bone, joint, and muscle disorders
Osteonecrosis
Treatment of Osteonecrosis
Nonsurgical measures to relieve symptoms Surgical procedures Hip replacement Some areas affected by osteonecrosis need only nonsurgical measures to relieve symptoms. Other areas need to be treated with a surgical procedure. Several nonsurgical measures are available for treating the symptoms caused by osteonecrosis. Taking anti-inflammatory medications or other pain relievers, minimizing activity and stress (such as weight bearing for osteonecrosis of the hip and knee), and undergoing physical therapy are ways to relieve symptoms but not cure the disorder or change its course. These measures, however, may be adequate for treatment of the shoulder, the knee, spontaneous osteonecrosis of the knee, and small areas of osteonecrosis of the hip, which may heal without treatment. Osteonecrosis heals without treatment in some people if the affected area is small (for example, when osteonecrosis is recognized early and before it progresses) and not in the major weight-bearing area. Spontaneous osteonecrosis of the knee is usually treated without surgery, and pain usually resolves. There are a number of surgical procedures that slow or possibly prevent progression of the disorder. These procedures are done to preserve the joint and are most effective for treating early osteonecrosis, particularly of the hip, that has not yet progressed to bone collapse. If bone collapse has occurred, a type of joint replacement procedure may be done to decrease pain and improve function. the simplest and most common of these procedures, involves drilling one or many small tracks or holes (perforations) into the area in an attempt to decrease pressure inside the bone. Core decompression often relieves pain and stimulates healing. In approximately 65% of people, the procedure can delay or prevent the need for total Hip replacement . In younger people, core decompression may also be used even if a small amount of collapse already has taken place. The procedure is relatively simple, has a low rate of complications, and requires the use of crutches, a walker, or a cane for about 4 to 6 weeks. Most people have satisfactory or good results overall. However, results for any particular person can be hard to predict. Approximately 20 to 35% of people require a total hip replacement. During core decompression, surgeons may inject a person's own bone cells into the small hole or holes. This enhancement to the core decompression procedure may help heal the femoral head (which is part of the hip joint). Bone grafting(transplanting bone from one site to another) is another procedure. For osteonecrosis of the hip, this can involve removing the dead area of bone and replacing it with more normal bone from elsewhere in the body. This graft supports the weakened area of bone and stimulates the body to form new, living bone in the affected area. Anosteotomyis another procedure designed to save the affected joint. This procedure is done particularly in the region of the hip and may be suitable for younger people in whom some degree of collapse already has occurred, which makes them poor candidates for core decompression or other procedures. Usually the osteonecrosis is in the weight-bearing area of the femoral head. An osteotomy changes the position of the bone so that the weight of the body is now supported by a normal area of the femoral head and not by the collapsed area. Bone grafting and osteotomy are difficult procedures, however, and are not often done in the United States. When done for osteonecrosis of the hip or knee, they require a person to spend up to 6 months on crutches. These procedures are done only at selected centers that have the surgical experience and facilities to achieve the best results. is an effective procedure to relieve pain and restore motion if osteonecrosis has caused significant joint collapse and osteoarthritis. Approximately 95% of people benefit from Replacing All of a Hip (Total Hip Replacement) or In younger people with osteonecrosis, a total joint replacement may have to be revised (called revision surgery) or replaced at some later time. However, with modern devices, revision surgery has become much less common. Because total joint replacement is now so successful, there is much less need to do other procedures that replace part of the joint or remove the surface cartilage and place a cap on each bone end. Occasionally, a partial or total replacement of an extremely painful knee or shoulder may be needed for advanced osteonecrosis that is not alleviated by nonsurgical treatment. 