Avascular necrosis (AVN) is when your bone starts to die because it isn’t getting enough blood flow. AVN most commonly happens in the hip but can also affect your knees and shoulders.
Over time, AVN weakens the bone and the joint, causing pain and making it harder to move your hip the way it should. Without treatment, the condition only gets worse.
Doctors often first try to slow the progression with nonsurgical treatments, but most people with AVN will need surgery.
At UPMC, our orthopaedic surgeons and sports medicine specialists have a lot of experience treating people with AVN.
Related services include:
AVN happens when a bone loses its blood supply. Without blood bringing essential nutrients, the tissue in the bone dies and, in time, the bone collapses.
Also called osteonecrosis of the hip, AVN can also happen in other joints, like knees or shoulders, but it usually affects the hip. When it does, doctors call this AVN of the femoral head.
Your femoral head is the “ball” of the ball-and-socket joint in your hip. The femur (thighbone) fits into the cup-shaped socket of your pelvis. Muscles, tendons, and ligaments hold the joint in place.
Without enough blood flowing to this joint, the bone dies and the joint weakens. This leads to bone necrosis or bone death.
Doctors in the U.S. treat more than 20,000 people for AVN every year. AVN causes about 10% of hip replacements.
AVN usually affects adults between the ages of 40 and 65. However, the group most likely to get AVN are men between ages 40 and 50 who do manual labor.
In general, AVN is more common in men than women. However, women who have lupus or other autoimmune disorders are also at risk.
AVN has four stages:
Doctors don’t always know what causes AVN. But there are some things we know can reduce the blood supply to a bone.
These include:
The reason AVN happens in the hip more than any other place is that long bones like your femur are more at risk.
If you know you’re at risk for AVN, you can seek treatment earlier and potentially avoid complications.
Anyone can get AVN, but some people are more at risk, including people who:
Left untreated, AVN can cause the tissue in the hip joint to die and, eventually, the bone can collapse. If this happens, walking without pain is very difficult.
In some cases, drugs like corticosteroids can cause this condition to worsen. If you've taken corticosteroids for a while, talk to your doctor about switching to a different drug to lower your risk of AVN.
In the early stages of this bone disorder, you may not display any symptoms.
But as AVN progresses, you may have:
At first, the pain may get better with rest. But, in the later stages of AVN, the pain can be more constant.
If you suspect you have avascular necrosis, you should see a doctor right away. The sooner you start treatment, the more you may be able to slow down the symptoms.
You don’t need a referral to make an appointment with UPMC orthopaedic doctors.
The earlier doctors diagnose and treat AVN, the better the chances of a good recovery.
Your doctor will:
To be able to see if there’s damage to the bone, the doctor may order imaging tests, such as:
The results of these imaging tests help us confirm the diagnosis and determine what stage you’re in. AVN has four stages, from mild to severe. If we can catch AVN in an early stage, when the hip is still healthy, there’s more we can do.
Ultimately, doctors can’t cure avascular necrosis without surgery. But not everyone needs surgery immediately after diagnosis.
The first goal of AVN treatment is to prevent more damage to the hip and give the bone a chance to heal.
With AVN treatment, we try to focus on:
Your treatment will depend on the stage of the disease, your age, and your overall health.
Your doctor will first try conservative treatment for AVN.
This may include:
Electrical stimulation, where electrical currents help your body produce new bone, is another nonsurgical AVN treatment option.
Your doctor may also prescribe drugs, depending on the cause of your AVN.
These can include:
Sooner or later, most people with AVN need surgery as the condition gets worse.
Surgical options for AVN include:
You can recover from AVN, but only with surgery. Nonsurgical treatment can help manage symptoms for a while, but these treatments can't cure it.
It’s similar to having severe osteoarthritis in your knees. There are ways to improve the pain for a while, but eventually, most people need a joint replacement to be pain-free.
Talk to your doctor about which surgical option is right for you. They all have recovery times that range from several weeks to several months. To fully recover, you’ll also need to do physical therapy.
