Materiały źródłowe

• #1 Avascular necrosis (osteonecrosis) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/diagnosis-treatment/drc-20369863

  The goal is to prevent further bone loss. […] In the early stages of avascular necrosis, certain medications may help ease symptoms: […] Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter medications like ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) might help relieve pain associated with avascular necrosis. […] Osteoporosis drugs. These types of medications might slow the progression of avascular necrosis, but the evidence is mixed. […] Cholesterol-lowering drugs. Reducing the amount of cholesterol and fat in the blood might help prevent the vessel blockages that can cause avascular necrosis. […] Medications that open blood vessels. Iloprost (Ventavis) might increase blood flow to the affected bone. More study is needed. […] Blood thinners. For clotting disorders, blood thinners, such as warfarin (Jantoven), might prevent clots in the vessels feeding the bones.

• #2 Avascular Necrosis (Osteonecrosis): What Is It, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/14205-avascular-necrosis-osteonecrosis

  Avascular necrosis is a painful bone condition that gets worse over time and can affect your mobility. Most people need surgery sometimes joint replacement to ease pain and improve mobility. […] Your treatment will depend on the amount of damage to your bones. Potential treatments you might have if your bone damage is limited to smaller bones that don’t bear weight include: Cold packs. Heat treatment. Rest. Nonsteroidal anti-inflammatory drugs (NSAIDs). Physical therapy to ease joint tenderness and increase range of motion. Walking aids such as canes and crutches. […] In most cases, you’ll need surgery to treat your avascular necrosis. Surgical options can include: Core decompression: Your surgeon drills small holes (cores) in your affected bone to improve blood flow to the affected bone. This procedure might be combined with injections or bone grafts to promote healing. Joint replacement: They replace your damaged joint with an artificial one. Hip replacements and knee replacements are 95% effective at relieving pain and restoring mobility in people with avascular necrosis. […] Treatment can slow the progress of avascular necrosis, but there is no cure. Most people who have avascular necrosis eventually have surgery, including joint replacement.

• #3 Treatment of nontraumatic hip osteonecrosis (avascular necrosis of the femoral head) in adults – UpToDate

  https://www.uptodate.com/contents/osteonecrosis-avascular-necrosis-of-bone

  Treatment of nontraumatic hip osteonecrosis (avascular necrosis of the femoral head) in adults […] The treatment of nontraumatic osteonecrosis remains one of the most controversial subjects in the orthopedic literature. If the disease is caught in an early stage, the goal of therapy is to preserve the native joint for as long as possible. However, given that osteonecrosis often progresses, the mainstay of treatment is surgical, using either a joint-preserving procedure, if possible, or joint arthroplasty. […] The optimal treatment of nontraumatic osteonecrosis is unknown. The goal of treatment is to preserve the joint for as long as possible while taking into consideration the patient’s quality of life, including the patient’s age, mobility, occupation, and lifestyle. The three main therapeutic options for management of osteonecrosis include nonsurgical management, procedures to prevent or limit joint collapse (ie, joint preservation), and joint arthroplasty when advanced collapse has occurred.

• #4 Avascular Necrosis Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/333364-treatment

  Medical management of avascular necrosis (AVN) primarily depends on the location and severity of disease, as well as the patient’s age and general health. Treatment outcomes correlate directly with the stage of the disease. No medical treatment has proven effective in preventing or arresting the disease process. […] Conservative measures include analgesic medication and limited weight bearing with crutches. This may be beneficial and is a reasonable initial course of action if the involved segment is smaller than 15% and far from the weight-bearing region. Immobilization may be helpful in some cases (eg, AVN of the distal femur or tibia). In advanced AVN, the disease course is unaffected by activity and will eventually require surgery. […] Treatment with bisphosphonates may be helpful. Although large-scale, randomized, double-blind studies have not been performed, a systematic review of eight articles involving 788 hips suggested that alendronate has short-term efficacy in reducing pain, improving articular function, slowing of bone collapse progression, and delaying the need for total hip arthroplasty in adults with AVN.

• #5 Avascular Necrosis of the Hip > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/avascular-necrosis-of-the-hip

  Treatment includes physical therapy, medication, surgery, stem cell implantation, hyperbaric oxygen therapy. […] Fortunately, treatments have been developed for early-stage AVN of the hip that can help prevent the collapse of the joint and the need for hip replacement surgery. Core decompression with stem cell therapy is one such treatment. It uses the patients stem cells to help the AVN-damaged bone repair itself, with the aim of halting progression of the disease to prevent joint collapse. […] Non-surgical treatment options may be used to treat early-stage AVN. Although these treatment options can help improve symptoms, they usually do not stop the progression of AVN. Non-surgical treatments may include: Rest, Physical therapy to strengthen hip muscles and improve range of motion, Pain medication, such as nonsteroidal anti-inflammatory drugs (NSAIDs), to relieve pain, Use of crutches, canes, and walkers to lessen the amount of weight placed on the affected hip.

• #6 Avascular Necrosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537007/

  Osteonecrosis is a degenerative bone condition characterized by the death of cellular components of the bone secondary to an interruption of the subchondral blood supply. […] Therefore, early recognition and treatment of osteonecrosis are essential. This activity discusses the etiology and pathogenesis of the disease, presentation, and treatment options of the most common forms of osteonecrosis. […] Early-stage treatment options involve immobilization, cortisone injections, radial wedge osteotomy, and bone graft. Later stages may warrant arthroscopic debridement, scaphoid excision, proximal row carpectomy, or even arthrodesis. Typically, surgical intervention is unavoidable in most cases. […] Nonoperative treatment (Alendronate only therapy and bisphosphonates combination) is controversial, with some trials showing the benefit of bisphosphonates in preventing a femoral head collapse and delaying disease progression in early cases with subchondral lucency.

• #7 Avascular Necrosis Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/333364-treatment

  Iloprost, a vasoactive prostaglandin analog that is approved for inhalational treatment of pulmonary hypertension, has shown clinical and radiographic benefits in early-stage AVN when administered intravenously. Iloprost produces vasodilation and increases microcirculation, reducing bone marrow edema and relieving pain and other accompanying symptoms; it inhibits platelet aggregation and diminishes the concentration of oxygen free radicals and leukotrienes. […] Statin therapy to prevent corticosteroid-induced AVN may be helpful. Pritchett reported a 1% incidence of AVN in 284 patients who were on statin therapy during the entire period of corticosteroid treatment (average, 7.5 y). […] Extracorporeal shockwave therapy (ESWT) has shown beneficial effects in early AVN of the femoral head. ESWT may relieve pain, improve hip function, and induce regression of AVN.

• #8 Avascular necrosis (osteonecrosis) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/diagnosis-treatment/drc-20369863

  Your health care provider might recommend: […] Rest. Restricting physical activity or using crutches for several months to keep weight off the joint might help slow the bone damage. […] Exercises. A physical therapist can teach exercises to help maintain or improve the range of motion in the joint. […] Electrical stimulation. Electrical currents might encourage the body to grow new bone to replace the damaged bone. Electrical stimulation can be used during surgery and applied directly to the damaged area. Or it can be administered through electrodes attached to the skin. […] Because most people don’t develop symptoms until avascular necrosis is advanced, your health care provider might recommend surgery. The options include: […] Core decompression. A surgeon removes part of the inner layer of bone. Besides reducing pain, the extra space inside the bone triggers the production of healthy bone tissue and new blood vessels.

• #9 A Comprehensive Review of Treatment Strategies for Early Avascular Necrosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10788237/

  Protected weight-bearing is a fundamental component of the conservative treatment approach for individuals with AVN. This intervention aims to reduce mechanical stress on the affected joint, providing an environment conducive to healing compromised bone tissue. […] Activity modification is a crucial aspect of managing AVN, involving adjustments to daily activities to minimize strain on the affected joint. Individuals are guided to avoid activities that impose excessive stress on the compromised joint, such as prolonged standing or sitting, which could exacerbate symptoms and hinder healing. […] Nonsteroidal anti-inflammatory drugs (NSAIDs), including commonly used medications such as ibuprofen and naproxen, play a crucial role in the pharmacological management of AVN. These medications are employed to alleviate pain and reduce inflammation associated with the condition, providing symptomatic relief to individuals affected by AVN.

• #9 A Comprehensive Review of Treatment Strategies for Early Avascular Necrosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10788237/

  Avascular necrosis (AVN), characterised by compromised blood supply leading to bone necrosis, poses a significant challenge in orthopaedic and rheumatologic practice. This review comprehensively examines early AVN treatment strategies, including aetiology and risk factors, clinical presentation, conservative and surgical approaches, emerging therapies, and rehabilitation. Key findings underscore the importance of early detection, personalised treatment plans, and a multidisciplinary approach involving orthopaedic specialists, rheumatologists, and physical therapists. The implications for clinical practice emphasise individualised care, staying abreast of emerging therapies, and patient education. Recommendations for future management strategies highlight the need for imaging technology advancements, regenerative therapies integration, and ongoing research into genetic and molecular pathways. As the field continues to evolve, translating research findings into clinical practice holds promise for improving outcomes and enhancing the overall quality of life for individuals affected by AVN.

• #10 Avascular Necrosis Treatment – Bolge Hospital International

  https://bolgehospitalinternational.com/avascular-necrosis-treatment/

  Which physical therapy applications in avascular necrosis focus on exercises to maintain joint mobility and strengthen the muscles around the affected joint. The benefits of physical therapy in the management of the disorder have been proven by many studies. […] Physical therapy for avascular necrosis will begin after assessing your pain, joint mobility, and ability to complete tasks. Functional goals will be determined after this assessment. Your specialist may use the following methods to treat your condition: If deemed necessary by your physical therapist, you may use walking aids such as crutches or a wheelchair. In the early stages of the condition, reducing the amount of weight bearing will allow time for the bone to heal. Your physical therapist will have you gradually move the joint to prevent any swelling and encourage blood flow to the area. A strengthening program is usually recommended to keep the muscles around the joint strong. This program will help protect the joint. Gentle exercises will help increase circulation and promote healing. Heat packs can also be used to help increase blood flow to the area. Electrical stimulation will help promote bone growth. Hydrotherapy is effective for this condition because the heat of the pool increases blood flow to the area and the buoyancy of the water helps to keep the area free of weight bearing, which can aggravate pain. If you have had a joint replacement (prosthesis), your specialist will focus on restoring range of motion in the joint followed by a strengthening program. Areas that are particularly important to strengthen include the back and abdominal muscles, as they play a major role in stabilizing the hip.

• #11 Avascular Necrosis Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/333364-treatment

  Hyperbaric oxygen therapy (HBOT) has demonstrated beneficial effects in early AVN of the femoral head, leading to a reduction in self-reported pain scores, localized edema, and lesion size on radiographic imaging. […] Several surgical procedures have been used in an attempt to treat AVN, with variable success. No surgical procedure is the consensual best among surgeons in the treatment of AVN. In early stages of AVN (precollapse), core decompression with or without bone graft is typically considered the most appropriate treatment. In late stages, characterized by collapse, femoral head deformity, and secondary osteoarthritis, total hip arthroplasty is the most appropriate treatment. […] Core decompression improves circulation by decreasing intramedullary pressure and preventing further ischemia and progressive joint destruction. The best results vary from 34-95%, which is significantly better than results of conservative treatment.

• #12 Avascular Necrosis of the Hip > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/avascular-necrosis-of-the-hip

  Hyperbaric oxygen (HBO) therapy. Another nonsurgical treatment known as HBO therapy is a safe and effective option for patients with early-stage hip AVN. […] Surgical treatment options aim to improve symptoms, prevent or slow the conditions progression, and restore the hip joints function. […] Core decompression, a minimally invasive surgery, involves drilling into the part of the femoral head affected by AVN. […] Core decompression can be combined with stem cell therapy. […] Total hip replacement may be done if the femoral head has collapsed, there is substantial damage to the hip joint, or the acetabulum is damaged. […] A number of studies have found that core decompression surgery with stem cell injection typically offers improved outcomes compared to core decompression alone. Patients report less hip pain and improved hip function, and the procedure helps slow the progression of AVN, thereby reducing the chances of femoral head collapse and the need for total hip replacement surgery. […] At Yale, we have an integrated program that incorporates patients into a hyperbaric oxygen treatment plan.

• #13 Avascular necrosis (osteonecrosis) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/diagnosis-treatment/drc-20369863

  Bone transplant (graft). This procedure can help strengthen the area of bone affected by avascular necrosis. The graft is a section of healthy bone taken from another part of the body. […] Bone reshaping (osteotomy). A wedge of bone is removed above or below a weight-bearing joint, to help shift weight off the damaged bone. Bone reshaping might help postpone joint replacement. […] Joint replacement. If the affected bone has collapsed or other treatments aren’t helping, surgery can replace the damaged parts of the joint with plastic or metal parts. […] Regenerative medicine treatment. Bone marrow aspirate and concentration is a newer procedure that might help avascular necrosis of the hip in early stages. During surgery, the surgeon removes a sample of dead hipbone and inserts stem cells taken from bone marrow in its place. This might allow new bone to grow. More study is needed.

• #14 Avascular Necrosis Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/333364-treatment

  Bone grafting is combined with core decompression, which may interrupt the cycle of ischemia. […] The best results have been reported with free vascularized bone grafts. Success rates of 70% and 91% have been reported in two small series. […] Most patients with advanced disease (stage III and above) require total hip arthroplasty. Total hip arthroplasty provides excellent pain relief for many years, although most young patients require repeat surgery. […] The use of stem cells implanted via core decompression has been studied for the treatment of early-stage (precollapse) AVN of the femoral head. […] Systematic reviews of studies with patient-reported outcomes have demonstrated clinical benefit with the use of stem cells for hip AVN, with a low rate of complications, but have highlighted the lack of standardization with this technique.

• #15 Avascular Necrosis Treatment Denver CO | Osteonecrosis Treatment Denver CO

  https://www.orthosportsandjoints.com/avascular-necrosis-orthopedic-specialist-denver-co.html

  Avascular necrosis can be treated by one of the following methods: Core decompression: During this procedure, a portion of the inner layer of the bone is removed to relieve the pressure inside the bone. This decreases the pain and allows the growth of new blood vessels; thereby, stimulating new bone growth. Bone transplant: A healthy bone harvested from another part of your body is grafted into the affected area. Bone reshaping (osteotomy): This procedure is performed in advanced stages and involves reshaping of the bone which is done to decrease the stress placed over the affected bone. Joint replacement: Joint replacement surgery is performed as a last resort when the bone has collapsed, requiring artificial replacement.

• #16 Femoral Head Avascular Necrosis Treatment & Management: Acute Phase, Recovery Phase, Return to Play

  https://emedicine.medscape.com/article/86568-treatment

  A systematic review and meta-analysis reported that regenerative therapies such as mesenchymal stem cell implantation in the osteonecrotic area, intra-arterial infiltration with mesenchymal stem cells, implantation of bioactive molecules, or platelet-rich plasma provided a significant improvement in survivorship over time when combined with core decompression. […] Anticoagulation therapy in the form of enoxaparin was shown in one investigation to retard progression of early AVN. […] The antiresorptive, alendronate, was demonstrated to prevent collapse of early AVN.

• #17 Avascular Necrosis Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/333364-treatment

  Autologous platelet-rich plasma has been used in conjunction with core decompression in early-stage AVN of the femoral head. A systematic review concluded that adjunctive platelet-rich plasma improves the efficacy of core decompression in these patients, especially when combined with stem cells and bone grafts, by inducing osteogenic activity and stimulating the differentiation of stem cells in necrotic lesions. […] AVN of the femoral condyles (knees) may respond to more conservative intervention such as arthroscopic lavage and debridement. AVN of the femoral condyles has a better prognosis than hip AVN, although osteoarthritis eventually develops. […] Obtain consultation with an orthopedic surgeon. Early intervention can save affected joints and obviate the need for joint replacement.

• #18 Treatment of non‑traumatic avascular necrosis of the femoral head (Review)

  https://www.spandidos-publications.com/10.3892/etm.2022.11250

  High-energy ESWT is a non-invasive approach that has been used for treating ONFH since the end of the last century. […] HBO has proved to be highly effective against early stages of femoral head necrosis, particularly in Asian populations. […] The literature related to the non-surgical treatment methods for NONFH are summarized in Table II. […] CD is the commonest surgical procedure for early-stage osteonecrosis and is used to relieve pain and promote bone regeneration and repair. […] Despite the inconsistencies regarding the therapeutic effects of CD alone, the combination of CD with other treatment methods has shown encouraging results. […] PRP has 8-fold higher load of platelets compared with whole blood, along with high levels of regenerative cytokines such as platelet-derived growth factor, transforming growth factor, basic fibroblast growth factor, endothelial growth factor, insulin-like growth factor and VEGF.

• #19 Femoral Head Avascular Necrosis Treatment & Management: Acute Phase, Recovery Phase, Return to Play

  https://emedicine.medscape.com/article/86568-treatment

  The addition of a vascularized fibular graft to core decompression offers promise in cases with more advanced lesions, but this procedure involves considerable morbidity. […] The results of prophylactic measures for femoral head AVN have considerable variation, but certain generalizations can safely be stated. […] Osteotomies are performed in attempt to move necrotic bone away from primary weight-bearing areas in the hip joint. […] Despite aggressive management, most hips that undergo collapse ultimately require reconstruction (ie, replacement). […] Total hip arthroplasty is perhaps the most commonly performed and successful surgery for advanced AVN of the hip. […] Injections of cortisone into the hip joint may temporarily alleviate the symptoms of AVN; however, these injections are not generally recommended because of their invasiveness and short-lasting effects.

• #20 Minimally Invasive Avascular Necrosis Treatment Is Developed at Yale, Combining 3D Modeling With Computer Navigation < Yale School of Medicine

  https://medicine.yale.edu/news-article/yale-developed-technique-combines-3d-modeling-with-computer-navigation-to-deliver-minimally-invasive-avascular-necrosis-treatment/

  In a paper published in the journal Arthroplasty Today, Daniel Wiznia, MD, assistant professor of orthopaedics rehabilitation and co-director of Yale Medicines Avascular Necrosis Program, presents a new surgical technique designed to prevent or delay hip collapse in patients with femoral head avascular necrosis (AVN). […] According to Wiznia, treatment of AVN using core decompression and concentrated bone marrow with stem cells has been shown to reduce pain and hip collapse in early stages of disease, but current surgical techniques lack the ability to consistently direct treatment to the primary necrotic region where the bone is dying. […] In this paper, we demonstrate a minimally invasive, real-time 3D image-guided approach for delivering personalized treatment to the optimal location in the femoral head, Wiznia said.

• #21 Minimally Invasive Avascular Necrosis Treatment Is Developed at Yale, Combining 3D Modeling With Computer Navigation < Yale School of Medicine

  https://medicine.yale.edu/news-article/yale-developed-technique-combines-3d-modeling-with-computer-navigation-to-deliver-minimally-invasive-avascular-necrosis-treatment/

  By using this new surgical technique, more than 95 percent of patients were able to weight bear immediately following surgery without even requiring the assistance of crutches. […] Through this technique, we are aiming to improve clinical outcomes for patients with early-onset femoral head AVN by precisely targeting necrotic regions and allowing for better comparison between therapies by standardizing treatment protocols, Wiznia said.

• #22 Regenerating Bones: Stem Cells for Osteonecrosis in Young Adults

  https://www.uvaphysicianresource.com/regenerating-bones-treating-osteonecrosis-young-adults/

  Young adults often lead active lives, but a rare and debilitating disease of the hip bone puts many at risk for advanced arthritis and mobility problems. Osteonecrosis of the femoral head (ONFH) also known as avascular necrosis affects more than 20,000 Americans each year and is most common in people aged 30 to 50 years old, according to the American Academy of Orthopaedic Surgeons. […] UVA orthopedic surgeon Quanjun Cui, MD, is one of the few U.S. experts using bone-forming stem cells to regenerate healthy bone tissue. This procedure interrupts the trajectory of the disease, helping patients avoid surgery for much longer. […] The goal is to try to keep patients from getting an artificial joint too early in their lives, Cui says. Joint preservation is a much better option. […] If ONFH gets caught early enough, before too much disease progression, patients are potential candidates for hip-preserving procedures.

• #23 Avascular Necrosis & Osteonecrosis Program > Departments > Yale Medicine

  https://www.yalemedicine.org/departments/avascular-necrosis-and-osteonecrosis-program

  The Yale Avascular Necrosis Osteonecrosis program focuses on maintaining joint function in patients with avascular necrosis (AVN), a condition in which bone tissue dies as a result of a temporary or permanent loss of blood supply to the bone. […] Our patients receive coordinated care across a spectrum of treatments, including 3D surgical planning, regenerative medicine, osteoinductive adjuvants, hyperbaric oxygen treatments, and stem cell therapies. […] As a leader in AVN treatments, our innovative program merges evidence-based regenerative medicine with novel surgical techniques. […] We offer the following treatments for AVN- and osteonecrosis-related conditions: […] We offer a minimally invasive 3D personalized surgery to address AVN of the hip joint. […] We treat AVN-related shoulder conditions, with the goal of preserving the shoulder joint whenever possible.

• #24 Avascular Necrosis & Osteonecrosis Program > Departments > Yale Medicine

  https://www.yalemedicine.org/departments/avascular-necrosis-and-osteonecrosis-program

  Our specialists have developed treatment options for AVN of the foot and ankle joints that range from traditional, conservative approaches, such as generic or custom braces, to surgical management, including joint-preserving or -sacrificing procedures. […] Our Hand Upper Extremity experts offer treatment for Keinbocks disease, Hegemann’s disease, and Panner’s disease. […] Our specialists are recognized experts in the use of hyberbaric oxygen for the treatment of AVN with the femoral head. […] During the procedure, a patients bone marrow is harvested, and stem cells are concentrated and isolated. […] Patients who have experienced the collapse of their joint may benefit from a partial or total joint replacement.

• #25 Can SoftWave Therapy Help Treat Avascular Necrosis? – SoftWave

  https://softwaveclinics.com/blog/can-softwave-therapy-help-treat-avascular-necrosis/

  Avascular necrosis (AVN), also known as osteonecrosis, is a debilitating condition that occurs when blood flow to a bone is disrupted, leading to bone tissue death. […] Fortunately, regenerative therapies like SoftWave therapy show promise in the treatment of AVN. By enhancing tissue regeneration and improving blood circulation, SoftWave therapy can help revitalize the affected bone, promoting its health and well-being. […] Current treatment options for AVN aim to alleviate symptoms, slow disease progression, and improve joint function. Non-surgical approaches include pain medication, physical therapy to improve range of motion and strength, and assistive devices to reduce joint stress. […] Therefore, there is a need for effective alternative treatments that can address AVN and improve patient outcomes.

• #26 Can SoftWave Therapy Help Treat Avascular Necrosis? – SoftWave

  https://softwaveclinics.com/blog/can-softwave-therapy-help-treat-avascular-necrosis/

  SoftWave therapy is an innovative regenerative treatment that utilizes broad-focused shockwaves to stimulate tissue repair and improve blood flow to the affected area. […] By promoting tissue regeneration and increasing blood flow, SoftWave helps to restore vitality to the affected bone. This can potentially halt the progression of AVN, reduce pain, improve joint function, and delay or eliminate the need for invasive surgical interventions. […] SoftWave therapy presents a promising alternative for the treatment of AVN, offering the potential to stimulate tissue repair and enhance blood flow to the affected bone. […] It is essential to approach SoftWave therapy with the understanding that its suitability may vary depending on individual circumstances and the stage of AVN.

• #27 Avascular Necrosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537007/

  Core decompression is most effective in the early stages of osteonecrosis and when the lesions only involve a small amount of the weight-bearing surface of the femoral head. […] Total hip arthroplasty is indicated for irreversible etiologies and when patients are older than 40 years and have large lesions or in young with more advanced femoral head collapse and degenerate acetabulum. […] Core decompression and bone grafting can prevent the progression of osteonecrosis of the hip. However, with advanced disease or failure of joint-preserving therapies, total hip arthroplasty is needed but is associated with increased complication rates. […] Core decompression and hemiarthroplasty of the shoulder have good outcomes in treating AVN in the early stages. However, total shoulder arthroplasty has higher complication rates. Total shoulder arthroplasties are indicated for end-stage AVN but put the patient at risk for postoperative complications.

• #28 A Comprehensive Review of Treatment Strategies for Early Avascular Necrosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10788237/

  Early detection of avascular necrosis is paramount for achieving favourable treatment outcomes. The insidious nature of AVN often means that symptoms may not become apparent until the disease has advanced, emphasizing the need for vigilant monitoring and diagnostic measures. Timely intervention during the initial stages offers the best chance to preserve joint integrity, minimize pain, and prevent the need for more invasive procedures like joint replacement. […] This review will delve into various aspects of early avascular necrosis, including its pathophysiology, aetiology, and risk factors. The clinical presentation of AVN and diagnostic imaging techniques will be explored to provide a comprehensive understanding of how healthcare professionals can identify the condition in its nascent stages. Moreover, the review will thoroughly examine conservative and surgical treatment approaches, encompassing pharmacological interventions, physical therapy, and advanced surgical techniques. Emerging therapies, rehabilitation protocols, and long-term management strategies will also be discussed.

• #29 HIP- AVASCULAR NECROSIS/OSTEONECROSIS – Treatment

  https://davidslattery.com/hip-conditions/hav-osteonecrosis/treatment/

  If osteonecrosis has advanced to femoral head collapse, the most successful treatment is total hip replacement. This procedure involves replacing the damaged cartilage and bone with implants. […] Total hip replacement is successful in relieving pain and restoring function in 90 to 95 percent of patients. It is considered one of the most successful operations in all of medicine. […] Core decompression prevents osteonecrosis from progressing to severe arthritis and the need for hip replacement in 25% to 85% of cases. This depends upon the stage and size of the osteonecrosis at the time of the procedure. […] When osteonecrosis is diagnosed after collapse of the bone, core decompression is not usually successful in preventing further collapse. In this situation, the patient is best treated with a total hip replacement, which relieves pain and restores function in over 95% of patients.

• #30 Avascular Necrosis Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/333364-treatment

  In early AVN, patients should use crutches or other supports to avoid weight bearing. In advanced AVN, the disease course is unaffected by activity; surgery is the only option. […] The following precautions can be taken to minimize the risk of developing avascular necrosis (AVN) and to improve outcomes in these patients: Use the minimum effective dose of systemic corticosteroids; when possible, use steroid-sparing agents. Early diagnosis and treatment are important; the earlier AVN is detected, the more treatment (and less invasive) options available to the patient. Provide patient education for high-risk patients.

• #31 A Comprehensive Review of Treatment Strategies for Early Avascular Necrosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10788237/

  Mesenchymal stem cells (MSCs), derived from sources such as bone marrow or adipose tissue, have emerged as a promising avenue in regenerative medicine for the treatment of AVN. […] Angiogenesis modulators are medications currently being investigated for their potential in treating AVN. […] Lifestyle modifications play a crucial role in managing AVN in the long term and aim to reduce stress on the affected joint. […] Regular follow-up appointments with orthopaedic specialists or rheumatologists are essential for ongoing joint health monitoring in individuals with AVN.

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