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Avascular Necrosis

Avascular necrosis (also called osteonecrosis) occurs when blood flow to bones in the joints is disrupted. Deprived of blood, the bone eventually starts to die and may eventually collapse.

Without treatment to keep the bone from breaking down, the pain typically grows so intense and movement becomes so limited that the joint can’t be used at all. This usually happens within two years of the first symptoms.

Doctors don’t always know why avascular necrosis happens, but some known causes and risk factors include the following:

  • Steroids
  • Alcohol use
  • Injury
  • Radiation therapy
  • Chemotherapy
  • Organ transplant

This disease is most common in the hips, knees, shoulders and ankles. It can affect more than one joint at a time.

Avascular necrosis: things you should know

  • Often, there are no symptoms at first. But as the disease gets worse, you will most likely start to feel pain in the affected joint. You may also have problems moving or bending the joint, or even feel pain when you’re not using the joint.
  • Treatment helps more when the disease is caught in the early stages. That’s why it’s important to talk to your doctor before the symptoms become crippling.

How can I get help for avascular necrosis?

See your doctor or a primary care sports medicine doctor if you experience any of the following:

  • Pain in a joint that is getting worse
  • Increasing difficulty bending or moving a joint
  • Pain in a joint even when you are resting

Care for avascular necrosis at Rush

A primary care sports medicine specialist can determine whether your pain is due to avascular necrosis or another condition. If you are diagnosed with avascular necrosis, your doctor will recommend a treatment plan with the following goals in mind:

  • Improving your ability to use the joint
  • Preventing further damage
  • Protecting the joint and bones

Treatment may start with nonsurgical options:

  • Rest
  • Anti-inflammatory medications
  • Electrical stimulation

These conservative treatments can only relieve pain, however. They cannot treat the disease or prevent bone death and breakdown. Your doctor may prescribe bisphosphonates to help preserve your bone density and strength. But most people with avascular necrosis eventually need surgery.

If surgery is recommended for you, you will be referred to an orthopedic surgeon at Rush. There are four procedures used to treat this condition. Which procedure you have depends on many factors, including which joint is affected and the extent of the damage:

  • Core decompression surgery to increase blood flow to the bone
  • Osteotomy to reshape the bone and relieve stress on the joint
  • Bone graft to replace damaged areas of bone with healthy new bone
  • Total joint replacement to replace the damaged joint with an artificial (metal and plastic) one

In some cases, orthopedic surgeons at Rush are able to use minimally invasive approaches for these procedures that offer patients less pain and a faster recovery. Your surgeon will discuss the options with you and determine which procedure will work best.

Why choose Rush for avascular necrosis care

  • The Orthopedics program at Rush is consistently ranked among the best in the country by U.S. News & World Report.
  • When it comes to joint replacement surgery, the experience of your surgeon can make a difference in how well you do after the procedure. Orthopedic surgeons at Rush perform around 3,800 hip replacements and knee replacements each year — among the most of any single center in the U.S.
  • The team of physical therapists, rehabilitation specialists and other experts at Rush can help you recover from your procedure and put you back on the path toward an active life.
  • The Orthopedic Building offers one convenient place to go for orthopedic care. You can see an orthopedic specialist, get your imaging tests, have outpatient procedures, and go through rehabilitation — all under one roof.

Departments and programs that treat this condition