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Treating avascular necrosis with surgery is usually reserved for the more severe cases. Later stages may also be treated with surgical methods. There are several surgical options available that patients can discuss with their doctors if surgery becomes necessary.
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This surgical procedure involves removing a portion of the inner layer of the affected bone. This can reduce the patient's pain through relieving pressure in the affected bone. With the new extra space, new blood vessels can form, stimulating new bone production. Patient's may receive either general or spinal anesthesia for this procedure. The surgeon will drill into the hip bone through the dead area. This surgical procedure is most successful when done before the joint collapses. Patients will have to use crutches for the six weeks after their surgery in order to prevent fracture risk.
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This surgical procedure has several different types, however, they all share the same goal. The goal of osteotomy is to try and relocate some living cartilage to the area that bears weight, through trying to shift the diseased femoral head, so that patient's will experience less pain when they walk. After this procedure is done, patients must severely limit their activity for three to twelve months.
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This procedure, sometimes referred to as a bone transplant, includes taking a piece of healthy bone, or a graft, from the bone located below the knee and placing it on the core once the procedure core decompression is complete. The grafting can be either vascularized, meaning using the hip's blood vessels, or non-vascularized, meaning not using the hip's blood vessels. With a vascularized procedure, the patient may not get complete relief from their pain and they will have to ensure a longer recovery period. There is also a chance that nerve damage to the calf can occur affecting the bone that the graft was taken from. When a bone graft is performed, most patients will require six to twelve months of recovery.
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Also referred to as a joint replacement, this procedure may be done when other treatments are not effective or when the bone that is diseased has already collapsed. This procedure uses an artificial joint to replace the damaged joint. When a total hip replacement is done, the best results tend to follow, often resulting in most or all of the patient's pain going away and relatively normal joint function is experienced by about 90 to 95 percent of patients. With all of the new devices and surgical techniques, most artificial hips will last and maintain function for a minimum of ten to fifteen years for most patients. Treating avascular necrosis with surgery via arthroplasty will result in a lengthy recovery period, however, lasting for several months. Patients will also have to spend significant time learning how to use their new joint.
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MedlinePlus. (2009). Osteonecrosis. Retrieved on September 14, 2010 from MedlinePlus: http://www.nlm.nih.gov/medlineplus/ency/article/007260.htm
MayoClinic.com. (2010). Avascular Necrosis. Retrieved on September 14, 2010 from MayoClinic.com: http://www.mayoclinic.com/health/avascular-necrosis/DS00650