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Progression of the disease In the earliest stage of the disease. It cannot be seen by a normal x-ray. Diagnosis is by MRI. Once it can be seen on x-ray, it is not actually the dead bone that can be seen but the response of the living bone to the area of necrosis. The advanced stages begin when the dead bone starts to fail mechanically through a process of microfractures of the bone. Eventually, this will result in damage to the other side of the joint, and need for a total joint replacement.
The greater the extent of the disease and the more advanced the progression, the less likely that the joint can be saved. Fortunately, joint replacement procedures today are highly successful, even in the relatively young patients affected by ON. It is always the physicians desire to preserve the normal joint whenever possible. Unfortunately many patients present with advanced, extensive disease.
Non-Surgical Treatment
Protected weight bearing Crutches or a walker are very useful in alleviating the pain associated with ON. They can also be useful in protecting the joint between the time of diagnosis and scheduling of elective surgery. They may also play a role in limiting progression while associated medical conditions aare managed. However, protected weight bearing alone is never adequate treatment for ON and will not result in cure of the condition, no matter how long it is maintained. Rarely, an associated medical condition may result in a patient not being able to have surgery. In this case, protected weight bearing may be an effective long-term solution for pain control.
Surgical Treatment
Core Decompression This is a simple surgical procedure, which involves taking a plug of bone out of the involved area. It is applicable for mild to moderate degree of involvement that has not yet progressed to collapse. Because this involves creating a hole in the bone, six weeks of protected weight bearing is necessary to avoid fracture through the hole, one of the complications of the procedure. There is some controversy about this procedure with a few series that have been reported showing generally poor results. However, in centers that do this procedure frequently, most series have reported good results in the appropriate cases.