Avascular Necrosis (Osteonecrosis)

Avascular necrosis (AVN)—also called osteonecrosis or ischemic bone necrosis—is a disease in which bone tissue dies when the blood supply to the bone is cut off. Bone is living tissue that requires blood, so an interruption in the blood supply causes the bone to die.

Left untreated, AVN can lead to painful osteoarthritis. In extreme cases, avascular necrosis can result in the collapse of a segment of bone. If avascular necrosis occurs near a joint, the joint surface may collapse.

AVN can occur in any bone, but it most often happens in the ends of a long bone. The most common body part affected by avascular necrosis is the hip, but it also can occur in the knee, spine, shoulder and wrist. It may affect one bone, several bones at one time, or different bones at different times.

Avascular necrosis is most common in people between the ages of 30 and 60, and is often associated with drinking too much alcohol, long-term steroid use, injury such as bone fracture or joint dislocation, and conditions such as blood coagulation disorders.

There are few, if any, symptoms in the early stages of the disease. Over time, however, there is pain as bone and joint begin to collapse, and your range of motion may be limited due to the pain. The time between when the first AVN symptoms appear and loss of joint function can range from several months to over a year.

Treatment varies, depending on the location of the avascular necrosis and its severity, and may range from physical therapy and medications to surgery—including joint replacement. 

Because avascular necrosis can lead to disability—particularly if it occurs in the hip—it’s important to see a specialist as early as possible for an accurate diagnosis and appropriate treatment.

Why Choose Cooper to Treat Avascular Necrosis

Cooper University Health Care has a team of fellowship-trained and board-certified orthopaedic surgeons with extensive experience in diagnosing and treating avascular necrosis. You can count on us for:

  • Unparalleled clinical expertise: As part of South Jersey’s only academic medical center, our subspecialty-trained orthopaedic surgeons excel at caring for even the most complex and high-risk patients
  • The region’s most trusted referral center: Because of our experience and advanced expertise, Cooper is where the majority of South Jersey’s physicians send their patients for orthopaedic care   
  • The latest surgical techniques and technology: We use today’s most updated techniques including minimally invasive core decompression, bone grafting and joint replacements using the latest implant technology

Causes and Risk Factors for Avascular Necrosis

The most common causes of avascular necrosis include:

  • Bone fracture or joint dislocation
  • Damage to blood vessels from such conditions as blood clots or inflammation
  • Long-term use of certain medicines, such as corticosteroids
  • Excessive, long-term use of alcohol
  • Certain blood disorders

In addition to long-term steroid use or alcohol abuse, factors that may increase your risk of avascular necrosis include:

  • Gaucher disease, an inherited metabolism disorder
  • Blood disorders, such as sickle cell anemia
  • Radiation treatments
  • Chemotherapy
  • Pancreatitis
  • Decompression sickness (the “bends,” caused by nitrogen bubbles in the bloodstream)
  • Hypercoagulable state (an abnormal increased tendency for blood clotting)
  • Hyperlipidemia (an abnormally high concentration of fats in the blood)
  • Autoimmune disease
  • HIV

Symptoms of Avascular Necrosis

While each person may experience this disease differently, these are the most common AVN symptoms:

  • Little to no joint pain in the initial/early stages
  • Gradually increasing joint pain; at first, it may occur only when putting weight on the affected joint, then be present even at rest
  • As AVN progresses, the bone and surrounding joint surface may collapse, causing a dramatic increase in pain
  • Joint stiffness may limit range of motion in the affected joint
  • Disabling osteoarthritis may develop in the affected joint
  • Limited range of motion due to pain

Treating Avascular Necrosis

Specific treatment depends on the extent of your AVN, the location and amount of bone affected, the underlying cause, your overall health, and your preferences. The goal of initial treatment is to improve joint function and prevent further damage and collapse of the bone or joint.

Treatments to keep joints from breaking down include:

  • Medication: Over-the-counter or prescription medicines to help control pain
  • Assistive devices: Used to reduce weight on the bone or joint
  • Core decompression: A surgical procedure in which the inner layer of bone is removed to reduce pressure, increase blood flow, and slow or stop bone and/or joint destruction
  • Osteotomy: This procedure reshapes the bone and reduces stress on the affected area.
  • Bone graft: Healthy bone is transplanted from another part of the body into the affected area
  • Joint replacement: This surgical procedure removes and replaces an arthritic or damaged joint with an artificial joint

Other treatments may include electrical stimulation and combination therapies to promote bone growth.

Find an Avascular Necrosis Expert at Cooper

To learn more about the services available for treating avascular necrosis at Cooper or to request an appointment, please call 800-8-COOPER (800-826-6737).