STAMFORD, Conn. -- Hospital for Special Surgery's Dr. Charles Cornell answers your questions on Avascular necrosis in the second part of a two-part series. The first article can be read here .
What should you do if you are diagnosed with avascular necrosis?
If you are diagnosed with AVN, seek treatment from a specialist in the disease. Endocrinologists, rheumatologists and orthopedic surgeons are the subspecialties that usually treat this disorder. Treatment remains very controversial and traditional surgical procedures such as core decompression have been prescribed. In my view, there is little scientific support for surgical treatment of this disorder in its early stages.
What happens if you do not diagnose avascular necrosis early?
Unfortunately, AVN is relatively asymptomatic in the early stages. Pain in the affected hip often does not present until the bone structure is weakened and collapse has begun. As a result, many patients don’t present until the hip is already damaged. If you are diagnosed with AVN, seek treatment from a specialist immediately. If you are diagnosed with AVN in the early stages, it can be successfully treated with a bisphosphonate drug.
Is there any current research available for avascular necrosis?
There is a lot of research being performed to improve the treatment of AVN. Most research concerns better drug treatment. There are new antiresorptive drugs being developed as well as drugs that stimulate the bone forming cells. Modifications of surgical procedures are also being developed in which stem cell implants are placed into the necrotic area to speed repair.
Research isalso being performed to assess the outcome of total hip replacement when needed. In the 1980’s when hip replacements were usually implanted with cement, the long-term durability of artificial hips was considered poor. However, modern implants seem to perform well for AVN and current research is being done to verify this assessment.
Dr. Charles N. Cornell is a Hip and Knee Surgeon and Clinical Director of Orthopedic Surgery at Hospital for Special Surgery. He practices at both the HSS Outpatient Center in Stamford and the hospital’s main campus in New York.