Avascular Necrosis (cont.)
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Avascular Necrosis Treatment
Avoiding injury to bone that is affected by avascular necrosis is the first line of treatment. This can include non-weight-bearing (crutches), etc. when a weight-bearing joint is involved. The aim is to attempt to preserve the affected joint and avoid joint replacement, when possible, especially in young individuals.
Treating any underlying cause of avascular necrosis (stopping smoking and alcohol intake, etc.) and management of underlying diseases is essential to minimize progression of disease and to prevent involvement of other bones. Bisphosphonate medications, such as alendronate (Fosamax), have been shown to reduce bone pain and improve function in patients with avascular necrosis. Additionally, medications to lower blood fats (lipids, including cholesterol and triglycerides) and blood-thinning medications (anticoagulants) have been used effectively in certain situations.
The surgical management of avascular necrosis can be divided into joint-preserving procedures and joint-replacement (arthroplasty) procedures. Joint-preservation operations that delay the need for total joint replacement include measures that allow improved blood supply to the affected bone. These procedures are typically used in early avascular necrosis of the hip and include removal of a core of bone from the head of the femur bone of the hip (core decompression) as well as local bone-grafting procedures. Sometimes bone-resurfacing procedures are used in an attempt to further delay joint-replacement surgery. When avascular necrosis has progressed to a significant stage and bone has collapsed, joint-replacement surgery is ultimately required.
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