Avascular Necrosis of the Femoral Head: Treatment Options and Outlook

Avascular necrosis of the femoral head

I have been experiencing pain in both hip joints while walking for the past month or two.
The MRI report confirmed that there is some avascular necrosis of the femoral head due to steroid use.
The doctor explained that it is still in the early stages and not yet severe enough for surgery.
Currently, I have been prescribed medication to promote peripheral blood circulation and a reduction in the steroid dosage.
Can medication help the femoral head recover, or will it only slow down the necrosis, ultimately requiring surgery in the future? Recently, the pain has intensified to the point where I wake up in pain when turning over in bed.
I am unsure how long it will take for medication to provide relief, or if medication will not improve the condition but merely delay the necrosis.
This is very distressing! Thank you!

Wen, 20~29 year old female. Ask Date: 2016/03/05

Dr. Shi Guozheng reply Orthopedics

In the early stages, some cases may have a possibility of recovery, although the chances are slim.
Pharmacological treatments are usually ineffective.
In the past, some have used Fosamax for treatment, but the results are not guaranteed.
Before undergoing joint replacement, there are some surgical options, such as decompression surgery, which may be effective.
However, avascular necrosis of the femoral head caused by steroid use typically worsens over time, ultimately leading to the necessity of total hip arthroplasty.

Reply Date: 2016/03/05

More Info

Avascular necrosis (AVN) of the femoral head, also known as osteonecrosis, is a condition that occurs when there is a loss of blood supply to the femoral head, leading to bone death and potential collapse of the hip joint. This condition can be caused by various factors, including long-term use of corticosteroids, which is the case you mentioned. The early stages of AVN may not require surgical intervention, and treatment often focuses on managing symptoms and slowing the progression of the disease.

In your situation, it seems that your doctor has recognized the early signs of AVN and has prescribed medications to improve peripheral blood circulation while also reducing your corticosteroid dosage. This approach is essential because corticosteroids can significantly impair blood flow to the bones, exacerbating the necrosis.
Regarding your question about whether medications can help restore the femoral head, the answer is somewhat nuanced. While there are no medications that can reverse the damage already done to the bone, certain treatments can help manage symptoms and potentially slow the progression of the disease. For example, medications like bisphosphonates, which are commonly used to treat osteoporosis, have been studied for their potential to reduce bone pain and improve bone density in AVN patients. Additionally, anti-inflammatory medications can help alleviate pain and improve function.

However, it is crucial to understand that while these medications may help manage symptoms, they do not guarantee that the necrosis will stop or that the bone will heal completely. The primary goal of non-surgical treatment is to relieve pain and maintain joint function for as long as possible.
As for the timeline for improvement, it can vary significantly from person to person. Some patients may experience relief from symptoms within weeks of starting treatment, while others may take months to notice any significant changes. It's essential to maintain open communication with your healthcare provider about your symptoms and any changes you experience. They may adjust your treatment plan based on your response to medications.

In terms of surgical options, if the AVN progresses and leads to significant joint damage or if conservative treatments fail to provide relief, surgical interventions such as core decompression or hip replacement may be necessary. Core decompression involves removing a small portion of the bone to relieve pressure and promote blood flow, while hip replacement involves replacing the damaged joint with an artificial one.

In summary, while medications can help manage symptoms and potentially slow the progression of avascular necrosis, they may not restore the femoral head to its original state. It's essential to follow your doctor's recommendations, including any lifestyle modifications, such as weight management and low-impact exercises, to help maintain joint health. Regular follow-ups with your healthcare provider will be crucial in monitoring the condition and determining the best course of action moving forward. If you have any concerns about your treatment plan or symptoms, do not hesitate to reach out to your doctor for further clarification and support.

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