Materiały źródłowe

• #1

  https://link.springer.com/article/10.1007/s00296-023-05373-8

  The current systematic review aimed to document published cases of femoral head avascular necrosis (FHAVN) post-COVID-19, to report the COVID-19 disease characteristics and management patients received, and to evaluate how the FHAVN were diagnosed and treated among various reports. […] Femoral head avascular necrosis post-COVID-19 infection is a real concern, primarily attributed to corticosteroid usage, besides other factors. Early suspicion and detection are mandatory, as conservative management lines are effective during early stages with acceptable outcomes. However, surgical intervention was required for progressive collapse or patients presented in the late stage. […] The current review confirmed the concerns some authors raised about FHAVN development in patients recovering from COVID-19 infection; most of the reports related this to corticosteroid administration as part of the COVID-19 management plan; however, other factors were suggested. In most hips, conservative management was adequate with acceptable outcomes; however, surgical intervention was required for progressive collapse or patients presented in the late stage.

• #1 Avascular necrosis: Symptoms, treatment, and more

  https://www.medicalnewstoday.com/articles/avascular-necrosis

  The main methods of preventing avascular necrosis involve addressing the risk factors that are possible to change. […] This may include: […] consuming alcohol in moderation […] quitting smoking, if applicable […] discussing alternatives to corticosteroids with a doctor, if a person takes these medications.

• #1 Mayo Clinic Health Library – Avascular necrosis (osteonecrosis) | Swiss Medical Network

  https://www.swissmedical.net/fr/healtcare-library/con-20369841

  To reduce the risk of avascular necrosis and improve general health: […] Limit alcohol. Heavy drinking is one of the top risk factors for developing avascular necrosis. […] Keep cholesterol levels low. Tiny bits of fat are the most common substance blocking blood supply to bones. […] Monitor steroid use. Make sure your health care provider knows about your past or present use of high-dose steroids. Steroid-related bone damage appears to worsen with repeated courses of high-dose steroids. […] Don’t smoke. Smoking narrows blood vessels, which can reduce blood flow.

• #1 Osteonecrosis of the Hip & Hips and Thigh | Sforzo Dillingham

  https://sforzodillingham.com/hips/osteonecrosis-of-the-hip-hips-and-thigh/

  Osteonecrosis (Avascular Necrosis) of the Hip Treatments […] Once the diagnosis of avascular necrosis of the hip is over and the results turn out to be positive, your doctor may suggest the most appropriate osteonecrosis treatment option such as: […] Prevention of Osteonecrosis (Avascular Necrosis) of the Hip […] There are many ways to prevent the risk of avascular necrosis problems. These prevention measures are in place to help you improve your health and live happily. Some of these effective ways to prevent avascular necrosis hip include: […] Limiting alcohol consumption: Heavy drinking of alcohol is one of the major reasons for developing avascular necrosis hip. […] Maintaining low cholesterol levels: Small bits of fat are considered the most common substances that block the blood supply to the hip bone. When your hip joint or hip bone lacks enough blood, avascular necrosis occurs.

• #1 Osteonecrosis of the Hip & Hips and Thigh | Sforzo Dillingham

  https://sforzodillingham.com/hips/osteonecrosis-of-the-hip-hips-and-thigh/

  Monitoring steroid use: During the diagnosis, allow your healthcare provider to know more about your present and past medical history. This may include the use of steroids to treat other conditions. Higher doses of steroids can cause bone damage that may worsen over time. […] Quit cigarette smoking: Heavy smoking of cigarettes is likely to increase the risk of avascular necrosis.

• #1 Osteonecrosis (ON) – Musculoskeletal and Connective Tissue Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/osteonecrosis/osteonecrosis-on

  Risk of osteonecrosis caused by corticosteroids can be minimized by using them only when essential and by giving them in as low a dose as needed and for as short a duration as possible. Patients should be informed of this complication when long-term and/or high-dose corticosteroid use is anticipated. […] To prevent osteonecrosis caused by decompression sickness, people should follow accepted rules for decompression when diving and when working in pressurized environments. […] Excessive alcohol use and smoking should be discouraged. Evidence for the efficacy of various medications (eg, anticoagulants, vasodilators, lipid-lowering medications) for prevention of osteonecrosis in patients at high risk is limited and inconclusive.

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

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

  Abstinence from excessive alcohol intake and taking the lowest possible dose of a corticosteroid (when indicated) are the 2 chief means of AVN prevention. […] Patients should also stop or avoid smoking tobacco products, as there is an increased risk of nontraumatic osteonecrosis of the femoral head, particularly in those who never received oral corticosteroids. […] There are some data regarding cholesterol-lowering statin therapy as a means of decreasing the risk of AVN for those receiving corticosteroids. […] Cutaneous electrical stimulation, in the form of capacitive coupling, is purported by some to have a disease-modifying effect, although long-term studies are lacking. […] Anticoagulation therapy in the form of enoxaparin was shown in one investigation to retard progression of early AVN. […] Lastly, the antiresorptive, alendronate, was demonstrated to prevent collapse of early AVN.

• #1 Osteonecrosis of the Femoral Head in Patients with Hypercoagulability—From Pathophysiology to Therapeutic Implications

  https://www.mdpi.com/1422-0067/22/13/6801

  Osteonecrosis of the femoral head (ONFH) is a debilitating disease with major social and economic impacts. […] Recognition of the prothrombotic state as part of the etiopathogeny of primary ONFH provides an opportunity for early medical intervention, with implications for both prophylaxis and therapy aimed at slowing or stopping the progression of the disease. […] Since significantly high prevalence of coagulation abnormalities is reported in patients with primary ONFH, our review aimed to conduct an in-depth analysis of their implications in the occurrence and progression of this disease. Additionally, since patients with inherited thrombophilia and hypofibrinolysis benefit from anticoagulant treatment in prophylaxis and treatment of thrombotic events, we also focused on anticoagulant use in primary ONFH patients with a hereditary thrombophilia-hypofibrinolysis background.

• #1

  https://journals.lww.com/md-journal/fulltext/2017/04210/the_use_of_anticoagulants_for_prevention_and.47.aspx

  Osteonecrosis of the femoral head (ONFH) is a progressive disease, which mainly affects young adults and often necessitates total hip arthroplasty (THA), so early interventions are critical to successfully protect hip joint from THA. In this review, our purpose was to determine the effects of anticoagulants for preventing and treating the primary and secondary ONFH, respectively, before the collapse stage or before the pathology of necrosis. […] Our findings supported that the anticoagulants could be used for primary ONFH. However, anticoagulants cannot play a protective role on secondary ONFH. […] Given this process characterized by bone death and reduced local blood flow, we performed a study with a purpose of determining the efficacy of anticoagulants for preventing and treating the primary and secondary ONFH on its precollapse stage to improve the hip prognosis.

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

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

  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 […] For patients undergoing pelvic radiotherapy, a variety of pharmacologic interventions for preventing AVN have been studied, including supplemental calcium and/or vitamin D, bisphosphonates, selective estrogen receptor modulators, hormone replacement therapy (estrogen or testosterone), denosumab, and calcitonin. However, a Cochrane review concluded that the evidence relating to those interventions is of very low certainty.

• #1 Osteonecrosis – Bone, Joint, and Muscle Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/bone-joint-and-muscle-disorders/osteonecrosis/osteonecrosis

  Stopping smoking, stopping excessive alcohol use, and minimizing the use of or lowering the dose of corticosteroids reduce the risk of developing osteonecrosis. […] To minimize the risk of osteonecrosis caused by corticosteroids, doctors use these medications only when essential, prescribe them in as low a dose as needed, and prescribe them for as short a duration as possible. […] To prevent osteonecrosis caused by decompression sickness, people should follow accepted rules for decompression during diving and when working in pressurized environments. […] Excessive alcohol use and smoking should be avoided. […] Various medications (such as those that prevent blood clots, dilate blood vessels, or lower lipid levels) have been evaluated for prevention of osteonecrosis in people at high risk, but there is no strong evidence that they are highly effective.

• #1 Avascular Necrosis Washington, DC – Scott Faucett, MD

  https://www.scottfaucettmd.com/conditions-and-treatments/hip/avascular-necrosis-washington-dc/

  To reduce your risk of avascular necrosis: […] Limit alcohol: Heavy drinking is one of the top risk factors for developing avascular necrosis. […] Keep cholesterol levels low: Tiny bits of fat are the most common substance blocking blood supply to the femoral head. […] Monitor steroid use: Make sure Dr. Faucett knows about your past or present use of high-dose steroids. Steroid-related bone damage appears to worsen with repeated courses of high-dose steroids. […] Avoid smoking: Smoking increases the risk of AVN […] Always monitor your dive ascents and avoid unsafe diving practices.

• #1 Osteonecrosis of the Jaw (ONJ): Stages, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24156-osteonecrosis-of-the-jaw

  Everyone should practice good oral hygiene like daily brushing and flossing and having regular dental check-ups. You may be able to reduce your risk of ONJ by having gum disease treatments. […] Its very important that your dentist or oral surgeon knows you receiving antiresorptive medications. They may be able to treat your dental issue with less invasive procedures. For example, if you need to have a tooth removed, your dentist may do a root canal instead of extracting your tooth. When possible, your provider may use less invasive treatments like a root canal instead of a tooth extraction.

• #1 AVN Clinics™

  https://www.avnclinics.com/blogs/avascular-necrosis-of-the-jaw.php

  Avascular necrosis of the jaw treatment involves antibiotics, pain relief medications, and oral rinses. […] Here are a few ways to prevent or reduce the risk of Avascular Necrosis of the jaw: […] If possible, have a routine dental examination and any necessary invasive dental treatment, before starting bisphosphonates treatment. […] While undergoing bisphosphonates treatment, maintain good mouth hygiene and have regular dental check-ups. […] If possible, invasive dental procedures should be avoided when undergoing bisphosphonates treatment. If invasive treatment is necessary, one must consult an experienced oral and maxillofacial surgeon.

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

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

  Studies show that local non-weight bearing can reduce the occurrence of femoral head deformity following ischemic osteonecrosis by increasing revascularization and reducing bone resorption in the infarcted epiphysis, although it does not stimulate new bone formation. […] Therefore, weight bearing can prevent the occurrence and development of osteonecrosis, especially femoral head collapse, in subjects at the early stage of the disease. […] Lipid-lowering agents, anticoagulants, vasoactive substances, statins and bisphosphonates have been used to prevent and treat femoral head necrosis at the early-stages. […] Overall, bisphosphonate drugs can be considered for treating femoral head necrosis caused due to metabolic disturbances. […] Studies show that the development of ONFH in the hip joint is associated with an increase in the number and size of circulating fat cells.

• #1 The efficacy of Denosumab in the treatment of femoral head osteonecrosis: a retrospective comparative study | Scientific Reports

  https://www.nature.com/articles/s41598-024-54685-7

  Denosumab can significantly reduce the volume of necrotic lesions and prevent femoral head collapse in patients with ARCO stage I or II ONFH. […] Denosumab is now being widely used, particularly in the treatment of osteoporosis as it can inhibit osteoclastic and bone resorption in patients. […] Denosumab has also been suggested as a novel treatment strategy to decrease femoral head deformity after ischaemic osteonecrosis in animal models. […] The important finding of this study is that necrotic lesions can be diminished after denosumab treatment in ONFH patients whose femoral head not collapsed. […] This suggests that denosumab can be used as an effective adjuvant therapy when combined with other hip preservation therapies for ONFH patients. […] If untreated, symptoms develop in 55.9% of asymptomatic ONFH cases, then which can lead to femoral head collapse and hip joint destruction.

• #1 Is There a Role of Pharmacological Treatments in the Prevention or Treatment of Osteonecrosis of the Femoral Head?: A Systematic Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6416144/

  Various pharmacological treatments have been suggested to treat osteonecrosis of the femoral head. However, their practicability remains a controversial issue. […] No pharmacological prevention or treatment of osteonecrosis is recommendable at this moment. […] Considering risk and lack of evidence, no pharmacological prevention or treatment of osteonecrosis is recommendable at this moment.

• #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: […] These types of medications might slow the progression of avascular necrosis, but the evidence is mixed. […] Reducing the amount of cholesterol and fat in the blood might help prevent the vessel blockages that can cause avascular necrosis. […] Your health care provider might recommend: […] Restricting physical activity or using crutches for several months to keep weight off the joint might help slow the bone damage. […] Electrical currents might encourage the body to grow new bone to replace the damaged bone. […] Because most people don’t develop symptoms until avascular necrosis is advanced, your health care provider might recommend surgery.

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

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

  Therefore, the lipid-lowering statins that are used to treat steroid-related inflammatory disorders can potentially be therapeutic against ONFH. […] Traditional Chinese medicine formulations have been used to treat osteonecrosis for decades. […] 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. […] The current treatments for NONFH can be classified into non-surgical and surgical methods. […] Core decompression is the commonest surgical procedure for early-stage osteonecrosis and is used to relieve pain and promote bone regeneration and repair.

• #1 Hip Avascular Necrosis in Young Adults: Risk Factors and Prevention Strategies

  https://www.srinobharammd.com/blog/hip-avascular-necrosis-in-young-adults-risk-factors-and-prevention-strategies-41908.html

  Preventing AVN involves addressing the risk factors: […] Limit Steroid Use: If steroids are recommended for a particular condition, use the lowest effective dose for the shortest possible time. […] Protect Your Hip: Use protective gear such as padding to reduce the risk of hip injuries. […] Exercise: Regular, low-impact activities like swimming or cycling can improve joint health without excessive strain. […] Nutrition: A balanced diet rich in calcium and vitamin D supports bone health. […] Quit Smoking and Reduce Alcohol Consumption: This may help to improve blood flow to the joint. […] Regular Check-Ups: Early detection of hip AVN may allow the condition to be treated conservatively.

• #1 Avascular Necrosis (osteonecrosis): What is, Stages, Causes, Symptoms, Treatment Options & Different parts It Affects

  https://www.polarishealthcare.in/post/avascular-necrosis

  Avoid prolonged corticosteroid use: If you require corticosteroid medications for the treatment of inflammatory conditions, work closely with your healthcare provider to minimize the duration and dosage of these medications whenever possible. Consider alternative treatment options and discuss potential risks and benefits with your doctor. […] Regular health check-ups: Schedule regular health check-ups with your healthcare provider to monitor your overall health and identify any potential risk factors for AVN. Be proactive in discussing your medical history, lifestyle habits, and any concerns you may have about bone health and joint function.

• #1

  https://link.springer.com/article/10.1007/s00296-023-05373-8

  The aim is to diagnose the AVN as early as possible before it progresses to advanced stages, as up to 97% of the hips could avoid having surgical intervention if diagnosed and managed during stages I or II. […] They recommended tailoring the follow up plan according to the risk category, where patients recovering from COVID-19 should be followed for at least 24 months, with MRI being the diagnostic modality of choice for screening and early detection; furthermore, the high-risk group should attend regular clinic follow up at two to six months intervals after being exposed to corticosteroids, while the frequency is less for the low and moderate risk groups. […] Most of the hips included in the current review (80.8%) were managed non-surgically, where 143 (78.6%) hips had various combinations of medical treatment, as shown in (Table 3), which was successful in controlling the progression of FHAVN, with acceptable outcomes. […] In cases where the FHAVN is advanced (stage III or IV) or when the disease progress rapidly after initial conservative management, various surgical options could be performed, including core decompression, bone grafting, and arthroplasty.

• #1 Osteonecrosis of the Hip – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/osteonecrosis-of-the-hip

  Osteonecrosis can affect anyone, but it is more common in people between the ages of 40 and 65. Men develop osteonecrosis of the hip more often than women. […] Although nonsurgical treatment options such as anti-inflammatory medications, activity changes, and using crutches can help relieve pain and slow the progression of the disease, the most successful treatment options are surgical. Patients with osteonecrosis that is caught in the very early stages (before the femoral head collapses) are potential candidates for hip-preserving procedures. […] When osteonecrosis of the hip is diagnosed early, core decompression is sometimes successful in preventing collapse of the femoral head and the development of arthritis. […] Core decompression prevents osteonecrosis from progressing to severe arthritis and the need for hip replacement in some cases. This depends upon the stage and size of the osteonecrosis at the time of the procedure. […] Core decompression achieves the best results when osteonecrosis is diagnosed in its early stages, before the bone collapses. In some of these cases, the bone heals and regains its blood supply after core decompression.

• #1 Guideline Principles for Hip Osteonecrosis – Complete Orthopedics

  https://www.cortho.org/workers-compensation/mtg/hip-and-groin-disorders/hip-osteonecrosis/

  Finding and treating reversible risk factors is the primary focus of early treatment for mild to severe cases of osteonecrosis. It is advised to cut back on or stop doing things that trigger symptoms noticeably, including avoiding dysbaric exposures. […] De/compression is the main activity to be concerned with in cases of acute and subacute osteonecrosis. Decompression treatments shouldn’t often be administered to patients with osteonecrosis until the condition has improved. […] In individuals with osteonecrosis (especially those with more severe illness at risk of collapse), high force and/or high impact force (e.g., jumping) should typically be avoided until the condition is either significantly improved or resolved. No matter whether stage of osteonecrosis you have (acute, subacute, or chronic), sticking to the decompression tables is strongly recommended. […] Dysbaric Exposures or Other Symptom-Providing Activities or Other Risk Factors are recommended reduction or cessation of actions that provide serious osteonecrosis risks, such as avoiding dysbaric exposures.

• #1 Core Decompression for Avascular Necrosis – Medical Clinical Policy Bulletins | Aetna

  https://www.aetna.com/cpb/medical/data/700_799/0753.html

  The authors concluded that early disease (stage I or II) is an ideal indication for decompression, but is insufficient alone to guarantee success. […] The authors concluded that implantation of autologous BMMC appeared to be a safe and effective treatment for early stages of osteonecrosis of the femoral head. […] The authors concluded that core decompression combined with implantation of autologous bone marrow concentrate with tricalcium phosphate did not prevent radiographic progression of early stage ON of the hip. […] The authors concluded that the findings of this study suggested that CD combined with implantation of autologous bone marrow concentrate and tricalcium phosphate would not prevent radiographic progression of early stage ON of the hip. […] The authors concluded that CD + BMDCT was found to decrease disease progression and conversion to arthroplasty; and was noted to have better functional outcome scores as compared to CD alone.

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

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

  This procedure can help strengthen the area of bone affected by avascular necrosis. […] Bone reshaping might help postpone joint replacement. […] Regenerative medicine treatment. Bone marrow aspirate and concentration is a newer procedure that might help avascular necrosis of the hip in early stages.

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

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

  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. […] Studies increasingly show that femoral head necrosis is associated with a weakened regenerative ability of the affected tissue, which can be attributed to the decrease in the number of BMSCs and lower osteogenic differentiation. […] Bone transplantation has been the mainstay of early NONFH treatment for more than 70 years. […] Osteotomy can effectively delay the need for THA in patients with NONFH and the most common type is intertrochanteric valgus flexion osteotomy.

• #1 Avascular Necrosis (Osteonecrosis) | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/avascular-necrosis.html

  Avascular necrosis (osteonecrosis) occurs when a portion of bone does not get enough blood. Without adequate blood supply, bone cells begin to die, and the bone breaks down. […] If avascular necrosis is diagnosed early, treatments may include medications, lifestyle changes, and physical therapy. As the condition progresses, doctors usually recommend surgery to limit the progression of osteonecrosis and repair the affected bone. […] It might not be possible to prevent all types of avascular necrosis. But you can lower your risk of corticosteroid-related avascular necrosis by limiting your use of this medication. To reduce your risk of avascular necrosis as well as a range of other health problems, avoid smoking and limit the amount of alcohol you drink. […] If you have any risk factors for avascular necrosis, talk to your doctor. They will monitor your health with regular checkups.

• #1 Avascular Necrosis | Kinvara Private Hospital | 01709 464200

  https://kinvarahospital.co.uk/avascular-necrosis-avn-osteonecrosis/

  Preventative measures are crucial in managing avascular necrosis (AVN), especially for individuals at high risk due to underlying health conditions or lifestyle factors. […] Early detection through regular medical assessments can significantly aid in identifying early stages of AVN, where interventions are more likely to be effective. […] Lifestyle changes such as reducing alcohol consumption, quitting smoking, and managing weight can decrease the risk of AVN. […] For those on long-term corticosteroid therapy, understanding steroids for inflammation relief is essential to consider alternative medications if feasible. […] Additionally, maintaining adequate physical activity within comfort limits can help improve blood flow to bones, potentially reducing the risk of AVN. […] Collaborative care involving orthopaedic specialists and rheumatologists is essential for tailored prevention strategies and effective management of this condition. […] Effective prevention and treatment is central in reducing the progression of AVN and maintaining the quality of life of patients.

• #2 Treatment Options for Hip Avascular Necrosis (Osteonecrosis) – OrthoKau Orthopaedic Surgery

  https://orthokau.com/articles/treatment-options-for-hip-avascular-necrosis-osteonecrosis/

  While not all cases of hip avascular necrosis (AVN) can be prevented, there are strategies to reduce the risk of developing this condition. These measures are particularly relevant for people with known risk factors for AVN. Key prevention and risk reduction strategies include: […] By adopting these lifestyle and health management strategies, people can significantly reduce their risk of developing hip avascular necrosis. Awareness and proactive management of risk factors are key components of prevention.

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

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

  Abstinence from excessive alcohol intake and taking the lowest possible dose of a corticosteroid (when indicated) are the 2 chief means of AVN prevention. […] Patients should also stop or avoid smoking tobacco products, as there is an increased risk of nontraumatic osteonecrosis of the femoral head, particularly in those who never received oral corticosteroids. […] There are some data regarding cholesterol-lowering statin therapy as a means of decreasing the risk of AVN for those receiving corticosteroids. […] Cutaneous electrical stimulation, in the form of capacitive coupling, is purported by some to have a disease-modifying effect, although long-term studies are lacking. […] Anticoagulation therapy in the form of enoxaparin was shown in one investigation to retard progression of early AVN. […] Lastly, the antiresorptive, alendronate, was demonstrated to prevent collapse of early AVN.

• #2 Osteonecrosis | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816037/all/Osteonecrosis

  Limit alcohol use. There is a dose-dependent relationship with alcohol consumption. The relative risk (RR) is 3.3 for 400 mL/week and 17.9 for 1,000 mL/week. […] Smoking cessation: Smokers have RR of 3.9 versus nonsmokers. […] Limit corticosteroid use: Serum corticosteroid concentration is cumulatively associated with osteonecrosis. […] Consider screening bone density for high-risk patients. […] Consider preventive dental checkup before high-dose bisphosphonate use in chemotherapy patients.

• #2 Mayo Clinic Health Library – Avascular necrosis (osteonecrosis) | Swiss Medical Network

  https://www.swissmedical.net/fr/healtcare-library/con-20369841

  To reduce the risk of avascular necrosis and improve general health: […] Limit alcohol. Heavy drinking is one of the top risk factors for developing avascular necrosis. […] Keep cholesterol levels low. Tiny bits of fat are the most common substance blocking blood supply to bones. […] Monitor steroid use. Make sure your health care provider knows about your past or present use of high-dose steroids. Steroid-related bone damage appears to worsen with repeated courses of high-dose steroids. […] Don’t smoke. Smoking narrows blood vessels, which can reduce blood flow.

• #2 Osteonecrosis (ON) – Musculoskeletal and Connective Tissue Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/osteonecrosis/osteonecrosis-on

  Risk of osteonecrosis caused by corticosteroids can be minimized by using them only when essential and by giving them in as low a dose as needed and for as short a duration as possible. Patients should be informed of this complication when long-term and/or high-dose corticosteroid use is anticipated. […] To prevent osteonecrosis caused by decompression sickness, people should follow accepted rules for decompression when diving and when working in pressurized environments. […] Excessive alcohol use and smoking should be discouraged. Evidence for the efficacy of various medications (eg, anticoagulants, vasodilators, lipid-lowering medications) for prevention of osteonecrosis in patients at high risk is limited and inconclusive.

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

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

  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 […] For patients undergoing pelvic radiotherapy, a variety of pharmacologic interventions for preventing AVN have been studied, including supplemental calcium and/or vitamin D, bisphosphonates, selective estrogen receptor modulators, hormone replacement therapy (estrogen or testosterone), denosumab, and calcitonin. However, a Cochrane review concluded that the evidence relating to those interventions is of very low certainty.

• #2 31 Osteonecrosis: prevention and treatment | Lupus Science & Medicine

  https://lupus.bmj.com/content/8/Suppl_1/A19.2

  Osteonecrosis (ON) is a well-known component of damage accrual in patients with systemic lupus erythematosus (SLE), it frequently causes disability and considerably affects patients quality of life. […] Preventing ON involves controlling modifiable risk factors. Corticosteroids, if needed, should be prescribed at the lowest possible dose and for the shortest period of time, regardless of patients disease manifestations. Anticoagulant therapy, and statins/lipid-lowering drugs, may reduce the incidence of CS-induced ON. […] Discuss the preventive measures for ON in patients with SLE.

• #2 Osteonecrosis of the Femoral Head in Patients with Hypercoagulability—From Pathophysiology to Therapeutic Implications

  https://www.mdpi.com/1422-0067/22/13/6801

  The association between hereditary thrombophilia-hypofibrinolysis and ONFH was confirmed by robust evidence accumulated over time from clinical trials and isolated case reports, allowing the expansion of therapeutic options by adding anticoagulant treatment. […] The working hypothesis is that anticoagulant treatment may limit the progression of intraosseous venous thrombosis, allowing the spontaneous lysis of thrombi. That, in turn, improves blood circulation and bone nutrition. […] Early intervention is even more important, as studies show that even asymptomatic osteonecrosis has a high rate of progression, regardless of its underlying cause (primary or secondary). Additionally, anticoagulant therapy has been shown to be particularly effective in patients with primary ONFH, but not in those with secondary ONFH, in whom the rate of progression to Ficat stages III or IV has been unchanged by anticoagulation.

• #2

  https://journals.lww.com/md-journal/fulltext/2017/04210/the_use_of_anticoagulants_for_prevention_and.47.aspx

  This review not only showed a positive effect on primary ONFH with the prevention and treatment of anticoagulants, but also suggested that for secondary ONFH, anticoagulants cannot play a protective role. So if we can use the anticoagulants to treat primary ONFH before collapse (Ficat stages I or II) or before the pathology of necrosis, this disease will be possibly reversed.

• #2 Guideline Principles for Hip Osteonecrosis – Complete Orthopedics

  https://www.cortho.org/workers-compensation/mtg/hip-and-groin-disorders/hip-osteonecrosis/

  Finding and treating reversible risk factors is the primary focus of early treatment for mild to severe cases of osteonecrosis. It is advised to cut back on or stop doing things that trigger symptoms noticeably, including avoiding dysbaric exposures. […] De/compression is the main activity to be concerned with in cases of acute and subacute osteonecrosis. Decompression treatments shouldn’t often be administered to patients with osteonecrosis until the condition has improved. […] In individuals with osteonecrosis (especially those with more severe illness at risk of collapse), high force and/or high impact force (e.g., jumping) should typically be avoided until the condition is either significantly improved or resolved. No matter whether stage of osteonecrosis you have (acute, subacute, or chronic), sticking to the decompression tables is strongly recommended. […] Dysbaric Exposures or Other Symptom-Providing Activities or Other Risk Factors are recommended reduction or cessation of actions that provide serious osteonecrosis risks, such as avoiding dysbaric exposures.

• #2 Avascular Necrosis (Osteonecrosis): Treatment, Causes, and More

  https://www.healthline.com/health/avascular-necrosis-osteonecrosis

  You may be able to prevent AVN by taking these actions: […] Avoid drinking too much alcohol. […] Avoid or quit smoking. […] If you need corticosteroids to manage a chronic illness, talk to your doctor about the smallest dose you can take for the shortest time. […] To specifically prevent AVN in the jaw: […] Brush your teeth and see your dentist for regular cleaning and screenings. […] See your dentist right away for jaw pain or gum problems, including swelling or redness. These can be signs of infection. […] If you need bisphosphonate treatment, have any dental work you need first. Also, be sure to take good care of your teeth while you take bisphosphonates.

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

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

  Therefore, the lipid-lowering statins that are used to treat steroid-related inflammatory disorders can potentially be therapeutic against ONFH. […] Traditional Chinese medicine formulations have been used to treat osteonecrosis for decades. […] 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. […] The current treatments for NONFH can be classified into non-surgical and surgical methods. […] Core decompression is the commonest surgical procedure for early-stage osteonecrosis and is used to relieve pain and promote bone regeneration and repair.

• #2 Algorithm for Treatment of Hip and Knee Osteonecrosis: Review and a Presentation of Three Example Cases

  http://clinmedjournals.org/articles/jrdt/journal-of-rheumatic-diseases-and-treatment-jrdt-3-053.php?jid=jrdt

  More recently and specific to the knee, six patients predisposed to clot formation with early stage osteonecrosis treated with enoxaparin had no collapse in short term follow-up. […] While prior studies had demonstrated less than optimal results with total knee arthroplasty relative to their non-osteonecrotic counterparts, more recent studies have shown success rates as high as 97% for total knee arthroplasty in the setting of osteonecrosis. […] We advocate the use of cement and stemmed prosthesis in order to achieve adequate fixation as well as transfer the forces away from the osteonecrotic bone and towards more healthy bone. […] Core decompression may be used in small, pre-collapse areas of osteonecrosis especially if the involved bone has minimal involvement of the weight bearing surface. […] Arthroplasty has proven to be an excellent option for patients with osteonecrosis and debilitating pain and function.

• #2 The efficacy of Denosumab in the treatment of femoral head osteonecrosis: a retrospective comparative study | Scientific Reports

  https://www.nature.com/articles/s41598-024-54685-7

  Many researchers tried to preserve the viability of the femoral head using various medical treatments. […] A recent comparative study conducted by Liu et al. reported that denosumab had a positive effect on preventing femoral head collapse in patients with steroid-induced ONFH. […] Furthermore, the mean volume of the necrotic lesions in non-collapsed ONFH significantly decreased after denosumab administration along with the collapse rate. […] Denosumab effectively inhibits this remodelling process in the human femoral neck. […] However, clinical studies researching the effect of denosumab on ONFH are scarce. […] The present study did not show a significant difference as to whether patients would require THA after receiving denosumab treatment.

• #2 Avascular Necrosis Hot Springs, AR | Osteonecrosis Hot Springs, AR

  https://www.drbrentlawrence.com/avascular-necrosis-orthopedic-surgeon-conway-little-rock-ar.html

  Avascular necrosis can be treated by one of the following methods: […] The treatment for avascular necrosis aims at preventing further loss of bone and it depends on the bone damage that has occurred already. […] Conservative treatment would reverse early stages of avascular necrosis, whereas surgical treatment may be required in more advanced stages. […] Restriction of physical activities and use of crutches to decrease weight-bearing on your joints may be beneficial. […] Regular exercises that improve your range of motion are recommended. […] Electric currents promote new bone growth. They can be applied directly to the area of damage or through electrodes fixed on the skin. They help to replace damaged bone.

• #2 Hyperbarics effective against Avascular Necrosis (AVN) – Osteonecrosis | Latest Research

  https://www.bayareahyperbarics.com/latest-research/hyperbaric-oxygen-therapy-effective-against-avascular-necrosis-avn-or-osteonecrosis

  Avascular necrosis, or bone death from an interruption in the blood supply to the bone, often results in debilitating pain, and can become crippling. […] However, in a recent study of 30 patients with avascular necrosis of the hip, researchers showed that after 20 to 30 hyperbaric oxygen therapy treatments, all patients in the study remained significantly painfree after 7 years, and none required hip reconstruction or replacement. […] Fortunately, hyperbaric oxygen therapy helps with both hip and knee necrosis. […] Authors indicated that all 30 patients remained significantly pain-free the after seven years! None of the 30 patients needed hip reconstruction or replacement. […] Researchers also saw this result reflected in increased movement, a decrease in pain, and of course, the prevention of joint collapse. As a result, researchers recommended that HBOT be started as early as possible after injury.

• #2 Avascular Necrosis (osteonecrosis): What is, Stages, Causes, Symptoms, Treatment Options & Different parts It Affects

  https://www.polarishealthcare.in/post/avascular-necrosis

  Maintain a healthy lifestyle: Adopting a healthy lifestyle is essential for reducing the risk of AVN. This includes eating a balanced diet rich in nutrients to support bone health, maintaining a healthy weight to reduce stress on the joints, and engaging in regular physical activity to promote blood circulation and joint flexibility. […] Limit alcohol consumption: If you consume alcohol, do so in moderation. Limiting alcohol intake can help protect against AVN by preserving blood vessel function and reducing the risk of alcohol-related bone damage. Aim to follow recommended guidelines for alcohol consumption and seek support if you struggle with excessive drinking. […] Manage underlying medical conditions: Individuals with underlying medical conditions such as autoimmune disorders or blood clotting disorders should work closely with their healthcare providers to manage these conditions effectively. This may involve taking medications as prescribed, attending regular medical appointments, and making lifestyle modifications to optimize overall health and well-being.

• #2 Avascular Necrosis (Osteonecrosis) of the Hip Treatments

  https://avantortho.com.sg/avascular-necrosis-osteonecrosis-of-hip-treatments-and-prevention/

  How to Prevent Avascular Necrosis (Osteonecrosis) of the Hip […] Though osteonecrosis of the hip still has no cure and steadily progresses, you can still take measures to slow down its progression and help you maintain your mobility and independence for a longer time. Simple things you can do to start include: […] Get as much regular low impact exercise as possible to maintain your hip’s normal range of motion and flexibility.[…] […] Pace yourself accordingly when exercising; avoid straining yourself during your routines, as it can exacerbate the progression of osteonecrosis.[…] […] Quit smoking and alcohol, as they can increase your risk of osteonecrosis. Smoking is known to slow the rate at which bones heal.[…] […] Maintain a healthy weight to reduce the pressure on your joints when you stand or walk. A healthy diet will also help with weight management and ensure you get sufficient nutrients to stay healthy.[…]

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

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

  This procedure can help strengthen the area of bone affected by avascular necrosis. […] Bone reshaping might help postpone joint replacement. […] Regenerative medicine treatment. Bone marrow aspirate and concentration is a newer procedure that might help avascular necrosis of the hip in early stages.

• #2 Osteonecrosis – Rheumatology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.16.20.

  Osteonecrosis (avascular necrosis of bone) is the end stage of various abnormalities of blood supply to the bone. […] Conservative management includes prevention of the collapse of articular surfaces and of the development of degenerative and proliferative changes (in the case of weight-bearing joints, this is achieved by partial unweighting for 4-8 weeks with the use of crutches or a walking stick) as well as treatment of pain. […] In patients with early osteonecrosis and preserved joint space, the aim of treatment is stopping the progression of changes. The best results are achieved by removal of necrotic bone fragments to reduce intraosseous pressure and simultaneous grafting of fragments of the trabecular bone with blood vessels and sometimes with joint cartilage (such procedures are not always effective).

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

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

  Nontraumatic osteonecrosis of the femoral head is the main cause of disability in young individuals and incurs major health care expenditure. […] Although the main goal of any treatment method is prevention and delaying the progression of disease, there is no common consensus on the most suitable method of treatment. […] The most suitable course of action is to perform appropriate physical and minimally invasive surgery when first diagnosed. […] Given the personal and social burden of NONFH, the optimal treatment method is based on the individual needs of the patients. […] The patients are advised to lose weight, reduce the force exerted on the femoral head of the affected side, avoid mutual and reverse movement, use crutches for walking and avoid sitting or lying in bed for a long period of time.

• #2 Core Decompression for Avascular Necrosis – Medical Clinical Policy Bulletins | Aetna

  https://www.aetna.com/cpb/medical/data/700_799/0753.html

  This Clinical Policy Bulletin addresses core decompression for avascular necrosis. […] Aetna considers core decompression medically necessary for the treatment of early/pre-collapse (stage I or II; before X-ray changes are evident) avascular necrosis of the hip (femoral head and/or neck). […] Core decompression of the hip is usually employed before collapse and fracture of the femoral head and/or neck to delay or avoid reconstructive surgery of the affected joint. It is generally carried out to preserve the function and the structure of the hip as well as to relieve pain associated with AVN. […] There is adequate evidence that core decompression is effective in treating early stages (I or II) of AVN of the hip. […] The authors concluded that core decompression with cancellous bone grafting is a safe and effective procedure for the treatment of early AVN of the femoral head.

• #2 Osteonecrosis | UW Orthopaedic Surgery and Sports Medicine

  https://orthop.washington.edu/patient-care/articles/arthritis/osteonecrosis.html

  A surgical treatment under study involves drilling a hole into the affected bone in the early stages of the disease before major damage has occurred. This procedure relieves the increased pressure usually present within the bone and may slow the progress of the condition. Meanwhile research into the causes and cures for osteonecrosis is continuing. We hope that one day it will be possible to prevent this condition and to treat it more effectively.

• #2 Conservative Treatment in Avascular Necrosis of the Femoral Head: A Systematic Review

  https://www.mdpi.com/2076-3271/12/3/32

  The burgeoning field of regenerative medicine also raises the possibility of utilizing the body’s own healing mechanisms, a prospect that remains deeply intertwined with conservative strategies. […] Yet, despite their apparent advantages, conservative treatments are not without their challenges. […] It is within this context that this review positions itself, endeavoring to map the landscape of conservative treatments in AVN of the femoral head. […] The promising avenues of regenerative medicine and patient-centric approaches denote a paradigm shift towards more sustainable and less invasive management strategies, fostering a collaborative effort to mitigate the orthopedic and systemic ramifications of AVN. […] The objective of this comprehensive literature review is to compare and contrast the efficacy, limitations, and evolving evidence of conservative treatments for AVN.

• #2 Conservative Treatment in Avascular Necrosis of the Femoral Head: A Systematic Review

  https://www.mdpi.com/2076-3271/12/3/32

  The systematic search strategy resulted in the identification of a total of 376 records across multiple databases, which included PubMed, MEDLINE, and Scopus. […] This comprehensive literature review delineated the potential of conservative treatments in managing AVN of the femoral head. […] The discussed studies exhibit a wide array of conservative interventions, underscoring their potential for symptom alleviation and decelerating disease progression, especially in the early stages. […] The heterogeneity in treatment outcomes, largely attributed to the disease stage at intervention onset, emphasizes the necessity for personalized treatment regimens. […] The conservative treatments were primarily geared towards symptom alleviation, delaying the progression of the disease, and enhancing the overall quality of life of the affected individuals.

• #2 Non-Surgical Treatment Options for Avascular Necrosis: What You Need to Know

  https://regenorthosport.com/non-surgical-treatment-options-for-avascular-necrosis-what-you-need-to-know/

  Rest and limiting weight-bearing activities are essential in treating avascular necrosis (AVN) because they reduce the pressure on the affected bone, allowing it to heal. […] Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen sodium can help to reduce pain associated with avascular necrosis. In contrast, core decompression, injections, and bone grafts can help to improve blood flow to the affected bone and promote healing. […] These Avascular necrosis treatments can help to reduce the risk of further joint damage and can help to improve the patients quality of life. […] While Avascular necrosis treatment can effectively relieve pain and improve function, it may not always be successful in stopping the progression of the disease. […] As a result, the efficacy of these treatments is limited, and they may not be able to prevent the need for surgery in the future. […] While these non-surgical treatment options can help alleviate symptoms and prevent further damage, they do not cure the condition.

• #2 Avascular Necrosis: Bone Death Symptoms, Causes, Stages, Treatments & Cure

  https://www.emedicinehealth.com/avascular_necrosis/article_em.htm

  Avascular necrosis is a localized death of bone as a result of local injury (trauma), drug side effects, or disease. […] Avoiding injuries, such as fractures of bone and dislocation of joints, will eliminate the risk of trauma-associated avascular necrosis. The key to the prevention of joint destruction from avascular necrosis is early diagnosis of the underlying cause. Optimal treatment of underlying diseases or conditions can reduce the risk of developing avascular necrosis.

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