How is osteonecrosis treated?
Although nonsurgical treatment options — such as anti-inflammatory medications, activity changes, and using crutches — can help relieve pain and slow the progression of the disease, the most successful treatment options are surgical. Patients with osteonecrosis that is caught in the very early stages (before the femoral head collapses) are potential candidates for hip-preserving procedures.
There are several different surgical procedures used to treat osteonecrosis of the hip, including:
Osteochondral (Bone and Cartilage) Grafting
Core decompression is often combined with bone and cartilage grafting to help regenerate healthy bone and support cartilage at the hip joint. A bone graft is healthy bone tissue that is transplanted to an area of thebody where it is needed. The tissue may be taken from a donor (allograft) or from another bone in your body (autograft). There are also several synthetic bone grafts available today.
Core decompression prevents osteonecrosis from progressing to severe arthritis and the need for hip replacement in some cases. This depends upon the stage and size of the osteonecrosis at the time of the procedure.
Core decompression achieves the best results when osteonecrosis is diagnosed in its early stages, before the bone collapses. In some of these cases, the bone heals and regains its blood supply after core decompression. It takes a few months for the bone to heal and, during this time, you will need to use a walker or crutches to avoid putting stress on the damagedbone.
Patients with successful core decompression procedures typically return to walking unassisted in about 3 months and have complete pain relief.
Vascularized Fibula Graft
Another surgical option is a vascularized fibula graft. In this procedure, a segment of bone is taken from the small bone in your leg (fibula) along with its blood supply (an artery and vein). This graft is transplanted into a hole created in the femoral neck and head, and the artery and vein are reattached to help heal the area of osteonecrosis.
When osteonecrosis is diagnosed after collapse of the bone, core decompression is not usually successful in preventing further collapse. In this situation, the patient is best treated with a total hip replacement. Total hip replacement is successful in relieving pain and restoring function in the majority of patients with osteonecrosis.