Osteonecrosis is bone death resulting from an injury or disease which inhibits the blood supply to the bone. Immediate osteonecrosis treatments are to limit the weight or restrict movement of the dying bone, but neither will heal the condition. Non-surgical osteonecrosis treatments include anticoagulants, hypertensive medications, and bisphosphonates. Surgical osteonecrosis treatments include performing osteotomy to relieve structural pressure by cutting and realigning the bone, joint replacement surgery, vascularized and non-vascularized bone grafts, and extracting part of the dying bone’s core to reduce internal pressure and promote the formation of blood vessels.
Thrombosis is a reduction in blood flow caused by blood clot formation, which may lead to osteonecrosis and can be treated with anticoagulant medications. Bones damaged by osteonecrosis often have an elevated core pressure, and hypertensive medications have been found to reduce it, which alleviates pain and may slow further bone death. Bisphosphonates are a group of drugs traditionally used to treat osteoporosis which work by inhibiting bone cells, called osteoclasts, which function to break down bone. The use of these drugs to treat osteonecrosis is controversial because studies have shown that it can actually cause osteonecrosis in patients receiving chemotherapy or undergoing dental work. These drug treatments primarily help to slow the progression of the osteonecrosis but do not typically improve the condition, so the patient and doctor should discuss the risks and the patient should be carefully monitored for any of the associated risks or changes in the bone.
Osteotomy, joint replacement, and bone grafts are all fairly technical surgical osteonecrosis treatments. In osteotomy, a surgeon restructures the dead bone by cutting it and realigning it to make it stronger. Joint replacement surgery will completely remove and replace a necrotic joint with an artificial joint. Bone grafts use bone taken from the patient’s hip, donor bone, or uses a synthetic material to improve osteonecrosis by promoting regrowth of the dead bone material. Vascularized bone grafts will transplant a blood supply along with the bone.
Core decompression is a less complicated surgical technique used to treat osteonecrosis and involves removing small cores from the dead bone to reduce pressure inside the bone and promote repair. Finding the best osteonecrosis treatment for a patient can be difficult. Sometimes more than one method will need to be tried before the bone will heal. The underlying cause of the necrosis needs to be address once the osteonecrosis has been treated to prevent the problem from reoccurring.
