Healthy bone needs a constant supply of blood providing nutrients to its tissues. These tissues support your bones and keep them healthy. So when your bone loses its blood supply, the tissue starts to die — and eventually, the bone collapses.
The technical term for the collapse of bone tissue is avascular necrosis (AVN) or osteonecrosis. AVN can happen in the bones of the knee or shoulder but is most common in the hips.
With avascular necrosis of the hip, symptoms start with a loss of range of motion. The pain and stiffness worsen without treatment. Fortunately, there are many ways to treat AVN.
Fast Facts About Avascular Necrosis of the Hip
Avascular necrosis of the hip is a complicated condition. The orthopaedic team at UPMC specializes in helping people with AVN. A few helpful facts to consider:
- Doctors in the U.S. treat more than 20,000 people for AVN every year.
- AVN is most common between the ages of 40 and 65.
- More men than women get AVN.
- AVN commonly happens because of an injury to the bone. Damage to the arteries, radiation from cancer treatment, excessive alcohol use, or conditions that affect blood flow can also degrade bone.
- There are 4 stages of AVN, ranging from a healthy hip (stage 1) to severe osteoarthritis (stage 4).
AVN Symptoms and Diagnosis
You may find it difficult to tell the difference between the early stages of AVN and a sore hip from an injury. AVN is progressive, though, so the pain keeps getting worse. For persistent hip or groin pain, hip joint stiffness, or a worsening limp, you should see a doctor.
The earlier a doctor diagnoses AVN, the better chances you have to recover and keep doing the activities you love.
To diagnose AVN, the doctor will ask about your health history and test your range of motion by moving your hip. They will order non-invasive imaging scans (like x-rays and MRIs) to confirm the diagnosis. They may want to do a bone biopsy to look at a sample of the tissue directly.
Getting Treated for Avascular Necrosis
Treatment for AVN depends on what stage of the disease you’re in, your age, and your overall health. Most people with AVN will eventually need surgery. But other treatments can help relieve pain and delay the need for surgery.
These treatments include:
- Lifestyle changes: Rest can help, as can using crutches to limit the impact on the joint.
- Physical therapy: Our physical therapists can work with you to build strength and decrease pain.
- Medication: Anti-inflammatory drugs, such as ibuprofen and acetaminophen, can reduce your pain. Your doctor may also prescribe blood thinners to prevent blood clots. Statins, or drugs that lower your cholesterol, can keep fat from blocking the blood supply to your bones.
AVN Surgery
Orthopaedic surgeons treat AVN in four main ways. As with other kinds of treatment, the type of surgery your surgeon recommends depends on how severe your case is.
- Core decompression: The surgeon drills a hole in your bone to reduce pressure in the core. This improves blood circulation, which can make the bone tissue healthier. This surgery is an option for people with early stage AVN.
- Osteotomy: This surgery reshapes the bone to reduce stress on the joint. It’s a good option if AVR is only affecting a small area of bone.
- Bone grafting: The doctor takes healthy bone from you or a donor and places it into the diseased bone. In some procedures, the doctor may also include the artery and vein. Both types of grafting help regenerate healthy bone and support cartilage at the hip joint.
- Total hip replacement: People who have stage 3 or 4 AVN — essentially, a collapsed bone — usually need a hip replacement. This surgery removes the damaged bone and replaces it with artificial parts.
With specialists in each type of orthopaedic injury and condition, UPMC Orthopaedic Care has the experts to cater to your specific needs. Visit the Hip Preservation Program website to learn about treatment of both mild and severe hip-related problems, including AVN.