Avascular necrosis can progressively weaken the bone within the hip and may eventually cause the joint surface to collapse. Early evaluation is important because treatment options often depend on how far the condition has progressed. Dr. Brian Cohen is a board-certified orthopedic surgeon with more than 20 years of experience, over 30,000 orthopedic surgical procedures performed, and more than 100,000 patient evaluations. He assesses the extent of bone damage, possible causes, and overall joint health to develop an individualized treatment plan for osteonecrosis.
What is Avascular Necrosis (AVN)?
Avascular necrosis, also called osteonecrosis or AVN, occurs when part of a bone loses its normal blood supply. Without sufficient blood flow, bone tissue may die and gradually weaken. As the condition progresses, the affected bone can collapse.
When osteonecrosis develops near a joint, damage to the bone and cartilage may eventually lead to degenerative arthritis. The condition most often affects the hip but may also develop in the shoulder, knee, or ankle.
Diagnosing Osteonecrosis
Diagnosis typically begins with a review of the patient’s symptoms, medical history, medication use, previous injuries, and known risk factors. Dr. Cohen may also examine the hip to assess tenderness, range of motion, strength, and discomfort with movement.
Imaging may include X-rays, MRI, or other studies. Early osteonecrosis may not be visible on an X-ray, while an MRI can often detect changes before the bone begins to collapse.
Osteonecrosis of the hip is commonly described in four stages:
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Stage I: Areas of damaged bone are visible on an MRI but not on an X-ray.
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Stage II: Bone damage is visible on an X-ray, but the femoral head has not collapsed.
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Stage III: Early collapse of the femoral head or a crescent-shaped fracture is visible.
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Stage IV: The femoral head has collapsed, and damage to the cartilage or surrounding joint is present.
Avascular Necrosis Causes and Risk Factors
The cause of osteonecrosis is not always identifiable. However, several injuries, medications, and medical conditions may interfere with blood flow to the bone or increase the risk of bone tissue damage.
Risk factors may include:
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A previous joint injury or fracture
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Blood clots or damage to nearby blood vessels
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Long-term or high-dose corticosteroid use
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Heavy alcohol use
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Obesity
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Certain medical treatments or medications
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Sickle cell disease
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Crohn’s disease
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Gaucher disease
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Systemic lupus erythematosus
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Arterial embolism or thrombosis
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Vasculitis
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Decompression sickness
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Pancreatitis
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Other autoimmune or blood disorders
Dr. Cohen reviews each patient’s medical history and possible risk factors when evaluating the cause and progression of osteonecrosis.
Osteonecrosis Symptoms
Osteonecrosis develops gradually, and some patients have no symptoms during its early stages. As the affected bone weakens, pain may begin and increase over time.
Symptoms of osteonecrosis of the hip may include:
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Pain in the hip or groin
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Pain that spreads into the thigh or buttock
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Limited range of motion
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Difficulty standing or placing weight on the affected leg
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A limp or change in walking pattern
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Certain medical treatments or medications
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Pain during activity that may later occur at rest
Without effective treatment, progressive bone collapse may damage the joint and contribute to arthritis.
Avascular Necrosis Treatment Options
Treatment for avascular necrosis depends on the stage of the condition, the location and extent of bone damage, and whether the joint surface has begun to collapse. Dr. Cohen also considers the patient’s age, overall health, medical history, possible cause of the condition, previous treatments, and personal goals.
Early-stage treatment may focus on reducing symptoms and slowing additional joint damage. More advanced osteonecrosis may require surgery to preserve the femoral head or replace the damaged joint.
Nonsurgical Treatment
Nonsurgical care may be recommended during the earlier stages of osteonecrosis or when surgery is not currently appropriate. The goal is to reduce pain, limit stress on the damaged bone, and address contributing medical conditions when possible.
Treatment may include:
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Activity modification
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Crutches or another assistive device to reduce weight-bearing
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Anti-inflammatory or pain medication
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Physical therapy to maintain motion and strength
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Electrical stimulation in selected cases
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Medication directed at an underlying clotting, cholesterol, or bone-health condition
Nonsurgical treatment may help manage symptoms, but it is generally less effective after the femoral head has begun to collapse.
Surgical Treatment
Surgery may be recommended when symptoms continue to worsen, imaging shows progressive bone damage, or the joint is at risk of collapse. The procedure selected depends largely on the stage and location of the osteonecrosis.
Surgical options may include:
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Core decompression: Removing a small portion of damaged bone to reduce pressure and encourage new blood flow.
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Bone grafting: Placing healthy bone tissue in the damaged area to provide support and promote healing.
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Osteotomy: Repositioning the bone to shift weight away from the damaged area.
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Total hip replacement: Replacing the damaged ball-and-socket joint when the femoral head has collapsed or advanced arthritis is present.
Dr. Cohen reviews the potential benefits, risks, and recovery requirements of each appropriate option before recommending surgery.
Why Choose Dr. Cohen?
OVER 25+ YEARS OF EXPERIENCE
One of the first orthopedic surgeons employed by a large hospital. Dr. Cohen spent 20 years.
TRUSTED BY OVER 100,000+ PATIENTS WORLDWIDE
Over his distinguished career, Dr. Cohen has cultivated a reputation of excellence and trust among his patients and his peers.
UTILIZING THE LATEST TECHNOLOGY
To achieve the best surgical outcomes, Dr. Cohen uses the most advanced technologies and techniques, keeping his practice state-of-the-art.
PATIENT SAFETY IS TOP PRIORITY
An individualized, patient-focused process coupled with decades of training and experience helps ensure maximum safety for all of Dr. Cohen’s patients.
Avascular Necrosis Care in Chillicothe, OH
Early evaluation of avascular necrosis may provide more opportunities to protect the affected bone and joint. Treatment may range from activity modification and symptom management to core decompression or total hip replacement, depending on the stage of the condition. Dr. Cohen develops a personalized plan based on imaging, overall health, and the extent of bone damage. To schedule a consultation with Dr. Brian Cohen, call (614) 788-0375.
