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.
There are several different surgical procedures used to treat osteonecrosis of the hip.
This procedure involves drilling one larger hole or several smaller holes into the femoral head to relieve pressure in the bone and create channels for new blood vessels to nourish the affected areas of the hip.
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 is often combined with bone and cartilage grafting to help regenerate healthy bone and support cartilage at the hip joint. A bone graft is healthy bone tissue that is transplanted to an area of the body where it is needed. The tissue may be taken from a donor (allograft) or from another bone in your body (autograft).
There are also several synthetic bone grafts available today.
Another surgical option is a vascularized fibula graft. In this procedure, a segment of bone is taken from the small bone in your leg (fibula) along with its blood supply (an artery and vein). This graft is transplanted into a hole created in the femoral neck and head, and the artery and vein are reattached to help heal the area of osteonecrosis.
If osteonecrosis has advanced to the point where the femoral head has already collapsed, the most successful treatment is total hip replacement. In this procedure, your doctor removes the damaged bone and cartilage, then positions new metal or plastic joint surfaces to restore the function of your hip.
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. It takes a few months for the bone to heal and, during this time, you will need to use a walker or crutches to avoid putting stress on the damaged bone.
Patients with successful core decompression procedures typically return to walking unassisted in about 3 months and have complete pain relief.
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. Total hip replacement is successful in relieving pain and restoring function in the majority of patients with osteonecrosis.