Avascular Necrosis


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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 it is diagnosed and treated early, the right 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.

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Avascular Necrosis Treatment

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 shoulderkneeelbowwristfoot, or ankle.

There is no cure for avascular necrosis, but if it's diagnosed early using X-rays or MRI, nonsurgical 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. 

Core Decompression

Diseased tissue is removed from the bone affected by AVN. This eliminates pain and promotes growth of new bone tissue and blood vessels. This procedure is for early stage AVN in people 35 and younger. 

Bone Graft

A section of healthy bone is removed from one part of the body -- or taken from a cadaver -- and used to replace the damaged bone. Blood flow is restored to promote healing. 

Free Vascularized Fibular Grafting

Dead bone tissue in the hip’s femoral head is removed and replaced with healthy bone (usually taken from the fibula). The blood supply is restored by reconnecting the blood vessels in the hip bone. This treatment is appropriate for people ages 35 and younger.

Total Joint Replacement

Tissue damaged by AVN is removed and replaced with an artificial joint, called a prosthesis, made from metal, plastic, or ceramic.

Duke Orthopaedic Clinics

Duke orthopaedic clinics are located throughout the Triangle. Find one near you. In-person and virtual appointments are available.

Avascular Necrosis Treatment Experts

Years of Experience
Our orthopaedic specialists see people from around the world with AVN. Our years of experience and high surgical volumes ensure you have the best possible outcome.

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.

Alternative to Hip Replacement Surgery
Avascular necrosis of the hip frequently occurs in people between the ages 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.

High-Volume Hip Replacement Hospital
When a 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.

Experts in Microsurgical Techniques
Our orthopaedic 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.

Ongoing AVN Research
Our researchers study osteonecrosis in hopes of gaining a better understanding of the disease, including how to prevent and treat it before it progresses.

Coordinated Care 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. 

Best Orthopaedic Hospital in North Carolina

Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our orthopaedics program is nationally ranked, and the highest-ranked program in North Carolina, according to U.S. News & World Report for 2023–2024.

This page was medically reviewed on 05/22/2023 by