Avascular Necrosis - Causes and Treatment

What is Avascular Necrosis?


Avascular necrosis is the death of bone tissue due to a lack of blood supply. Also called osteonecrosis, it can lead to tiny breaks in the bone and cause the bone to collapse. The process usually takes months to years.

A broken bone or dislocated joint can stop the blood flow to a section of bone. Avascular necrosis is also associated with long-term use of high-dose steroid medications and too much alcohol.

Avascular necrosis is a painful bone condition that gets worse over time and can affect your mobility.

Your bones are constantly changing as your skeletal system makes new bone tissue to replace aging bone tissue that eventually breaks down and dies. Think of this as a cycle — your body makes new tissue to replace the tissue that’s breaking down and dying. This pattern needs to happen correctly to keep your bones healthy and strong. Blood carries the nutrients and oxygen bones need to stay healthy and regenerate. Without blood flow, your skeletal system can’t make new bone tissue fast enough. The dying bone begins to crumble and eventually collapses.

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Symptoms & Causes of Avascular Necrosis

Some people have no symptoms in the early stages of avascular necrosis. As the condition worsens, affected joints might hurt only when putting weight on them. Eventually, you might feel the pain even when you’re lying down.

Pain can be mild or severe. It usually develops gradually. Pain associated with avascular necrosis of the hip might center on the groin, thigh or buttock. Besides the hip, the shoulder, knee, hand and foot can be affected.

Some people develop avascular necrosis on both sides, such as in both hips or in both knees.

The hip bone is the most commonly affected joint with avascular necrosis. Avascular necrosis also commonly affects the knee. Less often, avascular necrosis affects bones in these areas:

  • shoulder
  • wrist
  • ankle
  • hands
  • feet

In its early stages, Avascular Necrosis may not cause symptoms. As blood cells die and the disease progresses, symptoms may occur in roughly this order:

  • mild or severe pain in or around the affected joint
  • groin pain that spreads down to the knee
  • pain that occurs when putting weight on the hip or knee
  • joint pain severe enough to limit movement

Causes Known causes of avascular necrosis are:

  • Traumatic Avascular Necrosis: This can happen after you break a bone or dislocate a joint.
    • Hip fractures and dislocations About 20% of people who dislocate their hips (the hip is no longer aligned in the joint as it normally would be) develop avascular necrosis.
  • Nontraumatic Avascular Necrosis: There are several medical conditions or treatment that can lead to avascular necrosis:
    • Osteoporosis Elderly women (and some men) sometimes have spontaneous avascular necrosis of the knee
    • Blood disorders, such as sickle cell anemia.
    • Diabetes.
    • Cancer treatments, such as radiation therapy.
    • Decompression sickness in scuba divers.
    • HIV.
    • Lupus.
    • Organ transplants.

Diagnosis of Avascular Necrosis

Your doctor will start with a physical exam. They’ll press on your joints to check for tender spots. They’ll move your joints through a series of positions to check your range of motion. You might get one of these imaging tests to look for what’s causing your pain:

  • Bone scan. The doctor injects radioactive material into your vein. It travels to spots where bones are injured or healing and shows up on the image.
  • MRI and CT scan. These give your doctor detailed images showing early changes in bone that might be a sign of Avascular Necrosis.
  • X-rays. They’ll be normal for early stages of Avascular Necrosis but can show bone changes that appear later on.


Treatment goals for Avascular Necrosis are to improve the joint, stop the bone damage, and ease pain. The best treatment will depend on a number of things, like:

  • Your age
  • Stage of the disease
  • Location and amount of bone damage
  • Cause of Avascular Necrosis

If you catch avascular necrosis early, treatment may involve taking medications to relieve pain or limiting the use of the affected area. If your hip, knee, or ankle is affected, you may need crutches to take weight off the damaged joint. Your doctor may also recommend range-of-motion exercises to help keep the joint mobile.

  • Medications. If the doctor knows what’s causing your avascular necrosis, treatment will include efforts to manage it. This can include:
    • Blood thinners. You’ll get these if your Avascular Necrosis is caused by blood clots.
    • Nonsteroidal anti-inflammatory drugs (NSAIDs). These will help with pain.
    • Cholesterol drugs. They cut the amount of cholesterol and fat in your blood, which can help prevent the blockages that lead to Avascular Necrosis.
  • Surgery. While these nonsurgical treatments may slow down the avascular necrosis, most people with the condition eventually need surgery. Surgical options include:
    • Bone grafts. Removing healthy bone from one part of the body and using it to replace the damaged bone
    • Osteotomy. Cutting the bone and changing its alignment to relieve stress on the bone or joint
    • Total joint replacement. Removing the damaged joint and replacing it with a synthetic joint
    • Core decompression. Removing part of the inside of the bone to relieve pressure and allow new blood vessels to form
    • Vascularized bone graft. Using your own tissue to rebuild diseased or damaged hip joints. The surgeon first removes the bone with the poor blood supply from the hip, then replaces it with the blood-vessel-rich bone from another site, such as the fibula, the smaller bone in your lower leg.
    • Electrical stimulation. An electrical current could jump-start new bone growth. Your doctor might use it during surgery or give you a special gadget for it.