Unfortunately, there is no clear proof showing the best way to treat osteonecrosis but starting treatment early—before collapse of bone—is best.
Early treatment
Often, treatment starts with pain medications and by limiting weight-bearing (such as walking) on affected areas. This type of conservative treatment may work well for patients with early osteonecrosis in small areas of bone. Yet, it does not work for those with hip or knee osteonecrosis who are facing worsening disease and bone collapse. Instead, these patients may need surgical procedures to relieve pain and try to prevent bone collapse.
Surgery
Patients whose osteonecrosis is getting worse may need a procedure called core decompression. It removes a piece (core) of bone from the affected area, to try to improve blood flow.
More advanced cases may need a procedure called osteotomy. During this operation, surgeons remove dead bone and re-position the remaining bone so that healthy bone supports the weight-bearing joint surface. If bone collapse at the joint has already occurred, these patients often need total joint replacement (arthroplasty) of the hip or knee. This operation should improve pain and function.
Another surgery option for advanced cases is bone grafting. This involves taking a small piece of a person’s own healthy leg bone and grafting (transplanting) it to the area of dead bone. Bone grafting improves blood flow and support of the surrounding bone.
Medicine
There is no proven medical therapy for osteonecrosis. Some studies suggest that short-term bisphosphonate treatment may slow, improve or even prevent bone collapse in the hip and knee.