates growth of new blood vessels
  5. Stimulates the growth of new bone

It works by the patient entering a chamber, which is then regulated above atmospheric pressure, similar to a decompression chambers used for divers. They then breath 100% oxygen while inside the chamber.

There are a number of constraints for using HBOT, pregnancy, chemotherapy drugs etc. There is also a chance of problems related to the ear. 

Sadly there has been tragic loss of lives resulting from using these HBOT chambers, involving explosions and fires, pure oxygen is very flammable.

The debate is open to the actual results for AVN.

HBOT is not readily available in the UK.

.../Cont. Treatments for AVN. Page 3 of 3

Joint replacement - Arthroplasty

TreatmentsTreatmentsIt is generally accepted that preservation of the bodies own joint should always be the priority. However, when the joint finally collapses, joint replacement is the final solution for many sufferers. Once decided upon,  consideration should be given to the lifetime of the replacement joint compared to the age of the recipient, with the full understanding of the consequences and difficulties of what happens when the artificial joint fails.

For hips

When AVN is in the advanced stages, the condition is no different from osteoarthritis of the hip joint. Your surgeon will probably recommend replacing the hip with an artificial hip joint. For those patients with a limited bone defect that only affects the femoral head and does not extend into the hip socket, a resurfacing procedure might be considered. Hip resurfacing arthroplasty is a type of hip replacement that replaces the arthritic surface of the joint but removes far less bone than the traditional total hip replacement.

For knees

Knee replacement surgery (arthroplasty), involves replacing a damaged, worn or diseased knee with an artificial joint. It's a routine operation for knee pain most commonly caused by arthritis. More than 70,000 knee replacements are carried out in England and Wales each year, and the number is rising. Most people who have a total knee replacement are over 65.

For most people, a replacement knee will last for at least 15 to 20 years, especially if the new knee is cared for properly and not put under too much strain.

Types of surgery There are two main types of surgery, depending on the degree of collapse of the knee joint:

  • Total knee replacement (TKR) - both sides of your knee joint are replaced.
  • Partial (half) knee replacement (PKR) - only one side of your joint is replaced in a smaller operation with a shorter hospital stay and recovery period.

For shoulders

Total shoulder replacement surgery alleviates pain by replacing the damaged bone and cartilage with a metal and plastic implant. The shoulder joint is a ball-and-socket joint, much like the hip joint. The ball is the top of the arm bone (the humerus), and the socket is within the shoulder blade (scapula). This joint allows people an enormous range of motion at the shoulder.

When shoulder replacement surgery is performed, the ball is removed from the top of the humerus and replaced with a metal implant. This is shaped like a half-moon and attached to a stem inserted down the centre of the arm bone. The socket portion of the joint is shaved clean and replaced with a plastic socket that is cemented into the shoulder blade.

Important warning

Chinese Femoral Head hospital, or anything named similar.

Offering amazing claims for resolving AVN - Be warned, this is a complete scam, many people have lost thousands of pounds. Please don't go there.