Disclaimer: This information is provided for general educational and informational purposes only and is not medical advice, diagnosis, or treatment. It is intended to help you learn about various treatment options so you can discuss them with your primary care physician (PCP), orthopedic specialist, or other qualified healthcare professional. Treatment options vary depending on the individual and the stage, location, and severity of avascular necrosis.

If you have been diagnosed with avascular necrosis (AVN), also called osteonecrosis, there may be more treatment options to discuss with your doctor than you realize. AVN occurs when the blood supply to an area of bone is reduced or interrupted, causing bone tissue to die. When AVN affects a joint such as the hip, one of the major concerns is preventing the weakened bone from progressing to collapse.

Today, some specialists are using advanced imaging, computer-guided procedures, biologic therapies, and other technologies in an effort to preserve the natural joint—particularly when AVN is identified before significant collapse occurs.

Here are several options worth asking your PCP or orthopedic specialist about.

1. 3D-Guided Core Decompression

Core decompression has been used for years as a joint-preserving treatment for AVN.

A newer approach combines the procedure with 3D modeling and computer navigation to more precisely identify and target the area of dead or damaged bone.

Instead of relying on less-targeted drilling, the surgeon can use detailed imaging and navigation to plan a path directly toward the AVN lesion while attempting to preserve as much healthy bone as possible.

Centers such as Yale Medicine have described using intraoperative CT imaging, 3D modeling, and computer navigation for AVN core decompression.

Questions to ask your doctor:

• What stage is my AVN?
• Am I a candidate for core decompression?
• Do you offer 3D-guided or computer-navigated core decompression?
• Would a more targeted procedure help preserve healthy bone in my particular case?
• What would my weight-bearing and recovery restrictions be?

2. Bone Marrow Aspirate Concentrate (BMAC)

Another option to discuss is Bone Marrow Aspirate Concentrate, or BMAC.

BMAC is typically obtained from the patient’s own bone marrow and processed to concentrate cells and other biological components involved in tissue repair.

Some orthopedic specialists combine BMAC with core decompression. After creating channels into the affected bone, the concentrated bone marrow material can be delivered into the treatment area.

The goal is to combine the mechanical benefits of decompression with biological support for the healing environment.

Research into BMAC for AVN continues, and results can vary depending on the stage of disease and other factors.

A useful question for your orthopedic specialist is:

“Would adding BMAC to core decompression make sense for the type and stage of AVN that I have?”

3. Platelet-Rich Plasma (PRP)

Platelet-rich plasma, or PRP, is another biologic treatment you may hear about.

PRP is prepared from a patient’s own blood and contains a concentrated level of platelets and associated growth factors. It is used in several areas of orthopedic medicine in an effort to support tissue repair.

PRP has also been investigated as an adjunct to AVN treatment, including in combination with core decompression and other biologic procedures.

If a clinic recommends PRP, ask specifically how it would be used, what evidence supports its use for your stage of AVN, and whether it is intended to treat symptoms or to complement another joint-preserving procedure.

4. Hyperbaric Oxygen Therapy (HBOT)

Hyperbaric oxygen therapy (HBOT) is a non-surgical treatment that involves breathing oxygen inside a pressurized chamber.

The increased pressure allows substantially more oxygen to be carried in the blood and delivered to tissues.

HBOT has been studied in people with early-stage AVN, including its potential effects on pain, bone marrow edema, oxygenation, and biological pathways involved in healing.

It remains an area of ongoing research rather than a standard treatment for every person with AVN.

If you are interested in HBOT, consider asking your PCP or orthopedic specialist:

“Is there evidence that hyperbaric oxygen therapy could be appropriate for my stage of AVN, either alone or alongside another treatment?”

Your doctor can also help determine whether you have medical conditions that would make HBOT inappropriate.

5. Focused Shock Wave Therapy

Another non-surgical option to ask about is focused extracorporeal shock wave therapy (ESWT/FSWT).

Despite the name, this does not involve an electrical shock.

The treatment directs high-energy acoustic waves toward the affected area from outside the body. These waves are intended to stimulate biological responses associated with blood flow, bone remodeling, and tissue repair.

Research has examined shock wave therapy particularly in people with earlier-stage osteonecrosis of the femoral head.

There are still questions about which patients benefit most, the ideal treatment protocol, and whether the therapy changes the long-term progression of AVN.

That makes it something to discuss with an orthopedic specialist rather than assume is appropriate for every case.

6. Combination Joint-Preservation Treatments

One of the more interesting developments in AVN care is that treatment doesn’t necessarily have to involve only one technique.

Depending on the patient and the stage of AVN, specialists may consider combinations such as:

3D-guided core decompression + BMAC

or potentially other combinations of decompression, biologic augmentation, and supportive therapies.

This is an important reason to ask whether your orthopedic surgeon specifically treats osteonecrosis/AVN and what joint-preservation techniques are available.

A specialist who routinely treats AVN may be familiar with options that are not available at every orthopedic practice.

7. Robotic-Assisted Joint Replacement

Unfortunately, not every joint can be preserved.

Once AVN has caused substantial collapse of the femoral head or advanced joint damage, your orthopedic surgeon may recommend joint replacement.

Technology has advanced here as well.

Robotic-assisted systems such as the Mako Robotic-Arm platform can use CT-based 3D modeling to help the surgeon develop a patient-specific surgical plan and guide implant positioning during hip replacement.

Robotic assistance doesn’t replace the surgeon. Instead, it provides another planning and surgical tool that may help the surgeon execute the planned implant positioning.

If your AVN has progressed to the point where replacement is being considered, ask:

“Would I be a candidate for robotic-assisted hip replacement, and what advantage would it offer in my particular case?”

Why Knowing Your AVN Stage Matters

One of the most important conversations to have with your doctor is about what stage your AVN has reached.

There is a major difference between treating an area of osteonecrosis while the structure of the bone is still intact and treating a joint after the bone has collapsed.

Ask your PCP or orthopedic specialist to explain your imaging to you.

Find out:

Where is the AVN?

How large is the lesion?

Has any collapse occurred?

Is the joint surface still intact?

Am I still in the window for joint-preserving treatment?

Those answers can significantly influence which treatment options are worth discussing.

Don’t Be Afraid to Ask About Newer Options

Being diagnosed with AVN does not mean that every patient immediately needs a joint replacement.

Depending on the stage and severity of the disease, there may be joint-preserving, biologic, non-surgical, and advanced surgical options worth discussing.

Ask your PCP or orthopedic specialist about:

3D-guided core decompression.
BMAC.
PRP.
Hyperbaric oxygen therapy.
Focused shock wave therapy.
Combination joint-preservation procedures.
Robotic-assisted joint replacement when replacement becomes necessary.

Some of these treatments are established in selected situations, while others are still emerging or being studied. Availability also varies considerably between medical centers.

The purpose of learning about these options isn’t to decide on a treatment by yourself.

It’s to give you better questions to take into the doctor’s office.

Ask what stage your AVN is in. Ask what can still be preserved. Ask what treatments are available. Ask about the benefits, limitations, risks, recovery time, and evidence behind each option.

Then you and your healthcare team can discuss which approach makes sense for your individual situation.