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.../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

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.