Avascular necrosis treatment

Chronic joint pain and stiffness may be symptoms of avascular necrosis (AVN), a rare condition that can occur in any joint but is most common in the hip. Duke orthopaedic surgeons are nationally recognized experts in the treatment of avascular necrosis, also known as osteonecrosis. When diagnosed and treated early, the right avascular necrosis treatment can reduce your pain, stop progressive bone damage, and restore your function. Our surgical expertise in avascular necrosis treatment, including free vascularized fibular grafting and hip preservation surgery, may minimize your need for joint replacement surgery in the future.

Is surgery necessary for avascular necrosis?

Avascular necrosis refers to bone death caused by a loss of blood supply to the bone. When undiagnosed and untreated, the bone becomes fragile and can collapse. This results in debilitating osteoarthritis. While avascular necrosis typically affects the hip, it can occur in the shoulder, knee, elbow, wrist, foot and ankle.

There is no cure for avascular necrosis, but if diagnosed early using X-rays or MRI, non surgical treatments such as activity modification, anti-inflammatory medications, injections and physical therapy may slow its progression. Because avascular necrosis is a progressive condition, it often requires surgery. 

Seek care from experts in avascular necrosis treatments

As recognized innovators in avascular necrosis treatment, our orthopaedic experts see patients with AVN from around the world. Our years of experience, and high surgical volumes ensure the care you receive at Duke is unsurpassed.

Here’s why you should choose Duke for your avascular necrosis treatment.

  • Our orthopaedic program is ranked among the nation’s best by U.S. News & World Report. Many of our orthopaedic surgeons and doctors are fellowship trained.
  • You work with a dedicated team. Your surgeon works closely with a team of physician assistants, nurses, anesthesiologists, physical therapists and occupational therapists who are dedicated to your care. We provide you with the most accurate information and best possible care in a compassionate and timely manner.
  • We offer hip replacement alternatives. Avascular necrosis of the hip frequently occurs in people between the age of 20 to 35, ages at which hip replacement may not be the best option. In these cases, we offer an approach that we pioneered – free vascularized fibular graft – which allows younger patients to delay or possibly eliminate the need for hip replacement in the future. We are a training center for doctors who want to learn how to do this procedure.
  • We are a high volume hip replacement center. When hip replacement is needed, we offer every approach - from the back (posterior), the front (anterior) and the side (lateral).  Our orthopaedic surgeons perform more than 1,000 hip replacements every year.
  • We are experts in microsurgical techniques. Our surgeons use microscopes and precision instruments during bone grafting procedures. These techniques knit together tiny blood vessels and restore blood flow to areas damaged by AVN.
  • We conduct and learn from our AVN research. Our team or researchers are studying osteonecrosis in hopes or gaining a better understanding of the disease, including prevent it and treat it before it becomes too advanced.
  • We work closely with your local orthopaedic surgeon. If you travel to Duke for your avascular necrosis surgery, we share our notes and imaging results with your surgeon. You will return to Duke one year after your surgery for a follow-up visit. You may see your local orthopaedic surgeon for other follow-up visits. 


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